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For adults whose depression hasn't moved on standard care. A prescription ketamine nasal spray you take at home, with one licensed clinician from your first visit on.
Not sure?
Why Ketamine Cowboy
The evidence
responded to a single intranasal ketamine dose at 24 hours, versus 6% on placebo1
Randomized crossover · 18 peopleof people with treatment-resistant depression responded within 24 hours of a single IV ketamine dose2
NIH randomized trial · 18 peoplepeople with depression still aren't in remission after four rounds of standard treatment3
STAR*D · 4,041 people1 Lapidus et al., Biological Psychiatry, 2014. 2 Zarate et al., Archives of General Psychiatry, 2006. 3 Rush et al., American Journal of Psychiatry, 2006. Small published studies of ketamine, not studies of Ketamine Cowboy's compounded spray and not our patients' outcomes. Individual results vary, and some people don't respond. Compounded ketamine is not FDA-approved. Ketamine Cowboy is not affiliated with or endorsed by the institutions listed. We'll publish our own patients' de-identified results, whatever they show.
Your state, your age and what brings you here. Then our clinic's secure intake for your history.
30 seconds · freeA licensed clinician reviews your history, checks the state prescription registry, and decides. If it's no, you pay nothing.
About 20 minutesA licensed U.S. pharmacy fills your prescription and ships it in plain packaging, adult signature required.
4–5 days after approvalSessions at home on your clinician's schedule, blood pressure before and after, a short check-in before every refill.
Same clinician every month
Built-in support
How it compares
| Ketamine Cowboy | In-clinic esketamine | IV ketamine clinic | At-home lozenges | |
|---|---|---|---|---|
| Form | Nasal spray, at home | Nasal spray, in clinic | IV infusion | Troche in the cheek |
| Where | Home | Certified clinic, 2-hr observation | Clinic | Home |
| Typical self-pay price | $315–345 per month | $600–900 per session | $400–800 per infusion | $124–380 per month |
| FDA status | Off-label, compounded | FDA-approved for TRD | Off-label | Off-label, compounded |
| Insurance | HSA / FSA; receipt for out-of-network | Often covered | Rarely | Rarely; some HSA/FSA |
Typical publicly listed self-pay prices as of October 2026, before insurance; your costs vary by clinic, schedule and coverage. Esketamine (Spravato) is FDA-approved, often covered by insurance, and a trademark of Janssen Pharmaceuticals. Ketamine Cowboy is not affiliated with any provider referenced.
The first box
Our story
Ketamine has been in operating rooms since 1970 and in depression research since 2000. The most promising part of that story, a fast-acting option for people standard treatment hasn't helped, was locked inside clinics and IV chairs.
We started Ketamine Cowboy in Texas to bring it home without lowering the bar: live visits with licensed clinicians, real screening, monitoring that catches problems, and a pharmacy licensed to do this right.
The cowboy part is the spirit: independent, steady, a little irreverent. The medicine part is serious, and we treat it that way.
Questions
Three questions here. When we open, a live visit with a licensed clinician. Nothing charged unless they say yes.
Four steps. A licensed clinician makes every medical call along the way.
Tell us your state and what brings you here. Then you move to our clinic's secure intake for your medical history. It takes about ten minutes.
A nurse preps your chart and blood pressure, then a licensed clinician joins, reviews your history, checks the state prescription registry, and decides. If it's no, you're not charged, and we tell you why.
A licensed U.S. compounding pharmacy fills your prescription and ships it in plain packaging, adult signature required.
Your sessions at home on the schedule your clinician sets. Blood pressure before and after. A short check-in before each refill.
What a session looks like once you and your clinician have settled your dose and schedule.
A quiet room, phone on silent, somewhere to sit back or lie down. Check your blood pressure. Someone at home or reachable is a good idea.
Metered sprays as prescribed, alternating sides. Seconds, not fifteen minutes.
Effects build within minutes and ease within about an hour. Stay seated or lying down. Music or an eye mask can help.
Take it easy for the rest of the day. No driving until tomorrow. Note anything that felt off for your clinician.
Individual experience varies. Your clinician sets your dose and schedule and adjusts them based on how you respond.
Before every refill you complete a short check-in: mood, anxiety, blood pressure, side effects. Your clinician reads it and approves the next bottle, adjusts your dose, or books a call.
Miss a check-in and your next bottle waits until you two have talked. That's the deal, and it's what keeps at-home treatment safe.
See pricingMedicine, clinician, check-ins, shipping and your first box. No consult fees, no membership, nothing charged unless a clinician says yes.
We'd rather turn you away at the video visit than ship something that isn't right for you. Where we can, we'll point you to care that is.
| Ketamine Cowboy | In-clinic esketamine | IV ketamine clinic | At-home lozenges | |
|---|---|---|---|---|
| Form | Nasal spray, at home | Nasal spray, in clinic | IV infusion | Troche in the cheek |
| Where | Home | Certified clinic, 2-hr observation | Clinic | Home |
| Typical self-pay price | $315–345 per month | $600–900 per session | $400–800 per infusion | $124–380 per month |
| FDA status | Off-label, compounded | FDA-approved for TRD | Off-label | Off-label, compounded |
| Insurance | HSA / FSA; receipt for out-of-network | Often covered | Rarely | Rarely; some HSA/FSA |
Typical publicly listed self-pay prices as of October 2026, before insurance; your costs vary by clinic, schedule and coverage. Esketamine (Spravato) is FDA-approved, often covered by insurance, and a trademark of Janssen Pharmaceuticals. Ketamine Cowboy is not affiliated with any provider referenced.
Ketamine Cowboy is for adults whose depression or anxiety hasn't responded to standard care, who want a serious option they can take at home.
Weeks waiting for each one to work. Side effects that showed up first. A partial response that never became a full one.
Therapy helps, medication takes the edge off, and the loop still runs. Your clinician decides whether ketamine fits.
No half-day in an observation chair twice a week. You'd rather do this in your own space, with a clinician you can reach.
At-home ketamine isn't safe for everyone. If any of these apply, your clinician will say so and point you to care that fits.
We only make one thing: a compounded ketamine nasal spray, prescribed to you and filled by a licensed U.S. compounding pharmacy.
Swallowed ketamine is heavily broken down by the liver before it reaches the brain. The nasal lining absorbs it directly into the bloodstream, which is why esketamine was approved as a nasal spray.
Each pump delivers a measured amount. Your clinician prescribes the number of sprays per session and adjusts based on how you respond.
No holding a lozenge in your cheek, no IV line. You take it, sit back, and let the session run.
Ketamine hydrochloride in a sterile nasal solution, compounded to your clinician's prescription at a fixed concentration and dispensed in an amber glass bottle with a metered pump. Your label carries your name, your dose and your directions.
Compounded medications are prepared by state-licensed pharmacies for individual patients. They are not FDA-approved and haven't been through the FDA's review for safety or effectiveness. Ketamine's use for depression and anxiety is off-label. The FDA has issued alerts about compounded ketamine, including nasal sprays, which is why our program is built around live evaluation, blood-pressure checks and monthly clinician review.
The science
Most antidepressants adjust serotonin and take weeks. Ketamine works on glutamate, the brain's main signaling chemical, and in clinical studies its effects have appeared within hours to days.
FDA-approved as an anesthetic. Used every day in hospitals and emergency medicine.
Added to the World Health Organization's List of Essential Medicines.
FDA approves esketamine, half of the ketamine molecule, as a nasal spray for treatment-resistant depression.
Two different approaches
Typical antidepressants
Ketamine
Not everyone responds to either. Your clinician decides whether ketamine fits, often alongside your current treatment. Never stop a medication on your own.
How it works
Tap each step to see what happens at the synapse, the gap where two nerve cells talk.
Simplified. Much of the synapse-level evidence comes from animal studies (Li et al., Science, 2010; Moda-Sava et al., Science, 2019).
Effect one
Chronic stress and depression are linked to fewer, weaker connections in the prefrontal cortex, the brain's planning and mood-regulating region. In animal studies, ketamine rapidly triggers new dendritic spines, the small branches where connections form.
Li et al., Science, 2010. Moda-Sava et al., Science, 2019: new spines weren't needed for the first response, but were needed to sustain it.
Effect two
The default mode network is the brain system that's busiest when your mind wanders, and it's often overactive in rumination. In a brain-imaging study, ketamine reduced connectivity within this network, a possible reason people describe stepping out of a thought loop.
Scheidegger et al., PLoS ONE, 2012, a placebo-controlled fMRI study in healthy volunteers. How this applies to depression is still being studied.
Why a nasal spray
Swallowed ketamine is mostly broken down by the liver before it reaches the bloodstream. Lozenges held under the tongue do somewhat better. The lining of the nose absorbs it directly, which is why the FDA-approved esketamine is a nasal spray.
Bioavailability is the share of a dose that reaches the bloodstream, measured in pharmacokinetic studies: Clements et al., Journal of Pharmaceutical Sciences, 1982 (IV, injection, oral); Yanagihara et al., Biopharmaceutics & Drug Disposition, 2003 (nasal, sublingual). Absorption varies by person, formulation and technique.
The honest part
Compounded racemic ketamine nasal spray is not FDA-approved for any psychiatric condition, and its use is off-label. That's why our program is built on live evaluation, blood-pressure checks and monthly clinician review.
The research
The studies behind ketamine for depression, with the design, the size, the result and the limits laid out for each one. No study here was run on our product, and none predicts how any one person will respond.
First placebo-controlled trial in depression
Studies, approvals and alerts summarized below
Patient results of our own yet. We'll publish them, whatever they show.
How to read the evidence
U.S. FDA; WHO Essential Medicines List since 1985
One of the most widely used anesthetics in the world, valued because it doesn't suppress breathing.
Limits: approval covers anesthesia, not depression.
Berman et al., Biological Psychiatry · Yale
A single low IV dose improved depression within 72 hours, while placebo didn't. This was the study that started the field.
Limits: very small, single dose, short follow-up.
Yanagihara et al., Biopharmaceutics & Drug Disposition; Clements et al., J Pharm Sci, 1982
Through the nose, much more of the dose reaches the bloodstream than when it's swallowed or held under the tongue.
Limits: small pharmacology studies; absorption varies by person and formulation.
Zarate et al., Archives of General Psychiatry · NIMH
People who had tried an average of six antidepressants improved within hours. The effect lasted about a week for some.
Limits: small, IV in a clinic, effects faded without repeat dosing.
Rush et al., American Journal of Psychiatry · NIMH
The largest study of standard antidepressant treatment showed that many people need more than the usual options.
Limits: a 2023 reanalysis using the trial's original measures found lower remission (35%), meaning even more people didn't get well.
Li et al., Science · Yale
In rats, ketamine switched on the mTOR growth pathway and formed new synapses in the prefrontal cortex within hours.
Limits: animal research; how closely it maps to people is still being studied.
Scheidegger et al., PLoS ONE · Zurich
Ketamine reduced connectivity in the brain network linked to rumination, a possible piece of how it breaks negative thought loops.
Limits: studied in people without depression.
Lapidus et al., Biological Psychiatry · Mount Sinai
The first controlled evidence that ketamine through the nose works fast: 8 of 18 people responded at 24 hours, versus 1 of 18 on placebo.
Limits: small, single dose of 50 mg.
U.S. FDA · Spravato (Janssen)
Esketamine, half of the ketamine molecule, was approved for treatment-resistant depression as a nasal spray, given in certified clinics with two hours of monitoring. Later approvals added depression with suicidal thoughts (2020) and use on its own (2025).
Limits: approval covers esketamine, not the compounded racemic ketamine we prescribe.
Moda-Sava et al., Science · Weill Cornell
In mice, new dendritic spines weren't needed for the first response to ketamine, but they were needed to keep it.
Limits: animal research.
U.S. FDA, October 10, 2023
The FDA cautioned that compounded ketamine used at home for psychiatric conditions isn't FDA-approved, and that use without in-person monitoring carries risks such as dissociation, high blood pressure and misuse.
Our response: live evaluation, blood-pressure checks before and after every session, monthly clinician review and refill holds.
Our commitment
Every patient's monthly check-in includes standard mood and anxiety scales (PHQ-9 and GAD-7) and blood pressure. After our Texas pilot, we plan to publish de-identified results, including the people it didn't help.
References
Studies are summarized in plain English for education, not as claims about Ketamine Cowboy. Compounded ketamine is not FDA-approved; its use for depression and anxiety is off-label. Individual results vary.
At-home programs fail people when screening is a formality and a missed appointment is just a fee. Ours is built the other way around.
Live video evaluation, medical history, current medications, and a check of your state's prescription monitoring program.
Checked before and after, logged for your clinician. Out-of-range readings pause dosing.
A check-in before every refill. Your clinician adjusts, continues, or stops treatment.
No stockpiles, no early refills. Missed check-ins hold the next shipment.
Common and usually temporary: a rise in blood pressure and heart rate, dizziness or lightheadedness, nausea, headache, nasal irritation, drowsiness, and feelings of detachment or altered perception during the session.
Less common or with long-term heavy use: bladder irritation or urinary symptoms, and misuse. Recreational, high-dose, frequent use is linked to bladder damage; tell your clinician about any urinary symptoms right away.
Get emergency care for chest pain, severe headache, trouble breathing, or thoughts of harming yourself.
Ketamine hydrochloride is FDA-approved as an anesthetic. Compounded ketamine nasal spray is prepared by a state-licensed pharmacy to an individual prescription and is not FDA-approved. Its use for depression, anxiety, or any other psychiatric condition is off-label. The FDA has not evaluated compounded ketamine for safety or effectiveness for these uses and has issued alerts regarding compounded ketamine products, including nasal sprays.
Do not use if you have uncontrolled high blood pressure, an aneurysm, or a history of stroke or serious heart disease; have a current or recent substance use disorder, including alcohol; have a history of psychosis, schizophrenia, or bipolar I disorder with mania; are pregnant, planning pregnancy, or nursing; are under 18; or have a known hypersensitivity to ketamine.
Ketamine Cowboy is not an emergency service. If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room.
Plain-English guides to ketamine, written from the published research and reviewed by our clinical team.
We're opening to a small group of Texas patients first. Join the list and we'll email you an invitation to the clinic's secure intake when we open. Nothing else.
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Ketamine is FDA-approved as an anesthetic. Compounded ketamine nasal spray is prepared by a licensed pharmacy for an individual patient and is not FDA-approved; its use for depression, anxiety or other conditions is off-label. Your clinician will explain the risks, benefits and alternatives in the informed consent you sign before treatment.
Ketamine is a Schedule III controlled substance. If you are prescribed it, you agree to:
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You will review and sign this consent in the Practice's secure system before your first visit. Please read it carefully and ask your clinician about anything you don't understand.
Ketamine is FDA-approved as an anesthetic. You may be prescribed compounded racemic ketamine nasal spray, prepared by a state-licensed compounding pharmacy for you. Compounded medications are not FDA-approved and have not been reviewed by the FDA for safety, effectiveness or quality. Using ketamine for depression, anxiety or other psychiatric conditions is off-label. The FDA has issued alerts about risks of compounded ketamine products, including nasal sprays, especially when used at home without monitoring.
Some people with depression or anxiety that hasn't responded to other treatment improve with ketamine, sometimes within hours to days. Benefits are not guaranteed, may be temporary, and some people do not respond.
I agree to:
Alternatives include FDA-approved esketamine (Spravato) given in certified clinics, IV ketamine in a clinic, other antidepressant medications, psychotherapy, transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and no treatment. Each has its own benefits and risks, which my clinician will discuss with me.
I may stop treatment at any time. My clinician may pause, change or stop treatment if it isn't helping, if side effects occur, if safety requirements aren't followed, or if it is no longer appropriate.
By signing, I confirm that:
Patient name: ____________________ Date of birth: __________
Signature: ____________________ Date: __________
Clinician: ____________________ Date: __________
Your medical history stays between you and your clinician, inside the clinic's secure intake. This page only asks where you are and what brings you here.
This page collects your state, age range and reason for visiting only.
