When depression has not lifted, this can move fast.
IV ketamine is a rapid acting infusion for depression that has not responded to other treatment, including depression with acute suicidal thoughts. Two decades of research stand behind it, and relief can begin within hours rather than weeks.
Available in Cincinnati · Dayton · Indianapolis · Ages 18 and up
A different mechanism, and a fast one
Rapid acting
Ketamine works on the brain's glutamate system, a different pathway than standard antidepressants, and it can lift mood the same day rather than weeks later.
Within hours
an antidepressant effect can begin, peaking around 24 hours, versus the weeks a pill takes
Works when antidepressants haven't
Ketamine is one of the most studied options for treatment resistant depression, depression that has not responded to two or more medications. It opens a different door when the usual ones have not worked.
Eases suicidal thinking quickly
In study after study, ketamine has rapidly reduced suicidal thoughts, often within hours and partly apart from its effect on mood, which is why it is used in some of the hardest moments.
How IV ketamine relates to Spravato
They come from the same molecule. The difference is how much of it you get, how it is delivered, and how it is covered.
Ketamine is a racemic molecule, a mix of two mirror image forms, an R version and an S version. IV ketamine uses the whole molecule, both forms together. Spravato uses only the S form, called esketamine, delivered as a nasal spray.
Both rely on the same glutamate based mechanism, which is why both act fast. IV ketamine offers flexible dosing and a long research history, but it is used off label. Spravato is the FDA approved path and is usually covered by insurance.
IV ketamine
The whole molecule, given off label
Both mirror image forms, delivered by IV infusion with flexible, weight based dosing. Two decades of research, but not FDA approved for depression, so it is usually out of pocket.
Spravato · esketamine
Half the molecule, FDA approved
The single S form as a standardized nasal spray, FDA approved and usually covered by insurance. If coverage matters most, this is often the better starting point.
An acute series, then maintenance
Treatment comes in two phases. Click through to see each one.
The acute series
A short series of infusions builds and stabilizes the response. Many people notice a shift within the first week or two.
Dose is weight based, a subanesthetic 0.5 mg/kg in most cases.
Maintenance
A single course tends to fade over a few weeks, so most people who respond continue with spaced out booster infusions to hold the gains.
Your prescriber tailors the interval to how long your response lasts.
What every infusion looks like
- A small IV line is placed, and the infusion runs about 40 minutes.
- A temporary sense of detachment is normal and fades as it ends.
- We monitor you closely throughout and for a short while after.
- You cannot drive that day, so bring someone to drive you home.
Where the evidence is strongest
Treatment resistant depression
The most studied use, for depression that has not responded to two or more antidepressants.
Acute suicidal thoughts
Used to rapidly ease suicidal thinking alongside comprehensive care, never in place of it.
Bipolar depression and beyond
A growing evidence base supports use in bipolar depression and severe anxiety, decided case by case.
As effective as ECT, and faster than a pill
For decades, ECT has been the benchmark for depression that will not lift. A full course of ketamine stands with it, and works in hours instead of weeks.
After a full series of infusions, 71 percent of people responded in Murrough's repeated infusion study, a 50 percent or greater drop in depression. The lift tends to appear within hours and peak around 24, not the weeks an oral antidepressant takes.
And measured directly against ECT in the largest head to head trial, ketamine held its own: 55 percent responded to ketamine against 41 percent for ECT, without general anesthesia and without ECT's effect on memory.
These are averages, not promises, and exact figures shift with dosing, the number of infusions, and the person. What stays consistent is that ketamine produces rapid, measurable relief for many people with treatment resistant depression, including some for whom ECT was the only remaining option.
Cost and coverage
Straight talk on what it costs
Because IV ketamine is used off label, most insurance plans do not cover the infusion itself, so it is usually out of pocket. We are upfront about the exact cost before you decide, with no surprises.
Common questions about IV ketamine
IV ketamine is the full ketamine molecule given by infusion, used off label for depression, with flexible dosing. Spravato is esketamine, one half of the molecule, given as an FDA approved nasal spray that is usually covered by insurance. Same family, different delivery and different coverage.
Ketamine has been FDA approved as an anesthetic since 1970, but it is not FDA approved for depression. Using it for depression is off label, which is common and legal, and it is one of the most studied off label treatments in psychiatry.
Quickly. An antidepressant effect often begins within hours of an infusion and tends to peak around 24 hours, compared with the weeks an oral antidepressant usually takes.
The infusion runs about 40 minutes while we monitor you. Most people feel a temporary sense of detachment, called dissociation, that some find strange but not distressing, and it fades as the infusion ends.
Usually not. Because it is used off label, most plans do not cover the infusion itself, so it is typically out of pocket. We are upfront about the cost, and if that is a barrier, Spravato is an FDA approved alternative that is usually covered.
See if IV ketamine is right for you
A free consultation tells us whether IV ketamine fits your situation, and how it compares with the other options we offer.