Intranasal ketamine, as offered at HOPE Therapeutics, is racemic ketamine formulated as a nasal spray by a licensed compounding pharmacy to a clinician’s prescription. It is administered via nasal atomizer in a supervised clinical setting, where the medication is rapidly absorbed through the nasal mucosa into the bloodstream. It is an off-label treatment: ketamine itself is FDA-approved as an anesthetic, and its psychiatric applications, including this delivery format, are supported by peer-reviewed research but are not FDA-approved indications.
The mechanism is identical to IV ketamine. Ketamine blocks NMDA receptors in the glutamate system, triggering a rapid surge of BDNF release and a measurable increase in neuroplasticity. The brain begins forming new synaptic connections within hours of administration. The neuroplastic window this creates is the same biological opportunity that makes ketamine so clinically significant, available here through a route that does not require intravenous access and carries a gentler onset profile than infusion.
For patients in West Palm Beach who have tried antidepressants without adequate relief, who are exploring ketamine delivery options, or who want access to ketamine’s neuroplastic mechanism without IV administration, intranasal ketamine represents a distinct, clinician-managed pathway into neuroplastic care.
Intranasal ketamine, as offered at HOPE Therapeutics, is racemic ketamine formulated as a nasal spray by a licensed compounding pharmacy to a clinician’s prescription. It is administered via nasal atomizer in a supervised clinical setting, where the medication is rapidly absorbed through the nasal mucosa into the bloodstream. It is an off-label treatment: ketamine itself is FDA-approved as an anesthetic, and its psychiatric applications, including this delivery format, are supported by peer-reviewed research but are not FDA-approved indications.
The mechanism is identical to IV ketamine. Ketamine blocks NMDA receptors in the glutamate system, triggering a rapid surge of BDNF release and a measurable increase in neuroplasticity. The brain begins forming new synaptic connections within hours of administration. The neuroplastic window this creates is the same biological opportunity that makes ketamine so clinically significant, available here through a route that does not require intravenous access and carries a gentler onset profile than infusion.
For patients in West Palm Beach who have tried antidepressants without adequate relief, who are exploring ketamine delivery options, or who want access to ketamine’s neuroplastic mechanism without IV ketamine administration, intranasal ketamine represents a distinct, clinician-managed pathway into neuroplastic care.
Before anything is prescribed, we sit down with you to review your mental health history, previous treatments, current symptoms, and medical background. We screen for any contraindications, answer every question you have, and discuss how intranasal ketamine fits within your broader care at HOPE Therapeutics. If you are a good candidate, we build a personalized protocol around your specific situation.
You arrive at our West Palm Beach clinic for your scheduled session. Intranasal ketamine is self-administered using an atomizer under direct clinician supervision, with vital signs monitored throughout. You may experience mild dissociation or altered perception during the session. These effects are expected, temporary, and fully resolve within the observation window.
Following each session, you rest in our supervised clinical environment for a minimum of two hours while your care team monitors your response. Plan for transportation home in advance, as driving is not permitted after treatment. Once your initial series is complete, we assess your progress, develop a maintenance plan, and coordinate your ongoing care across all services at HOPE Therapeutics.
The clinical evidence for compounded intranasal racemic ketamine is both specific and compelling.
A 2025 outpatient study of 45 treatment-resistant depression patients completing a full intranasal ketamine induction course found a mean MADRS score reduction of 34.5 percent over four weeks, with 31.1 percent achieving complete response and 33.3 percent achieving partial response. The dropout rate due to adverse effects was just 4.2 percent. These are reproducible outcomes from patients whose depression had already failed conventional treatment.
Ketamine works by targeting what chronic depression actually does to the brain. Research confirms that BDNF expression is significantly reduced in the prefrontal cortex and hippocampus in patients with depression, and this impairment of neuroplasticity is central to the disorder’s pathophysiology. By blocking NMDA receptors, ketamine rapidly increases BDNF and promotes the formation of new synaptic connections in regions critical to mood regulation.
A Yale study published in Nature Communications confirmed that ketamine suppresses inhibitory interneurons in the medial prefrontal cortex, restoring synaptic activity in the dendritic spines of pyramidal neurons. Intranasal delivery achieves this same neuroplastic effect through a non-invasive, clinically supervised route.
For patients in Palm Beach County, HOPE Therapeutics brings this treatment close to home, without intravenous administration or travel to Miami or Tampa.
Intranasal ketamine works by blocking NMDA receptors in the glutamate system, triggering rapid neuroplastic changes: increased BDNF release, accelerated synaptic growth, and a surge in neural connectivity that begins within hours. Conventional antidepressants target serotonin and take weeks to work. Many patients with treatment-resistant depression never respond to them at all. Ketamine opens a different door entirely.
Administered via an atomizer, the medication is absorbed directly through the nasal mucosa into the bloodstream. Onset is gentler than IV administration, and peak effects are milder, which most patients find more comfortable. The underlying glutamatergic mechanism is identical.
During administration, patients commonly experience mild dissociation, altered time perception, and emotional softening. These effects resolve fully within the observation window. They are not side effects to be managed; they are the neurological opening that makes ketamine therapeutically significant, and when combined with psychotherapy, TMS, or IV ketamine at HOPE Therapeutics, each modality reinforces the others.
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Your provider will conduct thorough screening to confirm candidacy before any prescription is written.
Intranasal ketamine at HOPE Therapeutics is prescribed by a licensed clinician, prepared by a licensed compounding pharmacy, and administered under direct medical supervision at our West Palm Beach clinic. This structure distinguishes therapeutic use from unsupervised use and allows us to monitor your response, manage side effects, and adjust your protocol based on how you are actually progressing.
Your intranasal ketamine treatment is coordinated with the full range of care available at HOPE Therapeutics. If you are also receiving TMS, IV ketamine, psychotherapy, or medication management, your provider aligns every modality so that each component of your care is working together toward the same clinical outcome.
Intranasal ketamine is an off-label treatment, and we do not obscure that. We discuss it clearly during the initial evaluation, explain what the evidence supports and where its limits are, and ensure you have the information needed to make a fully informed decision about your care before anything is prescribed.
For patients who want access to ketamine's neuroplastic mechanism but for whom IV administration is not the right fit, intranasal ketamine offers a clinically supported, non-invasive alternative with its own evidence base, its own clinical applications, and its own place within the broader neuroplastic care model at HOPE Therapeutics.
Because the medication is compounded to prescription rather than produced in standardized commercial doses, your provider can adjust dosing to reflect your clinical response, your history, and your specific treatment goals. This flexibility is one of the practical advantages of the compounded intranasal format.
Intranasal ketamine is an off-label treatment and is typically not covered by insurance. Most patients pay out-of-pocket for this service. We will confirm coverage details with you prior to beginning treatment so there are no surprises.
For patients paying out-of-pocket, we offer:
For patients who have tried conventional treatments without adequate relief, intranasal ketamine represents access to a neuroplastic mechanism that most antidepressants do not reach, in a non-invasive format that fits a wider range of clinical situations and personal preferences than IV administration alone. During your initial consultation, we will discuss all costs and payment options clearly.
Both deliver racemic ketamine and work through the same NMDA receptor mechanism. The differences are in route of administration, onset profile, and bioavailability. IV ketamine is delivered directly into the bloodstream, producing a faster and more intense onset. Intranasal ketamine is absorbed through the nasal mucosa, producing a gentler onset with lower peak intensity. IV ketamine has higher bioavailability, which is reflected in dosing differences between the two formats. For patients who want access to ketamine’s neuroplastic mechanism without IV administration, intranasal delivery is a clinically supported alternative.
No. Ketamine is FDA-approved as an anesthetic. Its use for depression, PTSD, anxiety, OCD, and related conditions is off-label. Compounded intranasal racemic ketamine is not FDA-approved for any psychiatric indication. That said, off-label prescribing is a standard and legal practice in medicine, and the evidence supporting ketamine’s antidepressant mechanism is substantial across decades of peer-reviewed research.
Many patients notice the neuroplastic effects of ketamine within hours of administration, including mood shifts, reduction in depressive heaviness, and changes in thought patterns. The speed of clinical response is one of ketamine’s most clinically significant features, differentiating it sharply from conventional antidepressants that require weeks to build effect. Individual responses vary, and your provider will monitor your progress throughout your treatment series rather than in a single session.
You arrive at our West Palm Beach clinic and are settled into a private, supervised treatment room. The intranasal ketamine is self-administered under your clinician’s direct supervision using a nasal atomizer. You then rest comfortably in the supervised environment while your vital signs are monitored. The effects typically include mild dissociation, altered time perception, and a sense of emotional softening that resolves within the observation window. You will be monitored for a minimum of two hours following administration before you are cleared to leave with your arranged transportation.
The number of sessions varies based on your diagnosis, symptom history, and clinical response. Most patients complete an initial induction series followed by a reassessment. Some achieve meaningful improvement after the induction phase. Others benefit from ongoing maintenance sessions to sustain and build on their gains. Your provider will build a plan based on how you are actually responding rather than applying a fixed protocol.
Yes. Intranasal ketamine is coordinated with your full treatment plan at HOPE Therapeutics. If you are also receiving TMS, psychotherapy, medication management, or IV Ketamine, your provider will ensure that your intranasal ketamine treatment is timed and dosed appropriately within that broader plan.
Meet with our clinical team for a thorough review of your mental health history, current symptoms, previous treatments, and medical history. We will assess whether intranasal ketamine is appropriate for your situation and answer every question you have before anything is prescribed.
We will walk you through exactly what to expect during administration and monitoring, how intranasal ketamine fits within your broader care at HOPE Therapeutics, and what a personalized treatment protocol looks like for your specific situation.
Receive your supervised administration sessions in a private, comfortable clinical environment at our West Palm Beach clinic, with continuous monitoring and your care team present from the moment you arrive to the moment you leave.
Many patients notice meaningful changes in mood and symptom burden within hours of their first session. We track your progress closely and adjust your protocol based on your real-time response, coordinating with your full clinical team throughout.
If major depression, treatment-resistant depression, or suicidal depression has not responded to conventional treatment, intranasal ketamine provides clinician-supervised access to the same glutamatergic, neuroplastic mechanism that makes ketamine one of the most important psychiatric discoveries of the past half century, without IV administration.
At HOPE Therapeutics in West Palm Beach, intranasal ketamine is prescribed, supervised, and integrated with the full range of neuroplastic care we offer. Schedule your consultation to find out whether it is the right next step for you.
Dai, Y., Harrison, B. J., Davey, C. G., & Steward, T. (2025). Towards an expanded neurocognitive account of ketamine’s rapid antidepressant effects. International Journal of Neuropsychopharmacology, 28(2), pyaf010. https://doi.org/10.1093/ijnp/pyaf010
Kwan, A. C. (2020). Ketamine disinhibits dendrites and enhances calcium signals in prefrontal dendritic spines. Nature Communications, 11(1), 72. https://doi.org/10.1038/s41467-019-13809-8
Pardossi, S., Fagiolini, A., & Cuomo, A. (2024). Variations in BDNF and their role in the neurotrophic antidepressant mechanisms of ketamine and esketamine: A review. International Journal of Molecular Sciences, 25(23), 13098. https://doi.org/10.3390/ijms252313098
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