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Since the late ’90s, Kathy Wallace has been battling major depression with a series of drugs — first Prozac, then three others, and back again to Prozac. But in the last six months, nothing seemed to be helping. So her psychiatrist recommended something new: Spravato, a nasal spray approved in 2019 that delivers a drug similar to the hallucinogen ketamine.

When the 53-year-old researched nearby clinics, though, she found them out of reach. She’d need someone to drive her to and from the appointment, nearly an hour round-trip from her home in Orange County, Calif. She could have tried a clinic that offers off-label infusions of generic ketamine, which is approved as an anesthetic, to treat depression. Her psychiatrist wasn’t a fan of that option — and at nearly $1,000 out of pocket per infusion, neither was Wallace.

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