In brief
- An observational study published July 9, 2026, in Frontiers in Psychiatry compares intravenous ketamine and intranasal esketamine (Spravato) outside the laboratory in a community clinic in Ohio, USA.
- The cohort included sixty-three people; fifty-nine completed induction and contributed data for comparing mean PHQ-9 changes. Between-group differences were nonsignificant; this does not establish equivalence.
- The authors emphasize that the sample size is small and the protocols were not identical, meaning the results serve as an indication rather than a definitive conclusion.
A study from a Dublin, Ohio clinic, published July 9, 2026 in Frontiers in Psychiatry, analyzes induction records from its practice. This is observational evidence from one center with eligibility exclusions, not automatic representation of every clinic or population.
A look at the clinic, not the lab
Retrospective records covered sixty-three people starting induction: 37 with intranasal esketamine and 26 with IV ketamine. Completers were 35 and 24, not all sixty-three. Esketamine scheduled twelve sessions over eight weeks and ketamine six over three. Assignment was not randomized; durations, contacts and selection differ. Binary rates use full cohorts 37/26, while mean PHQ-9 changes use complete baseline/final cases 35/24.
Comparison without significant differences
Reported response rates were 64.9% versus 69.2% and remission 32.4% versus 23.1%, respectively for esketamine and ketamine, using 37/26 denominators. Mean changes were −10.31 and −9.50 points in 35/24 complete cases; difference 0.81, 95% CI −2.12 to 3.75, p=0.589. Nonsignificant differences do not establish equivalence or interchangeability. One patient stopped esketamine for intolerable dizziness and one stopped ketamine for intolerable nausea; no serious events were documented, without excluding rare complications. It is incorrect to characterize every effect as mild.
What this implies
Small size, nonrandom assignment, incomplete clinical variables and asymmetric protocols limit comparison. Induction was evaluated, not maintenance, relapse or durability. Within-group improvement can coexist with confounding and does not establish superiority or equivalence between treatments. The authors work at the clinic offering both services. From a harm reduction perspective, such real-world evidence—with all its nuances and limitations—is just as necessary as advanced-phase trials to understand what to expect from a treatment when it moves from paper to people.
Source
- Bellanti, P.A., Lewis, J., Seifferth, B., Adams, D.Z. “Real-world outcomes of intranasal esketamine and intravenous ketamine induction therapy for treatment-resistant depression in a community clinic: a retrospective cohort study”. Frontiers in Psychiatry, July 9, 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.
