Hi everyone,

I’ve been dealing with bipolar TRD for the past 2 years and a half.

Last year, during a hospitalization, I was put on Spravato and it was honestly the only treatment that ever helped me. Unfortunately, after only 4 weeks, we reduced the frequency to one a week, and I progressively lost the benefits. I stopped abruptly 3 months later because I wasn’t able to leave my house.

I’m currently hospitalized for a second time. We first tried 30 sessions of TMS, which didn’t work for me.

Now I’m doing IV ketamine because my new hospital can’t afford Spravato. I’m on my 7th session tomorrow and I’m at 0.8 mg/kg.

I’m doing slightly better than before, but it’s really not comparable to Spravato in terms of effectiveness. The sessions themselves are also intense and pretty uncomfortable. My last one was honestly rough. I completely lost the sense of having a body, felt like I was a “spirit” trapped in a box, flying in circles, convinced it would never end.

I’m going to ask my psychiatrist about switching back to Spravato at another hospital or clinic, but he needs to approve the transfer. He’s hesitant because studies suggest IV ketamine is actually more effective than Spravato overall.

So I have two questions for you guys :

- If you’ve tried both IV ketamine and Spravato, did you find Spravato more effective and/or a smoother experience overall ?

- Does anyone understand why Spravato might be more effective and tolerable than IV, despite the trial data on efficacy?

Any personal experiences or scientific insight would help me a lot as I prepare this conversation with my psychiatrist.

Thanks a lot !!!

Hi everyone,

I’ve been dealing with bipolar TRD for the past 2 years and a half.

Last year, during a hospitalization, I was put on Spravato and it was honestly the only treatment that ever helped me. Unfortunately, after only 4 weeks, we reduced the frequency to one a week, and I progressively lost the benefits. I stopped abruptly 3 months later because I wasn’t able to leave my house.

I’m currently hospitalized for a second time. We first tried 30 sessions of TMS, which didn’t work for me.

Now I’m doing IV ketamine because my new hospital can’t afford Spravato. I’m on my 7th session tomorrow and I’m at 0.8 mg/kg.

I’m doing slightly better than before, but it’s really not comparable to Spravato in terms of effectiveness. The sessions themselves are also intense and pretty uncomfortable. My last one was honestly rough. I completely lost the sense of having a body, felt like I was a “spirit” trapped in a box, flying in circles, convinced it would never end.

I’m going to ask my psychiatrist about switching back to Spravato at another hospital or clinic, but he needs to approve the transfer. He’s hesitant because studies suggest IV ketamine is actually more effective than Spravato overall.

So I have two questions for you guys :

- If you’ve tried both IV ketamine and Spravato, did you find Spravato more effective and/or a smoother experience overall ?

- Does anyone understand why Spravato might be more effective and tolerable than IV, despite the trial data on efficacy?
Any personal experiences or scientific insight would help me a lot as I prepare this conversation with my psychiatrist.

Thanks a lot !!!

Hi everyone,

I’ve been dealing with bipolar TRD for the past 2 years and a half.

Last year, during a hospitalization, I was put on Spravato and it was honestly the only treatment that ever helped me. Unfortunately, after only 4 weeks, we reduced the frequency to one a week, and I progressively lost the benefits. I stopped abruptly 3 months later because I wasn’t able to leave my house.

I’m currently hospitalized for a second time. We first tried 30 sessions of TMS, which didn’t work for me.

Now I’m doing IV ketamine because my new hospital can’t afford Spravato. I’m on my 7th session tomorrow and I’m at 0.8 mg/kg.

I’m doing slightly better than before, but it’s really not comparable to Spravato in terms of effectiveness. The sessions themselves are also intense and pretty uncomfortable. My last one was honestly rough. I completely lost the sense of having a body, felt like I was a “spirit” trapped in a box, flying in circles, convinced it would never end.

I’m going to ask my psychiatrist about switching back to Spravato at another hospital or clinic, but he needs to approve the transfer. He’s hesitant because studies suggest IV ketamine is actually more effective than Spravato overall.

So I have two questions for you guys :

- If you’ve tried both IV ketamine and Spravato, did you find Spravato more effective and/or a smoother experience overall ?

- Does anyone understand why Spravato might be more effective and tolerable than IV, despite the trial data on efficacy?

Any personal experiences or scientific insight would help me a lot as I prepare this conversation with my psychiatrist.

Thanks a lot !!!

Hi everyone,

I’ve been dealing with bipolar TRD for the past 2 years and a half.

Last year, during a hospitalization, I was put on Spravato and it was honestly the only treatment that ever helped me. Unfortunately, after only 4 weeks, we reduced the frequency to one a week, and I progressively lost the benefits. I stopped abruptly 3 months later because I wasn’t able to leave my house.

I’m currently hospitalized for a second time. We first tried 30 sessions of TMS, which didn’t work for me.

Now I’m doing IV ketamine because my new hospital can’t afford Spravato. I’m on my 7th session tomorrow and I’m at 0.8 mg/kg.

I’m doing slightly better than before, but it’s really not comparable to Spravato in terms of effectiveness. The sessions themselves are also intense and pretty uncomfortable. My last one was honestly rough. I completely lost the sense of having a body, felt like I was a “spirit” trapped in a box, flying in circles, convinced it would never end.

I’m going to ask my psychiatrist about switching back to Spravato at another hospital or clinic, but he needs to approve the transfer. He’s hesitant because studies suggest IV ketamine is actually more effective than Spravato overall.

So I have two questions for you guys :

- If you’ve tried both IV ketamine and Spravato, did you find Spravato more effective and/or a smoother experience overall ?

- Does anyone understand why Spravato might be more effective and tolerable than IV, despite the trial data on efficacy?

Any personal experiences or scientific insight would help me a lot as I prepare this conversation with my psychiatrist.

Thanks a lot !!!

Hi everyone! I’m a bit nervous because this is my very first post on Reddit. Also, English isn’t my native language (french 🇫🇷 here), so I’m apologizing for any mistakes.

Background & diagnosis

I (26M) was diagnosed with bipolar II disorder a few years ago, during a depressive episode. My psychiatrist told me the diagnosis isn’t entirely clear-cut, since my two suspected hypomanic episodes were pretty mild and somewhat debatable. That said, I have a strong family history of bipolar disorder/ depression/ ADHD from my mom side and schizophrenia/ASD from my dad side. Moreover, my depressive episodes come with bipolar-like features (increased appetite, hypersomnia, psychomotor retardation, etc.), so we’re leaning more towards that diagnosis.

As a kid, I had already been seeing a child psychiatrist for ADHD, and possibly ASD too (though never formally diagnosed). Back in my day, kids with ASD were mistreated and segregated from other children, so my parents didn’t want that for me.

My depression history

I’m currently on lithium and lamotrigine to stabilize my mood. Since I was 17, I’ve had recurrent depressive episodes, maybe 2+ times a year, with a few weeks of remission in between. But since January 2024, I’ve been stuck in depression with zero remission.

Here’s what happened: I was in my 3rd year of college, and December 2023 was extremely stressful because we had our most important diploma exams in early January. I was working every afternoon at the library until 11pm some days, which wasn’t normal for me. Looking back, I’m still not sure if I went through a hypomanic phase during that period. My psychiatrist saw me at the time and didn’t notice anything unusual, just that I seemed “less depressed.”

The week after my exams, I crashed into the worst depression of my life, and it’s never lifted since. I have extreme anhedonia (I even lost the ability to taste “hot”/spicy food), a total loss of motivation and will, and I ended up isolating myself from everyone except my mom.

💊Failed treatments (2024)

My psychiatrist tried several meds, none of which worked:
• Venlafaxine (Effexor) — no effect
• Quetiapine (Seroquel) — had to stop after gaining 10kg in a month and my blood sugar spiking dangerously
• Vortioxetine (Trintellix) — no effect at all
• Adding Abilify 2.5mg on top — actually made my depression worse

🏥 First hospitalization & Spravato (April 2025)

In April 2025, I was hospitalized in a specialized psychiatric hospital. My psychiatrist gave me the choice between ECT or Spravato (intranasal esketamine). I was really scared of ECT because of the memory issues I’d read about, so we went with Spravato: 84mg, twice a week for the first 4 weeks.

This was the first treatment in a long time that actually helped. I started reconnecting with old friends, re-enrolled at university (after having to drop out for a year), and started feeling joy again in small things — shopping, watching shows, etc. It wasn’t perfect, but my MADRS score dropped from 35 to 15.

After 4 weeks, I left the hospital and went to 1 session per week. That’s when things got inconsistent : good days, then really bad days right after. My mood slowly declined until I completely stopped Spravato in September 2025.

💥The crash (September 2025 – 2026)

I lived alone, and when I’m depressed, I don’t reach out for help. So I didn’t leave my house for months. My mom eventually moved in with me in November because I was in danger.

I got hospitalized again in December 2025 (a different, public hospital this time), staying until January 2026.
Honestly, it was a horrible experience. I didn’t feel safe or comfortable there, and I had severe insomnia that nothing helped, not even Zopiclone (Imovane). I was only seen by a doctor once every 2-3 days, for maybe 10-15 minutes each time. We started Pramipexole (Mirapex) and Mirtazapine (Remeron), slowly increasing mirtazapine up to 45mg/day and pramipexole up to 0.54mg over 3 weeks. Nothing improved, so I decided to just go home. The hospital refused to adjust my treatment further unless I stayed admitted.

🏥 Current hospitalization (since May 2026)

A few months later, I found a new hospital in my town that is specialized in mood disorders, and I’ve been admitted there since May 7th, 2026.

We stopped pramipexole (never actually reached the “optimal” dose of 1.5-4.5mg that I’ve read about) and I did 30 sessions of TMS (rTMS, twice a day). It barely helped. Just a little less fatigue and a bit more energy, but it didn’t last.

My psychiatrist then suggested IV ketamine. This hospital doesn’t offer Spravato because they consider it too expensive.

— Quick context on healthcare here: when
someone
is hospitalized, he’s fully covered by public
insurance with a small copay from his/her private
insurance. Unlike the others medical specialities
like cardiology or neurology, psychiatric services
get a fixed daily amount of money per patient (it’s
approximately 1000€) , which they use to cover
all care and medication costs. So some hospitals
avoid Spravato because of how pricey it is —

My psychiatrist told me IV ketamine is just as effective as Spravato, if not more, and works faster.

💉IV ketamine experience so far

I started IV ketamine last Monday and I’m now on my 6th session. I’m a bit disappointed because I haven’t really seen results yet — maybe slightly better? I laughed for the first time in ages two days ago, but other than that, nothing major. My doses started at 0.5mg/kg and I’m now up to 0.8mg/kg.

I feel IV ketamine :
- Much more intensely physically and sensationally, like
being sinked in the ground or being spread like a spaghetti
- Less visual
- Less control
- More inconsistent

At the opposite, I felt Spravato :
- Much milder and confortable
- More visual (I could see actual images or some scenes like standing on top of the Empire State Building, or standing on a crystal clear water beach)
- With a decent amount of control over the experience.

Some sessions of IV ketamine are fine. The one before my last one I even felt good, but I’m always in some other dimension and it’s genuinely hard to describe. Other sessions are not pleasant at all : no sense of direction, no coherence, and sometimes I feel intensely anxious for long stretches. It varies a lot from one session to the next.

💔My hell last session
My most recent session was honestly horrible, and I’m not exaggerating when I say it was one of the worst experiences of my life.

It started off fine, but suddenly I felt like I’d completely lost control of my body. I panicked, reached for my phone to change the music, and the second I touched it, I got stuck in some kind of loop, watching myself grab the phone over and over.

Then the phone froze, the music cut out, and I felt like my body had just vanished — like I’d become a soul with no body at all.

I genuinely thought the treatment had killed me.
Then my “soul” started spinning in circles too. It was this incredibly heavy, crushing sensation, like I was carrying an enormous weight, and I kept thinking I was going to be stuck like that forever, in some kind of hell. I regretted starting this treatment with everything in me.

After what felt like a few dozen minutes, I finally came back to myself.

I didn’t see my doctor since this happened. Monday, I will tell my doctor that I’m stopping the injections of IV ketamine right now . I will ask him to retry Spravato but I know that it is complicated for the hospital where I’m in has to find another hospital which uses Spravato and there are just a few number in the whole country.

⁉️My questions

I’m curious to hear your opinion on my experience with ketamine/eskeramine. What do you think ?

• Has anyone here tried both IV ketamine and Spravato? If so, did you notice a real difference in effectiveness or in the experience itself during the session?Has anyone experienced the opposite? I know inter-individual variability is huge with this stuff.

• If anyone understands the biochemistry behind ketamine vs. esketamine, could you explain why the subjective experience and effectiveness might differ so much between the two forms?

• Does my bipolar disorder have an impact on my reaction ?

• Have you find a medicine that potentializes the effects of Spravato (synergy) ? Which antidepressants is the best ? Does anyone tried pramipexole or Cytomel / Levoxyl (levothyroxine) as an add-on ? Or a MAOIs ? Or anything else ?

• Even though it’s not the topic but does anyone with or without bipolar disorder recognizes himself in my history ? If so, have you ever been falsely diagnosed with a bipolar disorder where you had a MDD , PDD or cPTSD ?

Thanks for reading all this, and sorry for the wall of text (…classic ADHD writing 😭)