Not esketamine, but I started taking intranasal ketamine about a year ago. I get it by prescription from a compounding pharmacy. I would have tried IV ketamine but I live in the sticks and it wasn't available without a 3 hour drive and the logistics of getting a ride a couple of times a week were beyond me. So my pdoc said he would give the intranasal a try. It is amazing. I had tried 20 different meds in all kinds of classes for MDD, none worked. I was suicidal all of the time. The ket provided immediate relief. It still astonishes me.
I took 50 mg weekly for about a year, and then I found that I need it less often. I went about 5 weeks earlier this spring, and am now at 3 or so weeks without. But it took a year to get there. I take it at home. I know that the FDA approval for esketamine requires that you dose yourself at a place that has approval/training in monitoring you. Which I think is fine-except that there are none of those around here-same issue as the IV ketamine. I have DID-the dissociation (if that is what it is) that the ketamine often causes is nothing like what I experience when I switch do to my mental illness. To me, it just feels like waking up from anesthesia-which I suppose you would expect. More like laughing gas. Not scary, although I definitely do not drive after I have dosed. It takes a couple of hours for me to return to feeling normal, so I just take it at night when I don't have any need to leave the house. It does burn a bit, and it tastes icky if it drips down the back of the throat.The side effects are SO worth it.

I take benzos as needed, which for me is a small dose maybe once a week. That has not stopped the ket from working. I also have a history of alcoholism and drug use, but I have not had an issue with addictive thoughts or behavior.

There is the issue of the amount that actually enters the bloodstream varying with the intranasal, but again, worth it. Sometimes I "feel" the medication more strongly. Maybe due to sinus congestion? But it has still worked.

I pay about $75 for 4 doses-insurance does not pay. But that is way less than IV ketamine, which insurance doesn't pay for, either. I don't know what they are charging for esketamine, but I would not be surprised if the co-pay was rather high. The cynical side of me suspects that the drug company developed esketamine because they can patent it and have exclusive rights for 10 years, while ketamine is available as a generic.