Ketamine Nasal Spray

Ketamine has been studied across mood, trauma, anxiety, and pain conditions. Below is a plain-language summary of the published evidence. Use of ketamine for these conditions is generally off-label, and individual results vary.

Depression

Ketamine is one of the most studied rapid-acting antidepressants. In a randomized, double-blind, placebo-controlled trial, 44% of patients responded within 24 hours of intranasal ketamine, compared with just 6% on placebo — and it was well tolerated with minimal dissociative effects.1 Systematic reviews and meta-analyses of controlled trials confirm a fast-onset antidepressant effect with intranasal ketamine, with adverse effects that are typically mild and transient.2

PTSD

Research led by Dr. Adriana Feder at Mount Sinai provided the first controlled evidence that ketamine can rapidly reduce PTSD symptoms. In a randomized trial of repeated dosing, 67% of the ketamine group were treatment responders, versus 20% on the active placebo, with meaningful improvement in trauma symptoms and good tolerability.3

Anxiety

In studies of treatment-resistant generalized and social anxiety disorder, patients reported reduced anxiety within one hour of dosing, with relief lasting up to a week. With maintenance dosing, the large majority of patients reported ongoing improvement in social and work functioning.4 This rapid, calming effect is part of why so many of our patients find the spray valuable for day-to-day anxiety (see microdosing, below).

Chronic pain

Ketamine blocks the NMDA receptor, which plays a central role in “central sensitization” — the process by which the nervous system becomes locked into a heightened pain state. By dampening that signaling, ketamine can help break the chronic pain cycle. The strongest evidence is in neuropathic pain and complex regional pain syndrome (CRPS), where consensus guidelines rate the evidence as moderate.5

Johnson & Johnson’s Spravato is an FDA-approved esketamine nasal spray — but it is only one mirror image of the ketamine molecule. Ketamine is what chemists call a racemic molecule, meaning it naturally exists as two mirror-image forms (the R- and S-enantiomers). Spravato contains only the S-mirror image (esketamine). The nasal spray we prescribe contains both mirror images — the complete, racemic ketamine molecule.

Why does that matter? A growing body of research suggests the R-mirror image contributes meaningfully to ketamine’s benefits and may be linked to longer-lasting effects. In fact, a meta-analysis of dozens of randomized controlled trials found that racemic ketamine consistently produced larger and more sustained antidepressant effects than esketamine, with greater remission rates and fewer dropouts due to side effects.6

Beyond Spravato, our nasal spray also gets into your system faster than any sublingual or oral route of ketamine — which is why so many patients prefer it.

A unique advantage of the nasal route is that ketamine can be combined with oxytocin in the same spray. This matters because oxytocin is a peptide that is poorly absorbed when taken orally or sublingually — the digestive system breaks it down. Delivered through the nose, however, oxytocin can travel directly along nerve pathways to the brain, which is why intranasal delivery is the preferred route in the research.7

For our patients, adding oxytocin to the nasal spray can enhance the antidepressant benefit of ketamine, and oxytocin carries the added benefit of supporting libido and feelings of connection — something the oral and sublingual forms simply can’t deliver as effectively. NutraBrain offers one of the only ketamine + oxytocin nasal spray formulations in the country.

Because we use a network of compounding pharmacies across different states, your exact price depends on your pharmacy and location. Here’s what patients typically see:

Compare that with clinic-administered Spravato, which — with a deductible — can be dramatically more expensive and requires a trip to a certified office for every single dose.