What patients should know about ketamine

No. Although ketamine is sometimes associated with recreational misuse, its use in a medical setting is very different. Psychiatric ketamine treatment involves carefully selected patients, controlled dosing, supervision by a trained healthcare professional, and monitoring throughout the treatment process.

The FDA has approved ketamine for use as an anesthetic, but ketamine itself is not FDA-approved as a treatment for depression or other psychiatric disorders. That use is considered off-label. Off-label prescribing is a legal and common part of practice when a clinician determines that a medication may be appropriate for a particular patient.

Research over the past several decades has demonstrated that ketamine can produce rapid antidepressant effects in some individuals, particularly those with treatment-resistant depression. In one randomized controlled study, participants receiving six infusions over approximately two weeks demonstrated greater improvement than following a single infusion, with 59% meeting the study’s criteria for treatment response. The American Psychiatric Association has published a consensus statement recognizing this evidence while emphasizing limitations in the existing research, including relatively small study populations and limited long-term data.

For psychiatric treatment, IV ketamine has been extensively studied and allows a clinician to deliver a precise dose over a controlled period. IV administration allows the treatment team to control the dose and rate of administration, observe your response, monitor vital signs and level of consciousness, and adjust or stop treatment when clinically indicated.

Treatment schedules are individualized. A commonly studied initial protocol for treatment-resistant depression consists of six IV infusions administered over approximately two weeks. If you respond, your provider may discuss whether additional treatments could be appropriate — some patients benefit from less frequent maintenance treatments, while others may not require additional ketamine. There is no single maintenance schedule that is appropriate for everyone.

Ketamine is generally well tolerated when administered appropriately, but side effects can occur. These may include temporary increases or decreases in blood pressure, increased heart rate, dizziness, nausea or vomiting, headache, drowsiness, changes in perception, dissociation, blurred or double vision, vivid dreams, temporary changes in cognition or coordination, increased salivation, unusual taste, muscle twitching, and changes in appetite, urination, or bowel habits.

Less common or more serious adverse effects can include allergic reactions, significant respiratory depression, severe changes in blood pressure or heart rate, hallucinations, and other clinically significant reactions. IV placement itself may cause temporary discomfort, bruising, swelling, irritation, or infection. Longer-term or repeated exposure may involve additional risks, which is one reason ongoing treatment should be regularly reassessed.

No. Because ketamine can temporarily affect alertness, perception, coordination, and judgment, you must arrange for a responsible adult to drive you home after treatment. Your treatment team will provide specific instructions regarding driving, operating machinery, alcohol, medications, and other activities following your appointment. If you arrive without the required transportation arrangement, your treatment will need to be postponed.

Ketamine has been studied for its rapid effects on depressive symptoms and suicidal thinking. However, it is important to distinguish improvement in suicidal symptoms from prevention of suicide itself. Ketamine should never be considered a substitute for emergency psychiatric care when someone is at immediate risk of harming themselves. If you are experiencing an immediate psychiatric emergency, tell your provider or seek emergency medical care rather than waiting for a scheduled treatment.

Esketamine is a medication derived from ketamine and is administered as a nasal spray. Unlike generic ketamine used off-label for psychiatric treatment, Spravato® (esketamine) has specific FDA-approved psychiatric indications. See our Spravato page.