IV ketamine infusion
Racemic ketamine delivered slowly into a vein over 40–60 minutes in a monitored clinic room. The most-studied route for depression and chronic pain, and the one with the largest randomized-trial base. Usually self-pay.
Conditions & treatment routes
Conditions ketamine may treat
Ketamine-based treatment spans one FDA-approved medicine — esketamine nasal spray (SPRAVATO®) — and off-label IV, IM, and oral ketamine. These guides cover every condition the directory tracks: what is approved, what the evidence shows, what a course of treatment involves, and who may be a candidate.
Condition guides
Each guide distinguishes approved use from off-label practice, cites where the evidence is strong or thin, and links to clinics that treat the condition.
FDA-approved (esketamine)
Treatment-resistant depression
Depression that has not responded adequately to at least two oral antidepressants. Esketamine nasal spray (SPRAVATO®) is FDA-approved for this use in adults; IV, IM, and oral ketamine are off-label options that many clinics offer.
Read the guideApproved in specific casesDepression (major depressive disorder)
Ketamine-based treatments act on glutamate, a different pathway from traditional antidepressants, and can work within hours to days for some patients. Only esketamine is FDA-approved, and only for specific depression populations; other routes are off-label.
Read the guideOff-label useAnxiety disorders
Early evidence from randomized trials and meta-analyses suggests ketamine can reduce anxiety symptoms short-term, including in people whose anxiety has resisted other treatments. All such use is off-label — no ketamine-based medicine is FDA-approved for anxiety.
Read the guideOff-label usePTSD
Ketamine is being studied and used off-label for post-traumatic stress disorder, with early trials suggesting rapid but temporary symptom reduction. Esketamine is not approved for PTSD, and treatment should be coordinated with trauma-focused therapy.
Read the guideOff-label useChronic pain
Ketamine is an FDA-approved anesthetic, but its use for chronic pain conditions — neuropathic pain, complex regional pain syndrome, fibromyalgia — is off-label. Evidence is mixed, with some support for neuropathic and CRPS pain.
Read the guideOff-label useOCD
Early research on ketamine for obsessive-compulsive disorder shows mixed and short-lived results in small trials. It remains off-label and experimental — standard care is still exposure-based therapy with SSRIs.
Read the guideHow ketamine is given
Ketamine reaches the brain through several routes. They differ in evidence, cost, session length, and monitoring — not in the basic rule that dosing always happens under clinical supervision.
IM ketamine injection
An intramuscular shot that absorbs over roughly 15–30 minutes. Used where IV access is impractical and for maintenance between IV courses. Off-label for psychiatric conditions; monitoring requirements mirror IV.
Oral ketamine
Tablets or sublingual lozenges prescribed for supervised home or in-clinic protocols, most often as a low-dose bridge between infusions. The weakest trial evidence of the three systemic routes; unsupervised use carries real risks.
Esketamine nasal spray (SPRAVATO®)
The only FDA-approved ketamine-based medicine — for adults with treatment-resistant depression, or depressive symptoms with acute suicidal ideation or behavior. Self-administered under observation in a REMS-certified setting, with at least two hours of monitoring. Often covered by insurance for approved uses.
Ketamine-assisted psychotherapy
Ketamine sessions paired with structured psychotherapy, on the theory that a temporarily more open cognitive state helps therapy work. A growing but not standardized field — ask any clinic exactly what their protocol includes.
Approved vs. off-label, in plain terms
FDA-approved
Esketamine nasal spray (SPRAVATO®) is approved for adults with treatment-resistant depression, or depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior — in both cases with an oral antidepressant (monotherapy is also labeled for treatment-resistant depression as of the 2025 label update). Its effectiveness in preventing suicide has not been demonstrated. It is dispensed only through the SPRAVATO® REMS program in certified settings.
Off-label
IV racemic ketamine, IM injection, and oral ketamine are not FDA-approved for any psychiatric condition, and no ketamine-based medicine is approved for anxiety, PTSD, OCD, or chronic pain. Clinicians may still prescribe them, and for treatment-resistant depression the IV evidence base is substantial — but insurers generally do not cover off-label care, and protocol quality varies between clinics.
Important safety context
The FDA label for esketamine carries boxed warnings for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. Off-label IV, IM, and oral ketamine share related risks, including elevated blood pressure, and repeated unsupervised use can damage the bladder. No dose of any ketamine-based medicine belongs at home or unsupervised: even self-administered esketamine happens only in a certified clinic under observation, with a ride home arranged afterward. If you are in crisis, call or text 988 for the Suicide & Crisis Lifeline.
Sources: FDA Prescribing Information for SPRAVATO® (esketamine), revised January 2025; peer-reviewed systematic reviews and meta-analyses of ketamine in mood, anxiety, PTSD, OCD, and pain populations. This page is educational and is not medical advice — only a prescriber who knows your history can say whether any ketamine-based treatment is right for you.