Imagine doing everything “right” to treat your depression—trying medication after medication—only to find yourself in the same mental fog. For millions living with treatment‑resistant depression (TRD), that’s reality.

A recent randomized clinical trial published in JAMA Psychiatry studied esketamine nasal spray as a monotherapy in 378 adults with TRD. Participants self-administered either 56 mg or 84 mg of esketamine twice a week for four weeks. The results were compelling:

• Rapid symptom relief within 24 hours

• Moderate-to-large effect size improvement by day 28

• Side effects like nausea, dizziness, and dissociation—common but generally mild

Read the full study here: JAMA Psychiatry – Esketamine Monotherapy Trial

There’s no doubt this is a meaningful advancement for those who haven’t responded to traditional antidepressants. But it also raises a bigger question:

Why is esketamine the only form of ketamine widely covered by insurance—when infusion therapy may actually be more effective?

The Bigger Picture: Ketamine Infusion Therapy (KIT)

While esketamine (Spravato®) is FDA-approved and commercially available, ketamine infusion therapy (KIT)—which uses the generic form of ketamine intravenously—has been shown in numerous studies and clinical settings to produce faster, more powerful, and longer-lasting results.

Psychiatrists often report significantly higher success rates with KIT, especially for severe, chronic, or suicidal depression. Patients describe profound changes after just a few sessions. And yet:

KIT is rarely covered by insurance.

Why the Disparity?

The reasons are rooted in regulation, economics, and branding:

• FDA Approval: Esketamine is approved for TRD; generic ketamine is not (despite decades of safe use).

• Market Forces: Esketamine is a patented, profitable drug. Ketamine, in its generic form, offers little financial incentive to pharmaceutical companies.

• Reimbursement Logistics: Infusions are used off-label, delivered in non-standardized protocols, making them harder to bill and justify under traditional insurance models.

This leaves patients facing high out-of-pocket costs for a treatment that may work better—while being steered toward a less effective, but insurable, alternative.

Reframing the Discussion

This isn’t about discrediting esketamine. For many, it provides relief where nothing else has. But if we’re serious about improving outcomes for people with TRD, we need to have an honest conversation:

• Why isn’t ketamine infusion therapy more accessible?

• What is the real cost of limiting treatment options to what is reimbursable?

• Are we letting policy, not science, decide who gets better?

What You Can Do

• Be informed: Understand the range of ketamine-based treatments available and the evidence behind them.

• Ask your provider: Inquire about both esketamine and infusion therapy if previous treatments haven’t helped.

• Push for parity: Advocate for insurance coverage based on clinical outcomes, not just FDA labels.

• Share your experience: Real stories move this conversation forward—whether you’ve benefited from esketamine, KIT, or neither.

Final Thought

Nasal spray may be the first widely approved ketamine-based treatment, but it shouldn’t be the final word. Ketamine infusion therapy deserves equal attention, research, and access—especially when it may offer faster, deeper healing.

If you’re struggling with TRD, know that there are options. And if KIT has worked for you, don’t stay silent—your story could help shift the system.

Disclaimer: This article is for informational purposes only. Always consult a licensed medical professional before making treatment decisions.