Most comparisons of ketamine-based depression care focus on the patient: which option is approved, which is studied, which costs what. Those questions matter most, and they belong with a clinician. But there is another question that gets less attention. What does each option ask of the person who lives with the patient?
This comparison looks at the three models most people encounter, from the partner's side of the kitchen table. It is not a recommendation for any of them. Which one, if any, fits your spouse is a clinical decision.
Why partners should understand the differences
Most people start out unfamiliar with the options. In a survey of 443 Midwest adults our publisher commissioned in June 2026, 73 percent said the name Spravato, an approved esketamine product, meant nothing to them. Their gut reactions to ketamine care leaned careful: cautious but open led at 34 percent, and 21 percent were skeptical. The survey numbers here are the final, validated ones.
A cautious spouse will have questions about safety and daily life. If you understand how each model works, you can help them get clear answers.
Model one: esketamine at a certified center
The basics. Spravato is esketamine in nasal spray form. The FDA has approved it in adults for treatment-resistant depression and for major depression that brings acute suicidal thoughts or behavior. Administration is limited to certified treatment centers. Brain Recovery Centers outlines the Spravato treatment process on its site.
What a session involves. The patient uses the spray under supervision, then stays at least two hours while staff monitor blood pressure and side effects such as drowsiness, dizziness, or a detached feeling.
What it asks of a partner.
- Driving: High. No driving for the patient until the next day, after sleep, and the opening month usually brings two sessions each week.
- Time: Each visit takes a few hours with travel. The schedule eases to weekly, then weekly or every other week.
- Monitoring at home: Lower. Trained staff handle the monitoring during the riskiest window. At home, the partner mostly supports rest.
- Paperwork: Moderate. Insurers commonly require prior authorization, and partners often help make those calls.
Model two: IV ketamine at a clinic
What it is. Ketamine holds FDA approval as an anesthetic. Using an infusion of it for depression is off-label: the FDA has never approved that use. Specialty clinics offer it, often on a cash-pay basis.
What a session involves. The patient receives an infusion in a clinic and is monitored until they recover enough to leave. Clinics commonly schedule a series of infusions over several weeks, followed by occasional maintenance sessions.
What it asks of a partner.
- Driving: High during the initial series, since patients generally need a ride home.
- Time: Similar to esketamine per visit, though schedules vary by clinic.
- Monitoring at home: Lower, since the clinic monitors during the session.
- Money: Often the heaviest. Because it is off-label, many insurers do not cover it, and partners who manage household finances feel that directly.
Model three: at-home ketamine by telehealth
What it is. Some online companies prescribe ketamine as tablets or lozenges, often compounded, after a video evaluation. It is taken at home. No approval covers that use for depression, and federal regulators have warned publicly about compounded ketamine used with no one monitoring.
What a session involves. The patient takes a dose at home, typically following the company's instructions. Some programs ask that another adult be present during sessions.
What it asks of a partner.
- Driving: Low. No trips to a clinic.
- Monitoring at home: High, and this is the key difference. If a program expects someone to be present, that someone is often the partner, without medical training, handling a session that clinics staff with professionals.
- Safety responsibility: Shifted toward the household. Partners should ask exactly what they would be expected to watch for and who to call if something goes wrong.
- Money: Usually cash-pay, often lower per dose than clinic options.
How people said they would prefer to receive care
Our survey asked about delivery preferences. Top of the list, with 44 percent, was a clinic visited in person. Home telehealth claimed 22 percent, a hybrid beginning in the clinic claimed 23 percent, and 11 percent were indifferent. Counting clinic-only and clinic-first answers together, 67 percent, combined, pictured a clinic somewhere in their care.
These are preferences, not safety findings. But they suggest that many people, when they picture this kind of care, picture professionals in the room. The family circle of veterans and first responders, spouses and parents included, 156 respondents, chose the in-person clinic at 49 percent.
Side by side, from the partner's chair
- FDA-approved for depression: Esketamine, yes. IV ketamine, no. At-home ketamine, no.
- Who monitors the riskiest window: Esketamine, trained staff. IV ketamine, trained staff. At-home, often the household.
- Driving burden: Esketamine, high. IV ketamine, high. At-home, low.
- Likely insurance coverage: Esketamine, often, though prior authorization is typical. IV and at-home ketamine, rarely.
Coverage shapes this for most families. Our respondents made that plain: coverage ranked top-two for 85 percent, and for 59 percent FDA approval would weigh heavily or decide the question of trying this care.
Questions to bring to a clinician together
- Which of these, if any, fits my spouse's history and health?
- What would I be responsible for at home under each option?
- What side effects should we watch for, and when should we call?
- What alternatives exist if none of these fit?
The answers depend on your spouse's medical history, and only a clinician who knows it can give them.
If your spouse is thinking about suicide, stop comparing and reach out. Phone or text 988, the free Suicide and Crisis Lifeline; it never closes, and a partner can seek help there for a loved one.
Methodology
Where the numbers come from: a Pollfish consumer panel survey our publisher commissioned and paid for. It closed on June 23, 2026. In all, 443 people aged 18 to 64 completed it, in Iowa, Illinois, Oklahoma, Ohio, Kansas, Wisconsin, Indiana, Nebraska, Minnesota, and Missouri. These are the final validated results; the one group figure covers family of veterans and first responders.