Find a doctor that specializes in treatment resistant depression, which IIRC is defined as failing more than two conventional antidepressant. I'm anything but

Find a doctor that specializes in treatment resistant depression, which IIRC is defined as failing more than two conventional antidepressant. I'm anything but objective on this, but I'm convinced that SSxx classes of antidepressants are entirely useless for depression (and likely anything else). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/ The usual method is IV ketamine treatment, every 6 weeks, but this can cost $400+ per session, which at the time I started treatment was not an option. My doctor went out on a limb for me and prescribed intranasal ketamine, which is off-label, and only $60 for a six week supply. I was taking it every three days for several years. There is also intranasal esketamine, which is quite likely what you will be offered these days, as it has received FDA approval. Unfortunately, this is not as effective as regular intranasal ketamine, while getting you 'higher' into the bargain. Why did this get drug get developed? Because ketamine isn't patentable, but an enantiomer of ketamine (s-ketamine) is, so there was money to pay for clinical trials and pharmaceutical executive enrichment. The other enantiomer, r-ketamine, is actually less innebriative and more therapeutic. So, why produce s-ketamine? There's no reasonable explanation for them to bring s-ketamine to market other than to be able to milk the patents as long as possible. That said, I'd still encourage you to pursue s-ketamine, if it is your only option, but IV ketamine may be better route, if you can afford it: insurance will cover esketamine, but not IV ketamine. I should mention: It's not clear whether the ketamine alone was responsible for the bladder discomfort (which was never more than a mild sensation - I discontinued mainly out of concern that it might worsen): it's likely that autoimmune illness played a part too. It's not usual to experience this on the dose of ketamine that I was taking. S-ketamine is not any easier on the bladder, and it was able to pass the clinical trials. Good luck.