IV Ketamine Infusion

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Treatment-resistant depressionAcute suicidal ideationPTSDChronic neuropathic painComplex regional pain syndrome

Mechanism

Ketamine is a non-competitive NMDA receptor antagonist that modulates glutamate release, enhances synaptic plasticity, and increases BDNF levels. This cascade promotes rapid changes in neural circuitry associated with mood regulation.

Protocol

Preparation

Comprehensive psychiatric evaluation; baseline vitals; informed consent.

Procedure

Administer ketamine 0.5 mg/kg IV over 40 minutes (common research protocol).
Monitor vitals continuously.
Provide a calm, low-stimulation environment to minimize distress from dissociation.

Frequency: Typical induction: 2–3 infusions per week for 2–4 weeks; maintenance varies by patient response.

Duration: Induction phase: 4–8 sessions; maintenance can be monthly or as clinically indicated.

Total Treatment Time: Initial course spans 2–4 weeks; ongoing maintenance possible.

Equipment

Infusion pump
IV access supplies
Blood pressure monitor
Pulse oximeter
Emergency medications and oxygen

Expected Outcomes

Immediate

Mood lift within hours
Reduction in suicidal thoughts

Short Term

Improved depressive symptoms
Increased motivation

Long Term

Sustained remission (with maintenance)
Reduced relapse frequency

Side Effects

common

Dissociation
Increased blood pressure
Nausea
Dizziness

uncommon

Headache
Blurred vision
Anxiety during infusion

rare

Hallucinations causing severe distress
Loss of consciousness

Contraindications

absolute

Uncontrolled hypertension
Aneurysmal vascular disease
History of psychosis

relative

Substance use disorders
Pregnancy
Severe cardiovascular disease

special considerations

Increased monitoring in elderly or medically fragile patients.

Patient Selection

ideal candidates

Adults with treatment-resistant depression
Patients with acute suicidal ideation
Chronic pain patients unresponsive to conventional therapies

screening required

Full psychiatric and medical history
Baseline blood pressure and cardiovascular assessment

Research Evidence

Key Studies

Zarate CA Jr, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry. 2006.
Feder A, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical trial. Am J Psychiatry. 2014.

Limitations

Effects are rapid but may be transient without maintenance; optimal dosing and long-term safety require further research.

Cost Considerations

typical session cost: $400–$800 per infusion

total treatment cost: $3,200–$6,400 for an induction course

insurance coverage: Variable; often out-of-pocket unless approved for pain indications.

cost effectiveness: High in cases where rapid symptom relief prevents hospitalization or suicide.

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Integration Support

Concurrent Therapies

Psychotherapy (especially CBT or trauma-focused)
Pharmacotherapy
Lifestyle interventions

Special Populations

👶Pregnancy

Avoid unless benefits clearly outweigh risks.

This treatment information is for educational purposes only. Treatment decisions should be made in consultation with qualified healthcare professionals based on individual circumstances, symptoms, and medical history. Do not attempt treatment without professional guidance.

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This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

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