Comment from Melissa Kleckner

As an infusion nurse who has worked in a ketamine clinic for the past 4.5 years, I have had the privilege of caring for hundreds of patients living with major depressive disorder. Many arrive after years of unsuccessful treatment, having exhausted multiple antidepressants, psychotherapy, and other interventions. I have witnessed firsthand the profound transformation that ketamine can provide; not just a reduction in symptoms, but a return to hope, purpose, and daily functioning. The scientific evidence supports what I see in clinical practice. Studies have consistently shown that approximately 50–70% of patients with treatment-resistant depression respond to ketamine, with many experiencing meaningful improvement within hours to days. By comparison, first-line SSRIs produce remission in roughly 30% of patients after an initial treatment trial, often requiring weeks before benefits become apparent. Ketamine’s side effects are generally transient and occur during or shortly after administration, while SSRIs commonly produce persistent adverse effects such as sexual dysfunction, weight gain, gastrointestinal symptoms, and emotional blunting that can contribute to poor adherence. Every week, I witness people who once believed they had no future begin reconnecting with their families, returning to work, and finding joy again. While ketamine is not a cure and is not appropriate for every patient, it has become an indispensable option for many who have failed conventional therapies. I respectfully urge the FDA to consider repurposing generic racemic ketamine for the treatment of major depressive disorder. Doing so would acknowledge the growing body of clinical evidence while helping reduce barriers created by cost and limited access. Ketamine has truly given countless people their lives back. Expanding access to this effective, evidence-based treatment could be one of the most meaningful steps we take to bring hope to patients who need it most.