Intranasal Ketamine

Shannon Coulson
Jun 9
2 min read

Intranasal ketamine is an emerging treatment for certain mental health conditions, particularly treatment-resistant depression, suicidal ideation, and in some cases, anxiety disorders and PTSD. It works differently from traditional antidepressants, offering rapid relief of symptoms in some individuals.

🌬️ What Is Intranasal Ketamine?

A nasal spray form of ketamine (or esketamine, a derivative).
Esketamine (Spravato) is FDA-approved in the U.S. for:
- Treatment-resistant depression (TRD)
- Major depressive disorder with suicidal thoughts
Must be administered in a clinical setting under supervision due to its psychoactive effects and potential for misuse.

🧠 How It Works

Acts on the glutamate system (via NMDA receptor antagonism), unlike most antidepressants which target serotonin/norepinephrine.
Increases neuroplasticity—the brain’s ability to form new connections.
Some users report improvement within hours to days, especially for suicidal ideation.

📈 Effectiveness

Rapid onset: Often noticeable within 1–24 hours.
Studies show it may reduce depressive symptoms in individuals who haven’t responded to SSRIs/SNRIs.
Repeated doses (typically twice a week for the first month) are more effective than one-time use.

⚠️ Side Effects & Risks

Common Side Effects	Less Common / Serious
Dissociation (feeling detached)	Increased blood pressure
Dizziness or nausea	Potential for misuse or dependence
Headache	Bladder issues (rare with nasal)
Fatigue	Worsening mood (rare)

Not for home use—must be given in a certified facility with monitoring for 2 hours post-dose.

🔍 Who It’s For

Adults with treatment-resistant depression
Those with active suicidal thoughts (in combination with oral antidepressants)
Being studied for: PTSD, OCD, severe anxiety, bipolar depression