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"Ketamine has more studies than most of the newer FDA-approved medications we use in psychiatry,” says Brandon S. Hamm, MD, a psychiatrist at »ªÌå»á. ”It is a more aggressive treatment for people with who have tried multiple antidepressant medications without success.”

What Class of Drug Is Ketamine?

As a medication, ketamine holds a unique position in psychiatric care and is available in multiple forms. The FDA approved it as an anesthetic and has also approved a chemically related nasal spray () for the treatment of depression.

Additionally, physicians may prescribe ketamine "off-label" in small IV doses for mental health treatment � a common practice when research supports a medication's benefits beyond its original approval. However, IV infusion is not currently FDA-approved, and insurance does not cover this type of therapy.

What to Expect

In a controlled healthcare setting, ketamine therapy is a carefully structured medical procedure. Here are the protocols in place at »ªÌå»á Psychiatric Clinic.

Before the procedure

A referral from a primary care physician or psychiatrist is recommended, but a patient can schedule an initial evaluation without one. An established relationship with a mental health provider is necessary before starting an IV infusion course. The clinic will reach out to the patient’s mental health provider after the patient’s initial evaluation.

“Our initial evaluation is about an hour and a half long. It is a formal evaluation to come to a mood disorder diagnosis,” says Dr. Hamm. “There are a lot of different presentations that end up being called depression. Not all of them are episodic mood disorders.”  

Dr. Hamm says that some patients may also need clearance from a neurologist, pulmonologist or cardiologist before ketamine treatment, depending on their health conditions.

Before the first ketamine treatment, patients must also provide a urine sample. This is tested for drugs and, if applicable, pregnancy.

During the procedure

Ketamine can only be given in a certified medical office under the care of trained medical professionals. At Northwestern Medicine Psychiatric Clinic, IV infusion is the method of treatment.

“Dosing is customized based on a patient’s weight and response,” explains Dr. Hamm. “If I were to have a patient in distress and they wanted to stop the treatment, I can do that very easily with the IV route. Symptoms fade quickly when the IV pump is paused.”

Each IV session lasts about 40 minutes and is conducted under close medical supervision, during which the patient’s vital signs are monitored.

A typical course is two infusions per week for six to eight weeks, followed by maintenance sessions based on the patient’s response.

After the procedure

After each infusion, patients remain under observation by medical staff members for 30 to 45 minutes to ensure any immediate effects have subsided. Following medical observation and release, patients are required to have an adult take them home.

In addition to the infusions, Dr. Hamm says integration therapy can be helpful. “There is evidence that there’s an increased learning capability up to several days after a ketamine infusion. So, some patients can gain major insights about cognitive distortions; they recognize the ways that they are defensive and ways that their self-image is inaccurate or too negative. Through integrative therapy, we work to make those insights more permanent versus fleeting.”

When Ketamine Therapy Cannot Be Used

Not everyone is a candidate for this type of therapy. Several medical conditions can make this treatment unsuitable or potentially unsafe.

Medical circumstances that prevent ketamine as an effective treatment option:

• Uncontrolled high blood pressure
• Pregnancy or planned pregnancy
• Certain genetic disorders affecting blood chemistry
• Active dementia or recent delirium
• Recent episodes of schizophrenia or mania
• Current substance use disorders
• History of adverse reactions to ketamine

Understanding the Side Effects of Ketamine

Like any medical treatment, ketamine can cause side effects, though most are temporary and subside shortly after treatment.

Common effects during treatment may include:

• A floating sensation or feeling disconnected from your body
• Euphoria, intense excitement (not mania)
• Temporary changes in vision or perception
• Mild anxiety or dizziness that passes
• Brief changes in balance or coordination
• Temporary increases in heart rate
• Occasional headaches or nausea
• Increased saliva production
• Vivid dreams or nightmares

“While these effects may sound concerning, they’re actually expected parts of the treatment process,” says Dr. Hamm. “We carefully prepare our patients for what they might experience, and our team is present throughout the entire session to ensure safety and comfort. Most people find the side effects quite manageable, and they typically resolve completely within an hour after treatment.”

Addiction Risk

Lower-dose ketamine therapy every few weeks does not carry a significant risk of addiction. Frequent recreational use, on the other hand, does have a low to moderate risk of leading to addiction. It is crucial to use ketamine only under your healthcare clinician’s guidance and supervision.

Other Treatment Options

Ketamine is not the only option for people with treatment-resistant depression. Other therapy options include:

• (ECT)
• Transcranial magnetic stimulation (TMS)
• Other antidepressant medications
• Antipsychotic medications
• Light therapy
• Intensive psychotherapy

Learn more about ketamine therapy.