Ketamine therapy is a treatment option for some people with depression that has not improved with standard antidepressants. Unlike traditional antidepressants, which can take weeks to work, ketamine may improve depressive symptoms within hours. The effects can fade, however, so treatment often involves repeated sessions and follow-up care.

There is an important distinction: intravenous ketamine is used off-label for depression, while Spravato (esketamine) is FDA-approved for specific depression indications and must be administered under a supervised treatment program.

TL;DR: Key Takeaways

  • Ketamine may provide rapid relief, but one session does not guarantee lasting improvement.

  • Spravato is an FDA-approved option for treatment-resistant depression; other ketamine formulations are used off-label for psychiatric conditions.

  • Compounded ketamine prescribed for at-home use carries safety concerns, particularly without direct medical monitoring.

  • You need a safe ride home after treatment because sedation and impaired judgment can persist.

  • Before paying for treatment, ask about screening, monitoring, costs, and the follow-up plan.

Need help with mental health concerns? August AI offers a $39 online urgent care visit. A US-licensed clinician can review your symptoms, medications, and medical history and determine whether further evaluation or treatment is appropriate. Medication costs are separate, and a prescription is not guaranteed.

Telehealth urgent care cannot provide ketamine infusion treatment or replace specialist psychiatric care. If you may act on suicidal thoughts or cannot keep yourself safe, seek immediate help. In the US, call or text 988; call 911 for an immediate emergency.

What Is Ketamine Therapy?

Ketamine therapy involves using ketamine under medical supervision, most commonly to treat depression that has not responded adequately to other treatments. Depending on the treatment, ketamine may be administered intravenously or intramuscularly, while esketamine is delivered as a nasal spray.

Traditional antidepressants often take several weeks to produce their full effect. Ketamine can work faster for some patients, sometimes within hours. However, responses vary, and rapid improvement does not mean the depression is cured.

A commonly studied intravenous regimen uses 0.5 mg/kg administered over approximately 40 minutes. Research reviewed in this clinical review of ketamine for depression describes rapid antidepressant effects, but benefits after a single infusion may diminish over subsequent days.

This is why treatment typically involves an initial series of sessions followed by reassessment. Some patients benefit substantially; others experience limited or short-lived relief.

People also ask

Usually. Most people continue an oral antidepressant throughout, and esketamine is labeled for use alongside one. The notable exception is benzodiazepines: ongoing use may blunt ketamine's antidepressant response. Whether to taper, time, or keep a benzodiazepine is a prescriber decision made with your full medication list, not something to adjust on your own.

It can be. Ketamine is a controlled substance with documented recreational misuse, which is precisely why supervised administration, fixed dosing, and no take-home supply are the structural safeguards in a legitimate program. Active substance misuse is a reason to discuss candidacy carefully before starting. Escalating your own dose or sourcing ketamine outside a clinic is the pattern to avoid.

Is Ketamine FDA-Approved for Depression?

The answer depends on which formulation you mean.

Spravato (esketamine) is FDA-approved for specific uses in depression, including treatment-resistant depression. It is administered in a certified healthcare setting under a restricted safety program.

Intravenous and intramuscular ketamine are not FDA-approved specifically to treat depression. Clinicians may prescribe them off-label, meaning they use an approved medication for a purpose that has not itself received FDA approval.

Compounded ketamine products, including some lozenges and nasal preparations, may also be offered for psychiatric use. Compounded products are not FDA-approved, and the FDA has raised concerns about ketamine prescribed for at-home use without appropriate supervision. Its compounding risk alerts discuss risks including sedation, dissociation, elevated blood pressure, and respiratory complications.

The American Psychiatric Association's consensus statement on ketamine for mood disorders also emphasizes careful patient selection, informed consent, and attention to the limitations of the evidence.

Off-label treatment is not automatically inappropriate, but the clinician should explain why it is being considered, what is known about its risks, and how your response will be monitored.

People also ask

Sometimes. Clinics do use it off label for anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, and some chronic pain syndromes, and small studies are encouraging. The evidence base is substantially thinner than for treatment-resistant depression, and no form is FDA-approved for these uses. Ask any clinic what evidence supports its protocol for your specific diagnosis.

Not usually. Many clinics accept self-referrals and do their own intake. A referral still helps you, because it brings a documented history of prior antidepressant trials, which establishes candidacy and supports an insurance claim for esketamine. Programs that skip psychiatric assessment entirely are cutting the step that protects you most.

Spravato vs. IV Ketamine: What Is the Difference?

 

Feature Spravato IV ketamine
Medication Esketamine nasal spray Racemic ketamine
FDA-approved for depression Yes, for specified indications No; used off-label
Administration Certified healthcare setting Usually a medical clinic
Monitoring Required under the REMS program Depends on the clinical protocol
Insurance coverage May be covered when eligibility and plan requirements are met Often self-pay
Treatment schedule Label-based induction and maintenance Varies by clinician and response

Spravato has a structured safety program. According to its FDA-approved prescribing information, patients must be monitored for at least two hours after each treatment, including assessment of sedation, dissociation, respiratory status, and blood pressure.

For treatment-resistant depression, the labeled schedule generally begins with twice-weekly treatment for four weeks, followed by weekly treatment during the next four weeks. After that, the frequency may be reduced according to response and tolerability.

IV ketamine protocols vary between clinics. Ask about the proposed schedule, the total expected cost, and how the clinician will decide whether continuing treatment makes sense. Insurance coverage depends on the product, indication, plan, and provider.

For related coverage questions, read August AI's guide to whether Medicare covers mental health care.

People also ask

Several. Switching route or format sometimes helps, since people respond differently to intravenous ketamine and intranasal esketamine. Beyond that, transcranial magnetic stimulation and electroconvulsive therapy both have stronger long-term evidence in treatment-resistant depression, and augmentation strategies that add a second medication to your antidepressant remain standard. A psychiatrist can sequence these for you.

How to Choose a Safe Ketamine Therapy Program

Choosing a qualified provider is at least as important as choosing a treatment format.

1. Confirm that you are an appropriate candidate.

Ketamine may be considered for treatment-resistant depression, often after multiple adequate antidepressant trials have not worked. Your clinician should review your psychiatric history, previous treatments, current medications, substance use, and medical conditions.

2. Understand the treatment model.

Some programs provide medication and medical monitoring only. Others combine ketamine with structured psychotherapy, sometimes called ketamine-assisted therapy.

If you are interested in psychotherapy alongside medication, explore the different types of therapy and learn what to expect from a first therapy session.

3. Ask how you will be monitored.

For a clinic-based treatment, ask who supervises the session, how blood pressure and oxygen levels are checked, what emergency equipment is available, and how complications are handled.

4. Agree on a way to measure progress.

Your clinician may use a validated depression questionnaire, such as the PHQ-9, alongside your symptoms and daily functioning. Establish when the response will be reviewed and what happens if treatment does not help.

5. Get the financial details in writing.

Ask about consultation fees, medication charges, monitoring, psychotherapy, and maintenance sessions. A low advertised price may not include the complete course of treatment.

What Happens During a Ketamine Therapy Session?

The exact experience depends on the medication and route of administration, but a supervised session generally has three stages.

Before treatment: The clinical team reviews your symptoms, medications, blood pressure, and relevant medical history. You may receive instructions about eating and drinking beforehand. Follow the clinic's specific guidance rather than assuming every protocol has the same fasting rules.

During treatment: With IV ketamine, the medication is commonly infused over approximately 40 minutes. You may feel detached from your surroundings, experience changes in perception, become dizzy, or feel sleepy. Some people find these effects manageable; others find them uncomfortable.

Your care team should monitor you and be available if you become distressed or develop concerning symptoms.

After treatment: You remain under observation until the team determines that you are stable enough to leave. Recovery time varies. Do not drive, operate machinery, or make important decisions until the period specified by your clinician has passed. Arrange transportation in advance.

With Spravato, you self-administer the nasal spray under supervision and remain at the healthcare facility for at least two hours of monitoring.

Side Effects and Longer-Term Risks

Common short-term side effects include:

  • Dizziness, nausea, or vomiting.

  • Sleepiness or sedation.

  • Dissociation or changes in perception.

  • Temporary increases in blood pressure or heart rate.

  • Headache or blurred vision.

These effects often improve within hours, but they can sometimes be more significant or last longer. Your clinician should explain which symptoms to report and when to seek urgent care.

There are also longer-term concerns. Repeated ketamine exposure has been associated with bladder problems, particularly with heavy or prolonged use. A published case report describes ketamine-associated cystitis in a patient receiving treatment-dose ketamine for depression.

Report new urinary urgency, frequent urination, pain when urinating, or blood in the urine promptly. Do not assume these symptoms are an expected part of treatment.

Ketamine also has misuse potential. A legitimate treatment program should assess your substance-use history, prescribe and administer medication responsibly, and arrange regular follow-up.

When to Seek Medical Help

Seek emergency care immediately if you experience:

  • Difficulty breathing, unresponsiveness, or severe sedation.

  • Chest pain or a severe headache accompanied by concerning symptoms.

  • A seizure, fainting, or sudden neurological symptoms.

  • A severe allergic reaction.

  • An immediate risk of suicide or an inability to stay safe.

Call or text 988 in the US for suicidal thoughts or emotional distress. If there is immediate danger, call 911. If not in US call your local crisis line.

Contact your clinician promptly if you develop:

  • Persistent nausea or dizziness after treatment.

  • New urinary symptoms or blood in your urine.

  • Hallucinations, paranoia, or confusion that do not resolve as expected.

  • Repeated high blood pressure readings.

  • Worsening depression or new suicidal thoughts.

Conclusion

Ketamine therapy may offer relatively rapid relief for some people with depression, particularly when standard treatments have not worked. But it is not a one-session cure, and the benefits, risks, costs, and follow-up requirements vary.

Before starting, confirm the treatment's regulatory status, choose a qualified provider, understand the monitoring plan, and agree on how progress will be measured. The safest next step is a thorough psychiatric evaluation to determine whether ketamine is appropriate for you.

Frequently Asked Questions

Often, yes. Many patients continue their existing antidepressants, but the right plan depends on the specific medications and treatment protocol. Tell your prescriber about every prescription, supplement, and over-the-counter product you use. Do not stop or adjust psychiatric medication on your own.

Ketamine has misuse and dependence potential. Supervised dosing, careful screening, and follow-up help manage the risk, but they do not eliminate it. Tell your clinician if you have a history of substance use or concerns about cravings.

Ketamine is used off-label in some settings for conditions beyond depression, including certain pain disorders and psychiatric symptoms. The evidence varies by condition, and these uses are not all FDA-approved. Ask what evidence supports the proposed treatment for your specific diagnosis.

Requirements vary by clinic and insurance plan. Some programs accept self-referrals, but a comprehensive psychiatric evaluation is important. Records of previous treatments can also help establish whether you meet criteria for a particular treatment.

Your clinician should reassess your diagnosis, response, side effects, and treatment goals rather than continuing indefinitely without benefit. Other options for treatment-resistant depression may include medication adjustments, transcranial magnetic stimulation, or electroconvulsive therapy, depending on your circumstances.