Please don’t feel hard on yourself if the infusions did not work for you; I tend to think it really only helps a subset of patients, and unfortunately we don’t have the diagnostic instruments and/or clinical training/willingness to appropriately identify the subtypes most likely to respond to treatment. Luckily some smart people ahem @Jimmy @Lucia ahem (sorry I’ve got a case of founders lung) are working on that Unfortunately, ketamine infusions are still too costly to just experiment with indefinitely, so I’d be prudent about going in for another round.
What I think might be worth considering is whether you might need to find some medication regimen to enable a robust response. For me, it wasn’t until adding lithium and later MAOIs that I really reaped the full benefits from it. Ketamine is not the silver bullet it’s hyped up to be, many would be better served to think about it as just another therapy in the TRD armamentarium. Consider that even with ECT, it’s standard practice to reinstate patients on some medication following treatment.
Also it’s okay if it simply doesn’t work for you: it doesn’t make you “more resistant” necessarily, it simply means you might be more responsive to other interventions — which is honestly a good thing, considering ket is still prohibitively expensive to sustain regularly. And no, I don’t think that nasal spray makes much sense if you did not benefit from the infusions, as the overwhelming consensus seems to be that IV is the gold-standard and the rest is really just used as maintenance.