Ketamine for depression: addiction, risks, and real benefits

If you're considering ketamine for depression because nothing else has helped, you're not alone. I've sat with people who felt like they were standing in a dark room for yearsand then a light flicked on within 40 minutes of a ketamine session. It can be that fast for some. And yes, it can be the first real relief after a long stretch of trying.

But let's talk honestly: Is ketamine addictive? When used in a medical setting with proper safeguards, the addiction risk appears low, but it's not zero. My goal here is to give you a clear, no-drama guide to the good, the bad, and the "be careful" of ketamine for depressionso you can make choices that feel safe and smart.

What ketamine can do

Okay, let's set expectations. Ketamine isn't a magic wand, but it can be a powerful toolespecially for treatment-resistant depression. Think of it as a reset button for a brain that's been stuck in a loop.

How fast it works and how long it lasts

Many people feel something shift within an hoursometimes even during the session. That early lift can feel like someone opened a window and let air into a heavy room. But how long does it last? Typically:

• Onset: Around 40 minutes to a few hours after dosing
• Initial course: Usually 26 weeks (for example, 68 sessions)
• Maintenance: Spaced-out "boosters" based on response (weeks to months apart)

Response and remission rates vary across studies, but many trials report meaningful symptom reduction in a substantial portion of people with severe or treatment-resistant depression, and a notable subset reach remission. Some research also shows rapid reduction in suicidal thoughts, sometimes within hours to days after dosing. That speed matters when life feels urgent.

Who it's best for

Ketamine for depression is often considered when standard treatments haven't worked. "Treatment-resistant depression" usually means you've tried at least two adequate trials of antidepressants (right dose, right duration) and still didn't get betteror you couldn't tolerate side effects. If that's you, ketamine may be worth discussing with your clinician, especially if symptoms are severe or suicidal thoughts are present.

Part of a plan, not a cure

Here's the truth: ketamine can open the door, but you still walk through it. In other words, it sets the stage for changethen therapy helps you rehearse the new script. Many clinics now pair ketamine with psychotherapy like CBT during or soon after sessions to reinforce learning and shift patterns. There's a growing body of work suggesting this pairing may help sustain gains by supporting neuroplasticityyour brain's ability to form new, healthier connectionsafter treatment. As Yale Medicine explains, ketamine may stimulate synapse regrowth, creating a window where therapy can "stick" more effectively.

Is it addictive

Short answer? In a medical setting, the risk of addiction looks low for most peoplebut it's not zero. Outside of medical care, with frequent, unsupervised use, risk rises.

The short answer

Let's separate two worlds. Recreational use carries higher risk of ketamine use disorder because of frequent dosing, high amounts, and lack of safeguards. Medical use for depression happens under supervision, at controlled doses, and with time between sessionsso the risk appears much lower. Still, if you have a history of substance use disorder, your care team will weigh risks carefully and may set tighter limits or recommend alternatives.

Medical vs recreational risk

• Medical: Controlled dosing, supervised sessions, pre-screening, and no take-home supply (for esketamine) lower risk.
• Recreational: Repeated, high-frequency use significantly increases risk for dependence and other harms (like bladder issues).

What raises the risk

Certain factors nudge risk upward:

• Personal or family history of substance use disorder
• Unsafeguarded access to ketamine or frequent unsupervised dosing
• Mail-order compounded ketamine without appropriate oversight or monitoring

That last one deserves a spotlight: The FDA has warned about safety and oversight issues with compounded ketamine products, especially when shipped for at-home use without proper medical monitoring, as noted by Harvard Health. This doesn't mean compounded ketamine is always unsafeit means the model of unsupervised access can increase risks.

How clinics lower risk

• Supervised dosing with medical staff present
• Monitoring blood pressure, heart rate, and mental status
• Spacing sessions to avoid frequent redosing
• Integration therapy to support healthy coping
• Coordination with your psychiatrist or primary clinician

Is it perfect? No. But these guardrails matter.

Safety and side effects

Let's talk about what you might feel in your body and mind, and who should be cautious.

Common, short-term effects

Most are short-lived and fade within hours:

• Dissociation (feeling "floaty," altered sense of time or self)
• Dizziness or unsteady walking
• Nausea or vomiting
• Temporary rise in blood pressure and heart rate
• Blurred vision, nystagmus (eye movements)
• Anxiety or unease during the experience
• Drowsiness or fatigue afterward

Clinics typically prepare for theseanti-nausea meds on hand, blood pressure checks, and a quiet recovery space.

Who should be cautious

Ketamine therapy isn't for everyone. Use extra cautionor sometimes avoidif you have:

• Psychosis or schizophrenia
• Uncontrolled hypertension or serious cardiovascular disease
• Pregnancy or are breastfeeding
• Adolescence (use is more limited and specialized)
• Active substance use disorder
• Dementia or significant cognitive impairment

Your clinician will review your medications too. Interactions matter.

Long-term questions

We're still learning about:

• Tolerance with long-term or frequent use
• How durable benefits are after months or years
• Optimal maintenance schedules (how often "boosters" should happen)

That's one reason structured follow-up and outcome tracking are so important. We want a plan that's not just helpful today, but sustainable.

Treatment types compared

There are two main medical approaches: IV ketamine and esketamine nasal spray (brand name Spravato). They're cousins, not twins.

IV vs esketamine

Here's how they typically differ:

• Setting and supervision: Both are done in clinics with monitoring. Esketamine is FDA-approved for treatment-resistant depression and must be given under a Risk Evaluation and Mitigation Strategy (REMS), meaning no take-home; you're observed for at least two hours after dosing. IV ketamine is used off-label for depression, usually with similar monitoring in reputable centers.
• FDA status: Esketamine is FDA-approved for treatment-resistant depression and for depressive symptoms with acute suicidal ideation or behavior (with an oral antidepressant). IV ketamine is not FDA-approved for depression but has a growing clinical evidence base.
• Cost and insurance: Esketamine is more likely to be covered by insurance due to FDA approval. IV ketamine often requires out-of-pocket payment, though some centers and insurers are evolving. Michigan Medicine discusses real-world access and remission/response data, plus ongoing research comparing approaches.
• Head-to-head research: Trials are underway to compare outcomes and durability directly. Early signals are promising for both, but we're still learning which patients do best with which route.

What to expect at a good clinic

Reputable clinics tend to follow a rhythm:

• Screening: Medical, psychiatric, and medication review to check safety
• Informed consent: Clear discussion of benefits, risks, alternatives, and costs
• Dosing: A tailored plan (weight-based for IV; fixed dosing for esketamine) with staff present
• Monitoring: Vitals, comfort, and readiness before discharge
• Integration: A brief debrief and referral to or coordination with therapy
• Follow-up: Outcome measures to track progress and adjust the plan

Clinic red flags

• Minimal or rushed evaluation
• No coordination with your current providers
• Mail-order compounded ketamine without adequate oversight or monitoring
• Guarantees of cure or pressure sales tactics

If something feels off, trust that feeling and get a second opinion.

Deciding with care

How do you know if ketamine is right for you? Let's slow down and check a few boxes.

Quick self-check

• Have you tried at least two antidepressants at adequate doses and duration?
• Have you had structured psychotherapy (CBT, ACT, IPT) with a skilled therapist?
• Are suicidal thoughts present and in need of rapid relief? If yes, talk urgently with your clinician.
• Any medical contraindications (like uncontrolled blood pressure)?
• Do you have support for aftercare and transportation?

Smart questions to ask

Bring this list to your consultation:

• What is your protocol (number of sessions, dosing, schedule)?
• How do you monitor safety during and after sessions?
• What emergency procedures are in place?
• How do you coordinate with my psychiatrist or therapist?
• How do you track outcomes and decide on maintenance?
• What are total costs, including follow-up and integration therapy?
• Do you screen for substance use risk, and how do you mitigate it?

Cost, access, insurance

Money matters, and it's okay to ask direct questions. IV ketamine often ranges from hundreds to a few thousand dollars for an induction series, usually out of pocket. Esketamine is more likely to be covered but still can involve co-pays and time commitments due to observation requirements. University-affiliated clinics may offer sliding-scale options or research studies; private centers may have financing plans. It's worth calling several places to compare.

Maximize benefits, minimize risks

• Pair treatment with therapyideally timed within 2472 hours of sessions
• Prioritize sleep, nutrition, and gentle movement to support neuroplasticity
• Avoid alcohol and non-prescribed substances, and set clear boundaries around use
• Create a safety plan with your clinician and a trusted support person
• Track symptoms with simple scales to see what's actually changing

Real experiences

Let's humanize this.

Rapid reliefand when it doesn't land

Sam, 34, had tried four antidepressants and a year of therapy. After the second ketamine session, they described feeling "like someone cracked a window in my brain." Suicidal thoughts faded to background noise. With weekly CBT, Sam learned to ride the waves rather than drown in them. Six months later, they still need occasional boosters, but life feels livable again.

On the flip side, Erin, 47, felt only a slight lift after six sessions. Disappointing? Absolutely. But it helped her and her psychiatrist pivot to transcranial magnetic stimulation (TMS), which ended up being the right fit. The lesson: a "no" from ketamine isn't a "no" from recovery.

If you don't respond

Take a breath. You still have options:

• Esketamine (if you tried IV ketamine, or vice versa)
• TMS or ECT for severe, persistent cases
• Medication optimization (augmentations like lithium, atypical antipsychotics)
• Therapy focusespecially if trauma, anxiety, or insomnia are in the mix

Recovery paths aren't linear. They're winding, and that's okay.

Evidence check

What does the science actually say right now? Here's the gist, in plain language.

Key study takeaways

• Response is common in treatment-resistant depression; remission happens for a significant subset after a short series of sessions.
• Reductions in suicidal ideation can occur rapidly, which is a major clinical advantage.
• Benefits can wane without maintenance or ongoing therapyhence the emphasis on integration and follow-up.

For a balanced overview of clinic safeguards, side effects, and supervised-use requirements (especially for esketamine), see this summary from Harvard Health. And for the neuroplasticity angle and pairing with psychotherapy, Yale Medicine offers an accessible explanation. Real-world data and ongoing comparisons of IV vs nasal approaches are discussed by Michigan Medicine.

How it may help the brain

If depression is like well-worn grooves in a record, ketamine seems to soften those grooves so new tracks can form. On a biological level, ketamine modulates NMDA receptors and may increase glutamate signaling at AMPA receptors, which then boosts brain-derived neurotrophic factor (BDNF). Translation: conditions that favor neuroplasticityyour brain's ability to grow new synapses and strengthen healthier circuits. That's your window for change.

What we still need to learn

• Who responds best (predictors, biomarkers)
• Long-term safety and the most sustainable maintenance strategies
• How to tailor dosing and therapy timing for maximum durability

The field is moving quickly, and clinics are steadily improving protocols with better screening and outcome tracking.

Safety checklist

Let's make your first experience smoother and safer.

Before your first session

• Arrange a rideyou shouldn't drive the same day
• Eat light to reduce nausea, and follow clinic instructions on meds
• Set intentions: What do you hope to feel or learn?
• Tell a trusted person what time you'll be done and how to reach you
• Schedule therapy within a day or two, if possible

During and after sessions

• Expect drifting thoughts or altered perceptionsthis is normal
• Speak up if you feel anxious; staff can help ground you
• Rest afterward, hydrate, and keep the evening low-key
• Journal or voice-note insightsthese can guide therapy
• Call your clinic if severe nausea, intense anxiety, lingering confusion, or blood pressure concerns arise

Substances and meds

• Avoid alcohol and non-prescribed substancesthese can blunt benefits and raise risks
• Disclose all medications and supplements to your clinic
• Ask specifically about benzodiazepines and stimulantsthey may affect your experience

One more thing: It's okay to feel nervous. You're making a brave choice to try something new for your mental health. That's not small. It's huge.

A gentle close

Ketamine for depression can be a lifelineespecially when nothing else has helpedbut it isn't magic and it isn't for everyone. Used in a supervised medical setting, the addiction risk appears low, and many people feel relief quickly. The safest path is one that balances hope with caution: proper screening, expert oversight, a plan for integration therapy, and honest conversations about side effects, costs, and alternatives. If you're curious, bring the questions from this guide to your primary clinician or psychiatrist and decide together. Your care should feel collaborative, transparent, and grounded in evidenceand your safety should always come first.

What do you thinkcould this be your next step? If you've tried ketamine, what helped you prepare or recover? Share what you're comfortable sharing. And if questions are swirling, don't hesitate to ask. We'll take it one thoughtful step at a time.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.