Frequently asked questions

When it works, it can work quickly. In trials, some people improve within hours to a day of an infusion. Others improve more gradually. In one small trial that gave six IV infusions over two weeks, the typical responder needed three infusions before responding. For Spravato®, the label says to evaluate benefit at the end of the four-week induction phase. If there is no meaningful change by the end of the planned induction series, talk with your clinician about whether to continue.

It varies. After an induction series, benefits commonly last weeks to a few months. Many patients need maintenance sessions to sustain them. Budget and plan for this from the start. More in How Many Ketamine Treatments Do You Need?

In treatment-resistant depression studies, roughly half of patients respond meaningfully to a course of ketamine. In a large 2023 trial, about 55% responded after six IV infusions. In a pooled analysis of real-world studies, about 45% did. That's a strong number for a population that has already failed multiple treatments. It also means many people won't respond. Anyone quoting you 80–90%+ success is marketing. More in How Well Does Ketamine Work?

At clinical doses, most people experience dissociation rather than vivid hallucinations. That means dream-like detachment and altered perception of time and space. It typically fades within an hour or two after the session.

No. Every legitimate program requires a ride home. The ketamine label advises no driving for 24 hours after a dose, and the Spravato® label says not until the next day after a restful sleep. Our What to Expect page covers what the day looks like for the driver.

Start with three sections written for family members and friends: what the day looks like for the person driving them home, questions a family member can ask the clinic, and warning signs to watch for between sessions. Ask the clinic your questions with the patient present or with the patient's consent.

Usually yes. Most clinics ask you to keep taking your regular psychiatric medications. For depression with acute suicidal thoughts, Spravato® is given with an oral antidepressant. Since January 2025, it can also be used on its own for treatment-resistant depression. Some medications need a conversation first. Observational studies suggest benzodiazepines may blunt ketamine's antidepressant effect, so some programs adjust dose timing on session days. Spravato®'s label says stimulants and MAO inhibitors can add to the blood-pressure rise. Benzodiazepines, opioids, and alcohol can add to sedation. Never change or skip a medication without your prescriber.

Ketamine has real misuse potential. It's a Schedule III controlled substance, and chronic heavy misuse causes serious harm. Supervised clinical protocols at spaced intervals are structured specifically to manage this risk. Tell the evaluating clinician about any substance-use history.

The October 2023 FDA compounding risk alert concerns compounded ketamine marketed for psychiatric conditions. That includes oral or sublingual tablets and lozenges, often used at home without monitoring. The alert does not apply to Spravato®, which is FDA-approved and given under supervision. Our article on at-home ketamine therapy explains what the FDA found, and our safety page covers the wider risk picture.

Standard workplace panels don't usually test for ketamine, but expanded panels can. How long it stays detectable depends on the test, the dose, and how often it was used. If you're subject to testing, discuss documentation with your clinic and employer policy first.

Spravato®: often covered with prior authorization by commercial plans and Medicare when a plan's treatment-resistant depression criteria are met. FDA approval makes coverage more likely, but it depends on your plan, diagnosis, and treatment setting. IV infusions: rarely covered because they're off-label, though evaluation and monitoring visits sometimes are. Details and tactics on our cost page. How the two differ on coverage: Ketamine vs. Spravato. For the published Spravato rules of eight commercial insurers, Medicare, and East Coast Medicaid programs, see our Spravato insurance page.

Cash-pay IV: about $1,800–$4,800 for a six-infusion series, plus maintenance after. That is our arithmetic: six infusions at the $300–$800 per-infusion range reported by HealingMaps, a commercial clinic directory. Spravato® with insurance: your per-visit cost depends on your plan. For people with commercial insurance, a manufacturer savings program can lower the out-of-pocket cost of the medicine to as little as $10 per treatment, up to an annual maximum. It does not cover the clinic's observation fee. A separate manufacturer rebate program pays back what eligible people with commercial insurance paid for observation, up to an annual maximum, after they have paid the clinic. It is not available to residents of Massachusetts, Minnesota, or Rhode Island. Neither program is available with Medicare or Medicaid. Details on our Spravato insurance page.

Yes, when it is prescribed and administered by a licensed, DEA-registered clinician. Ketamine is a Schedule III controlled substance. It is an FDA-approved anesthetic that clinicians can legally prescribe off-label for other conditions. Spravato® is specifically approved for treatment-resistant depression. Buying, holding, or using ketamine without a valid prescription of your own is a crime. The tight rules are about who can prescribe and dispense it.

All three treat resistant depression, and their profiles differ. TMS is noninvasive and often covered by insurance, but it takes weeks. ECT has the strongest efficacy data for severe cases, but the heaviest logistics and side effects. Ketamine is fastest-acting, with the most open-ended maintenance costs. A 2023 randomized trial studied outpatients with nonpsychotic treatment-resistant depression who had been referred for ECT. In that trial, ketamine was noninferior to ECT. This is a decision to make with a psychiatrist, so it helps to be treated somewhere connected to psychiatric care. For a closer look at two of them, see Ketamine vs. TMS.