Introduction
Ketamine therapy has rapidly evolved from an experimental treatment to a mainstream option for people with treatment-resistant depression. In 2024, we're seeing more clinics, more research, and more insurance coverage—but also more questions about safety, efficacy, and whether it's right for you.
If you've tried multiple antidepressants without relief, ketamine might have crossed your radar. This article breaks down what we know now, what's changed, and what you actually need to know before considering treatment.How Ketamine Actually Works
Unlike traditional antidepressants that work on serotonin, norepinephrine, or dopamine, ketamine acts on glutamate—the brain's most abundant neurotransmitter. Specifically, it blocks NMDA receptors, which triggers a cascade of changes in neural connectivity.
What makes ketamine unique is its speed. While SSRIs can take 4-6 weeks to show effects, ketamine can reduce suicidal thoughts and depressive symptoms within hours. The catch? The effects are often temporary, requiring ongoing treatment.
Think of traditional antidepressants as slowly building a new road in your brain, while ketamine is more like clearing debris off an existing path—fast, but potentially temporary without maintenance.What the Research Shows in 2024
Recent studies continue to support ketamine's efficacy for treatment-resistant depression:
• Multiple meta-analyses have found response rates of 50-70% in people with treatment-resistant depression
• Response rates appear higher than those typically seen with switching to another traditional antidepressant
• Effects typically last 1-2 weeks per infusion on average, though duration varies significantly between individuals
• The FDA-approved nasal spray Spravato (esketamine) received approval in 2019 for treatment-resistant depression and shows comparable efficacy to IV ketamine in clinical trials
However, long-term studies beyond 6-12 months remain limited. Questions about optimal dosing schedules, duration of treatment, and long-term safety continue to be investigated in ongoing research.Types of Ketamine Treatment
IV Ketamine Infusions
The original and most studied method. You'll receive ketamine through an IV over 40 minutes in a medical setting. Typically starts with 6 sessions over 2-3 weeks, then maintenance sessions as needed.
Spravato (Esketamine) Nasal Spray
FDA-approved specifically for treatment-resistant depression. Must be administered in a doctor's office with 2-hour observation. Often combined with an oral antidepressant.
At-Home Ketamine (Oral Lozenges)
Some clinics now prescribe oral ketamine lozenges for home use. Less expensive and more convenient, but potentially less effective and with more safety concerns.
Ketamine-Assisted Psychotherapy (KAP)
Combines ketamine sessions with psychotherapy, aiming to process insights that emerge during treatment. Growing in popularity but limited research.The Reality of Cost
Here's where things get tough:
IV Ketamine: $400-800 per session
Initial series (6 sessions): $2,400-4,800
Maintenance sessions: $400-800 per session, frequency varies
Spravato: $600-900 per session (but more insurance coverage)
Insurance Coverage in 2024
Spravato has broader insurance coverage since it's FDA-approved. IV ketamine is rarely covered unless you're in a research study. Some flexible spending accounts (FSAs) or health savings accounts (HSAs) may cover it.
Many clinics offer payment plans, but the cost remains a significant barrier for most people.What to Expect During Treatment
Before Treatment:
• Medical screening (ketamine isn't safe for everyone)
• Blood pressure check (ketamine raises BP temporarily)
• Discussion of mental health history
• Someone to drive you home
During a Session:
• You'll be in a comfortable chair or bed
• Blood pressure monitored throughout
• Many people experience dissociation—feeling disconnected from your body or reality
• Some describe it as floating, dreaming while awake, or an out-of-body experience
• This typically isn't scary when you know it's coming and temporary
After Treatment:
• Effects wear off within 30-60 minutes
• You shouldn't drive for at least 24 hours
• Some people feel immediate mood improvement
• Others notice changes over the next few daysWho Shouldn't Consider Ketamine
Ketamine isn't appropriate for everyone:
• People with uncontrolled high blood pressure
• History of psychosis or schizophrenia
• Active substance use disorder (particularly stimulants)
• Severe liver disease
• Pregnancy
• History of ketamine abuse
Also, while ketamine can be effective for treatment-resistant depression, it's not typically a first-line treatment. You should have tried at least 2-3 different antidepressants first.The Addiction Question
Ketamine is a controlled substance with potential for abuse. However, the doses used therapeutically are much lower than recreational doses.
In clinical settings with medical supervision, addiction risk appears low. The bigger concern is psychological dependence—feeling like you need ketamine to function. This is why integration therapy and having a tapering plan is important.
At-home ketamine prescriptions raise more concerns about misuse, which is why medical supervision is strongly recommended.Questions to Ask Your Provider
Before starting ketamine therapy, ask:
1. How many ketamine treatments have you administered?
2. What's your protocol for initial and maintenance dosing?
3. Do you offer integration therapy or just medication?
4. What's your plan if I respond well? If I don't respond?
5. How do you screen for contraindications?
6. What percentage of your patients continue beyond the initial series?
7. What happens if I have a bad reaction during treatment?
8. Do you prescribe at-home ketamine, and if so, what are your safety protocols?Bottom Line
Ketamine therapy in 2024 offers real hope for people with treatment-resistant depression, but it's not a miracle cure. It works quickly for many people, but effects can be temporary without ongoing treatment.
The costs are substantial, insurance coverage is limited (except for Spravato), and we're still learning about long-term use. If you've tried multiple antidepressants without success and can afford treatment, ketamine may be worth discussing with a psychiatrist.
Just remember: ketamine works best as part of comprehensive treatment that includes therapy, lifestyle changes, and addressing underlying factors contributing to depression. It's a tool, not a complete solution.