Exploring IV ketamine for depression can feel like standing in two places at once. Part of you wants relief, and part of you wonders what you are walking into. That hesitation makes sense. Big treatments deserve real questions, especially when you have already tried other options, and you still feel stuck.
This article answers the questions patients tend to ask out loud, and the ones they keep to themselves.
Quick Answer Summary
IV ketamine for depression is a medically supervised infusion used when standard treatments have not provided enough relief. Sessions typically involve low-dose ketamine delivered over about 40 minutes with continuous monitoring of blood pressure, heart rate, and alertness. Common short-term effects include dissociation, dizziness, nausea, and temporary blood-pressure increases, which usually resolve during observation. Real-world studies show that about 1 in 4 patients achieve a clinical response by six weeks, with smaller but meaningful remission rates. Careful screening, onsite monitoring, and follow-up planning are essential to balance potential benefits with known risks.
What Is It and Why Is It Used for Depression?
Ketamine is an FDA-approved anesthetic that clinicians also use in carefully monitored, lower-dose settings for depression when other treatments have not helped enough. People usually hear it described as fast-acting, and that idea alone can make it feel different from standard antidepressant care.
The strongest “why” comes from what we see in real-world clinical settings. In the 2024 VA study by Ganoczy et al., 215 veterans received repeated infusions, and clinicians tracked outcomes with the PHQ-9. By week six, 26% met “response,” defined as a 50% or greater PHQ-9 improvement, and 15% met remission, defined as a PHQ-9 below 5. That is not everyone, but it is a measurable signal in a group that, by definition, has not responded well to prior treatment.
A second real-world lens helps patients understand expectations. In Kevin et al. (2025), a U.S. health-system cohort compared 143 patients who received infusions plus medication management with 427 who received medication management alone. The study reported a higher likelihood of response for the infusion group, with an adjusted relative risk of 1.72, while remission differences stayed smaller at 8% vs. 5% and did not separate clearly.
What Happens During a Session?
The best way to lower anxiety is to make the session feel predictable. A reputable clinic explains what they monitor, what you may feel, and what happens after the infusion ends.
Setting
A typical session happens in a calm clinical space where staff can monitor your body in real time. The VA’s October 2025 protocol gives a concrete example of what a structured model looks like, including 0.5 mg/kg given over 40 minutes. That same protocol lays out repeated vital checks at baseline and then at 10, 20, 30, 40, and 80, with a stability check around 120 minutes before discharge.
Sensation
Many patients worry about the “weird” part more than the needle. Ketamine can cause dissociation, which often feels like being slightly detached from your body or like your thoughts float in a dreamlike way.
Ketamine without proper monitoring can carry risks tied to sedation and dissociation, which is why clinics treat these effects as expected and temporary rather than alarming surprises.
Support
You do not do this alone. Clinicians stay close, and they watch for changes in blood pressure, heart rate, and alertness. If you feel uncomfortable, staff can slow down, pause, or adjust the plan based on what they see and what you report.
Common Concerns About Side Effects and Risks
Safety concerns usually come in two layers. People want to know what might happen today in the chair, and what it might mean long-term if they continue treatment.
Short-term Effects
Short-term effects tend to be transient, but they still matter because they shape your first experience. Blood pressure and pulse often rise after administration, which explains why clinics keep checking vitals during a ketamine infusion.
The FDA also describes risks like respiratory depression in its safety communication about unmonitored compounded ketamine, which reinforces why onsite observation is not a formality.
Long-term Safety
Long-term safety usually comes up once people realize ketamine isn’t a one-and-done treatment. The honest answer is that researchers still don’t have every piece.
In the VA study by Ganoczy et al. (2024), patients who stayed in treatment ended up receiving an average of 18 infusions over about a year, and the authors paused on something important: We need more data on what repeated dosing looks like over time. That doesn’t mean the treatment is unsafe; it means responsible care keeps an eye on patterns as they develop.
Misuse is a different conversation. The 2024 CDC MMWR review of 228,668 overdose deaths found ketamine in 0.4%, involved in 0.2%, and used alone in just 0.01%. Most cases also included fentanyl, methamphetamine, or cocaine (82.4%), which shifts the concern toward polysubstance risk, not monitored clinical use.
Candidacy
Screening protects you. Because ketamine can affect the cardiovascular and respiratory systems, clinics look closely at factors like uncontrolled blood pressure and other conditions that raise risk.
The DEA also lists ketamine as a Schedule III substance, which helps explain why reputable programs handle dosing, storage, and follow-up with extra structure.
What Does “Improvement” Look Like and How Long Does It Last?
Patients usually want one thing here: a timeline they can trust. The reality is not one-size-fits-all, but the data does show patterns worth naming.
Timeline
Some people notice shifts early, while others need more time to see whether the benefit builds. In the VA study by Ganoczy et al. (2024), symptom improvement showed a plateau around week six, which suggests early change may carry the most visible momentum for many patients receiving an IV ketamine infusion.
Nature of Response
People sometimes expect a dramatic shift, but early progress is usually quieter. Maybe the mind feels less crowded or the day feels a little more doable.
In Meisner et al. (2025), symptom scores on QIDS dropped by 49.22% with IV ketamine compared with 39.55% for intranasal esketamine.
Sustainability
Most patients ask the hard follow-up question right after: What happens when the effect fades? The VA data by Ganoczy et al. (2024) reflects longer-term care patterns, including continued infusions over months for some patients, which supports the idea that maintenance can become part of a responsible ketamine infusion therapy plan.
How to Get Ready for Your First Appointment
Preparation sounds small, but it can make the day feel safer and calmer.
Medical History
Bring a clear medication list and be ready to talk through cardiovascular history and prior treatment response. That information matters because clinicians monitor physiologic shifts during a ketamine IV for depression session.
Logistics
Plan for a ride and enough time afterward, since many clinics keep you for observation. Comfortable clothes help, and some places add fasting rules, so it’s worth checking those details before you show up.
Mindset
Try to keep the rest of the day light. Many people do better when they plan for rest afterward and avoid stacking stress on top of a treatment day.
From Uncertainty to Informed Choice
Questions do not signal doubt or weakness. They signal judgment, and you need that when you make decisions about depression care. When you understand what a session looks like, what safety monitoring protects, and what outcomes tend to look like in real-world studies, you stop guessing and start choosing.
A reputable clinic welcomes questions and answers them with specifics. If you want to talk through your situation and whether a medically supervised IV ketamine for depression approach fits, we can help. At Zeam in Sacramento, Roseville and Folsom, we start with a thorough consultation, review your history carefully, and walk you through what to expect before you commit to anything, so contact us to schedule your evaluation and discuss next steps.
Key Takeaways
- Real-world VA outcomes show measurable improvement.
In a 2024 VA cohort of 215 veterans receiving repeated IV ketamine infusions, 26% achieved clinical response (≥50% PHQ-9 improvement) and 15% reached remission (PHQ-9 ≤5) by week six . - Comparative U.S. health-system data support benefit over medication alone.
A 2025 chart review found patients receiving infusions plus medication management were 1.72 times more likely to respond than those on medication management alone, though remission differences were smaller . - Structured monitoring is standard practice.
The 2025 VA clinical protocol outlines 0.5 mg/kg over 40 minutes with vital-sign checks at baseline and throughout the visit, plus observation for roughly two hours before discharge . - Short-term effects are common but usually transient.
Dissociation, sedation, nausea, and blood-pressure elevations are expected and managed onsite; FDA safety communications stress the need for medical supervision rather than unmonitored compounded ketamine . - Population safety context differs from misuse statistics.
CDC overdose surveillance found ketamine involved in only 0.2% of deaths, with most cases including fentanyl, methamphetamine, or cocaine, highlighting the difference between supervised treatment and polysubstance misuse . - IV ketamine and intranasal esketamine show related but distinct patterns.
A 2025 comparison reported greater symptom reduction with IV ketamine (49.2% QIDS improvement) versus intranasal esketamine (39.6%), though both modalities demonstrated benefit .
Citations
- Clinical outcomes of intravenous ketamine for depression in the VA health system – Psychiatrist.com
https://www.psychiatrist.com/jcp/clinical-outcomes-intravenous-ketamine-for-depression-va-health-system/ - Repeated ketamine infusion vs intranasal esketamine chart review – ScienceDirect
https://www.sciencedirect.com/science/article/abs/pii/S0165178124005584?via%3Dihub - VA Formulary Advisor: Ketamine Infusion for Treatment-Resistant Depression (Oct 2025)
https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Ketamine_Infusion_for_Treatment_Resistant_Depression_Rev_Oct_2025.pdf - FDA warning on risks of compounded ketamine
https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine - CDC MMWR overdose surveillance report
https://www.cdc.gov/mmwr/volumes/73/wr/mm7344a4.htm - Comparison of IV ketamine and intranasal esketamine – Psychiatrist.com
https://www.psychiatrist.com/jcp/repeated-ketamine-infusion-vs-intranasal-esketamine-patients-treatment-resistant-depression-chart-review/
