The People's Perspective on Medicine

Doctor Prescribes Inexpensive Generic Ketamine Nasal Spray

Spravato (esketamine) is a pricey new antidepressant nasal spray. It is a chemical cousin of the inexpensive generic ketamine anesthetic. Does it work?
Girl sprays the spray from runny nose into the nasal pass

There’s a new drug for depression. It’s called esketamine (Spravato) and it is pricey! We’re talking thousands of dollars a month pricey. The FDA approved this nasal spray for “treatment-resistant depression.” The agency describes its approval of Spravato in the New England Journal of Medicine (May 22, 2019) “Esketamine represents a novel treatment for a severe and life-threatening condition, and its rapid onset of effect is a key benefit. The studies provide evidence of clinically meaningful efficacy when esketamine is used in combination with a newly initiated oral antidepressant.” But some doctors are prescribing the much older and inexpensive generic ketamine. Here is one example.

How Does a Doctor Prescribe Inexpensive Generic Ketamine?

Q. As a doctor, I prescribe generic ketamine for my hard-to-treat depressed patients. A compounding pharmacy makes it into an affordable nasal spray. My patients have called it a game changer.

A. Ketamine (Ketalar) has been available since 1970 as an injectable anesthetic. Some doctors have prescribed it off-label for people with chronic pain or challenging depression. The generic form is relatively inexpensive.

A brand-new FDA-approved chemical cousin of ketamine, esketamine (Spravato), is now available. A study published in the American Journal of Psychiatry (June 1, 2019) found that esketamine nasal spray worked better than placebo nasal spray to alleviate treatment-resistant depression. The conclusions:

“Current treatment options for treatment-resistant depression have considerable limitations in terms of efficacy and patient acceptability. Esketamine is expected to address an unmet medical need in this population through its novel mechanism of action and rapid onset of antidepressant efficacy. The study supports the efficacy and safety of esketamine nasal spray as a rapidly acting antidepressant for patients with treatment-resistant depression.”

Esketamine Side Effects:

Eskatamine does have some side effects. They include dizziness, a bad taste in the mouth, dissociation and nausea. The dissociation could be described as a feeling of not being connected to the body.

The brand name Spravato has another drawback. It is expected to cost over $4000 a month.

Learn more about Inexpensive Generic Ketamine:

We have written quite a lot about this fascinating compound. Here are some links:

For a comprehensive overview of ketamine and its fascinating history go to:

Surprising Ketamine Side Effects and Anti-Suicide Benefits

Here is a discussion of ketamine IV infusions:

Will Ketamine Really Battle Life-Long Depression?

To get a personal perspective here is a story from Lori in Colorado:

“My husband has struggled with serious depress for close to 20 years. While conventional antidepressants and psychotherapy allows him to live a relatively normal life, he has encountered periods when these modality are ineffective.

“About five years ago, when the options were between electroconvulsant therapy (ECT) or a trial of ketamine compounded locally, my husband and his psychiatrist decided to try ketamine. My husband has used it as a ‘rescue’ drug since. He has used it 5-6 times throughout those years.

“He experiences relief for many months before needing another dose. Luckily he has not encountered any side effects and he has not needed any hospitalizations, ECT, or had any suicide attempts since.”

Share Your Own Story:

We recognize that ketamine has not been approved for the treatment of depression! Its only FDA-approved use is as an anesthetic. Any physician who prescribes it for hard-to-treat depression or suicidal thoughts is taking a risk. The FDA generally frowns on such activities, but doctors are allowed to prescribe a medicine “off-label” as long as they can justify such treatment. 

We would like to learn about personal experience with either ketamine or esketamine. Has your doctor prescribed Spravato? Did your insurance company pay for it? Many people will want to know how well it worked and whether there were uncomfortable side effects.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I am a retired Veterinarian. I used this drug for many years to do short procedures on cats without any significant problems. If the animals were kept in quiet isolation, with few and/or quiet interruption, they just slept it off. I also used it in conjunction with other short-acting drugs to give to dogs and was able to get the desired effect satisfactorily. I was aware that physicians were using this drug for anesthesia with small children but not adults. It was very inexpensive.

I have battled bipolar disorder life-long. Some twenty years ago I also fell 24’ while attempting repair on my home and have lived in chronic pain coupled with the bipolar and feelings of uselessness. I was a homeless child and worked my way to an MAT (Master of Arts in Teaching) and am University professor. It’s been a long slow bleed. The fact that I cannot get my hands on what may be my only hope add to that frustration

Good luck, Lee. Please let us know how well you do and are. I especially will watch for an update, as I grew up in Milwaukee!

Ketamine has been used by vets for years . It is known to produce crazy behavior in animals. My first experience was with an old dog, who woke up in a super paranoid state, snarling, agitated. That took hours to wear off enough so he would let us approach him. Second time was with a pet cat, again “woke up” frantically frightened, scratching , biting, running all over the place. Vets don’t seem to want to talk about this of course, possibly because they send the pets home before they are really awake!!. IMO, this is a piece of news the media has run with, and people better take their first dose with close supervision until they know how they will respond. Ket is also used for the dissociative effect by drug users.They would steal it from vets.

I was dosed with Ketamine when I broke my leg and needed surgery. I’ve tracked my depression, which is cyclical and has not responded to medication, for almost 50 years. While recovering, I experienced a change, like a cloud lifting. The effect seemed to last, and indeed at the next cycle, my depression was much reduced. I started researching, and discovered the off-label effect for depression. Now, 3 years later, I am looking for another dose, in hopes I can get the same effect. Luckily, I can get medical care outside the US, so I may be able to get treatment more easily.

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