Supportive Therapy
Ketamine treatment has opened new doors for people who haven’t found relief from traditional antidepressants or therapy alone. It works differently in the brain, often providing noticeable symptom improvement within hours or days instead of weeks.
Whether it’s given through an IV infusion, Intramuscular (IM) injection, oral lozenge (troche), or nasal spray (Spravato®), each method offers its own pros and cons. Understanding these options helps you choose the path that feels safest and most supportive for your healing journey.
Key Summary:
The four main types of ketamine treatments are IV infusions, IM injections, oral lozenges, and Spravato® nasal spray. IV and IM treatments work quickly and are done in clinics, while oral lozenges are often used for ketamine assisted therapy in the presence of a trained therapist, or in the home setting. Spravato® is FDA-approved for treatment-resistant depression and is often covered by insurance.
What Is Ketamine Treatment?
Ketamine treatment is a medical therapy that uses low, subanesthetic doses of ketamine to help relieve symptoms of depression, suicidal ideation, anxiety, PTSD/trauma, and chronic pain.
It works on brain receptors that regulate mood and emotion, often helping when other medications haven’t. Unlike traditional antidepressants, ketamine can create a rapid shift in how the brain processes thoughts and emotions, bringing relief much sooner for some individuals.
Ketamine was originally developed as a dissociative anesthetic in the 1960s, but clinical trials later discovered its powerful antidepressant and neuroplastic effects. In addition to anesthesia, today it is often used in carefully monitored settings for mental health care.
At clinics like Innate Wisdom Psychiatry & Wellness, ketamine may be prescribed/and or administered as part of an integrative treatment plan, which can include medication management, supportive therapy, mindfulness and somatic education, and lifestyle support.
How Ketamine Works
Ketamine’s mechanism of antidepressant action is complex and still being studied. It is thought to reduce depression by blocking NMDA receptors in the brain, which leads to changes in the levels of the neurotransmitter Glutamate, which is involved in mood regulation. In some areas of the brain, it is thought to decrease glutamate activity. In others, it has been shown to increase glutamate levels, which leads to the release of BDNF, or brain-derived neurotrophic factor. This promotes neuroplasticity and repair of synaptic connections thought to be impaired in depression.
Studies of depression using various routes of ketamine administration have demonstrated that approximately 70% of individuals have a positive antidepressant response. Typically, these effects are rapidly felt within 24 hours to days, and the antidepressant effects of one session can last upwards of one week. When more sessions are done over a particular period, this reduction in symptoms can last for longer, possibly up to a month or more.
The strength and duration of the response often depends on the individual. Ketamine effects typically do wear off over time. Relapses can occur and may require periodic additional sessions. A certain small number of patients may become unresponsive to further ketamine sessions.
Here’s a simple way to think about it:
Traditional antidepressants slowly “balance” brain chemicals.
Ketamine helps the brain rewire faster, improving communication between mood-related regions and/or disrupting old patterns.
This can lead to a renewed sense of calm, clarity, and emotional flexibility.
In fact, a 2021 qualitative study found that most patients experienced rapid mood improvement and a clear reduction in suicidal thoughts within 3 to 6 days of ketamine infusions, often describing the change as “life-changing.”
Conditions It May Help Treat
Ketamine treatment can support recovery from several mental health and pain-related conditions, especially when other approaches haven’t worked.
Common conditions include:
Treatment-resistant depression
Anxiety and panic disorders
Post-traumatic stress disorder (PTSD)
Obsessive-compulsive disorder (OCD)
Bipolar depression
Chronic pain syndromes, such as fibromyalgia or neuropathic pain
Each person’s response is unique, which is why careful evaluation and personalized treatment planning are key to safe and effective results.
What Are the Different Types of Ketamine Treatments?
The main types of ketamine treatments are IV infusions, IM injections, oral lozenges, and Spravato® (nasal spray). IV, IM, and oral ketamine are known as R-ketamine and are used off-label for mental health treatment, while Spravato® is FDA approved. Spravato® only contains one part of the ketamine molecule, known as S-ketamine, and the racemic form of ketamine (R-ketamine) contains both R and S isomers.
Each method delivers ketamine differently-the right option depends on your symptoms, goals, and overall treatment plan.
Let’s look at how each type works and who might benefit most.
IV Ketamine Infusions
IV ketamine infusions are one of the most researched and effective forms of treatment. Ketamine is delivered directly into the bloodstream through an IV line, allowing precise control over dosing and timing.
Each session typically lasts approximately 60 minutes in a calm, supervised setting. Because IV ketamine therapy ensures consistent absorption and controlled dosing, many patients notice rapid improvement in symptoms, sometimes within hours.
Studies show that ketamine infusion therapy can help with treatment-resistant depression, post-traumatic stress disorder, OCD, and chronic pain conditions. In one study, patients receiving sub-anesthetic IV ketamine (0.5 mg/kg) experienced significant relief within the first hour, with benefits lasting up to a month.
IV therapy is ideal for those with more severe symptoms, such as suicidal ideation, or individuals who require closely monitored care and faster results when other treatments haven’t helped.
Pros:
Provides the most precise control over dosage and duration.
Produces rapid, measurable symptom improvement.
Backed by the most clinical research and data.
Supervised by trained medical professionals during the entire session.
Cons:
Usually not covered by insurance and can be costly.
Requires in-person visits to a medical facility.
Is often done more for symptom management and not combined with therapy
IM (Intramuscular) Ketamine Injections
IM injections deliver ketamine into a large muscle, such as the thigh or shoulder, where it’s rapidly absorbed into the bloodstream. The onset is typically fast, but unlike IV infusions, the dose cannot be adjusted once administered. Because of this, depending on the dose, IM ketamine can often more reliably produce non-ordinary states of consciousness (NOSC) than IV infusions.
Session times are similar to IV (around 60 minutes), and monitoring still takes place in a clinical environment.
IM ketamine is a practical and efficacious option for individuals who want the benefits of in-clinic treatment without the need for IV access. It is suitable for those dealing with depression, suicidal ideation, anxiety, or trauma-related symptoms who prefer a simpler setup.
Pros:
Quick onset of therapeutic effects may more reliably lead to NOSC
No need for IV placement
Can be administered safely in a clinic with minimal setup.
Cons:
Dosing cannot be adjusted once injected.
May produce a more intense experience for some.
May cause soreness at the injection site.
Oral Ketamine Lozenges (or Troches)
Oral ketamine lozenges, also called troches, dissolve under the tongue or inside the cheek, allowing ketamine to be absorbed through the oral tissue.
They are often prescribed as an in-home maintenance option for patients who have already undergone in-clinic treatments or for use in conjunction with Ketamine-Assisted Psychotherapy (KAP).
While lozenges have a lower absorption rate than IV or IM treatments, they can still support ongoing emotional stability, improvement in mood and anxiety, and help catalyze therapeutic growth change. When combined with therapy, ketamine may help patients process insights more quickly than traditional therapy alone.
Pros:
Often more readily accessible for KAP or maintenance treatment
Non-invasive administration method, avoiding the use of needles required for IV or intramuscular injections.
Can be more affordable than in-clinic treatments.
Cons:
Less predictable absorption and slower onset.
Not ideal for severe or urgent symptoms needing close monitoring.
Taste or need for oral absorption may be a barrier for some.
Spravato® (Esketamine) Nasal Spray
Spravato® is an FDA-approved form of nasal ketamine therapy (esketamine) designed for treatment-resistant depression. This nasal therapy is administered in a certified clinic under supervision, offering a structured, insurance-covered option for those seeking a safe and regulated form of ketamine treatment.
The nasal spray delivers esketamine through the nasal passages, where it’s quickly absorbed and starts working within 10 to 20 minutes.
Research shows that esketamine can significantly improve depressive symptoms, making it an accessible and effective choice for many patients.
FDA approval for intranasal esketamine in 2019 came after large Phase 3 trials demonstrated meaningful improvements in depression scores after four weeks of twice-weekly treatment in conjunction with an oral antidepressant compared to placebo.
As of 2025, the FDA no longer requires Spravato® to be used in conjunction with an oral antidepressant. Spravato® provides a well-monitored, insurance-supported treatment path for those seeking relief from persistent depression.
Pros:
FDA-approved and covered by many insurance plans.
Fast onset and minimally invasive.
Conducted in a safe, supervised clinic environment.
Cons:
Recent research indicates R-ketamine may have an advantage over Spravato® in treating depression
Requires regular in-clinic visits for administration and maintenance treatments
Requires fixed dosing schedule (less flexible).
Comparing the Types of Ketamine Treatments
Each type of ketamine treatment has its own strengths, level of monitoring, and onset speed. Here’s a simple comparison to help you see how they differ and which may best fit your needs.
| Type | How It’s Given | Setting | Onset Time | Dosing Control |
Insurance Coverage |
Best For |
|---|---|---|---|---|---|---|
| IV Infusion | Delivered directly into a vein | In-clinic | Within minutes | High precision | Typically self-pay | Treatment-resistant depression, suicidal thoughts, PTSD/trauma, or chronic pain |
| IM Injection | Injected into a large muscle | In-clinic | 5–10 minutes | Precision | Typically self-pay | Treatment-resistant depression, suicidal thoughts PTSD/trauma |
| Oral Lozenges | Dissolved under tongue or cheek | At home or clinic-guided | Approx. 30 minutes | Moderate/Low | Typically self-pay | Maintenance care or KAP with therapist |
| Spravato® (Esketamine) | Nasal spray | In-clinic | 10–20 minutes | Fixed dosing | Often covered | Treatment-resistant depression, insured patients |
What Are the Side Effects of Ketamine Treatment?
Most people experience only mild and short-term side effects from ketamine treatment, which typically fade within an hour after the session.
These effects can vary depending on the dose, type of treatment, and individual sensitivity. Ketamine sessions are always supervised to make sure you stay comfortable and safe throughout the process.
Common short-term effects may include:
Lightheadedness or dizziness
Mild nausea or upset stomach
Impaired coordination/unsteadiness
A floating or dream-like sensation, feeling strange or “unreal.”
Headache
Blurred vision or mild disorientation
Temporary increase in heart rate or blood pressure
Mild fatigue after the session
Your provider will monitor you closely and guide you through these effects, helping you recover smoothly before you leave the clinic.
Is Ketamine Safe for Long-Term Use?
When prescribed and monitored by experienced health care providers, ketamine therapy has shown a strong safety record in both short-term and long-term use. Most side effects are temporary and manageable, and ongoing research continues to support its use for treatment-resistant depression and mood disorders.
Long-term safety depends on proper medical oversight and responsible use. Regular follow-ups help maintain controlled dosing, prevent overuse, and support lasting improvement.
Who Should Not Use Ketamine Treatment
Ketamine treatment is safe for most adults, but it may not be right for everyone. People with certain health conditions or risk factors should discuss alternatives with their provider.
Avoid ketamine therapy if you have:
Uncontrolled high blood pressure or heart disease
A history of psychosis, schizophrenia, or severe personality disorder
Active substance use disorder
Severe liver or kidney disease
Pregnancy or are breastfeeding
Glaucoma
Untreated hyperthyroidism
Unstable medical conditions that need hospital-level care
Is Ketamine Treatment Right for You?
Before ketamine treatment at Innate Wisdom Psychiatry & Wellness is considered, patients undergo a thorough psychiatric and medical evaluation to confirm that it is safe and indicated for their specific conditions.
You may be a good candidate if you:
Have depression, treatment resistant depression, anxiety, PTSD/trauma, or OCD that hasn’t improved with other treatments
Are interested in pursuing intramuscular ketamine treatments or oral treatment in conjunction with Ketamine Assisted Psychotherapy (KAP)
Are working with a licensed therapist who is certified in KAP
Have no major contraindications
Are willing to attend regular follow-ups to track progress and adjust treatment
Understand that ketamine works best as part of an integrative plan
If you’re unsure whether ketamine is right for you, a ketamine treatment evaluation can determine whether ketamine fits safely into your treatment path.
How Much Does Ketamine Treatment Generally Cost?
The cost of ketamine treatment typically ranges from $400 to $800 per session, depending on the method, clinic, and treatment plan.
IV and IM treatments are usually self-pay, while Spravato® (FDA approved nasal spray) is often covered by insurance. The total cost typically depends on how many sessions you need.
While the price may seem high, many patients find it worthwhile because of the rapid relief and ongoing benefits that ketamine can provide to treat depression, post-traumatic stress disorder, as well as chronic pain conditions.
Some clinics also offer payment plans or help verify insurance coverage to make care more accessible. It’s always best to discuss options directly with your provider so your treatment plan fits both your goals and your budget.
How Innate Wisdom Psychiatry & Wellness Can Help
Innate Wisdom Psychiatry & Wellness takes an integrative approach to ketamine treatment. Care plans often contain evidence-based psychiatric medication management and supplementation as needed, supportive therapy, mindfulness, and somatic techniques, and lifestyle guidance.
Each treatment plan is customized, focusing on your emotional, physical, and mental well-being, not just treating symptoms.
Under the care of Daniel Plastino, PMHNP-BC, patients receive thoughtful evaluations to determine whether ketamine treatment is a safe and appropriate option.
Daniel offers supervised Intramuscular (IM) ketamine treatments in a quiet and comfortable office setting. If you desire, these sessions can include integration as well to facilitate processing of your experience. At this time, IM ketamine sessions are self-pay only and are $400 for the two hour session.
Additionally, Daniel conducts ketamine treatment evaluations and prescribing for individuals working with their therapist for ketamine-assisted psychotherapy (KAP). For the treatment evaluations, clients can utilize their insurance. KAP sessions and the medication are typically self-pay. This collaborative model helps ensure that both the medical and therapeutic aspects of care align, optimizing results.
Whether you’re exploring ketamine for the first time or looking for guidance after previous treatments, the goal at Innate Wisdom Psychiatry & Wellness is simple: to support you with compassionate, evidence-based care every step of the way.
Conclusion
Ketamine treatment has become a promising option for people who haven’t found relief through traditional methods.
By understanding the different forms of treatment, such as IV, IM, oral, and Spravato®, you can make more informed decisions about your mental health care and choose the approach that best fits your needs.
If you’re ready to explore whether ketamine therapy might be right for you, Innate Wisdom Psychiatry & Wellness offers caring, personalized support to guide you through the process.
Contact us today and take your first step toward lasting relief and renewed balance.
FAQs
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The effects of ketamine treatment can last anywhere from several days to a few weeks after a single session. Many patients complete a short series of treatments over several weeks, followed by maintenance sessions as needed to support lasting benefits.
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Coverage depends on the type of treatment. Spravato® (esketamine) is FDA-approved and may be covered by Medicaid or other insurance plans, while IV, IM, or oral ketamine treatments are usually self-pay. It’s best to check with your provider to review your specific coverage options.
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Most patients begin with a structured series of 3 to 6 sessions over a few weeks, followed by periodic maintenance appointments. The exact number depends on how you respond and your provider’s recommendations based on your progress and goals.
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Although there are online and telepsychiatry companies that utilize in-home oral ketamine treatment models, at Innate Wisdom Psychiatry & Wellness, we believe that ketamine is best utilized in clinical settings under direct supervision from medical and psychiatric professionals to ensure safety and effectiveness.
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Ketamine works on glutamate and NMDA receptors, promoting rapid-acting antidepressant effects and neuroplasticity, while most antidepressants target other neurotransmitters, like serotonin, norepinephrine, and dopamine. This difference allows ketamine to provide faster relief, often within hours or days, instead of weeks.
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Yes, ketamine therapy has been shown to help with major depressive disorder, bipolar disorder, anxiety disorders, PTSD, and other psychiatric conditions. It acts as a dissociative anesthetic with rapid antidepressant effects, making it a breakthrough treatment for people who haven’t found relief with traditional options.