IV Ketamine therapy remains the gold-standard of TRD treatment, however the FDA approved esketamine (Spravato) is an option. The drug is basically one half of the original ketamine molecule. The attempt was to split the drug to remove the “unwanted” psychedelic effects of the medicine. We understand that the concept of a transcendental experience is not part of mainstream Western medicine, but we are certain that the transcendental experiential effects of a ketamine infusion play an essential part of the treatment. The nasal delivery of the drug is certainly more desirable, however studies show that it may not be as effective, as dosing and absorption will be less precise. The benefit of FDA approval of esketamine is that, depending on your coverage, insurance companies may pay for its higher cost, estimated to be $1000 per dose. Spravato will not be dispensed to patients to take home like ketamine troches. It will only be available in approved and certified treatment centers.