Ketamine therapy is available through specialty infusion clinics, certified psychiatric facilities, and telehealth platforms that ship oral ketamine to your home. The right option depends on your diagnosis, budget, and how much clinical oversight you want. A standard series of six IV infusions costs between $2,400 and $4,800 out of pocket, while at-home oral programs run significantly less per session.
IV Infusion Clinics
Intravenous ketamine is considered the gold standard for off-label psychiatric use, with the strongest evidence behind it. These clinics are standalone medical offices or hospital-affiliated centers staffed by psychiatrists, anesthesiologists, or nurse practitioners trained in IV administration. During a session, you sit in a reclining chair while ketamine is delivered through an IV line over about 40 minutes. A nurse monitors your blood pressure, heart rate, and oxygen levels throughout the infusion and for at least an hour afterward.
The standard initial protocol is six infusions spread over two to three weeks. Individual sessions typically cost $400 to $800 each, and most clinics charge $250 to $500 for the initial consultation and evaluation before treatment begins. After the induction series, many patients return for periodic booster infusions to maintain results.
To find an IV clinic near you, the American Society of Ketamine Physicians, Psychotherapists, & Practitioners (ASKP3) maintains a searchable directory of member clinics. Membership in the society signals a commitment to ethical standards in treating mood disorders and pain conditions, though it’s not a government certification. Psychology Today’s provider directory also lists ketamine practitioners filtered by location.
Spravato (Esketamine) Nasal Spray Centers
Spravato is the only FDA-approved form of ketamine for depression. It uses esketamine, a close chemical relative of ketamine, delivered as a nasal spray. Unlike IV ketamine, which any qualified provider can prescribe off-label, Spravato can only be given at healthcare settings certified under a mandatory FDA safety program called REMS (Risk Evaluation and Mitigation Strategy). This means you cannot take it home or self-administer it outside a certified facility.
At a REMS-certified center, you self-administer the spray under supervision, then stay for at least two hours of monitoring because of the risks of sedation and dissociation. You’ll need someone to drive you home afterward. The key advantage of Spravato over IV ketamine is insurance coverage: because it has FDA approval for treatment-resistant depression, many insurers will cover it, sometimes after prior authorization. Your prescribing psychiatrist can help locate a certified center, or you can search the Spravato REMS website directly.
At-Home Telehealth Programs
Several telehealth companies now prescribe oral or sublingual ketamine that you take at home. These platforms pair you with a licensed prescriber through a video consultation, then ship dissolvable tablets or lozenges to your door. Sessions are typically guided by recorded or live virtual support, and you’re expected to have a sober companion present during your experience.
The major players in this space include Mindbloom (sublingual tablets or subcutaneous injections), Innerwell (oral rapid-dissolve tablets), Better U (dissolvable lozenges), and Joyous, which uses very low doses compared to competitors. Monthly costs vary but are generally lower than in-clinic IV treatment. Because ketamine is a Schedule III controlled substance, these platforms verify your identity and age before prescribing.
At-home programs trade clinical oversight for convenience and lower cost. You won’t have a nurse checking your vitals, and oral ketamine has less consistent absorption than IV delivery. For people with moderate symptoms who have already tried standard antidepressants, this can be a reasonable entry point. For severe or complex cases, in-clinic treatment with direct medical monitoring is the safer choice.
Who Qualifies for Treatment
Most clinics and telehealth platforms require that you’ve tried other treatments first. Ketamine therapy is generally positioned as a next step after standard antidepressants, medication combinations, or other interventions like transcranial magnetic stimulation (TMS) haven’t produced lasting improvement. The clinical term for this is treatment-resistant depression, typically defined as failing two or more adequate antidepressant trials.
Spravato is FDA-approved specifically for severe major depressive disorder. IV and oral ketamine are used off-label for depression, PTSD, and suicidal ideation. Some clinics also treat chronic pain conditions. Whether you need a formal referral depends on the provider. Private infusion clinics often accept self-referrals but will conduct their own psychiatric evaluation. Hospital-based programs and Spravato centers more commonly require a referral from your psychiatrist or primary care doctor, along with a summary of your treatment history and current medications.
What to Look for in a Safe Clinic
Not all ketamine clinics are created equal. A well-run facility should have at least one provider certified in advanced cardiac life support, along with resuscitation equipment on site. Nurses should be trained in IV administration and monitoring of controlled substances. During your infusion, you should be connected to monitors tracking your heart rate, blood pressure, and oxygen saturation, with vitals checked every 15 minutes for at least an hour after the infusion ends.
A psychiatrist should be present for your first infusion and immediately available for subsequent ones. The clinic should also assess your mood and cognitive function at regular intervals to track your response over time. If a clinic skips the initial psychiatric evaluation, doesn’t monitor vitals, or lets you leave immediately after treatment, those are red flags. Ketamine causes dissociation and sedation in the moment, and blood pressure can spike during infusions, so proper monitoring isn’t optional.
Insurance and Out-of-Pocket Costs
Insurance coverage for ketamine therapy is inconsistent and depends heavily on which form you receive. Spravato, with its FDA approval, has the best chance of being covered by commercial insurance and Medicare, though prior authorization and step therapy requirements (proving you’ve failed other treatments) are common. IV ketamine, prescribed off-label, is rarely covered by private insurance. Some providers bill using infusion therapy procedure codes, and a few state Medicaid programs have begun reimbursing IV ketamine for major depressive disorder, but this is not widespread.
For most people pursuing IV ketamine, the realistic expectation is paying out of pocket. The initial six-infusion series runs $2,400 to $4,800 depending on your location and the clinic. Maintenance boosters add ongoing costs, though they’re typically spaced weeks or months apart. Telehealth oral ketamine programs tend to charge monthly subscription fees that are lower per session but add up over time. Some clinics offer payment plans or financing to make the initial series more manageable.
Availability Outside the United States
In the UK, nasal esketamine has limited availability through the National Health Service on a named-patient basis, but most ketamine therapy happens through private clinics at significant out-of-pocket cost. Racemic (standard) ketamine for depression is growing in both public and private sectors there as a more affordable off-label option. Canada and Australia have seen similar growth in private ketamine clinics, and esketamine nasal spray has been approved for therapeutic use in multiple countries. Access and legal frameworks vary, so availability depends on local regulations and whether your country’s health system has created a reimbursement pathway for ketamine-based treatments.