Mystical experiences, which may have therapeutic value, occurred in about 17-18% of ketamine treatments among 60 veterans with treatment-resistant depression. In those receiving esketamine, more treatment sessions were linked to higher mystical experience scores; in those receiving racemic ketamine, higher doses were linked to higher scores. The findings suggest that ketamine can occasion mystical experiences in this population.
Intramuscular (IM) ketamine is as effective as intranasal (IN) esketamine for treatment-resistant depression, with comparable safety and a dramatically lower cost. In a retrospective cohort of 179 Veterans, the difference in depression symptom improvement was only 0.04 points on the PHQ-9, well within the non-inferiority margin. PTSD symptom reductions were also similar, and rates of emergency department visits or hospitalizations did not differ significantly. The cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, driven primarily by the cost of the nasal spray. These results indicate that IM ketamine could be a high-value alternative that expands access to care.