Continuing the discussion from Medicare:
I finally managed to get a series of six infusions. I have not had much of a response with my TRD and am wondering what comes next. The clinic has been somewhat unresponsive, rarely returning phone calls and not particularly helpful. Should I pursue more treatment? Am I within my rights to request lozenges and/or nose spray?
That is really annoying that your clinic has not been responsive to you. Sorry to hear that you have not had much of a response 
sending you best wishes!!
A lot of people would get more ketamine treatment - it may be worth changing the protocol or the dose if you didn’t respond to their standard series of six. A lot of providers may do different things. For most people I know, they get lozenges after they respond as a way to maintain the response, or as part of KAP, but that’s a limited sample size in my personal network. Depending on what you’re going through KAP may work better than infusions. It may be worth getting opinion from a mental health doc outside of the clinic, and I guess that’s the right move especially since they’re not being helpful…
best of luck
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.