VA has options for you
Esketamine, a novel and mental health treatment therapy, is being used across VA for Veterans with treatment-resistant depression and acute suicidality.
Esketamine is administered under the supervision of trained clinicians. The therapy is delivered via an intranasal device in the form of a spray. Patients are treated in a clinic where they are observed by a medical team for two hours. After the two-hour monitoring period, they are cleared prior to discharge with approved transportation.
“Esketamine is one of the most effective FDA-approved antidepressant therapies available today,” said Dr. Sarah Canoy, a psychiatrist at Truman VA in Columbia, Mo. “Its use is especially effective for those experiencing treatment-resistant depression. Since we began offering this option in 2022, we have been able to increase its availability to our Veterans, especially after we opened a new dedicated treatment room in January 2024.”
How it works
“Typically, esketamine treatments are given twice a week for the first month per protocol,” Canoy continued. “If the patient’s symptoms improve, treatments are continued. The frequency of the maintenance phase is based on the patient’s response to the medication and the continued improvement of depressive symptoms.
“For people who haven’t had success with other antidepressant therapies, esketamine may be another tool that offers them a chance to see what it’s like to have significantly reduced or no depression. It also provides positive reinforcement that they can feel better with the right treatment. I’m very happy and excited that we can provide this level of care for our Veterans.”
Veterans interested in the esketamine treatment can ask for a referral from their mental health provider.
This article was originally published on the VA Columbia Missouri Health care System site and has been edited for style and clarity.
Topics in this story
More Stories
Women Veterans enrolled in VA health care now have the option to schedule gynecology appointments without needing a referral from primary care.
MVP researchers are using their skills to make discoveries for Veterans. Here, they share why it’s important for women to be included in medical research.
VA TelePulmonology delivers expert lung care to Veterans at home, helping them save time and allowing them to focus on recovery.
I had this treatment in 2025, at Lake Nona, Orlando VA.
Can I have the treatment again?
If I’ve done this in 2025,can I get these treatments again?
What a crock of shit. I have MDD, PTSD, and Generalized Anxiety and was turned down for this treatment through Hampton VA. I was set up at another practice in community care who accepts VA patients for Sprovato treatments only to be told that the VA wasn’t paying for it anymore. This system has become so dumbed down with the beurocracy and red tape it makes it impossible to get treatment to heal, they just want to put you on medications to dumb you down and leave you be. They would rather you die than take their hand out of big pharma pockets and actually help people. Oh, and Tricare will cover 20% of each treatment until destructive deductible is met, leaving me with $800 weekly visits….what a joke. Insurance is broken in this country. 22 a day will never go away with these policies and will likely start climbing in the future.
I hope the VA gets a big price break. One year ago the price was over 900.00 for a small vial or spray.
I know someone who got it off the street- don’t know how it was formulated and that perdson developed bladder problems.
I did not know. I will definitely ask my psychiatrist.
Thank you for this information. I hope I’m eligible to take it.
Is this a possible replacement for Citlopram?
Sounds so positive. Try being a veteran eligible for treatment in New Mexico’s ABQ VAMC or, even worse, Farmington CBOC.
I’m a 100% service-connected veteran. For years, across multiple VA systems, I have repeatedly requested ketamine-based care, including intranasal esketamine, for severe treatment-resistant depression. What I keep encountering is not a clear clinical evaluation, but resistance to even considering it, unclear referral pathways, and inconsistent access—especially in New Mexico. Years have passed.
I live remote: about 90 minutes to the nearest town (with no VA esketamine option) and about 4 hours to the Albuquerque VA. Travel and lab logistics can become a de facto denial of care.
VA has a national intranasal esketamine protocol (Oct 2025). Please improve veteran-facing communication on how to access care (who can refer, where it goes, timelines, and a point of contact). Please ensure New Mexico VA provides timely evaluation and access, including capacity and/or community care pathways.
For remote veterans, the protocol’s tight timing for urine testing can be a major barrier. Please consider practical remote accommodations such as local/community lab collection with standing orders and results routing, and clinician-directed risk-based testing frequency when appropriate, while maintaining safety safeguards.
Thank you.
VA national intranasal esketamine protocol (Oct 2025):
https : // www . va . gov / formularyadvisor/DOC_PDF/CRE_Intranasal_Esketamine_for_Depression_National_Protocol_Rev_Oct_2025_.pdf
I think this is a wonderful opportunity for patients in these situations. Unfortunately, as with my own experience I was not approved in my own VA healthcare system after being misdiagnosed to have an illness I didn’t have , then after appealing that decision as meritless, was told I had to jump through treatments far more dangerous before I could be reconsidered oh and because I had an a fib ablation three years ago, even though, no signs of reoccurrence. Since that time, I’ve shamefully had 2 attempts and one was ICU TREATMENT REQUIRED.
Yes I agree this therapy is successful and however. Shouldn’t be with held because a higher up doe t want to ruin his budget
The last thing I need is another medication.
Doctors put me on one about 50 years ago that I didn’t ask for but they didn’t know what is to do, I had already been through months of counseling.
Now I am thoroughly addicted to it and my last VA doctor said he would never take me off it now as he had seen too many horrible things happen to those that tried to get off the medication.
So I don’t want any more drugs than I have already been put on.
Would love for it to be available to me I’ve been denied but approved for intervenes ketamine make that make sense I’ve asked my psychiatrist multiple times but he can’t get it approved for me he could send me out to the community where somehow it’s approved for me but again no community care clinics in my area are currently working with the VA the VA as whole is a joke
I have been denied this service from my mental health team at the VA even though I qualify for it and have treatment resistant depression. I’ve taken every ssri and meds they have given me, took a break from those meds and then they said they wanted to try those meds again because it is given by different doctors this time……I give up!
Have had similar issues, where I meet all protocol for use, but individual providers decide that someone else is going to say no so they say no and don’t even try.