Ketamine therapy involves the monitored use of the dissociative anesthetic, ketamine, at sub-anesthetic doses to treat conditions like chronic pain syndromes or refractory mental health disorders. This treatment has garnered increasing attention for its rapid-acting effects in patients who have not responded to conventional approaches. Determining the minimum age is complex, driven by regulatory frameworks, clinical data, and the specific condition being treated. The answer depends heavily on whether the patient is receiving an FDA-approved formulation or an off-label treatment.
Standard Age Requirements for Adult Treatment
For most clinics providing off-label ketamine treatments, such as intravenous (IV) infusions or compounded oral lozenges, the established minimum age is 18 years old. This 18-year cutoff aligns with the legal requirement for an individual to provide fully informed consent for a medical procedure. Clinical guidelines accept this age because most foundational research regarding ketamine’s therapeutic use has focused on adult populations. While ketamine has been used safely as an anesthetic in children for decades, its application for mood disorders and pain management outside of a hospital setting lacks extensive long-term data for minors.
Pediatric and Adolescent Treatment Protocols
Minors under 18 can receive ketamine therapy, but only under highly specialized and restrictive protocols based on the medical need. The most established use in adolescents is for severe, refractory chronic pain conditions, such as Complex Regional Pain Syndrome (CRPS). Ketamine infusions have demonstrated effectiveness in reducing pain intensity for these patients. These pediatric pain treatments typically involve IV administration of sub-anesthetic doses in specialized pediatric pain centers or inpatient hospital settings. This treatment is a valuable option when standard pain management fails to provide relief.
Conversely, the use of ketamine for psychiatric disorders in minors is far more limited and considered experimental. Psychiatric treatment is usually reserved for extremely treatment-resistant depression in adolescents when all other medications have proven ineffective. This off-label use requires rigorous medical and psychiatric clearance, stringent monitoring, and mandatory informed consent from parents or legal guardians. Some providers may consider teens as young as 13 to 16 years old, but this practice requires significantly more clinical oversight than that required for adult patients.
Medical and Psychiatric Eligibility Factors
Even when a patient meets the age minimum, numerous health factors can make them ineligible for ketamine therapy due to safety concerns. The drug transiently raises heart rate and blood pressure, making certain cardiovascular conditions absolute contraindications. Individuals with uncontrolled hypertension (resting systolic pressure above 160 mmHg) are excluded, as the surge could trigger a serious event. Other absolute contraindications include a recent heart attack, unstable cardiovascular disease, or the presence of aneurysmal vascular disease.
Ketamine’s dissociative effects also pose a risk for patients with certain psychiatric histories. Individuals with active psychosis, schizophrenia, or a history of drug-induced mania are usually disqualified because the treatment can exacerbate these symptoms. A thorough medical screening is performed to rule out other risks, such as elevated intracranial pressure or severe hepatic impairment, because the liver metabolizes the drug.
Regulatory Differences Based on Administration Type
The specific formulation of ketamine dictates the official minimum age requirement based on regulatory approval. Esketamine (Spravato) is the only form of ketamine that has received official Food and Drug Administration (FDA) approval for psychiatric use. This nasal spray is explicitly approved for adults aged 18 and older to treat treatment-resistant depression or Major Depressive Disorder with acute suicidal ideation. Because the FDA approval for esketamine is strictly limited to adults, it is not approved for use in pediatric patients. In contrast, most other forms of ketamine, including IV infusions and compounded lozenges, are used “off-label” for depression or pain. This off-label status allows a clinician to prescribe it based on professional judgment, but established clinical practice standards overwhelmingly default to 18 years of age for non-anesthetic use.