IV ketamine may be considered for selected patients after a psychiatric evaluation. The evidence and goals differ by condition.
Ketamine is FDA-approved as an anesthetic. Its use for depression and other psychiatric conditions is off-label. Esketamine nasal spray is a different product with separate FDA approvals; those approvals do not apply to IV ketamine.
Depression that has not improved sufficiently
IV ketamine may help some adults with treatment-resistant depression. The 2022 VA/DoD depression guideline suggests ketamine or esketamine as an additional treatment after several adequate medication trials have not helped enough. Response and duration vary, and follow-up treatment may be needed.
Bipolar depression
Bipolar depression requires a treatment plan that considers the whole illness. The 2023 VA/DoD bipolar guideline found insufficient evidence to recommend for or against ketamine or esketamine for acute bipolar depression, either alone or added to another treatment. Decisions require individualized psychiatric assessment.
PTSD
Ketamine should not be described as an established PTSD treatment. The 2023 VA/DoD guideline suggests against ketamine for treating PTSD. When PTSD and treatment-resistant depression occur together, ketamine may be considered for the depression while PTSD receives its own treatment plan.
Suicidal thoughts
The 2024 VA/DoD suicide-risk guideline suggests IV ketamine as an additional treatment for short-term reduction of suicidal thoughts in patients with major depressive disorder. Evidence is insufficient to establish that it reduces suicide attempts or deaths. Improvement in thoughts does not replace ongoing risk assessment, safety planning or emergency care.
If you may act on suicidal thoughts or cannot stay safe, call 911 or go to the nearest emergency department. Do not wait for an outpatient infusion appointment.
Care at our Fort Worth practice
Our practice evaluates carefully selected adults for supervised, in-office IV ketamine treatment. We review potential benefits, risks, alternatives, medications and follow-up needs. Risks include sedation, dissociation, increased blood pressure and potential misuse or dependence. We do not provide ketamine for at-home use.
Read about treatment-day monitoring and transportation requirements or request a consultation.