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You’ve tried antidepressants. Maybe several. The side effects were rough, or they just didn’t touch the heaviness, the exhaustion, the feeling that you’re going through the motions without actually living. You’re still showing up, but the relief hasn’t.
That’s where ketamine infusion therapy fits. It doesn’t work like a pill. It works differently,targeting a completely different system in your brain than standard antidepressants. For some people with treatment-resistant depression, IV ketamine can reduce symptoms within hours to days, not weeks. Ketamine offers a different approach.
53.6% Response Rate
Among patients completing treatment, according to a 2022 study analyzing 537 patients across 178 community practices https://pubmed.ncbi.nlm.nih.gov/38321641/
67% Response Rate & 52% Remission Rate
In a 2024 multi-site clinical trial of 75 patients with treatment-resistant depression https://www.sciencedirect.com/science/article/abs/pii/S016503272301501X?via%3Dihub
67% Reduction in Suicidality
Two-thirds of participants with significant suicidal ideation at baseline experienced at least a 50% reduction https://www.sciencedirect.com/science/article/abs/pii/S016503272301501X?via%3Dihub
Off-label use
A 2026 meta-analysis found no significant differences between ketamine and ECT in response, remission, or relapse rates https://www.nature.com/articles/s41398-026-03806-z
Ketamine has been FDA-cleared as an anesthetic since 1970 (FDAgov). For psychiatric conditions like treatment-resistant depression, IV ketamine is used off-label. This is a legally accepted medical practice.
The related drug esketamine (Spravato),a nasal spray derived from ketamine,is FDA-cleared specifically as a monotherapy for treatment-resistant depression in adults who have had an inadequate response to at least two oral antidepressants (Pharmacytimes). Treatment-resistant depression accounts for approximately 30% of all major depressive disorder cases
At FitMind, we follow established clinical protocols under the supervision of licensed psychiatric providers.
Treatment-resistant depression isn’t just “sadness that won’t go away.” It’s a neurological condition where standard treatments haven’t worked,often despite multiple medication trials.
Symptom Domain
Persistent low mood
Loss of interest
Severe fatigue
Brain fog
Concentration issues
Motivation paralysis
Emotional blunting
Hopelessness
Sleep disruption
Common Impact
Feeling hollow, numb, or nothing at all,not just “down”
Things you used to care about feel pointless or empty
Waking up exhausted after 8 or 10 hours of sleep
Thinking feels slow, like wading through cement
Reading the same paragraph over and over without retaining it
Knowing you need to do something but your body won’t start
You don’t cry, don’t get angry, don’t laugh,you just don’t feel
The quiet belief that nothing will ever change
Can’t fall asleep, can’t stay asleep, or sleeping 12+ hours
If this sounds familiar, and you’ve tried at least one antidepressant at a full dose for 6–8 weeks without adequate relief, you may be a candidate for ketamine infusion therapy.
Forget what you know about ketamine as an anesthetic or a party drug. At subanesthetic doses,far lower than what’s used for surgery,it works entirely differently in the brain.
Standard antidepressants like SSRIs target serotonin. They take weeks to work, and for many people, they don’t work at all. Ketamine targets the glutamate system, the brain’s primary excitatory neurotransmitter. Esketamine also targets glutamate receptors in the brain. It blocks NMDA receptors and appears to trigger downstream changes in synaptic plasticity,the brain’s ability to form new connections. Think of it as temporarily lifting the “brakes” that depression puts on your brain’s ability to adapt and rewire itself.
A reputable clinic follows a structured protocol. At FitMind, we follow established clinical protocols under the supervision of licensed psychiatric providers, guided by the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3) consensus guidelines (Psychiatry Online)..
Step 1:
Comprehensive psychiatric evaluation
You meet with our psychiatric provider to review your depression history, prior treatments, medications, substance-use history, suicide risk, and any medical conditions that could increase risk. We assess whether ketamine is appropriate for you,or if another treatment might be a better fit.
Step 2:
Medical screening
We check blood pressure, cardiovascular history, and review any contraindications. Ketamine can temporarily raise blood pressure and heart rate, so this matters.
Step 3:
The induction series
The standard dose is typically 0.5 mg per kilogram of body weight, infused over 40 minutes Schedule is 4 to 6 infusions over 2 to 4 weeks. You recline in a comfortable chair in our clinic, monitored by trained medical staff. You may feel detached from your body, dreamlike, or experience visual changes. These effects are usually temporary and resolve within a few hours. Research shows both 40-minute and 100-minute infusions show comparable safety and efficacy, suggesting infusion duration does not alter outcomes.
Step 4:
Monitoring and recovery
Blood pressure and heart rate are monitored throughout. You cannot drive, operate machinery, or make major decisions after treatment. We require a responsible adult to take you home.
Step 5:
Response assessment
We track your symptoms using standardized tools before, during, and after the induction series. Research shows that early response is suggestive for eventual remission,while 40% of non-responders after a single infusion go on to achieve remission, only 20% of non-responders after two infusions achieve remission
Step 6 :
Maintenance (if needed)
Maintenance (if needed),Some patients need less-frequent “booster” infusions to sustain improvement. The ideal frequency varies,some need boosters every few weeks, others every few months. In real-world practice, about half of patients choose to continue with ketamine maintenance
Feature
Mechanism
FDA clearance for depression
Onset of action
Systemic side effects
Treatment schedule
Driving afterward
Insurance coverage
IV Ketamine Infusion
NMDA receptor antagonist / glutamate modulation
Off-label
Hours to days
Transient dissociation, blood pressure elevation
4–6 infusions over 2–4 weeks
No,must have a driver
Often self-pay; varies
Antidepressants (SSRIs/SNRIs)
Serotonin or norepinephrine reuptake inhibition
Yes
4–8 weeks
Weight gain, sexual dysfunction, sedation
Daily pill, indefinite
Yes
Usually covered
Esketamine (Spravato)
NMDA receptor antagonist (Pharmacy Times)
Yes, as monotherapy for TRD
As early as 24 hours
Dissociation, blood pressure elevation, nasal discomfort
Twice weekly for 4 weeks, then maintenance
No,must have a driver
Usually covered with prior authorization
ECT
Controlled seizure
Yes
2–4 weeks
Memory loss, confusion, anesthesia required
2–3 times/week for several weeks
No,requires anesthesia recovery
Usually covered
IV ketamine’s advantage is speed,it works faster than any standard antidepressant. Research shows IV ketamine is not inferior to ECT for treating treatment-resistant depression.
A 2026 meta-analysis of seven studies with 731 participants found no significant differences between ECT and ketamine in terms of response to treatment, remission, and relapse
Not a first-line treatment,it's for people who haven't gotten relief from standard antidepressants
Not an FDA-cleared depression treatment,it's used off-label, though the evidence base is strong
Not a standalone cure,it works best as part of an ongoing treatment plan with psychiatric care, therapy, and lifestyle support
Not an at-home treatment,IV ketamine requires clinical supervision, monitoring, and a ride home
Not a guarantee,real-world response rates in community clinics may be lower than those in clinical trials, with approximately 53.6% achieving response and 28.9% achieving remission https://pubmed.ncbi.nlm.nih.gov/38321641/
Efficacy data
Real-world data from community practices shows a 53.6% response rate and 28.9% remission rate. However, outcomes may differ in more severely ill populations,at the Massachusetts General Hospital Ketamine Clinic, where patients have failed an average of 4 to 15 antidepressants, fewer than 20% achieve full response, though about one-third achieve partial response
Comparison to ECT
A 2026 meta-analysis of seven studies with 731 participants found no significant differences between ECT and ketamine in response rates, remission, or relapse. Another meta-analysis of six studies with 676 patients found similar results: no significant differences between ketamine and ECT in response, remission, or adverse events
Safety profile
Common side effects include temporary blood pressure elevation, dissociation, drowsiness, nausea, and headache. These are usually mild and short-lived. In the Bio-K study of 75 patients, side effects were minimal
Contraindications
Ketamine is not recommended for people with uncontrolled hypertension, significant cardiovascular disease, active psychosis, a history of mania, or substance-use disorder involving ketamine.
IV ketamine for psychiatric conditions is typically not covered by most insurance plans because it's used off-label. However, some plans may cover it if you have prior authorization or out-of-network benefits.
Spravato (esketamine) is more likely to be covered, but requires prior authorization and treatment at a REMS-certified facility. Spravato is only available through a restricted program due to the risks of sedation, dissociation, respiratory depression, abuse, and misuse
At FitMind, we can verify your benefits before treatment begins, provide superbills for out-of-network reimbursement, and discuss payment options. Call us at (904) 827-3714 to discuss your coverage.
You’ve likely tried at least one antidepressant at a full dose for 6–8 weeks without enough relief. A psychiatric evaluation at FitMind will confirm whether ketamine is appropriate.
No more than any IV. You’ll feel a small pinch when the IV is placed, but the infusion itself is painless.
It varies. Many people describe feeling detached from their body, dreamlike, or having visual changes. Some feel calm; others feel anxious. The effects are usually temporary and resolve within a few hours.
No. We require a responsible adult to take you home. You cannot drive, operate machinery, or make major decisions for 24 hours after treatment.
Some people notice improvement within hours of the first infusion. For others, it takes a few infusions. Research shows that early response is suggestive for eventual remission,about 40% of non-responders after a single infusion still go on to achieve remission after three infusions.
Yes. Most patients continue their medications. Do not stop any medication without your doctor’s approval.
Yes. Common side effects include temporary blood pressure elevation, dissociation, drowsiness, nausea, and headache. These are usually mild and short-lived.
Ketamine has misuse potential, particularly at higher doses or with frequent use. In clinical settings with appropriate dosing and monitoring, the risk is low. Spravato is only available through a restricted program due to these risks.
Some people see minimal benefit. If ketamine isn’t effective, we’ll discuss other options, including TMS, ECT, or medication adjustments.
Cost varies by clinic and geographic location. We’ll provide a clear cost estimate before you start. Most patients pay out of pocket, though some receive partial reimbursement through out-of-network benefits.
Yes. Ketamine infusion therapy is also being studied for chronic pain, PTSD, anxiety disorders, and bipolar depression. However, the strongest clinical evidence is for treatment-resistant depression. Your psychiatrist can help determine if ketamine is appropriate for your specific condition.
Plan for about 2 hours total at the clinic. This includes a brief check-in, preparation for the IV, the 40-minute infusion itself, and recovery time before you go home. We monitor you throughout to make sure you’re stable before leaving.
We recommend a light meal about 2 to 3 hours before your appointment. Avoid heavy or greasy meals, which can increase the chance of nausea during the infusion. Staying hydrated is also helpful.
With an IV drip, the medicine goes straight into your bloodstream, so the clinic controls the exact dose and a nurse watches your blood pressure and how you’re doing the whole time.
With at-home pills or lozenges, your stomach and liver break down most of it before it reaches your brain, the amount that actually works varies from person to person, and nobody is there to check on you if something goes wrong.
For many patients, symptom relief can last anywhere from a few days to several weeks after completing the induction series. The duration varies from person to person. Maintenance infusions,typically scheduled every few weeks or months,can help sustain improvement over time.
Depression can make it difficult to enjoy the things you love in life, but there is hope for a better future. If your depression symptoms have not responded to your attempts at treatment, NeuroStar Advanced TMS Therapy in Jacksonville may be a good fit for you.
Our providers at FitMind Therapeutics are here to help. Schedule a consultation with our team today to determine whether TMS is the next step in your treatment plan.
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