Ketamine treatment for depression is available through several types of providers: specialized ketamine infusion clinics, psychiatrist offices, certified healthcare settings that offer the nasal spray form, and telehealth companies that prescribe at-home oral doses. Where you go depends on which form of ketamine you receive, what your insurance covers, and how much supervision you need.
The Two Forms of Ketamine and Why It Matters
There are two distinct treatment paths, and they come with different rules about where you can get them. The first is IV (intravenous) ketamine, which is the generic drug used off-label for depression. The FDA approved ketamine decades ago as an anesthetic, not as a depression treatment, so when clinics offer it for mood disorders, they’re prescribing it outside its official indication. That’s legal and common in medicine, but it means insurance rarely covers it.
The second is esketamine, a nasal spray sold under the brand name Spravato. This is the only form the FDA has specifically approved for treatment-resistant depression in adults and for depressive symptoms in people with major depression who have acute suicidal thoughts. Because of this approval, insurance is more likely to cover it, but it comes with strict requirements about where and how you receive it.
Ketamine Infusion Clinics
Standalone ketamine infusion clinics are the most common place people receive IV ketamine for depression. These clinics have grown rapidly over the past decade, and most mid-sized to large cities now have at least one. They’re typically run by anesthesiologists, psychiatrists, or a combination of specialists. Some operate within larger medical practices, while others are independent facilities focused exclusively on ketamine.
A typical treatment course starts with an induction phase of six to eight infusions, usually spaced over two to three weeks. After that, maintenance sessions are spaced roughly every three weeks, though the exact schedule varies by provider and how you respond. Each IV session lasts about 40 minutes for the infusion itself, plus monitoring time afterward.
The cost is significant. Without insurance, a single IV infusion runs $425 to $750, and the full initial course of 11 to 18 sessions totals $4,675 to $13,500, with a median around $8,000. Most clinics offer package pricing or payment plans, but this is overwhelmingly an out-of-pocket expense.
Certified Spravato (Esketamine) Centers
If you’re looking for the FDA-approved nasal spray, you’ll need a healthcare setting certified through the Spravato REMS (Risk Evaluation and Mitigation Strategy) program. This is a safety program the FDA requires because of concerns about sedation, dissociation, and misuse potential. Spravato cannot be dispensed directly to patients or taken at home. You self-administer the spray under the direct observation of a healthcare provider, then stay for at least two hours of monitoring before you’re cleared to leave.
Certified settings include psychiatrist offices, outpatient mental health clinics, and some hospital-based programs. Both you and the healthcare facility must be enrolled in the REMS program before treatment begins. Your prescriber’s office can walk you through enrollment, or you can search for certified locations through the Spravato website or by calling your insurance company directly. Because Spravato has FDA approval for treatment-resistant depression, many commercial insurers and Medicare plans cover it, though prior authorization is almost always required.
To qualify, you generally need to have tried at least two different antidepressants at adequate doses without sufficient improvement. This is the standard definition of treatment-resistant depression. Spravato is also prescribed alongside an oral antidepressant, not as a standalone treatment.
Psychiatric Hospitals and Academic Medical Centers
Some university-affiliated hospitals and psychiatric inpatient units offer IV ketamine as part of broader treatment programs for severe depression. These settings can be a good option if you have complex medical or psychiatric needs that require closer oversight. Traditionally, ketamine infusions in hospitals involved collaboration between psychiatrists and anesthesia specialists, though some psychiatric teams now administer infusions independently. A pilot program at an inpatient psychiatric facility demonstrated that a team of a psychiatrist, physician assistant, pharmacist, and psychiatric nurse could safely run a ketamine program without anesthesia involvement.
Academic centers sometimes have the advantage of more structured screening and follow-up protocols. They may also be running clinical trials, which could provide access to treatment at reduced or no cost.
At-Home Telehealth Programs
A newer option involves telehealth companies that connect you with a prescribing clinician who can send compounded oral or sublingual ketamine to your home. Companies like Mindbloom have treated thousands of patients this way. The typical protocol involves a video-based intake with a licensed clinician, followed by four dosing sessions over four weeks, with ongoing clinical and behavioral support through the platform.
There are important caveats. The FDA has issued warnings about compounded ketamine products, noting they have not been evaluated for safety, effectiveness, or quality for psychiatric use. Compounded drugs are not FDA-approved for any indication, and they fall outside the safety monitoring programs that govern Spravato. At-home programs do screen for contraindications including uncontrolled high blood pressure, heart failure, psychotic disorders, active suicidal ideation with a plan, severe respiratory problems, glaucoma, and pregnancy. You’re also required to have a trusted adult physically present during each dosing session and access to a safe, private environment.
At-home options tend to cost less per session than IV infusions, but they deliver the drug differently (absorbed under the tongue rather than directly into the bloodstream), which affects how much reaches your system and how predictable the response is.
How to Find and Vet a Provider
The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP) maintains a clinic directory on its website that can help you locate providers in your area. Your psychiatrist or primary care doctor may also be able to refer you to a reputable clinic. For Spravato specifically, your insurance company can provide a list of certified treatment centers in your network.
When evaluating any ketamine clinic, look for several concrete safety standards. The facility should have standard IV equipment, monitoring equipment for heart rate, blood pressure, respiratory rate, and oxygen levels, and emergency medications readily available. Staff should check your vital signs and level of consciousness during the infusion and watch for dissociative effects or signs of toxicity. Before your first session, expect a medical clearance process that evaluates your general health and any specific risk factors like cardiac, neurological, or urological issues. You should receive a thorough informed consent discussion covering risks, benefits, side effects, and alternative treatments.
A few practical red flags: be cautious of clinics that skip the medical screening, don’t monitor you during and after the infusion, let you drive yourself home, or promise guaranteed results. Any reputable clinic will require you to arrange a ride home with another adult after every session.
Who Qualifies for Treatment
For Spravato, the eligibility criteria are clear: you need a diagnosis of major depressive disorder and an inadequate response to at least two antidepressant trials. For off-label IV ketamine, providers set their own criteria, but most follow similar guidelines and look for evidence that standard treatments haven’t worked. A large trial published in the New England Journal of Medicine enrolled patients between ages 21 and 75 who met diagnostic criteria for major depression without psychotic features and had not responded adequately to at least two antidepressants.
Certain conditions will disqualify you from ketamine treatment in most settings. These include active psychosis or mania, uncontrolled high blood pressure, heart failure, severe lung disease, glaucoma, hyperthyroidism, pregnancy, and a history of ketamine misuse. Active substance use disorders and severe trauma history are evaluated on a case-by-case basis by most providers.