Ketamine Therapy for Depression

What the Evidence Says About Ketamine for Depression

Ketamine is the most closely studied rapid-acting antidepressant. In the National Institute of Mental Health's words, "ketamine works within hours to strongly reduce depression symptoms in people for whom other treatments have not worked" — a sharp contrast with oral antidepressants, which typically take weeks. NIMH also notes the flip side: "serious concerns limit its use, including problematic side effects and a high risk of misuse."

For patients whose depression has not responded to other medications, the FDA has approved one form of the drug: Spravato (esketamine) nasal spray, indicated for treatment-resistant depression, administered under supervision at a certified treatment center through the Spravato REMS safety program. IV and IM ketamine for depression remain off-label, which is why most clinics offer them on a self-pay basis.

FDA status: Spravato (esketamine) is FDA-approved for treatment-resistant depression and for depressive symptoms in MDD with acute suicidal ideation or behavior. Generic IV/IM ketamine for depression is off-label.

Sources:

• NIMH — New Hope for Rapid-Acting Depression Treatment (2024)
• FDA prescribing information for Spravato (esketamine)

Related Reading

• Does Ketamine Therapy Work for Depression?
• How Many Ketamine Treatments for Depression?
• New Depression Treatments Beyond Antidepressants