The Depression and Anxiety Experts

Ketamine and Spravato May Ease Your Painful Depression

As a psychiatrist with 23 years’ experience, I am always looking for innovative and scientifically grounded methods of easing depression and the suffering it causes.

Two new tools that we have for better treating depression are Ketamine and Spravato. Historically, ketamine has been used as an anesthetic and for pain management, but recent research has indicated its potential as a powerful antidepressant. It is administered intravenously under supervision in our offices. Spravato is a new FDA-approved formulation of esketamine, a version of ketamine, that is also given in our office in the form of a nasal spray.

What types of depression are Ketamine and Spravato used for?

  1. Treatment Resistant Depression, where at least two medications have    been tried, without success, and
  2. Suicidality, where the patient has thought of ending their own life.

What is the response rate to the first infusion?

Fifty percent of patients respond well to the first infusion of ketamine, so there is validity to trying it once, but many patients improve progressively by repeating the procedure.

Can I get a ketamine infusion right away?

Shortly after an assessment, a depressed patient who meets treatment criteria can receive their first ketamine infusion, often on the same day or the next day.

Other antidepressants generally take effect more slowly, over a 3-to-6-week period. That’s why it is potentially so helpful for patients with suicidal thoughts, or in cases in which we are trying to prevent hospitalizing a person with severe depression.

Should my antidepressants be adjusted before starting ketamine?

There is an advantage to getting a fresh set of eyes to evaluate your psychiatric medications. Often changing an antidepressant, increasing its dose, or adding another medication makes sense. Genetic testing can also shed light on why some medications have not been as effective as hoped.

I feel that a multichannel approach that attacks different receptors in the depression pathway increases the chances of remission. Why undergo ketamine infusions if you remain on the same dose of Prozac that you have been on for five years? To me it seems logical to tweak all psychiatric medications when ketamine is given.

Real-World Cases*

Ketamine and Spravato are game-changers for treating people with depression as the following case studies show:


A patient I’ll call Cathy*, was a 45-year-old manager with chronic, moderate intensity depression. Her alcohol consumption was considered to be in the hazardous range and she was a daily cannabis user. 

Through counseling, she stopped alcohol and cannabis, which was a big help. I treated her with three different antidepressants. Her depression scores dropped somewhat, but she remained perpetually sad.

After four ketamine IV treatments, Cathy’s depression score had dropped by 50%.

As a side effect, the ketamine worsened pre-existing high blood pressure. We increased her anti-hypertensive medication and her blood pressure normalized. Cathy elected not to have follow-up ketamine infusions because she did not want to miss work. Her depression returned one month later. She now receives monthly maintenance ketamine infusions at 8 AM to better fit her work schedule.

After her Ketamine treatment, Cathy reflected:
“The initial dissociation [feeling sleepy and disconnected] was helpful in jettisoning my preoccupation with depression or anxiety.  For the first time in quite a while, all the restrictions I normally imposed on myself had dissolved and I felt optimistic and hopeful.”


A patient I’ll call Mark*, a lawyer, sought treatment after a one-year crisis of severe depression. He was frantic and paralyzed by intrusive suicidal thoughts, although he did not want to die. I made the diagnosis of bipolar depression.

We treated Mark over time with several mood stabilizers, and antidepressants but he had side-effects and the depression remained unchanged.

After 6 weeks of intense struggle, we started the Spravato nasal spray. By the sixth treatment, the depression score had dropped by 50%. By treatment 11, Mark was in remission, which was sustained with monthly maintenance inhalations in conjunction with a mood stabilizer and antidepressant.

Mark noted, “I was desperately depressed but the Spravato and the other medications turned me around. I am back on track now and in the gym three times a week”

What’s the Catch?

Ketamine and Spravato work well but they are not without controversy.

There is little long-term data for these medications. For example, we don’t know whether they impact medical parameters, such as blood pressure, when given for many years.

There is also the potential for misuse, although this seems less likely in a highly controlled clinic setting such as ours.

Most people find the dissociation and sedation pleasant, but some find it frightening and we have to stop treatment.

High blood pressure is a common side-effect that needs careful assessment.

The treatments take 2 hours, twice weekly for 2-4 weeks and you can’t drive until the next day.


Safety is our top priority. That’s why we administer ketamine strictly according to the American Psychiatric Association’s consensus statement.

This means that we don’t do home treatments. All treatments are given in our ketamine suite under strict medical care with careful monitoring of patients’ reactions and vital signs. 

Next Steps

My goal is to fight depression and reduce suicidal risk. Ketamine and Spravato are exciting new treatment options that represent a future wave in depression treatment, offering great hope to people with depression.

To learn more about whether ketamine or Spravato might be treatment options for yourself, or someone that you know, please call us on 646-830-0131.

*Identifying details have been changed to preserve anonymity. Quotes have been used with patient consent.

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