Positives

• Treatment-resistant patients reported rapid mood lift, often within hours, when conventional antidepressants had failed Johns Hopkins.
  
  
• Patients welcomed the markedly lower rate of sexual side effects compared to their prior SSRI/SNRI regimens PMC.
  
  

Negatives

• About 40% of patients experienced dissociation and over half reported sedation during dosing sessions AAFP.
  
  
• Up to 17% of patients had transient blood pressure spikes greater than 40 mm Hg systolic in the first 90 minutes AAFP.
  
  

Hurdles & Side Effects

• Patients must attend a certified REMS clinic for two-hour monitored sessions twice weekly and cannot drive home afterward Mayo Clinic.
  
  
• Cost and clinic availability remain major access barriers, especially for patients without commercial insurance coverage NAMI.