Ketamine Therapy for Depression: Spravato, IV Ketamine, and What the Evidence Shows

Ketamine has drawn attention as a treatment for depression that has not improved with standard approaches. Used for decades as an anesthetic, ketamine and a closely related medicine called esketamine are now used, in carefully controlled medical settings, to help some people with hard-to-treat depression. What makes it notable is speed: where many antidepressants take weeks, some people report improvement within hours to days. But ketamine is not a casual or take-home treatment—it is administered and monitored by clinicians, carries real risks, and its long-term role is still being studied.

This guide explains the two main forms used for depression, what the evidence suggests, the risks, who it is considered for, and how to find legitimate care. It is educational and conservative by design.

What ketamine therapy is

Two forms are most relevant to depression care:

Both are given in a medical setting where staff can watch for side effects. Because these treatments can cause dissociation (a temporary sense of detachment) and raise blood pressure, patients are typically monitored for a period after each dose and should not drive afterward.

How it may work

Ketamine acts on the brain’s glutamate system, a different pathway from the serotonin-focused mechanism of many common antidepressants. Researchers think this may help restore certain connections between brain cells, which could explain the rapid mood changes some people notice. This is an area of active study, and the full picture is not settled.

What the evidence supports

Some studies suggest ketamine and esketamine can produce meaningful, sometimes rapid reductions in depression symptoms for people who have not responded to other treatments. Esketamine’s approval was based on clinical trials, and it is used within a monitored program. For IV ketamine, evidence is more preliminary, and reviewers such as Cochrane and organizations like NIMH have noted that questions remain about optimal dosing, how long benefits last, and long-term safety.

Two honest caveats: improvements are often temporary, so ongoing or maintenance treatment may be discussed, and results vary widely from person to person. Ketamine is not a cure, and it is generally considered when other treatments have not worked rather than as a first step.

Risks and side effects

Common short-term effects include dissociation, dizziness, nausea, increased blood pressure, headache, and anxiety around the time of treatment. Because ketamine can be misused and may be habit-forming, treatment is structured to reduce that risk—doses are given and monitored by professionals, not sent home. It may be unsuitable for people with certain heart or blood-pressure conditions, some psychiatric conditions, a history of substance misuse, or during pregnancy. These are decisions for a qualified clinician who knows your full history.

A safety point that matters: ketamine for depression should only be received through licensed medical providers in appropriate settings. “DIY” ketamine or unmonitored use can be dangerous.

Who it is considered for

Ketamine-based treatment is generally considered for adults with treatment-resistant depression—depression that has not improved after trying other adequate treatments—and, for esketamine, in some cases of depression with acute suicidal thoughts, always alongside other care. Whether it fits you depends on your diagnosis, medical history, and prior treatments, and is decided with a psychiatrist or other qualified clinician. If you are weighing your overall options, our overview of therapy versus medication may help frame the conversation, and our guide to psychedelic-assisted therapy covers related, largely investigational approaches.

How to find legitimate care

Start with a psychiatrist, your primary care clinician, or a mental-health provider who can assess whether ketamine or esketamine is appropriate and refer you to a certified or reputable clinic. For esketamine, treatment happens within an FDA-regulated program at certified healthcare settings. Be cautious of clinics that promise guaranteed results or downplay monitoring; appropriate ketamine care includes medical screening, supervised administration, and follow-up.

When to seek help

Reach out to a clinician if depression is interfering with your daily life, especially if it has persisted despite treatment. Do not wait to seek help if symptoms are worsening.

If you are in crisis—having thoughts of suicide or self-harm, or worried about someone who is—call or text 988 (the Suicide and Crisis Lifeline in the US) or go to your nearest emergency department right away. Ketamine treatment is not a substitute for emergency care.

Frequently asked questions

Is ketamine for depression FDA-approved? The esketamine nasal spray (Spravato) is FDA-approved for certain adults with treatment-resistant depression; IV ketamine is used off-label under medical supervision.

How fast does it work? Some people report improvement within hours to days, but effects are often temporary and vary by person.

Can I do ketamine therapy at home? No. It should be administered and monitored by licensed clinicians; unsupervised use can be dangerous.

Is it addictive? Ketamine has misuse potential, which is one reason treatment is closely supervised and dosing is controlled.

Will I need ongoing treatment? Because benefits can fade, clinicians may discuss maintenance sessions; plans are individualized.

Can I stay on my other antidepressants? Esketamine is used together with an oral antidepressant; your clinician will guide any medication decisions.

Explore more in our wellness guide.

Sources

• National Institute of Mental Health (NIMH) — treatment-resistant depression and esketamine
• Mayo Clinic — depression treatments and ketamine
• American Psychological Association (APA) — depression care
• Cochrane — reviews of ketamine for depression