Ketamine therapy: the complete guide

What it is

Ketamine is a generic anesthetic that, at roughly a tenth of the anesthetic dose, produces a rapid antidepressant effect in many people who have not responded to standard medications. It is given in clinics by intravenous infusion (the most studied route), intramuscular injection, or as a lozenge or nasal spray compounded by a pharmacy. Its use for depression is off label, which is the single fact that drives everything about cost and coverage. See the ketamine therapy hub, the coverage hub, the coverage checker, treatment comparisons and condition and treatment pages.

Who it helps

The best evidence is for major depressive disorder that has not responded to two or more antidepressants. Smaller studies support use in bipolar depression (with a mood stabilizer), PTSD, and suicidal thinking. Response rates in clinical series run 50 to 70 percent for an initial course, with effects that fade over days to weeks without maintenance.

Ketamine is not appropriate with uncontrolled high blood pressure, active psychosis, a history of ketamine or other dissociative misuse, pregnancy, or certain heart conditions. A reputable clinic screens for all of these before the first dose.

What a series looks like

• Induction: six infusions over two to three weeks, each 40 minutes at 0.5 mg/kg, with about an hour of recovery.
• Assessment: a rating scale (PHQ-9 or MADRS) at baseline and after the series. No response after three or four sessions usually means stopping.
• Maintenance: boosters every two to six weeks for responders, tapering as symptoms allow.

During an infusion you feel detached, floaty, and sometimes anxious for 30 to 45 minutes. Nausea, a brief rise in blood pressure, and dizziness are common. You cannot drive afterward.

Why insurance rarely pays

Insurers classify ketamine for depression as experimental because it lacks an FDA indication. A few plans reimburse the infusion or monitoring codes (96365, 96374) when a clinic submits them, and PPO out-of-network benefits sometimes pay a share of a superbill. The drug and the psychiatric supervision are almost always cash.

Spravato, the esketamine nasal spray, is FDA approved and covered. If your plan covers it and you meet its criteria, it is the insured route to the same mechanism.

Cost

Published cash prices run 50 to 50 per infusion, with a six-infusion series between ,100 and ,800. Consultations add 50 to 00. See ketamine therapy cost for current ranges by metro.

Questions to ask a clinic

• Who administers the infusion and who is present for the whole session?
• What is the dosing protocol, and how is response measured?
• What is the full-course price, and is the consultation included?
• Do you provide a superbill, and do you also offer Spravato?