Psychiatrist or depression researcher I'm trying again to find a scientist, scientist, or other expert knowledge about major depression or treatment-resistant depression to comment on Spravato/esketamine use -- someone with no conflict of interest with the manufacturer, Janssen Pharmaceuticals or J&J. Specifically, I'm looking for comments/an interview on: (1) While esketamine may have risks, so does major depression. These are sometimes not acknowledged by the scientists who criticize its use. Even if you have not (or best if you have not) prescribed it clinically, I'd like thoughts on how severe depression is a serious disease with a high risk of death by suicide and hence treatments are worth exploring (or, if you have a contrary view thats ok - but I have someone with that view already). This could be a counselor, psychologist, therapist OR scientist. (2) Comments on the overall state of the esketamine research - safety and efficacy from 5 years of use. Have only found 1 psychiatrist/researcher with no ties to Janssen but he only emailed one sentence. Expert does not have to study it, though that is ideal. I know there's a lot of people at Yale who worked on the drug. Anyone else? (3) A person who has seen esketamine improve someone's life, depression, etc. It could be even unrelated to your day job, or perhaps you're a nurse or assistant at a clinic but not the psychiatrist/doctor. Thoughts on the importance of set and setting on a patient's experience, as well (I've seen everywhere from 10 patients taking it in a room with cubicles to private rooms, sofas, meditation...) Or, in contrast, who has seen negative effects of the drug (esketamine/Spravato only, not ketamine for this). Or anything else from anyone with thoughts on this, from anyone without a COI. FYI I personally have taken it, and am writing from that experience but interviewing patients, scientists, etc about the overall big picture on how it's revolutionized depression research (the NMDA receptor vs the monoamine nerotransmitter model) - to the inconsistent implementation in clinical practice, and what we still need to learn about it. Preference is for US-based researchers, but please reach out if you have any expertise! Article is done but I had to remove some experts due to COIs, so need to replace interviews.

I have worked with multiple patients who have undergone spravato treatment as well as patients who have done ketamine treatment through IV or in-home lozenges. I have seen incredible results in both cases, however, spravato being FDA approved, makes it far more accessible to a larger demographic. The FDA approval also makes skeptics more willing to try the drug. As far as set and setting, I do think there is a deliberate attempt to move away from the "psychedelic" image and an attempt to be seen as a more traditional medical treatment done in a sterile medical environment. However, during treatment, people are in such a vulnerable state that I think there should be every effort made to create a warm and nurturing environment. Some of the most powerful sessions I have had as a therapist have been in office Ketamine sessions. For many reasons it is usually only possible to have a therapist with you during the experience if you have been prescribed lozenges, which can be done outside of a medical office. Spravato is required to be done in a clinic, usually with a nurse in the room during treatment. However, having a psychotherapist whom a patient has already developed a relationship with would not only make a patient feel less vulnerable, it would also lead to more powerful integration sessions post-treatment. Generally I think our society has an issue with wanting to "cure" depression when instead I believe the focus should be on reducing symptoms and extending the length of time between depressive episodes. Spravato has been able to do that for every patient I have seen.

In the debate over the side effects of esketamine, we often ignore the most dangerous side effect of all: untreated major depression. When a patient reaches the stage of treatment-resistant depression, we are no longer dealing with a benign condition. We are dealing with a life-threatening illness that erodes relationships, careers, and the will to live. Critics frequently cite the risks of dissociation or transient blood pressure spikes associated with Spravato. These are valid medical concerns that require monitoring. However, in my clinical practice, I have to weigh those temporary, manageable risks against the permanent risk of suicide. When standard antidepressants fail—which happens in about a third of cases—the "safe" option of doing nothing or repeating the same failed trials is actually the most dangerous path we can take. We accept that chemotherapy has severe toxicity because the alternative is cancer progression. We need to start viewing severe, resistant depression with that same level of urgency. Treatments that target the NMDA receptor offer a mechanism of action that is fundamentally different from the standard "serotonin model." For a patient who has been drowning for years, offering a new mechanism isn't just about symptom reduction; it is often a matter of survival.

Hi there, I'm a licensed therapist in NYC and offer ketamine assisted therapy in my practice. I partner with an MD who prescribes clients with ketamine lozenges, and they bring these lozenges to my office for ketamine assisted therapy sessions. The setting of the ketamine treatment is crucial for a safe and effective journey. Clients are set up with noise canceling headphones, playlists created specifically for them and to be experienced while on ketamine, we set intentions before a journey, and we share time to integrate afterwards. I'm sharing this because (1) I don't prescribe ketamine and (2) I don't work with Spravato, nor do I know many therapists who do. Among therapists, Spravato is seen as an insurance marketing success story, with little support for clients. The facilities that provide Spravato are often overly clinical (like hospital settings), don't provide proper integration or preparation sessions, and administer the drug...like a drug. Low-dose ketamine, in the form that Spravato is used in, has an amazing ability to lower defenses and help clients access hard emotions, or things that are leading to their depression. But without a therapist there, Spravato becomes a timely treatment with little access to deeper healing. Ketamine also increases neuroplasticity, so the days after Spravato sessions have a great ability to help depressed clients make behavior changes. But this is extremely difficult to learn into if clients are accessing treatment for MDD without therapists, just a medical team. Spravto is cost effective because it's approved by many insurances, but it's just a band aid solution in terms of long term treatment. For MDD, I believe the most effective treattment is working with an IV ketamine clinic that also prioritizes mental health. Feel free to email me if you have other questions, happy to chat more!

As a dermatologist, I see depression up close. Severe acne, hidradenitis, psoriasis, and scarring can sit on top of major depression, and untreated depression can be fatal. When I want a voice without a Janssen tie, I lean on methodologists. In 2025, Florian Naudet, Erick Turner, and Ioana Cristea reanalyzed individual patient data from 7 randomized trials (1505 patients). They reported a mean MADRS change of about minus 2.94 at 4 weeks, and a continuation trial relapse hazard ratio of 0.38. They also disclose no competing interests with manufacturers. For set and setting, I would interview REMS clinic nurses, medical assistants, and care coordinators. Ask how the room is run. Ask how blood pressure and dissociation are handled. In my own procedure rooms, quiet structure changes how people cope. You will get the same lesson here, one story at a time.

I may be a good fit for what you're looking for, particularly from the perspective of research literacy, clinical observation, and lived exposure without industry ties. My background is in mental health research analysis and long-form medical journalism rather than pharmaceutical development or sponsored clinical trials, and I have no financial or professional relationship with Janssen, J&J, or affiliated entities. Over the past several years, I've closely followed the esketamine literature, FDA post-marketing data, and real-world clinical reports, while also speaking with clinicians, patients, and support staff involved in its use. On your first point, I strongly agree that discussions around esketamine often underweight the severity and lethality of major depressive disorder and treatment-resistant depression. From a risk-benefit standpoint, severe depression is not a neutral baseline. Suicide risk, functional collapse, and medical comorbidity are material harms that deserve equal consideration when evaluating newer treatments, even imperfect ones. I can speak to this framing in a balanced, non-promotional way. Regarding the state of the research, I can comment on what five years of use have realistically shown so far: modest but meaningful efficacy for a subset of patients, unresolved questions around durability, dissociation and blood pressure risks that are real but often manageable, and the gap between controlled trial settings and heterogeneous real-world clinics. I'm also familiar with critiques from researchers outside the original development ecosystem and can contextualize those without dismissing them. Finally, while I am not a prescriber, I have directly observed both positive and mixed patient experiences with Spravato in clinical settings and have spent time documenting how environment, preparation, supervision, and follow-up profoundly shape outcomes. I can speak thoughtfully about set and setting, inconsistent implementation across clinics, and why patient experience varies so widely, including cases where the treatment did not help or was discontinued. If you're open to including a non-industry-affiliated expert voice that bridges research interpretation, patient experience, and ethical framing of risk in severe depression, I'd be glad to contribute. I can share credentials, prior published work, and references upon request.