Ketamine Infusion for Treatment-Resistant Depression: FAQs

If you're researching ketamine infusion for treatment-resistant depression, you probably have a lot of questions, and some of them feel awkward to ask. Will I feel out of control? Will insurance cover it? Is it safe to combine with my medication? This guide walks through the questions patients most often have before a first session, so you can walk in informed and decide whether it's worth pursuing with your care team.

Key Takeaways

• Ketamine is usually considered after several antidepressants and other treatments haven't provided enough relief.

• IV ketamine and esketamine (Spravato) are different treatments with different approval status and delivery methods.

• A first session means a health screening, monitored dosing, and a recovery period; plan for a ride home.

• Coverage varies: esketamine is more likely to be covered than off-label IV ketamine, so check with your insurer first.

• Come with questions about who is monitoring you, what the maintenance plan looks like, and how it fits with the rest of your care.
  

Is ketamine infusion different from Spravato?

Yes. Ketamine infusion delivers ketamine through an IV, typically over about 40 minutes or longer, and is used off-label for depression. Spravato is esketamine, a related compound given as a nasal spray in a certified clinic, and it carries FDA approval for treatment-resistant depression. They share a mechanism but differ in delivery, approval status, and how insurance treats them.

Who is a candidate for ketamine infusion for treatment-resistant depression?

Treatment-resistant depression, as the National Institute of Mental Health describes it, affects people whose depression doesn't improve after trying multiple treatments. In practice, many clinics look for people who haven't responded to at least two adequate antidepressant trials, and who have a medical review showing ketamine is safe for them.

You might not be a candidate if you have uncontrolled high blood pressure, certain vascular conditions, a history of psychosis, or an active substance use disorder. Honest, complete answers during screening protect you.

How long does it take to work, and how long does it last?

Some patients feel a lift within hours to a few days, which is much faster than most antidepressants. But the benefit can wear off, sometimes within days to weeks after a dose. That's why treatment often starts with a series of sessions followed by periodic maintenance, and why it's usually combined with ongoing therapy and medication management rather than used alone.

Not everyone responds. If you don't, that doesn't mean you did something wrong.

What does a first ketamine session feel like?

Expect a screening first: blood pressure, a review of your medications, and a conversation about what you might feel. Then you receive the dose and are monitored. Many people feel floaty, detached, or dreamy for an hour or so; some feel nauseated or dizzy. You'll rest afterward until staff clear you to leave.

Plan ahead: arrange a ride home and clear the rest of your day. Don't drive until the next day after a good night's sleep.

Is ketamine treatment safe?

When given by trained clinicians in a monitored setting to appropriately screened patients, short-term side effects are generally manageable: dissociation, dizziness, nausea, drowsiness, and a temporary blood pressure rise. Longer-term effects of repeated use are still being studied. Ketamine is a controlled substance, so it's not meant to be used outside medical supervision.

If you ever feel worse, experience new thoughts of self-harm, or are in crisis, call or text 988 or go to the nearest emergency room.

Will insurance cover ketamine?

It depends on the product. Esketamine (Spravato) is FDA-approved, so many insurers cover it with prior authorization. IV ketamine is off-label for depression and is frequently paid out of pocket. Ask the clinic for a clear price per session, what's included in the series, and what maintenance costs look like. Verify with your insurer directly, since policies differ.

What should I ask before booking my first session?

Good questions give you a sense of whether a clinic is well run. Consider asking:

• Who screens me, and who is physically present during and after dosing?

• What are your protocols if my blood pressure rises or I feel unwell?

• What does the full treatment plan and cost look like, including maintenance?

• How will you coordinate with my current prescriber and therapist?

• What happens if it doesn't help?
  

Should I explore anything else first?

Often, yes. Stubborn depression can be driven or prolonged by factors that are fixable, such as thyroid issues, vitamin D, B12, or iron deficiency, poor sleep, inflammation, or alcohol use. At Intrepid Mental Wellness, our psychiatric nurse practitioners look at these root causes, sometimes with lab testing, and tailor medication and natural support to the person. If you'd like help figuring out whether ketamine is the right next step or whether something else should come first, you can contact our team.

FAQ

Is ketamine infusion painful? The IV placement feels like any blood draw. The infusion itself isn't usually painful, though some people feel nauseated or lightheaded.

Can I take ketamine with my antidepressant? Often yes, and esketamine is actually approved to be used alongside an oral antidepressant. But never change your medications without your prescriber; some combinations need adjustments.

How many sessions will I need? It varies. Treatment commonly begins with several sessions over a few weeks, followed by maintenance if it's working. Your clinic should explain the plan before you start.

What if ketamine doesn't work for me? Not everyone responds. Other options may include adjusting medication, adding therapy, evaluating for underlying contributors, or other approaches your prescriber can discuss.

This post is educational and not a substitute for medical advice. Talk with a qualified prescriber about whether any treatment is appropriate for you.

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