Getting ketamine treatment typically starts with your current mental health provider and involves a medical screening, specialist clearance, and a structured series of sessions at a monitored clinic. The process has several steps, and understanding what’s involved helps you know what to expect before your first appointment.
What Ketamine Treatment Is Approved For
There are two distinct paths to ketamine treatment, and knowing the difference matters. The FDA has approved a nasal spray form called esketamine (brand name Spravato) for two specific conditions: treatment-resistant depression in adults, and depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. Treatment-resistant depression generally means you’ve tried at least two different antidepressants without adequate improvement.
The other path is IV (intravenous) ketamine, which clinics administer off-label. “Off-label” means a doctor is legally prescribing an FDA-approved drug for a purpose the FDA hasn’t specifically reviewed. This is common in medicine and is not the same as experimental treatment. IV ketamine clinics treat depression, anxiety, PTSD, chronic pain, and other conditions, though the evidence base is strongest for depression. The American Psychiatric Association’s consensus guidance, issued in 2017 and still considered current, is based on controlled studies of ketamine infusions for depression.
Step 1: Talk to Your Mental Health Provider
You need to be under the active care of a psychiatric prescriber to receive ketamine therapy. If you stop seeing that provider at any point, treatment will typically pause until you establish care with a new one. This requirement exists because ketamine is meant to complement ongoing psychiatric care, not replace it.
Start by telling your psychiatrist or prescribing provider that you’re interested. They’ll review your treatment history, particularly how many medications you’ve tried and how you’ve responded. For the FDA-approved nasal spray, a documented history of treatment resistance is usually required. For off-label IV ketamine, the threshold varies by clinic, but most want to see that standard treatments haven’t worked well enough. Your provider can either refer you to a ketamine clinic or, in some cases, offer the treatment in their own practice.
Step 2: Medical Screening
Before you’re approved for treatment, you’ll go through a thorough medical evaluation. This typically includes a review of your full medical history, your current medications, and how severe your symptoms are. Depending on your health, you may need clearance from other specialists, such as a cardiologist, neurologist, eye doctor, or kidney specialist.
Your provider may also order lab tests, including liver and kidney function panels, to confirm your body can safely metabolize the drug. Some clinics require random drug screenings throughout the course of treatment, since certain substances (including alcohol and some recreational drugs) interact dangerously with ketamine.
Several conditions can disqualify you or require extra caution. These include heart disease, uncontrolled high blood pressure, a history of head injury, pregnancy or breastfeeding, and any known allergy to ketamine. A history of psychosis or active substance use disorder may also be a concern, depending on the clinic’s protocols.
Step 3: Finding a Reputable Clinic
Quality varies significantly among ketamine clinics, so choosing carefully is important. The American Psychiatric Association recommends that clinicians delivering ketamine hold a license to administer Schedule III medications and carry Advanced Cardiac Life Support certification. Facilities should be equipped to monitor cardiovascular and respiratory function, with access to electrocardiograms and emergency resuscitation equipment.
The American Society of Anesthesiologists has raised concerns that some outpatient clinics and at-home ketamine services may not have routine access to vital sign monitoring, rescue personnel, or emergency equipment. Their guidance states that ketamine for mental health conditions should only be given under the supervision of a physician who is immediately available and familiar with the drug’s full range of effects.
One practical resource for finding a vetted provider is the directory maintained by the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3). Clinics listed in that directory are members of the organization and have committed to its standards of ethical practice. You can search by location on their website. Beyond directories, ask any prospective clinic directly about the credentials of the administering physician, what monitoring equipment is on site, and what their emergency protocols look like.
What the Treatment Schedule Looks Like
Ketamine treatment follows a phased schedule. Most clinics begin with what’s called a “ketamine challenge,” a series of three to five initial sessions given either every other day or twice per week. This short trial determines whether you respond to the treatment at all before committing to a full course.
If you respond well, the standard induction phase involves sessions twice per week for four to five weeks, followed by a gradual taper. The total number of sessions and their frequency are meant to be the minimum necessary to achieve a clinical response. After the induction phase, some patients move to periodic maintenance sessions, which might be monthly or as needed. The exact schedule depends on how you respond and how long the effects last between visits.
What to Expect During a Session
For IV ketamine, a typical infusion lasts about 40 minutes, though you’ll be at the clinic longer than that. You’ll sit in a comfortable chair or recline while the medication is delivered through an IV line. For the nasal spray version, you self-administer the doses under direct clinical supervision.
During the session, you’ll likely experience dissociative effects: a sense of floating, altered perception of time, or feeling detached from your surroundings. Some people find this disorienting, while others describe it as calm or even pleasant. Nausea, dizziness, and temporary increases in blood pressure and heart rate are common. Staff will monitor your vital signs throughout the infusion.
You won’t be able to drive yourself home. Plan to have someone pick you up, and expect to feel groggy or “off” for the rest of the day. Most clinics ask you to avoid eating for several hours before your appointment to reduce nausea risk.
Cost and Insurance Coverage
The FDA-approved nasal spray (Spravato) is more likely to be covered by insurance, though coverage varies by plan and often requires prior authorization proving treatment resistance. It must be administered in a certified healthcare setting, not at home.
Off-label IV ketamine is rarely covered by insurance. Sessions typically cost between $400 and $800 each, and a full induction course of eight to ten sessions can run $3,000 to $8,000 out of pocket. Some clinics offer payment plans or financing options. Before committing, ask for a clear breakdown of total expected costs, including the initial evaluation, infusion sessions, and any follow-up appointments.
How Quickly It Works
One of the reasons ketamine has generated so much interest is its speed. Traditional antidepressants often take four to six weeks to show effects. Ketamine can produce noticeable improvement in mood within hours to days of the first infusion. However, these effects are temporary. A single infusion might relieve symptoms for a few days to a couple of weeks, which is why the structured series of sessions is necessary to build and sustain the response. Not everyone responds, and the initial challenge phase is specifically designed to identify whether you’re one of the people who benefits before investing in a full treatment course.