While we believe IV ketamine therapy is the best treatment for TRD PTSD and neuropathic pain, it is not well covered by insurance and we know there are cost barriers to folks. There are several alternatives to IV ketamine therapy for treating conditions like treatment-resistant depression. These include:

1. Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is FDA-approved and has been shown to be effective for patients who do not respond to traditional antidepressants. While TMS takes longer to show results compared to ketamine (usually 4-5 weeks), its benefits are often more durable, and it does not involve the dissociative side effects associated with ketamine (HealingMaps) (Psych Atlanta).
2. Spravato (Esketamine): Esketamine is a nasal spray that is derived from ketamine. It is FDA-approved for treatment-resistant depression and can be administered in a clinical setting. The nasal spray form is less invasive than IV therapy and is more likely to be covered by insurance. However, it requires repeated dosing and has similar dissociative side effects to ketamine (PharmaNewsIntelligence) (Psych Atlanta).
3. Oral Ketamine: Researchers are exploring oral formulations of ketamine as an alternative to IV infusions. While current studies suggest that oral ketamine is safe and can be effective, its efficacy is generally lower compared to IV or intranasal forms. Efforts are underway to develop extended-release formulations to improve its therapeutic benefits and reduce side effects (PharmaNewsIntelligence).
4. Electroconvulsive Therapy (ECT): ECT has long been used for treatment-resistant depression. It involves electrical stimulation of the brain under anesthesia. Recent studies have shown that ketamine can be as effective as ECT for some patients, with fewer side effects such as memory loss. However, ECT remains a viable option, especially for severe cases where other treatments have failed (Psychology Today).

These alternatives each have their own advantages and limitations, and the best choice can depend on individual patient needs, medical history, and personal preferences. Consulting with a healthcare provider is essential to determine the most appropriate treatment.