IV ketamine vs esketamine
| IV ketamine infusion | Esketamine nasal spray (Spravato) | |
|---|---|---|
| FDA status for depression | Not approved (off-label); ketamine is approved as an anesthetic | Approved for treatment-resistant depression, and for depressive symptoms with suicidal thoughts or actions alongside an oral antidepressant |
| How it's given | Through an IV in the arm at a clinic | Self-given nasal spray inside a certified clinic, watched by staff |
| Monitoring | Set by the clinic | At least 2 hours after each dose, under a required FDA safety program (REMS) |
| Insurance | Often self-pay | More often covered, usually with prior authorization |
Ketamine is thought to work through glutamate, a brain chemical messenger, which may help brain cells form new connections. That is a different pathway from most antidepressants. See ketamine therapy cost for what each option usually costs.
Who may be a candidate
Ketamine therapy is usually considered for adults whose depression hasn't improved after other treatments. Clinics typically review your history, may ask for lab tests or clearance from other specialists, and expect you to be under the care of a psychiatric prescriber.
Cleveland Clinic lists situations where ketamine may not be a good fit:
- A history of psychosis or substance use disorder, or high risk of addiction
- Uncontrolled high blood pressure, a recent heart attack, or aortic aneurysm or dissection
- Increased pressure inside the skull or serious liver disease
- Pregnancy or breastfeeding (talk to a clinician first)
- Certain medicines, such as MAO inhibitors
What a session is like
During treatment many people feel dreamlike or detached from their body. Blood pressure is checked because ketamine can raise it. Grogginess or dizziness can last the rest of the day.
You'll need someone to drive you home. After esketamine, MedlinePlus says not to drive or operate machinery until the next day after a restful night's sleep. Your prescriber decides the dose and schedule; Gabriel never gives ketamine dosing.
Side effects and risks
- Common: nausea or vomiting, anxiety or restlessness, blurred vision, feeling detached, raised blood pressure, dizziness.
- Less common: bladder or liver problems, hallucinations, allergic reactions.
- Misuse: ketamine and esketamine can be habit-forming, which is one reason they're given in supervised settings.
- Unknowns: long-term safety of repeated treatment is still being studied.
If you're thinking about suicide or are in crisis, call or text 988 (the Suicide & Crisis Lifeline, free and available 24/7) or call 911. Ketamine and other depression treatments are never a substitute for urgent help.
At-home and online ketamine products
In June 2026, FDA sent warning letters to websites selling ketamine troches, liquids and nasal sprays for depression and anxiety. FDA said these products are unapproved, may be contaminated or vary in strength, and that using them without medical supervision poses significant risk.
Gabriel can help you find and book licensed clinicians who offer ketamine or esketamine treatment. Gabriel doesn't prescribe ketamine.
Common questions
What is ketamine therapy?
Supervised use of low-dose ketamine, an anesthetic, for depression that hasn't responded to other treatment. It's given as an IV infusion off-label, or as FDA-approved esketamine nasal spray in certified clinics.
Is ketamine FDA-approved for depression?
Ketamine itself is not. Esketamine (Spravato), a related nasal spray, is FDA-approved for treatment-resistant depression and for depressive symptoms with suicidal thoughts or actions.
How fast does ketamine therapy work?
Some people notice improvement within hours or days. Benefits can fade within days or weeks, so a series of sessions is common.
What are the side effects of ketamine therapy?
Feeling detached or dreamlike, nausea, dizziness, blurred vision and raised blood pressure are common. It can be habit-forming, and you can't drive afterward.
Is at-home ketamine safe?
FDA has warned that unapproved ketamine products sold online may be contaminated or inconsistent, and that use without medical supervision is risky.
Does Gabriel prescribe ketamine?
No. Gabriel can help you find and book licensed clinicians who offer ketamine or esketamine treatment, and they decide what's appropriate.
Sources
- Ketamine Therapy Cleveland Clinic
- Warning letter: Ketamine Store (MARCS-CMS 725147), June 23, 2026 U.S. Food and Drug Administration
- Esketamine Nasal Spray MedlinePlus, U.S. National Library of Medicine
- Esketamine (Spravato) (CPB 0950) Aetna
- Ketamine Infusion Huntsman Mental Health Institute, University of Utah Health
- 988 Suicide & Crisis Lifeline 988 Lifeline
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.