Ketamine Therapy FAQ
Answers to the most commonly asked questions about ketamine therapy, covering eligibility, costs, insurance, side effects, treatment protocols, and how to find a provider.
Reviewed for clinical accuracy against peer-reviewed literature and FDA guidelines · Last updated April 2026
22 Questions Answered
This FAQ covers the most common questions patients ask before starting ketamine therapy. All answers are reviewed for accuracy against published clinical literature and FDA guidelines. For treatment-specific details, see our comprehensive therapy guide or individual treatment pages.
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Eligibility & Getting Started
Who is eligible for ketamine therapy?
Ketamine therapy is generally available to adults aged 18 and older with qualifying conditions such as treatment-resistant depression (TRD), PTSD, anxiety disorders, chronic pain, OCD, or suicidal ideation. For Spravato specifically, patients must demonstrate documented failure of at least 2 adequate antidepressant trials. Common contraindications include uncontrolled hypertension, active psychosis, aneurysmal vascular disease, unstable cardiovascular disease, pregnancy, and active substance use disorder. Your provider will evaluate your complete medical history before recommending treatment.
What conditions does ketamine treat?
Ketamine therapy is used for treatment-resistant depression (TRD), major depressive disorder with suicidal ideation, PTSD, generalized anxiety disorder, chronic pain conditions (CRPS, fibromyalgia, neuropathic pain), OCD, and bipolar depression. The strongest clinical evidence exists for treatment-resistant depression, where response rates of 60–70% have been demonstrated in randomized controlled trials. Spravato is FDA-approved specifically for TRD and MDD with suicidal ideation. All other ketamine applications are considered off-label.
How do I know if I have treatment-resistant depression?
Treatment-resistant depression (TRD) is generally defined as depression that has not responded adequately to at least 2 different antidepressant medications tried at adequate doses for adequate durations (typically 6–8 weeks each). If you have tried multiple antidepressants without satisfactory improvement, you may have TRD. Your psychiatrist can formally evaluate your treatment history and determine if ketamine therapy is an appropriate next step.
Do I need a referral to start ketamine therapy?
Most ketamine clinics do not require a formal referral from another physician, though some providers prefer one. You can typically contact a ketamine clinic directly to schedule an initial consultation. For Spravato, your prescribing psychiatrist will handle the prior authorization process with your insurance company. It is helpful to bring records of your treatment history, including medications tried and outcomes, to your initial evaluation.
Side Effects & Safety
What are the side effects of ketamine therapy?
Common side effects include dissociation (41% of patients), dizziness (29%), nausea (26–40%), sedation (23%), transient blood pressure increase, headache, and blurred vision. Most side effects resolve within 1–2 hours after treatment. Serious side effects are rare at the sub-anesthetic doses used for depression. Patients are monitored throughout treatment and during a post-treatment observation period. You cannot drive on the day of treatment.
Is ketamine therapy addictive?
Ketamine does have potential for misuse, which is why it is a Schedule III controlled substance. However, the risk of addiction at the low, sub-anesthetic doses used in clinical treatment is considered low when administered under medical supervision with structured protocols. The REMS program for Spravato includes safeguards against misuse. Patients with a history of substance use disorder should discuss risks thoroughly with their provider, as some clinics will not treat active substance use disorders while others implement additional monitoring.
Can I drive after ketamine treatment?
No. You cannot drive on the day of ketamine treatment, regardless of the administration route. For Spravato, the REMS program mandates no driving for the remainder of the treatment day. For IV and IM ketamine, clinics require patients to arrange transportation home. The dissociative and sedating effects can impair coordination, reaction time, and judgment even after you feel recovered. Always arrange a ride in advance.
Is ketamine therapy safe long-term?
Long-term safety data from the SUSTAIN-2 open-label trial of Spravato showed a consistent safety profile over 1 year of treatment with no new safety signals. Potential long-term risks of repeated ketamine use include bladder toxicity (interstitial cystitis), though this is primarily seen at much higher doses in recreational use rather than clinical treatment settings. Cognitive effects of long-term, low-dose medical ketamine are still being studied. Regular monitoring by your treatment provider is essential.
Insurance & Costs
How much does ketamine therapy cost?
Costs vary by treatment type: IV ketamine costs $400–$800 per session ($2,400–$4,800 for a standard 6-infusion series). Spravato costs $590–$885 per session at list price but is often covered by insurance. IM injection costs $250–$500 per session. Oral/sublingual ketamine costs $100–$250 per month. Ketamine-assisted psychotherapy (KAP) costs $500–$1,500 per session. Annual maintenance costs for IV ketamine range from $4,800 to $12,800 depending on frequency. See our IV vs Spravato comparison for detailed cost breakdowns.
Does insurance cover ketamine therapy?
Spravato (esketamine nasal spray) is FDA-approved and covered by many insurance plans including Medicare Part D, Medicaid in most states, and major commercial insurers such as Blue Cross, Aetna, UnitedHealthcare, and Cigna. Prior authorization is required, and patients must document failure of at least 2 antidepressants. The Janssen Savings Program offers $0 copay for eligible commercial insurance patients. IV ketamine, IM ketamine, oral ketamine, and KAP are all off-label and rarely covered by insurance.
Can I use HSA or FSA for ketamine therapy?
Yes. All forms of ketamine therapy — including IV infusions, Spravato, IM injections, oral ketamine, and KAP — are generally eligible for Health Savings Account (HSA) and Flexible Spending Account (FSA) reimbursement as qualified medical expenses. Check with your specific plan administrator to confirm eligibility, but ketamine therapy prescribed by a licensed physician for a medical condition typically qualifies.
What is the Janssen Savings Program for Spravato?
The Janssen Savings Program (also called the Spravato Savings Card) is a patient assistance program offered by the manufacturer of Spravato (Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson). Eligible patients with commercial insurance can receive Spravato treatments with a $0 copay. The program is not available to patients on government insurance (Medicare, Medicaid, TRICARE). Your Spravato treatment center can help you determine eligibility and enroll.
Treatment Duration & Protocols
How many ketamine sessions do I need?
The standard IV ketamine protocol for depression consists of 6 infusions over 2–3 weeks. About 60–70% of patients respond to this initial series. After induction, maintenance infusions are typically needed every 3–6 weeks, with the frequency determined by how quickly symptoms return. Spravato follows a different schedule: twice weekly for 4 weeks, weekly for 4 weeks, then weekly or biweekly for ongoing maintenance. Your provider will assess your progress using validated rating scales and adjust the schedule accordingly.
How quickly does ketamine therapy work?
Ketamine is one of the fastest-acting treatments for depression. Some patients report noticeable improvement in mood within hours of their first treatment. The landmark Zarate et al. 2006 study demonstrated significant antidepressant effects within hours of a single IV infusion, with effects lasting up to 1 week. However, the full benefit of ketamine therapy typically develops over the initial treatment series (2–4 weeks). Not all patients respond, and those who do may notice improvement gradually across sessions rather than immediately.
Will I need ketamine therapy forever?
Most patients require ongoing maintenance treatments to sustain benefits, though the frequency varies widely. Some patients maintain improvement with booster infusions every 4–6 weeks, while others need treatments every 2–3 weeks. Some patients are able to extend intervals gradually over time or transition to less frequent maintenance. Ketamine therapy is typically used alongside other treatments including oral medications, therapy, and lifestyle modifications — not as a standalone permanent solution.
What is the difference between induction and maintenance?
Induction is the initial intensive treatment phase designed to achieve the maximum therapeutic response. For IV ketamine, this is typically 6 infusions over 2–3 weeks. For Spravato, induction is twice-weekly treatment for 4 weeks. Maintenance is the ongoing phase after induction, with treatments spaced further apart to sustain benefits. Maintenance IV ketamine is typically every 3–6 weeks; maintenance Spravato is weekly or biweekly. Your provider adjusts the maintenance schedule based on your individual response.
Finding a Provider
How many ketamine clinics are there in the US?
As of 2026, there are over 3,606 ketamine therapy providers across 51 states in the United States. This includes 3,302 Spravato REMS-certified treatment centers registered with the FDA and approximately 419 member clinics of the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP). The number of providers has grown significantly since 2019 following FDA approval of Spravato. You can browse clinics by state in our directory.
What should I look for in a ketamine clinic?
Key factors include: (1) Medical credentials — board-certified psychiatrists, anesthesiologists, or physicians with specific ketamine training; (2) Treatment environment — clinical setting with vital sign monitoring, emergency protocols, and resuscitation equipment; (3) Spravato REMS certification — required for Spravato treatment; (4) ASKP membership — indicates adherence to professional standards; (5) Transparent pricing; (6) Comprehensive evaluation and follow-up protocols; (7) Experience — how many patients the clinic has treated.
What is the difference between ASKP and Spravato REMS?
ASKP (American Society of Ketamine Physicians, Psychotherapists, and Practitioners) is a professional membership organization for ketamine therapy providers. Membership is voluntary and indicates the provider follows professional standards for ketamine therapy. Spravato REMS (Risk Evaluation and Mitigation Strategy) is an FDA-mandated certification program that healthcare facilities must complete to administer Spravato. REMS certification is legally required for Spravato treatment and involves specific safety protocols including 2-hour post-dose monitoring. Our directory includes approximately 419 ASKP member clinics and 3,302 REMS-certified centers.
Comparing Treatments
What is the difference between IV ketamine and Spravato?
IV ketamine uses racemic ketamine (both S- and R-enantiomers) delivered intravenously with 100% bioavailability. It is off-label and rarely covered by insurance ($400–$800/session). Spravato (esketamine) contains only the S-enantiomer, is delivered as a nasal spray with ~48% bioavailability, and is FDA-approved and often covered by insurance. Spravato requires treatment at a REMS-certified facility with 2-hour monitoring. See our full IV vs Spravato comparison.
What is ketamine-assisted psychotherapy (KAP)?
KAP combines sub-anesthetic doses of ketamine with guided psychotherapy in a structured three-phase protocol: preparation (setting intentions), medicine session (ketamine with therapeutic guidance), and integration (processing insights). Sessions last 2–4 hours and cost $500–$1,500. KAP is particularly effective for trauma-related conditions like PTSD. The therapist helps patients access and process difficult emotions and memories while the ketamine-induced neuroplasticity facilitates deeper therapeutic work.
Can I take ketamine at home?
Oral/sublingual ketamine lozenges can be prescribed for at-home use after an initial evaluation with a qualified provider. Many telehealth platforms now offer this option. Most providers require a responsible adult present during sessions. At-home ketamine costs $100–$250 per month and has lower bioavailability (~25–30%) than clinical routes. IV and IM ketamine require in-clinic administration. Spravato cannot be taken home — the REMS program mandates supervised administration at a certified facility.
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