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The spray has a “black box” warning about the risk of sedation and trouble with attention, judgment, and thinking, as well as risk for abuse or misuse of the drug and suicidal thoughts and behaviors.

Other forms of ketamine not approved by the FDA for mental health conditions include IV infusion, a shot in the arm, or lozenges. Most research looks at ketamine given by IV. You can only get it by IV or shot in a doctor’s office. Some doctors will prescribe lozenges for at-home use — often to keep depression at bay between infusions.

At his clinic, Stewart only sees patients who have referrals from a doctor that diagnosed them with treatment-resistant depression. Stewart doesn’t make these diagnoses. He starts patients with a research-based six infusions spaced over 3 weeks.

“That’s how people get started,” Krystal says. “Two infusions a week, and then they go down to one infusion a week, and then most people go down to eventually one infusion every 2 to 4 weeks.”

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