What Is Petulant BPD? Signs, Causes, and Treatment

Someone you love starts saying things that don't add up. They're sure they're being watched, or they hear voices no one else hears. A doctor uses the word "psychosis," and the next question in your head is: does that mean schizophrenia?

Not necessarily. Psychosis is a set of symptoms in which a person loses some contact with reality. Schizophrenia is one specific, long-term condition in which psychosis is a central feature. Every person with schizophrenia has experienced psychosis, but many people who experience psychosis never develop schizophrenia.

What is psychosis?

The NIMH describes psychosis as a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode, a person's thoughts and perceptions are disrupted, and they may have difficulty recognizing what is real and what is not.

The main symptoms of psychosis are:

• Hallucinations: seeing, hearing, or feeling things that aren't there, such as hearing voices
• Delusions: strongly held false beliefs, such as believing others are trying to harm you or that the TV is sending you messages
• Disorganized thinking and speech: jumping between unrelated ideas or speech that's hard to follow

According to the NIMH, studies estimate that between 15 and 100 people out of every 100,000 develop psychosis each year, most often between the late teens and mid-20s.

Psychosis is a symptom, not a diagnosis

Psychosis can appear in many conditions. The NIMH lists schizophrenia, bipolar disorder, and severe depression among the mental illnesses that can include it, along with sleep deprivation, certain prescription medications, misuse of alcohol or drugs, and diseases of older age such as Parkinson's and Alzheimer's. And, the NIMH notes, a person can experience psychosis and never be diagnosed with schizophrenia or any other disorder.

What is schizophrenia?

Schizophrenia is a long-term mental illness that affects how a person thinks, feels, and behaves. It's less common than people often assume: the NIMH estimates that schizophrenia and related psychotic disorders affect between 0.25% and 0.64% of people in the U.S. It's typically diagnosed between the late teens and early 30s, and tends to appear earlier in men than in women.

According to the NIMH, schizophrenia involves three groups of symptoms:

• Psychotic symptoms: hallucinations, delusions, and thought disorder
• Negative symptoms: loss of motivation, loss of interest or enjoyment in daily activities, withdrawal from social life, and difficulty showing emotions
• Cognitive symptoms: problems with attention, concentration, and memory, which can make it hard to follow a conversation or remember appointments

That's the core difference. Psychosis is one piece. Schizophrenia adds the negative and cognitive symptoms, and they often affect day-to-day life as much as the psychosis does. The NIMH notes that cognitive functioning is one of the best predictors of how someone functions day to day.

Psychosis vs. schizophrenia: key differences

• What it is. Psychosis is a group of symptoms. Schizophrenia is a diagnosis.
• Causes. Psychosis has many possible causes, from drugs and lack of sleep to bipolar disorder and dementia. Schizophrenia is one of those causes.
• Duration. Psychosis can be brief. To diagnose schizophrenia, clinicians look for symptoms that have continued for at least six months, according to the DSM-5-TR criteria summarized by the MSD Manual.
• Other symptoms. Psychosis on its own centers on hallucinations, delusions, and disorganized thinking. Schizophrenia also involves negative and cognitive symptoms.
• Outlook. Psychosis from a clear cause, such as a drug or severe sleep loss, can resolve when the cause is treated. Schizophrenia usually needs long-term care, though recovery is possible.

How schizophrenia is diagnosed

There's no blood test or brain scan for schizophrenia. Under the DSM-5-TR criteria, as summarized by the MSD Manual, a diagnosis requires two or more characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, or negative symptoms), at least one of which is delusions, hallucinations, or disorganized speech. The symptoms must cause a decline in work, school, or social functioning and continue for at least six months. Lab tests are often done to rule out substance use or a medical condition that can cause psychosis.

That's why a first episode of psychosis doesn't come with an immediate schizophrenia diagnosis. When psychotic symptoms last less than a month and then fully resolve, the diagnosis may be brief psychotic disorder. Other possibilities include bipolar disorder with psychotic features, depression with psychotic features, or psychosis caused by a substance or medical condition. Getting the diagnosis right takes time and careful follow-up.

What causes psychosis and schizophrenia?

The NIMH says there's no one cause of psychosis. It appears to result from a complex combination of genetic risk, differences in brain development, and exposure to stressors or trauma.

For schizophrenia, the WHO notes that an interaction between genes and a range of environmental factors is thought to cause the disorder, and that heavy cannabis use is associated with an elevated risk. Family history matters. We've covered that in more depth in is schizophrenia genetic.

Early warning signs

Psychosis often doesn't start suddenly. The NIMH lists behavioral changes that can come first:

• Suspiciousness, paranoid ideas, or uneasiness with others
• Trouble thinking clearly and logically
• Withdrawing socially and spending much more time alone
• Unusual or overly intense ideas, strange feelings, or a lack of feelings
• Decline in self-care or personal hygiene
• Disrupted sleep
• Difficulty telling reality from fantasy
• A sudden drop in grades or job performance

For schizophrenia, the NIMH notes that subtle changes in thinking and relationships may come before the diagnosis, often by years.

Treatment for psychosis and schizophrenia

Treatment depends on the cause. When psychosis comes from a drug, a medication, or lack of sleep, treating that cause may resolve it. When it's part of a mental illness, the NIMH notes that treatment of psychosis usually includes antipsychotic medication, along with other elements.

For early psychosis, coordinated specialty care is the standard. The NIMH describes it as a recovery-oriented team approach that combines treatment and support with shared decision-making among specialists, the person experiencing psychosis, and their family. People do better when it starts soon after symptoms appear. Timing matters: the NIMH notes that people often have psychotic symptoms for more than a year before receiving treatment, and that early treatment often means better recovery.

Schizophrenia usually needs ongoing care. That's not the same as a fixed outcome. According to the WHO, at least one in three people with schizophrenia will be able to fully recover. For a closer look at the options, see schizophrenia treatment options and the best treatment for schizophrenia.

When to get help

If someone is hallucinating and seems detached from reality, confused, or at risk of harming themselves or others, call 911 or go to the emergency room. If there are thoughts of suicide, call or text 988.

For warning signs that are building more slowly, such as withdrawal, suspiciousness, or a drop in functioning, get a psychiatric evaluation soon. Early care makes a difference.

At Amae Health, our clinics specialize in conditions including first-episode psychosis, schizophrenia, and schizoaffective disorder. Our care teams bring psychiatrists, therapists, primary care physicians, peer mentors, and care coordinators under one roof, working from one treatment plan. Learn how we treat psychosis.

Frequently asked questions

Is psychosis the same as schizophrenia?

No. Psychosis is a set of symptoms, mainly hallucinations, delusions, and disorganized thinking. Schizophrenia is a long-term condition that includes psychosis along with negative and cognitive symptoms. Many people experience psychosis without ever having schizophrenia.

Can you have psychosis without schizophrenia?

Yes. Psychosis can be caused by bipolar disorder, severe depression, drugs or alcohol, certain medications, severe sleep loss, or medical conditions. The NIMH notes that some people experience psychosis and are never diagnosed with any disorder.

Does a first episode of psychosis mean schizophrenia?

Not necessarily. A schizophrenia diagnosis requires symptoms lasting at least six months, along with a decline in functioning. A first episode can turn out to be brief psychotic disorder, part of a mood disorder, or caused by a substance or medical condition. Close follow-up helps clarify the diagnosis.

What's the difference between bipolar psychosis and schizophrenia?

In bipolar disorder, psychosis usually happens during severe manic or depressive episodes and tends to ease as the mood episode resolves. In schizophrenia, psychotic symptoms are not tied to mood episodes and come with negative and cognitive symptoms. Schizoaffective disorder combines features of both.

Can schizophrenia be cured?

There's no cure, but recovery is possible. The WHO reports that at least one in three people with schizophrenia will be able to fully recover, and treatment that starts early tends to lead to better outcomes.

Key takeaways

• Psychosis is a set of symptoms. Schizophrenia is one condition that causes it.
• Psychosis can come from many causes and can be brief. Schizophrenia requires at least six months of symptoms and includes negative and cognitive symptoms.
• Early warning signs often appear before psychosis starts, and early treatment leads to better recovery.
• Coordinated specialty care is the standard for early psychosis.

If you or someone you love is showing signs of psychosis, request an intake appointment. Our team will explain how an evaluation works and what the first visit involves.

You hold it together at work. You're the one who remembers everyone's birthday, because you set four reminders for each. But the effort is constant, the to-do list never shrinks, and by evening there's nothing left. If that sounds familiar, you may be wondering whether ADHD symptoms in women could explain it, especially if no one ever suggested ADHD when you were a child.

ADHD in women often looks different from the hyperactive schoolboy most people picture. It tends to show up as inattention, mental restlessness, emotional overwhelm, and an exhausting amount of compensating. Many women aren't diagnosed until adulthood, after years of being told they're anxious, scattered, or just not trying hard enough.

What ADHD looks like in women

ADHD is a pattern of inattention and/or hyperactivity and impulsivity that makes it hard to function in at least two areas of life, such as home and work. The NIMH describes three types: inattentive, hyperactive-impulsive, and combined.

In girls and women, inattention often dominates. A 2014 review of ADHD in women and girls found that clinicians tend to see girls' symptoms as "subthreshold" because inattentiveness is more prominent than hyperactivity, and that girls may develop stronger coping strategies that mask their symptoms. That combination is a recipe for being overlooked.

It's common, too. In a 2023 national survey, an estimated 15.5 million U.S. adults, about 6.0%, reported a current ADHD diagnosis. Roughly half were diagnosed at 18 or older.

ADHD symptoms in women

ADHD symptoms in women are the same core symptoms anyone with ADHD has. What differs is how they show up and how well they're hidden.

Inattention and mental restlessness

• Losing the thread of conversations, meetings, or what you walked into a room for
• Starting many tasks and finishing few
• Losing keys, phones, and paperwork, then building elaborate systems to compensate
• A busy, noisy mind even when your body is still
• Zoning out during tasks that don't hold your interest

Time, organization, and follow-through

The NIMH notes that adults with ADHD often find it hard to stay organized, keep appointments, and complete large projects. In practice that looks like chronic lateness, piles of half-finished projects, and deadlines met only through last-minute panic.

Emotional intensity

Emotional dysregulation isn't one of the formal diagnostic criteria, but it's part of the picture for many women. An expert consensus statement published in BMC Psychiatry in 2020 noted that difficulties with emotional lability and dysregulation may be more severe or common in girls and women with ADHD. Small frustrations hit hard. Criticism lingers for days. Calming down takes longer than it should.

Impulsivity that's easy to miss

Impulsivity in women often looks less like risk-taking and more like interrupting, oversharing, saying yes to too much, or impulsive spending. It's real impulsivity. It just doesn't get flagged.

What "high-functioning ADHD" means

High-functioning ADHD isn't a diagnosis. You won't find it in the DSM-5. It's an informal way of describing someone whose ADHD symptoms are real and impairing, but hidden behind good grades, a solid job, or a well-run household.

The cost is the part nobody sees. The 2020 consensus statement points to the compensatory strategies that may mask or overshadow ADHD in women: over-preparing, perfectionism, rigid routines, working longer hours than colleagues to produce the same result. Those strategies work, until a new job, a baby, or a parent's illness pushes demands past what they can absorb. That's often when women first seek help.

"High-functioning" can also be misleading. Functioning well in one area doesn't mean functioning well in all of them. A woman can excel at work and still be overwhelmed at home, or keep her household running while her own health slips.

Is it ADD or ADHD?

"ADD" is an older, informal name that many people still use, especially for ADHD without obvious hyperactivity. Clinicians now use ADHD for all three types. What people usually mean by "ADD symptoms in women" is the inattentive type of ADHD: trouble focusing, organizing, and following through, without much visible restlessness.

Why ADHD in women gets missed

There are a few overlapping reasons:

• Quieter symptoms. Inattention is less disruptive than hyperactivity, so teachers and parents are less likely to refer a girl for evaluation.
• Masking. Coping strategies hide symptoms, sometimes from the woman herself.
• Other diagnoses first. The NIMH notes that ADHD often co-occurs with anxiety and depression, which can make each condition harder to diagnose and treat. Many women are treated for anxiety or depression for years before anyone considers ADHD. (We've written about how anxiety and depression overlap.)

The NIMH puts it plainly: ADHD symptoms in girls and women are especially likely to have been missed in childhood, and sex differences in diagnosis rates start to even out in adulthood. A 2023 systematic review in the Journal of Attention Disorders of women diagnosed as adults found recurring themes of strain on emotional wellbeing, difficult relationships, a sense of lack of control, and, after diagnosis, self-acceptance. For more on how presentations differ, see ADHD in women vs. men.

Hormones and ADHD symptoms

Many women notice their ADHD symptoms change across the month or at different life stages. Research is starting to catch up. A 2025 systematic review of 11 studies found evidence suggesting a link between sex hormones and ADHD symptoms in females, particularly during puberty and across the menstrual cycle. The authors called the evidence limited, with small samples, and noted that menopause has barely been studied.

If your symptoms seem to shift before your period or during perimenopause, you're not imagining it. Research just hasn't mapped those patterns well yet, so a symptom log gives a clinician more to work with than the studies do.

How ADHD is diagnosed in adults

There's no blood test or brain scan for ADHD. According to the NIMH, a diagnosis in adulthood requires:

• Symptoms that started before age 12, which is why clinicians ask about childhood and may want to talk to family members or see old school reports
• At least five symptoms of inattention or of hyperactivity and impulsivity (adults and teens over 16 need five, children six)
• Symptoms that cause problems in at least two areas of life

A careful evaluation also looks for conditions that mimic or accompany ADHD, especially anxiety, depression, sleep problems, and mood disorders. That step matters for women, who are more likely to arrive with one of those diagnoses already in their chart.

Treatment for ADHD in women

The most common treatments for adult ADHD, according to the NIMH, are medication (usually stimulants) and psychotherapy such as behavioral and cognitive behavioral therapy. Effective treatment often combines both, and some people need to try more than one approach. ADHD coaching can help with executive-function skills like planning and time management.

When ADHD comes with depression, anxiety, or bipolar disorder

For many women, ADHD isn't the whole story. It's the overlooked layer beneath years of depression, anxiety, or mood instability. When those conditions are severe or keep coming back despite treatment, getting the full picture right matters more than any single diagnosis.

At Amae Health, we treat complex mental health conditions, including Major Depressive Disorder and Bipolar Disorder, in integrated outpatient clinics. Our care teams bring psychiatrists, therapists, primary care physicians, and care coordinators under one roof, so a co-occurring condition like ADHD is considered as part of one treatment plan rather than in isolation. See how our integrated outpatient clinics work.

Frequently asked questions

What are the first signs of ADHD in women?

Common early signs include chronic disorganization, losing things, trouble finishing tasks, a restless mind, and feeling far more exhausted by everyday demands than peers seem to be. Many women recognize these patterns only in hindsight, often after a child is diagnosed or life demands increase.

Can you have ADHD and still be successful?

Yes. Many women with ADHD do well in school and work, often by compensating with extra effort, structure, and perfectionism. Success doesn't rule out ADHD. A clinician looks at impairment across areas of life and at how much effort functioning takes.

Is it ADHD or anxiety?

They can look alike and often occur together. Anxiety centers on worry and fear. ADHD centers on attention, organization, and impulsivity that have been present since childhood. Some women have both, and an evaluation should consider each.

Does ADHD get worse during perimenopause?

Some women notice that it does, and early research suggests hormones can affect ADHD symptoms. But studies on menopause are still very limited, so it isn't yet clear how common or predictable the change is.

How do I get tested for ADHD as an adult woman?

Start with a primary care provider or a psychiatrist who evaluates adults. Expect questions about childhood, current symptoms, and other conditions. Bringing old school reports or a family member who knew you as a child can help.

Key takeaways

• ADHD symptoms in women often center on inattention, mental restlessness, emotional intensity, and disorganization, rather than visible hyperactivity.
• "High-functioning ADHD" and "ADD" are informal terms. The diagnosis is ADHD, with three types.
• Masking and co-occurring anxiety or depression are two common reasons ADHD in women goes undiagnosed until adulthood.
• Diagnosis requires symptoms that began before age 12. Treatment usually combines medication, therapy, and skills support.

If ADHD has been sitting underneath depression, anxiety, or mood swings that haven't improved, you don't have to keep sorting through it alone. Request an intake appointment, and our team will explain how an evaluation works and what your first visit includes.

Comparing Spravato vs ketamine infusion treatment means comparing two versions of the same idea: using ketamine's fast action on the brain's glutamate system to treat depression that standard antidepressants haven't relieved. The best comparison so far, a 2025 meta-analysis by Mayo Clinic researchers, found no statistically significant difference in how often the two lead to response or remission. What separates them is everything around the drug: FDA status, how it's given, how quickly it tends to work, what it costs, and who pays.

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So far, neither has been shown to be the better drug.

What Is Spravato (Esketamine)?

Esketamine vs ketamine comes down to chemistry. Standard ketamine is an equal mix of two mirror-image forms of the same molecule. Esketamine is one of those forms on its own, and Spravato is esketamine delivered as a nasal spray.

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The FDA first approved Spravato in 2019 for treatment-resistant depression, taken together with an oral antidepressant, as the Mayo Clinic review notes. A second approval, again paired with an oral antidepressant, covers depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. And the most recent change came in January 2025, when the FDA added standalone use for treatment-resistant depression, as the current prescribing information shows.

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Every dose happens in a certified healthcare setting under the Spravato REMS, an FDA-required safety program. Each device delivers 28 mg, and a session uses two or three devices (56 or 84 mg), with a five-minute wait after each one. You're then monitored for at least two hours, and you can't drive again until the next day, once you've had a restful night's sleep. The label sets the early schedule: twice a week for weeks one through four, once a week for weeks five through eight, then weekly or every two weeks, adjusted to the least frequent dosing that maintains the response.

What Is Ketamine Infusion Therapy?

A ketamine infusion uses standard ketamine, both mirror-image forms together, delivered through an IV line. Ketamine has been FDA-approved as an anesthetic since 1970, but for depression, IV ketamine "remains an off-label treatment," in the Mayo Clinic review's words. Off-label prescribing is legal and common in medicine. It also means there is no FDA-approved depression regimen, so dosing schedules and safety protocols are set by each clinic.

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The most studied dose is 0.5 mg per kilogram of body weight, infused over about 40 minutes with continuous heart and blood pressure monitoring. A first course typically runs two to three infusions a week for about three to six treatments, followed by maintenance sessions on a schedule that varies from clinic to clinic.

Spravato vs Ketamine Infusion: Side-by-Side Comparison

Efficacy: What the Research Shows

The most complete head-to-head evidence is the 2025 Mayo Clinic meta-analysis in Therapeutic Advances in Psychopharmacology. The authors identified eight studies with 978 patients in total. Only one was a randomized trial, and it compared IV ketamine with an IV form of esketamine rather than the nasal spray, so the pooled comparison rests on observational studies of IV ketamine versus nasal esketamine.

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In those studies, the odds of response were 1.26 times higher with IV ketamine and the odds of remission 1.31 times higher, but neither difference was statistically significant. The authors concluded that the evidence suggests no significant difference in short-term efficacy, with a slight numerical trend favoring IV ketamine.

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Speed may be where the two differ. In one Mayo Clinic observational study included in the review, people reached remission after a median of two IV ketamine treatments, compared with seven nasal esketamine treatments. That's a real gap in lived experience. But it comes from observational data, where the people who choose or can access each treatment may differ in ways a study can't fully account for.

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So is Spravato better than ketamine infusions? On current evidence, neither has been shown to be. A randomized trial built to settle the question, called EQUIVALENCE, plans to assign 400 people to one treatment or the other for eight sessions over four weeks. Its protocol was published in 2026, and results are not yet available.

FDA Approval and Insurance Coverage

FDA approval changes who pays. Because Spravato has approved indications, insurers can write coverage criteria around it, and they typically require prior authorization and documentation of earlier antidepressant trials. Ketamine infusions for depression are off-label, so coverage is inconsistent, and many people pay out of pocket.

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The Spravato vs ketamine cost comparison has a twist. Economic modeling cited in the Mayo Clinic review found nasal esketamine unlikely to be cost-effective compared with IV ketamine from a health-system perspective. Yet an individual patient's out-of-pocket cost for Spravato may be lower, thanks to insurance coverage or manufacturer assistance. Published price estimates vary too widely by dose, frequency, and coverage to quote a single figure, so ask each provider and your insurer for the numbers that apply to you.

Side Effects and Safety Considerations

Because both drugs act on the same receptor, their side effects overlap. In Spravato's clinical trials, 48% to 61% of people developed sedation, and 61% to 84% experienced dissociative or perceptual changes, such as distortions of time or space, according to the prescribing information. Dizziness, nausea, vertigo, anxiety, and a temporary rise in blood pressure are also common, which is why blood pressure is rechecked about 40 minutes after dosing. IV ketamine produces the same family of effects, concentrated during and shortly after the infusion.

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Direct safety comparisons are limited. In one retrospective analysis included in the Mayo Clinic review, a rise in blood pressure during treatment occurred in 45% of IV ketamine patients versus 9.2% of nasal esketamine patients, and dissociative effects were also more frequent with IV ketamine, though they were described as transient. That is one retrospective study. It doesn't establish either drug as safer overall.

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Both drugs carry a potential for misuse, which shapes who is a candidate, and each has its own exclusions. Spravato, for example, isn't used in people with aneurysmal blood vessel disease, an arteriovenous malformation, or a history of bleeding in the brain.

What Influences the Choice Between Them

There isn't a universal right answer. A psychiatrist weighing the two usually considers:

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• Coverage and cost. Whether insurance will cover Spravato in your situation, and whether infusions are affordable out of pocket.
• How quickly relief is needed. Early data suggest infusions may reach remission in fewer sessions, which matters more when symptoms are severe.
• Medical history. Blood pressure, vascular conditions, and any history of substance misuse.
• Route. Some people would rather avoid an IV line. Others prefer an infusion that can be slowed or stopped.
• Logistics. Spravato means at least two hours in the clinic and no driving until the next day, twice a week at first. Infusions take about 40 minutes, plus recovery time that varies by clinic.
• Continuity. Whether you're already established with a psychiatrist or clinic that offers one of them.

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The choice belongs in a conversation with a psychiatrist who knows your treatment history, not in a ranking of favorites.

Making the Decision With a Psychiatrist

Spravato and ketamine infusions are tools for treatment-resistant depression, not a complete plan. They work alongside medication, therapy, and ongoing psychiatric care, and they sit among other options, including TMS therapy for depression that hasn't responded to medication. When depression brings thoughts of suicide, care for suicidal thoughts comes first.

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We don't offer Spravato at Amae. Our psychiatrists treat depression that hasn't responded to medication through our integrated care model, with therapy, medication management, and TMS, which we provide in Los Altos, San Mateo, and Los Angeles. Whether the question is Spravato vs ketamine infusion or something else entirely, talk through your options with an Amae psychiatrist, including ones we don't provide ourselves. For anyone in crisis right now, 988 is a call or text away.

Frequently Asked Questions

Is Spravato more effective than ketamine infusions?

Not on current evidence. A 2025 meta-analysis found no statistically significant difference in response or remission between IV ketamine and nasal esketamine, only a slight numerical trend favoring IV ketamine. Most of that evidence is observational, and a large randomized head-to-head trial is still underway.

Which works faster, Spravato or ketamine infusions?

IV ketamine may reach remission in fewer sessions. In one observational study, the median was two IV infusions versus seven nasal esketamine treatments. Because that finding comes from observational data rather than a randomized trial, treat it as preliminary.

Is Spravato safer than ketamine infusions?

Neither has been established as safer overall. The two share a similar side-effect profile because they act on the same receptor. One retrospective comparison found more blood pressure spikes and dissociation with IV ketamine, but a single study can't settle the question, and individual risk depends on your medical history.

Why is Spravato covered by insurance but ketamine infusions often aren't?

Spravato has FDA approval for treatment-resistant depression, which gives insurers defined criteria for covering it, usually with prior authorization. IV ketamine for depression is off-label, so coverage is inconsistent and infusions are often self-pay.

Can I switch between Spravato and ketamine infusions?

That's a clinical decision to make with a psychiatrist, based on how you've responded, the side effects you've had, your goals, and your coverage. It isn't something to change on your own.

How many sessions does each treatment typically require?

Spravato starts at twice a week for four weeks, then weekly, then weekly or every two weeks based on response. Ketamine infusions often begin with three to six sessions given two to three times a week, followed by maintenance on a schedule that varies by clinic.

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Citations

1. Elmosalamy A, Tarikogullari I, Patarroyo-Rodriguez L, et al. Intravenous ketamine versus esketamine for depression: a systematic review and meta-analysis. Therapeutic Advances in Psychopharmacology. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12615959/
2. U.S. Food and Drug Administration. SPRAVATO (esketamine) nasal spray prescribing information, revised January 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf
3. Wilkinson ST, Prashad S, Dalthorp R, et al. Non-inferiority, comparative effectiveness study of intravenous ketamine v. intranasal esketamine for treatment-resistant depression: the EQUIVALENCE trial protocol. Contemporary Clinical Trials. 2026;164:108273. https://pubmed.ncbi.nlm.nih.gov/41780747/
4. 988 Suicide and Crisis Lifeline. https://988lifeline.org

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