Positives

• In an outpatient cohort using compounded racemic ketamine, 31% of patients achieved a complete antidepressant response and another 33% had a partial response ScienceDirect.
  
  
• A hospitalized treatment-resistant depression group given compounded intranasal racemic ketamine showed reductions in suicidal ideation alongside depressive symptom relief PubMed.
  
  

Negatives

• FDA documented patients who experienced delusions, dissociation, hallucinations, and panic attacks after using compounded ketamine nasal sprays at home FDA.
  
  
• A patient self-dosing without a clinician on site can experience unmonitored sedation, respiratory depression, or accidental overdose, as one PTSD patient did with double the anesthetic blood level FDA.
  
  

Hurdles & Side Effects

• A patient must use a mucosal atomizer correctly to achieve absorption, and many cohorts required nurse oversight for proper technique Springer.
  
  
• A patient seeking insurance coverage will be denied because compounded racemic ketamine is not FDA-approved and lacks a standardized psychiatric dosing regimen FDA.