In brief
- An analysis of clinical records from over 10,000 people compares intravenous ketamine with intranasal esketamine for treatment-resistant depression.
- IV ketamine was associated with a 34% remission rate compared to 26% for esketamine, and a 63% response rate compared to 58%.
- This is not a randomized trial, and the data comes from a conference presentation that has not yet undergone peer review.
On June 5, a team of researchers from Osmind—an electronic health record company specializing in mental health—and Yale University presented the largest analysis to date comparing real-world ketamine infusions with intranasal esketamine for people with treatment-resistant depression. The presentation took place at the annual meeting of the American Society of Clinical Psychopharmacology in Miami. According to the data, the intravenous route was associated with higher remission rates than the nasal spray.
Clinical records instead of a classic trial
The study did not recruit patients or randomly assign them to treatments. Instead, it used anonymized electronic records from people treated at nearly 800 community psychiatry practices that use the Osmind platform: 8,224 treated with IV ketamine and 1,830 with intranasal esketamine. From there, the authors matched participants based on their baseline characteristics to build a comparable subgroup of 3,560 people. The primary outcome measure was the change in depressive symptoms as evaluated by standard clinical questionnaires.
The figures presented
According to the data presented at the conference, 34% of those who received IV ketamine achieved symptom remission, compared to 26% in the intranasal esketamine group (odds ratio of 1.51; p<0.001). Regarding clinical response—a noticeable but not complete improvement—the figures were 63% versus 58% (odds ratio of 1.22; p<0.003). The study authors include researchers from Osmind and psychiatrist Samuel Wilkinson from Yale.
What this implies
It is important to note the source of this information: it is a conference communication, not yet a peer-reviewed article, and its public dissemination came via a press release from NRx Pharmaceuticals, a company with commercial interests in the IV ketamine space. This does not invalidate the data, but it is advisable to wait for the full publication before drawing definitive conclusions. The authors themselves acknowledge the fundamental limitation: no one was randomly assigned to treatment. Patients who receive IV infusions—which require traveling to a clinic and spending several hours there—may differ systematically from those who choose a faster-acting nasal spray, and factors such as cost, insurance coverage, and availability weigh as heavily as clinical criteria. A few days ago, we reported on a much smaller study from a single clinic in Ohio that found no differences between the two routes: the contrast between the two works illustrates the extent to which sample size and context influence observations. For those evaluating either option, the useful takeaway is not that one is inherently better than the other, but that the route of administration appears significant enough to be part of the conversation with the professional guiding the process.
Source
- NRx Pharmaceuticals. NRx Pharmaceuticals (Nasdaq:NRXP) notes presentation by Osmind, Inc. of IV Ketamine Efficacy vs. Nasal esketamine Efficacy at American Society of Clinical Psychopharmacology. GlobeNewswire, June 5, 2026.
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
