Getting ketamine therapy involves finding a qualified provider, completing medical and psychiatric screenings, and committing to a treatment schedule that typically starts with multiple sessions over a few weeks. The process differs depending on whether you pursue the FDA-approved nasal spray (esketamine, brand name Spravato) or off-label IV infusions, which are more widely available but rarely covered by insurance. Here’s what each path looks like from start to finish.
Two Main Options: Spravato vs. IV Infusions
The only FDA-approved ketamine product for depression is Spravato, a nasal spray containing esketamine. It’s approved specifically for treatment-resistant depression and for major depression with suicidal thoughts. You self-administer the spray in a certified healthcare setting while staff monitor you. Because of risks like sedation, dissociation, and respiratory depression, Spravato is only available through a restricted safety program called REMS. Every clinic that offers it must be certified, and you’ll be monitored for at least two hours after each dose, including pulse oximetry checks.
IV ketamine infusions are the other common route. Ketamine itself is FDA-approved only as an anesthetic, so its use for depression, anxiety, PTSD, and chronic pain is entirely off-label. That said, hundreds of clinics across the U.S. offer IV infusions for these conditions. You can also find clinics offering intramuscular injections or sublingual lozenges, though the FDA has flagged safety concerns with compounded oral and sublingual formulations dispensed through telemedicine platforms, particularly the lack of in-person monitoring.
Who Qualifies for Treatment
For Spravato, insurance companies set clear eligibility bars. Aetna’s policy is representative: you need to have tried at least two antidepressants from different drug classes, each at the maximum tolerated dose for at least eight weeks, within the past five years, without adequate improvement. Other insurers follow similar criteria. Your prescribing provider will need to document this treatment history.
For IV ketamine infusions at private clinics, the requirements are less standardized but still exist. Most clinics look for evidence that you’ve tried multiple medications without success. One common benchmark is at least four prior medication trials across two different drug classes during the current depressive episode, plus augmentation strategies like therapy, lithium, or brain stimulation treatments like TMS or ECT. Clinics vary in how strictly they enforce these thresholds, but a documented history of treatment resistance is the norm.
The Screening Process
Before your first session, expect a thorough intake evaluation covering both physical and mental health. The physical screening asks about heart conditions, high blood pressure, history of stroke, head injuries, liver disease, kidney disease, breathing problems like asthma or sleep apnea, and any history of problems with anesthesia. Women will be asked about pregnancy. These aren’t formalities. Ketamine raises blood pressure and heart rate, so uncontrolled hypertension and heart disease are key concerns.
The psychiatric evaluation digs into family history of psychosis or schizophrenia, your own experience with panic attacks or dissociation, and your history with alcohol and recreational drugs. A history of psychotic disorders is generally a disqualifying factor, since ketamine can trigger dissociative and psychotic-like experiences. Active substance abuse is another red flag, given that ketamine is a Schedule III controlled substance with its own potential for misuse.
You’ll fill out detailed questionnaires, list every medication and supplement you’re currently taking, and have all of this reviewed by a physician before treatment is approved. Some clinics also require baseline lab work or a recent physical exam from your primary care provider.
How to Find a Reputable Clinic
Not all ketamine clinics are created equal, and the rapid growth of this market means quality varies widely. The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP) recommends checking several things before committing to a provider.
- Board certification in a relevant specialty. Look for physicians trained in anesthesiology, psychiatry, emergency medicine, or internal medicine. Any licensed medical professional can legally administer ketamine, but relevant specialty training matters.
- Experience with ketamine specifically. Providers with more than two years of ketamine experience are considered well-established in this field. Ask how many patients they’ve treated.
- Professional affiliations. Membership in ketamine-specific organizations or attendance at ketamine-focused conferences signals ongoing education.
- Clean licensing history. Check your state medical board’s website for any disciplinary actions or license suspensions.
You should also ask about monitoring during sessions. A reputable clinic will have staff present throughout your infusion, track your vital signs including blood pressure and oxygen levels, and have protocols for managing adverse reactions. If a clinic seems willing to rush you through intake or skip screening steps, that’s a warning sign.
What a Typical Treatment Schedule Looks Like
For IV infusions targeting depression, the standard induction phase involves six infusions over two to three weeks. Each session lasts about 40 to 60 minutes for the infusion itself, plus recovery and monitoring time. For chronic pain, some protocols use five consecutive daily infusions as the initial course. A common dosing approach is 0.5 milligrams per kilogram of body weight, infused over 40 minutes, though your provider will adjust based on your response and tolerance.
Spravato follows its own schedule: sessions are typically twice a week for the first month, then weekly for the second month, then weekly or every two weeks after that. Each session requires you to stay at the clinic for at least two hours of post-dose monitoring.
After the initial induction phase for either approach, some people move to maintenance sessions. The frequency varies, ranging from monthly to every few months depending on how long benefits last. One study tracking outcomes after a five-day infusion protocol found improvements in depression, pain, and overall functioning held steady at six months. But there’s no universal maintenance schedule, and you’ll work with your provider to find what keeps your symptoms managed.
Costs and Insurance Coverage
Spravato is the most likely path to insurance coverage. Because it’s FDA-approved for treatment-resistant depression, most major insurers cover it once you meet their prior authorization requirements (documented failed medication trials). Your out-of-pocket costs will depend on your specific plan, copays, and deductible.
IV ketamine infusions are a different financial picture. Because this use is off-label, most insurance plans do not cover it. The national median price is around $450 per session, with a typical range of $400 to $800. In some regions you can find sessions for $300 to $350, while premium clinics in major cities charge up to $1,400. For a standard six-session induction course, you’re looking at roughly $2,400 to $4,800 out of pocket at average prices. Some clinics offer package pricing or payment plans. Ask about total expected costs upfront, including the initial consultation, infusion sessions, and any follow-up appointments.
What to Expect on Treatment Day
Plan to be at the clinic for two to three hours per session. You’ll typically sit in a recliner or lie on a bed in a private or semi-private room. Staff will start an IV line and begin the infusion at a controlled rate. During the infusion, you may experience floating sensations, visual distortions, a feeling of detachment from your body, or mild nausea. These effects are temporary and typically fade within an hour or two after the infusion ends.
The single most important logistical detail: you cannot drive for 24 hours after a ketamine session. This applies to both IV infusions and Spravato. Arrange a ride home before your appointment, whether that’s a friend, family member, or rideshare service. You should also avoid operating heavy machinery or making important decisions for the rest of the day. Most people feel back to normal the following morning.
Getting Started Step by Step
The practical path forward depends on your situation. If you’re already working with a psychiatrist and have a documented history of failed antidepressants, ask them about a Spravato referral. They can check your insurance eligibility and connect you with a certified treatment center. If Spravato isn’t covered or you prefer IV infusions, search for ketamine clinics in your area, verify the provider’s credentials, and schedule a consultation. Most clinics offer an initial phone or video call to discuss your history and determine if you’re a candidate before scheduling the full intake evaluation.
Bring a complete list of your current medications, your psychiatric treatment history (including names and durations of past antidepressants), and any relevant medical records. The more documentation you bring to your first appointment, the faster the screening process moves. From initial consultation to first infusion, most people are looking at one to two weeks, though some clinics can move faster if your records are in order.