Ketamine therapy for depression

Where the evidence stands

Racemic ketamine has the most trial data of any off-label treatment for major depression. Infusions of 0.5 mg/kg produce response in roughly half to two thirds of patients within days, including in people who have failed several medications. The effect of a single infusion fades within one to two weeks; a series of six holds gains longer, and boosters extend them. See the coverage hub, the ketamine therapy hub, and the coverage checker.

Who is a candidate

Adults with major depressive disorder that has not responded to at least two antidepressants, without uncontrolled hypertension, psychosis, active substance misuse or pregnancy. Ketamine is also used earlier than that in severe depression with suicidal thinking because it works within hours.

What treatment looks like

Six infusions over two to three weeks, each 40 minutes plus recovery, then boosters as needed. Most clinics track a PHQ-9 or MADRS score and stop after three or four sessions without any response.

Coverage and cost

Insurers do not cover ketamine for depression because it is off label. Expect $350 to $850 per infusion cash. If you meet the criteria for Spravato, the FDA-approved esketamine spray, most plans cover it instead. See Spravato for depression.