Ketamine has been used as an anesthetic medication for just over 50 years. (Technically “born” in 1963) It sedates patients and controls pain. It was literally “battle tested” and popularized during the Vietnam war. And yes… it IS used as a horse tranquilizer as well.

Studies began in the early 2000’s into it’s use for treating PTSD. This laid the foundation for today’s use in treatment resistant depression, PTSD and pain management therapies.

It is worth noting that the FDA has NOT approved ketamine for any use other than anesthesia and sedation of patients. It is currently being used “off-label”, by practitioners to treat other novel conditions. Source

The FDA HAS approved esketamine (Spravato) for use in the treatment of TRD.

I have had both IV and intranasal (Esketamine - up your nose) treatments.

It is worth noting that there are also intramuscular, subcutaneous and sublingual (troches) administrations as well. I have no experience with any of these, so I won't be covering them in this FAQ.

For IV, it is an infusion just like any other IV infusion you have seen or experienced. Your dose of ketamine and about 100ML of saline are dripped into your vein over the course of 40 minutes. From what I’ve read and heard from others is that this is pretty standard among psychiatric treatments. (If you want more specifics, here is an NIH article with those details.) The sensations from the infusion begin about 3 to 5 minutes after the drip is started.

For Spravato, the intranasal route, you get 2 (56mg total) to 3 (84mg total) nasal spray devices. They are similar to Afrin bottles, however, there are 2 metered doses per container. You press it to one of your nostrils, depress the plunger thingy and inhale gently. You then turn a “dial” on the base of the device and repeat for your other nostril. You then wait 5 minutes and repeat with the other device(s). The effects of Spravato seem to only last about 30 minutes, HOWEVER, it is REQUIRED by manufacturer that you stay for 2 hours after your first dose for observation. The sensation seems to take a bit longer to hit with Spravato. I am not sure if it is or not. (Both treatments really jack up your sense of time.)

My preference is IV. The Spravato is ONLY available in 56mg, or 84mg prescriptions and does not cause me to dissociate. Ketamine treatments are woefully ineffective for treatment resistant depression if you do not dissociate.

Ah, The big question... Put plainly, it costs A LOT.

First, Spravato… While it is approved by the FDA, the majority of insurance companies will not cover the cost of the meds. If they DO, they still often will not cover the cost of the treatment session with the doctors office. I waited about 6 months, and my doctors office was quite tenacious and managed to get my insurance company to cover the cost for Spravato and the visit costs. All I had to pay was a $35 doctors office co-pay. This was great news! Unfortunately, the Spravato, at it’s highest dosage, would not cause me to dissociate, so within about 2 months, I was feeling bad.

Now for IV… IV ketamine itself is cheap. It is generic and costs nil to the clinics and psychiatric practices to purchase. However, since it is not FDA approved for depression/PTSD/pain management purposes, insurance does not cover the costs. IV treatments are all out of pocket.

In my area (Southeastern US) “ketamine clinics” (see FAQ below for definition) run around $475.00 per treatment. Psychiatric practices run around $550.00 per treatment.

Now for the cherry on top. For BOTH options, Spravato and IV treatments, you have to go 6 times in a 2 to 3 week period, then once a week for a month after that, before you can begin to figure out how often you need to return for the treatment to keep working at peak. So for me, it was $5500 to get the first 2 months out of the way. That’s a terrifying amount of money to invest for most anyone these days, and at the time, only my wife was working.

There are also pop-up charges, but they aren’t too bad. $35 for an EKG, and $35 for urinalysis every 3 or 6 months. They will request your blood work every year as well, but you can simply send them the results from your yearly checkup with your GP. Otherwise, they will send you somewhere that they farm out to, and that is another $150.00.

All of this being said I would spend it again, and possibly more for what I got out of it. NO THERAPY, nor medication EVER had the effect that this therapy did.

Spravato dosing schedule
Proposed IV Ketamine dosing schedule

You can. I’ve heard that many, if not most do. I don’t find it to be very comfortable. I find myself unmotivated, drowsy and unfocused. It is worth noting that I also receive Versed in my infusions, to lower my anxiety during dissociation, which causes EXTRA drowsiness.

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This one varies wildly from person to person. For me, I can feel it beginning to wear off around the end of the 2nd week from treatment. I have been going for treatments every 2 weeks for over 4 years.

I will add this though: The first year of the treatments was like a completely new and different life. The 2nd year and beyond.. well, I fear that the “treatment resistant” part of my depression is returning. The ketamine therapy still gets me much farther than anti-depressants alone, but it’s overall effect has waned over time. I believe that this is in part to my bi-weekly regimen. 

Most people at the practice that I go to get one treatment per month. Some even go 2 months in between. I’ve been so afraid of slipping back into the funk, that I have not let up on the 2 week visits.

Surprisingly few. I am usually dopey and drowsy for about 36 hours after my treatments. I tend to have vivid nightmares for a couple of nights. (If I dream, it’s always a nightmare. I’m not saying ketamine therapy causes nightmares.) 

Once or twice, I have had a headache, due to my BP spiking so much during infusion. 

I will say that I’m a bit concerned about what it MIGHT be doing to my kidneys, based on some things that I’ve read, but I suffer no obvious ill-effects.

Ah yes, the infamous K-hole... where you lose all sense of reality and slide into a deeply dissociative, terrifying state. It’s like being buried alive and suffocating in your own subconscious.

Have I been there?

Yes. Once, and it was brutal .

Before I go any further, I want to clarify some things, as I know that this is a hot topic for naysayers of ketamine therapy: As of June 2025, I have had roughly 115 ketamine therapy experiences, spaced out over 4.5 years. Some of them have been very intense and mildly uncomfortable, but I would not characterize them as negative. It took roughly 96 treatments before I had this experience, so do not let this anecdote dissuade you. When using my stats, there is a 1.05% chance of a bad trip.

I went in feeling fragile. The dose wasn’t changed, but my mental state was. I had an emotional intake session with the staff, as I had just learned of my wife’s breast cancer diagnosis and had to report my feelings on that. I had honestly not allowed the reality of her situation to sink in. I had simply buried it for the 2 weeks prior and kind of “popped the cork” on those emotions during intake and prep.

The staff at a psychiatry practice will generally ensure that you are in the right head-space before allowing you to begin your trip. On this day, I simply nodded when queried about my current state of mind. I never had to think about it before… I was always glad to be in the chair, ready to decompress the past 2 weeks of mental sludge on my trip to la-la-land. I never really had to think about my head-space before “lift-off”.

The nurse kicked off the IV drip, handed me the “E-button”, wished me luck and left the room. (The e-button is literally just a button that you hang around your neck on a lanyard. If you press it, the staff is alerted and they come to see what you need.)

I was still emotionally unstable and suffering some severe anxiety. Yet, I was glad that my infusion had begun. My hope was that the treatment would erase the pain and anxiety that I was feeling in that moment.

Unfortunately, that is not how ketamine therapy works…

I generally lose the sense of time after about 5-7 minutes of IV drip. And by that I mean, a minute could feel like an hour, or a fleeting second. It varies from moment to moment. This time it was different. My anxiety, rather than decreasing, turned to dread and an impending sense of “OH shit.. what have I done?” Time seemed to become non-existent. I mean, I lost my sense of what time even was.

I lost my sense of being.. I no longer understood what it was to be conscious or really know that I was even human. I couldn’t remember how to breathe, but I knew that I had to perform this function. I did not understand why, and could not seem to do it. (Apparently I WAS breathing, because I didn’t die from asphyxiation.) Thoughts were no longer thoughts. I was in a whirlwind of notions and sensations that were all wholly unpleasant… yet time had stopped. There was no movement. I could not hear anything. There was deafening silence, while simultaneously a thousand voices screaming in a language that I didn’t understand inside my head.

I could go on, but even now it freaks me out a little, and I’m not sure that this will make sense to anyone. I will wrap it up…

Somehow, I got with it just enough to realize that I had the E-button. Upon review, I did NOT have the button, rather, I had placed it on the table next to me. I was essentially in a state of sleep-paralysis. I could not move my appendages. Eventually, I was able to grab the button and press it.

The nurse came in and ask what I needed, but I could not talk. (I couldn’t remember how to even use my mouth..) I made a motion of some type with my arm and pointed my eyes towards the IV machine and he got the message that something was seriously wrong. He turned off the IV and sat down in a chair about 5 feet away from me. He looked like he was at the end of a hallway. His head was huge compared to his body.

He began asking me questions similar to those that EMT’s ask when you have had head trauma, but I couldn’t understand his meaning. Eventually, I made a grunt and motioned towards my throat. He took this to mean that I needed water and retrieved a small bottle for me. By this time, my faculties were slowly returning. NOTE: once the IV is stopped, the effects of the ketamine begin to wear off with a quickness. After a few sips of water, I was able to move my head and arms a bit. While feeding me water, he was offering reassurances that what I was experiencing was ONLY TEMPORARY and to stay with him, because it would be over soon.

Oddly, my first reaction was to apologize… I always saw that e-button as “How annoying that must be?? A-holes, pressing that button to summon someone, when they should be letting go and enjoying their trip.” I apologized profusely and was extremely embarrassed. The nurse assured me that it was not a big deal. That I was actually handling my bad trip like a champ, compared to some that he had seen.

He monitored my vitals for a bit and kept talking to me. Probing questions to make sure that my brain-pan was functioning properly, mixed with general small talk to get my mind off of what had just occurred. Eventually, I was released back into the wild, a little worse for wear, but still alive…

That session wrecked me for several days. I was terrified of falling asleep. That feeling of half consciousness that you get when you are in between falling asleep and awake is a common feeling during dissociation. Every-time I got near sleep, I would jolt awake, terrified of the sensation. This went on for about 4 days. I wound up scheduling an appointment with my psychiatrist to unpack the whole thing. I was afraid that I would not be able to bring myself to continue treatments, but he got me through it and I was able to return to treatments 2 weeks later.

Lesson? 
Set and setting matter. Even in clinical treatments. If I’m anxious, emotionally raw, or exhausted, I let the staff know. They give me some time alone with calming music playing or in silence to get my head straight. They might adjust the dose or add more Versed to soften the edge. They can also add time to the IV trip so that the meds enter your system at a slower rate and therefore you get less “edge” or intensity to your dissociation.

It’s rare, but yeah… it can happen. It’s survivable.

“Ketamine clinic” generally refers to anesthesiologist run facilities. They usually specialize in treatments for pain management, rather than depression or PTSD. I’ve found that they are not picky though, they’ll take anyone who can pay. 

If you are looking for TRD therapy, I recommend going to a licensed psychiatrist for treatment. Anecdotal evidence tells me that the staff in ketamine clinics can probably handle your blood pressure if it spikes during a treatment, but are not trained in what to do or how to handle someone who is having a bad experience.

Oh yes. Say hello to the less-talked-about monster under the bed:

“Ketamine Bladder” (aka: Your Pee Hates You Now)

Ketamine, especially in frequent/recreational use, can cause ulcerative cystitis.  Which is a nasty inflammation of the bladder lining.

Symptoms include:

• Frequent urination

• Pain during urination

• Bladder spasms

• Blood in urine (in severe cases)

This is rare in clinical use, but it can happen. I started noticing I was waking up to pee more than usual. A nurse casually dropped “maybe get a urology checkup” and… well, here we are.

Don’t panic — just be proactive:

• Mention any urinary issues to your doc

• Get a yearly urinalysis, especially if you’re a long-term user

• Stay hydrated like your life depends on it

Link