When your partner is weighing ketamine-based care for depression, you will likely hear about three versions: a nasal spray at a certified clinic, an IV infusion, and something taken at home. To someone reading from the sidelines, they can sound like three brands of the same thing. They are not. The biggest dividing line between them is FDA status, and it changes what you, the partner, will actually experience.
This side-by-side is written for spouses and partners across the Midwest. It compares approved and off-label ketamine care on the things partners notice: oversight, safety checks, cost, and what happens when something feels off.
The trust question, in numbers
In our commissioned sample of 443 Midwest adults, FDA approval weighed heavily for 59 percent, who called it big or deciding. First reactions to "ketamine therapy for depression or PTSD" split several ways: cautious but open led at 34 percent, with skepticism at 21 percent and hope or curiosity at 18 percent. Put the cautious and hopeful together and 51 percent were open to it, against 9 percent who were negative. Relatives of veterans and first responders, counting spouses, numbered 156, and 57 percent of them leaned open. These numbers are final and validated.
Most people are neither sold nor opposed. They want to know what they are dealing with. That is what this comparison is for.
The three versions at a glance
- Esketamine (Spravato): an FDA-approved medicine, taken as a nose spray, for depression that earlier treatment did not ease, given only in certified clinics.
- IV ketamine: Approved by the FDA for anesthesia only, so depression use is off-label.
- At-home ketamine: Often compounded lozenges or tablets. Not FDA-approved for depression.
Oversight: who has reviewed this use?
Esketamine: The FDA reviewed clinical trial evidence for this specific use and approved it, with a safety program attached.
IV ketamine: The FDA's review of ketamine covered anesthesia and never extended to depression. Doctors may legally use it off-label based on their judgment and published research, but no FDA review covers this use.
At-home ketamine: No FDA review for depression. Compounded products are not reviewed for safety, effectiveness, or quality before reaching patients. The FDA has warned about risks of compounded ketamine used without monitoring.
What you notice: With the approved version, there is a published label you can read that describes who it is for, how it is given, and what the risks are. With the others, you rely more heavily on the individual clinic's explanation.
Safety checks: who is watching?
Esketamine: Required. Your partner takes the spray under direct observation, then stays two hours or more while staff check blood pressure and other signs. Driving waits until the next day and a night's sleep. Brain Recovery Centers explains what happens during a Spravato session.
IV ketamine: Typically monitored by clinic staff during and after the infusion, but the protocols are set by each clinic rather than by an FDA-required program.
At-home ketamine: Often little or no in-person monitoring. Some programs use video check-ins or ask for a "sitter," which may be you.
What you notice: The at-home route can quietly make the partner the safety monitor. If a program asks you to be present during doses, ask exactly what you are supposed to watch for and what to do if something goes wrong. That is a lot to ask of a spouse with no medical training.
Setting: where does it happen?
Our survey asked where people would want this kind of treatment. The largest share, 44 percent, preferred an in-person clinic. A clinic-first model that later moves home drew 23 percent, telehealth at home 22 percent, and 11 percent had no strong preference at all.
What you notice: Esketamine fits the clinic preference by design. The at-home route fits the smaller share who want treatment at home, but with less oversight. For a partner, "at home" means your home, your schedule, and possibly your supervision.
Cost: how predictable is it?
Esketamine: Approval gives insurers a defined path. Many commercial, Medicare, and Medicaid plans cover it with prior authorization. The drug and the monitoring visit may be billed separately, and a manufacturer savings program exists for eligible commercially insured patients.
IV ketamine: Often self-pay, since coverage for off-label use is inconsistent. Prices vary widely by clinic.
At-home ketamine: Usually self-pay, often by subscription.
What you notice: The approved path usually involves more paperwork and waiting. The off-label paths can move faster but put more of the cost on your household. In our survey, just over half of respondents preferred the covered route even with more hoops, while fewer than a quarter preferred to pay and move faster.
Accountability: what happens if something feels off?
Esketamine: Side effects are observed on-site by trained staff, and the certified setting has procedures for responding.
IV ketamine: Clinic staff respond on-site during treatment. Ask what follow-up they provide between sessions.
At-home ketamine: If something happens at home, you may be the first responder. Before agreeing to at-home care, ask who you call, how quickly they answer, and when to call 911.
Where TMS fits
If the reason your partner hesitates is the idea of any drug, TMS is worth asking about. It is an FDA-cleared device for depression that has lingered despite antidepressants, uses no medication, and is given in a clinic. Most people drive themselves afterward.
How to use this comparison
Bring it to your partner's doctor, together if your partner wants that. That is the voice most people listen to: 74 percent of our respondents said a nudge from their own doctor would get them to try something new. A doctor can tell you which version, if any, fits your partner's history. This comparison is general information and not medical advice, and none of these options can promise results.
If your partner is in crisis or talking about ending their life, call or text 988 immediately. The Suicide and Crisis Lifeline answers day and night, and you can call on your partner's behalf.
Methodology
This side-by-side reports top-line results from a Pollfish consumer panel survey. It closed June 23, 2026, with responses in hand from 443 people, adults 18 to 64, living in Oklahoma, Nebraska, Ohio, Illinois, Minnesota, Wisconsin, Missouri, Indiana, Iowa, and Kansas. One figure combines two answer options and is labeled as combined. With the panel validated, results are final. Behind this comparison is research our publisher commissioned and financed.