When multiple antidepressants fail, when anxiety persists despite therapy, or when trauma remains stubbornly lodged in the nervous system, the question becomes: what options remain? Ketamine therapy has emerged as a scientifically-backed intervention for mental health conditions that resist conventional treatments. Originally developed as an anesthetic in 1962 and FDA-approved in 1970, ketamine has been used safely in medical settings for over five decades. In the past two decades, researchers discovered its rapid-acting antidepressant properties, marking what many consider a breakthrough in psychiatric treatment.
This guide provides comprehensive information about ketamine therapy—how it works, who it helps, what sessions involve, potential risks, and questions to ask before beginning treatment.
What is Ketamine Therapy?
Ketamine is a dissociative anesthetic medication that, at lower doses than used for surgery, produces rapid mental health benefits. The FDA approved ketamine for use as a general anesthetic, while its psychiatric applications remain “off-label,” meaning physicians prescribe it based on research evidence rather than specific FDA approval for mental health conditions. In 2019, the FDA did approve esketamine (a ketamine derivative) as a nasal spray specifically for treatment-resistant depression, providing additional validation for ketamine’s psychiatric use.
Unlike traditional antidepressants that gradually adjust serotonin or norepinephrine levels over weeks, ketamine acts on the glutamate system—the brain’s primary excitatory neurotransmitter. This different mechanism explains both its rapid onset and its effectiveness in people who haven’t responded to other medications.
How Ketamine Works in the Brain
The NMDA Receptor Connection
Ketamine blocks NMDA receptors, which are involved in glutamate signaling. When these receptors are temporarily blocked, the brain experiences a surge in glutamate release, triggering a cascade of neurochemical events. This process activates proteins that promote the growth of new neural connections—a phenomenon called synaptogenesis.
Neuroplasticity and Brain-Derived Neurotrophic Factor
Chronic depression and stress physically shrink certain brain regions, reducing the number of synaptic connections between neurons. Ketamine stimulates the release of Brain-Derived Neurotrophic Factor (BDNF), a protein essential for neuron growth, maintenance, and survival. Elevated BDNF levels help repair neuronal damage and build new pathways, essentially allowing the brain to rewire itself. This neuroplasticity—the brain’s ability to form new connections—creates opportunities for breaking out of rigid patterns of negative thinking and emotional response.
Effects on the Default Mode Network
The default mode network is a collection of brain regions active when your mind wanders or rests. In depression and anxiety, this network becomes overactive, generating rumination, negative self-talk, and worst-case scenario thinking. Ketamine temporarily disrupts this network’s connectivity, which many patients experience as a mental reset—a break from the constant loop of distressing thoughts.
Timeline of Effects
Ketamine produces measurable symptom reduction within 40 minutes to 24 hours—dramatically faster than conventional antidepressants. Peak benefits typically appear around 72 hours post-treatment. However, effects from a single dose generally last only a few days to two weeks, which is why repeated treatments are usually necessary.
What Conditions Does Ketamine Treat?
Research supports ketamine therapy for several mental health conditions:
Treatment-Resistant Depression
The most robust evidence exists for treatment-resistant depression, defined as major depression that hasn’t responded to at least two adequate trials of antidepressants. Studies show that 50-70% of people with treatment-resistant depression experience significant improvement with ketamine when conventional medications have failed.
Suicidal Ideation
Ketamine demonstrates anti-suicidal effects that appear within hours and work independently of its antidepressant properties. This rapid action can be life-saving for individuals in acute crisis, providing relief while longer-term treatments take effect.
Anxiety Disorders
Research documents meaningful reductions in anxiety symptoms, including panic attacks and obsessive thoughts. The anxiolytic (anxiety-reducing) effects often appear as quickly as the antidepressant benefits.
Post-Traumatic Stress Disorder (PTSD)
Studies show high remission rates for PTSD symptoms when ketamine is combined with trauma-focused psychotherapy. The medication appears to help individuals process traumatic memories with less emotional overwhelm.
Chronic Pain
Beyond mental health, ketamine has extensive evidence for treating various pain conditions including trauma-related pain, fractures, and chronic pain syndromes. Sub-anesthetic doses (also called low-dose ketamine) provide pain relief either alone or alongside other pain medications.
How Ketamine is Administered
Routes of Administration
Ketamine can be delivered through several methods:
- Intravenous (IV) infusion: Most widely used in clinical settings because it offers superior control over dosing and bioavailability. A typical session involves 0.5 mg/kg administered over 40-60 minutes.
- Intranasal (esketamine spray): FDA-approved specifically for treatment-resistant depression. Administered in a medical office under supervision.
- Intramuscular injection: Higher doses (2-3 mg/kg) sometimes used in ketamine-assisted psychotherapy models.
- Oral, sublingual, or other routes: Require less clinical infrastructure but have lower bioavailability and less precise dosing.
Typical Treatment Protocols
Induction phase: Most protocols begin with 4-6 infusions over 2-3 weeks, often administered twice weekly. Some people notice improvement after one session, while others require the full series.
Maintenance phase: Because effects fade after days to weeks, ongoing treatments are usually needed to sustain benefits. Maintenance schedules vary from weekly to monthly infusions depending on individual response.
What to Expect During a Ketamine Session
Before Treatment
A comprehensive medical and psychiatric evaluation determines whether ketamine is appropriate and safe. This assessment reviews medication history, current symptoms, cardiovascular health, and any contraindications. Ketamine is contraindicated in people with severe heart disease, uncontrolled high blood pressure, active psychosis, or severe liver disease.
During the Infusion
You will sit or recline in a comfortable setting while a medical provider establishes IV access and begins the infusion. The session typically lasts 40-60 minutes with continuous monitoring of blood pressure, heart rate, and oxygen levels. Many clinics provide a calm environment with dim lighting and minimal stimulation.
Subjective effects: At therapeutic doses, ketamine produces a dissociative state—a feeling of being detached from your body or surroundings. Some people describe this as floating, dreamlike states, altered time perception, or visual distortions. These effects generally fade within 15-30 minutes after the infusion ends.
After the Session
Dissociative effects resolve quickly, but you should not drive for the remainder of the day. Some clinics provide structured integration time immediately following treatment, helping you process any insights or experiences that emerged. The hours and days following ketamine represent a critical window when the brain is more receptive to forming new patterns through therapy, mindset work, or behavioral changes.
Potential Side Effects and Risks
Common Short-Term Effects
During and immediately after treatment, people may experience:
- Dissociation (feeling disconnected from reality)
- Elevated blood pressure and heart rate
- Nausea or vomiting
- Dizziness or drowsiness
- Perceptual distortions (visual or auditory)
- Confusion or disorientation
These effects typically resolve within hours after treatment ends.
Longer-Term Considerations
The long-term effects of repeated medical ketamine use are still being studied. Recreational ketamine users who consume high doses frequently have shown liver and urinary toxicity, but these patterns of use differ substantially from supervised medical protocols.
Contraindications
Ketamine should not be used in people with:
- Severe cardiovascular disease
- Uncontrolled hypertension
- History of psychosis or schizophrenia
- Active substance use disorders (in most cases)
- Severe liver impairment
- Pregnancy (ketamine crosses the placental barrier)
Abuse Potential
Ketamine is a Schedule III controlled substance with potential for misuse. When used recreationally, it produces hallucinogenic and dissociative effects that some people seek. Medical protocols use controlled doses in supervised settings with careful screening to minimize misuse risk.
The Role of Integration and Psychotherapy
Ketamine creates neuroplastic change—a temporary state where the brain is more malleable and receptive to forming new patterns. However, that window is time-limited. Research increasingly shows that combining ketamine with psychotherapy produces better outcomes than ketamine alone.cambridge
Integration practices help translate acute neurochemical changes into lasting behavioral shifts. This might include processing insights that emerged during sessions, practicing new thought patterns, establishing healthier habits, or working through trauma with a therapist during the period of enhanced neuroplasticity.
How to Choose a Ketamine Provider
When considering ketamine therapy, look for:
- Medical supervision: Treatment should be overseen by physicians or advanced practice providers with training in ketamine protocols and mental health.
- Comprehensive evaluation: Legitimate providers conduct thorough psychiatric and medical assessments before treatment, not just online questionnaires.
- Monitoring protocols: Sessions should include continuous vital sign monitoring and immediate access to emergency equipment.
- Integration support: Ask whether the clinic offers preparation before sessions and integration support afterward.
- Transparent communication: Providers should clearly explain potential benefits, risks, costs, and alternatives.
Cost and Insurance Considerations
Ketamine therapy can be expensive, with costs varying widely based on location and protocol. IV ketamine infusions typically range from $400-$800 per session, and insurance coverage is inconsistent since psychiatric uses remain off-label. Esketamine nasal spray has better insurance coverage because it’s FDA-approved for treatment-resistant depression, though it often requires prior authorization.
Some clinics offer payment plans or package pricing for multiple sessions. When evaluating cost, consider the total treatment course (usually 6-12 initial sessions plus maintenance) rather than per-session pricing.
Questions to Ask Before Starting Treatment
Before beginning ketamine therapy, consider asking potential providers:
- What is your training and experience with ketamine protocols?
- What medical monitoring occurs during sessions?
- What are the contraindications based on my medical history?
- How many treatments will I likely need, and what is the total cost?
- Does insurance cover any portion of treatment?
- What integration or psychotherapy support is included?
- What happens if I have a difficult or distressing experience during a session?
- How do you determine if ketamine is working for me?
- What is your plan if ketamine doesn’t provide adequate relief?
Who is Ketamine Therapy Right For?
Ketamine therapy deserves consideration if you:
- Have been diagnosed with treatment-resistant depression (failed at least two adequate antidepressant trials)
- Experience severe anxiety that hasn’t responded to conventional treatments
- Live with PTSD or complex trauma that persists despite psychotherapy
- Have active suicidal thoughts requiring rapid intervention
- Are willing to commit to a series of treatments plus integration work
- Have been medically cleared (no severe cardiovascular disease, uncontrolled hypertension, or active psychosis)
- Understand that while ketamine can provide rapid relief, maintaining benefits typically requires ongoing treatment
Ketamine is not appropriate for everyone. It works best for individuals committed to a comprehensive treatment approach that may include ongoing therapy, lifestyle modifications, and maintenance sessions.
Ketamine Therapy at Eterna Wellness MD
At Eterna Wellness MD in Peoria, Arizona, ketamine therapy is offered as part of an integrative wellness approach that addresses hormonal balance, nutritional optimization, nervous system regulation, and comprehensive mental health support. The clinic provides physician-supervised protocols with personalized treatment plans designed for each individual’s unique needs.
Read Also: Choosing a Medical Wellness Clinic in Arizona: Expert Guide
Final Considerations
Ketamine represents a significant advancement in treating mental health conditions that resist conventional approaches. Its rapid action and unique mechanism offer hope to people who have exhausted other options. However, ketamine is a tool, not a cure. The medication creates windows of opportunity—periods of enhanced neuroplasticity when lasting change becomes possible—but capitalizing on those windows requires active engagement through therapy, integration practices, and often lifestyle changes.
If you’re considering ketamine therapy, thorough research and consultation with qualified medical providers will help determine whether it aligns with your needs, health status, and treatment goals. For those who are appropriate candidates, ketamine can be a powerful catalyst in the journey toward mental health recovery.
Disclaimer: This article is intended for educational purposes and should not replace professional medical advice. Consult with qualified healthcare providers to determine whether ketamine therapy is appropriate for your individual situation.
