The question usually arrives secondhand. You told your sister a psychiatrist had raised ketamine, and by the end of the call she had sent a news clip and a sentence with the word “horse” in it. So now it is late and you are searching medical ketamine vs street ketamine.
You are not looking for reassurance. You want something to say back at Sunday dinner.
One word is doing three jobs. Ketamine is a general anesthetic the FDA approved in 1970. It is also a drug diverted, dried into powder, and sold on the street, and a wellness product a website will mail to your door. Same molecule, three situations that share almost nothing else.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room. We are an outpatient practice and cannot provide emergency care. For non-urgent questions, our Fort Worth office is 817-659-7344.
Is ketamine FDA-approved for depression?
No. Use of intravenous ketamine for depression is off-label and considered investigational by the FDA. That sentence is on our own ketamine infusion therapy page.
The FDA is blunter. In a warning letter issued June 23, 2026 to a website selling ketamine to consumers, the agency wrote that “ketamine is not FDA-approved for the treatment of any psychiatric disorder.”
Off-label prescribing is legal and ordinary. It does mean this use never went through the approval process the anesthetic use did, and anyone offering it should say so unprompted.
Medical ketamine vs street ketamine: one word, three situations
Ketamine as an FDA-approved anesthetic
According to the FDA’s Drugs@FDA record, KETALAR (ketamine hydrochloride injection) was approved on February 19, 1970, and the current label indicates it as a general anesthetic for diagnostic and surgical procedures. The Drug Enforcement Administration’s March 2025 fact sheet notes it has been marketed here as an injectable anesthetic for humans and animals since the 1970s.
So your sister is not wrong about the veterinary use. She is incomplete.
Ketamine as a recreational drug
The DEA calls ketamine “a dissociative anesthetic that has gained popularity as a drug of abuse,” and lists street names including Special K, Vitamin K, and Cat Valium. Illicit powder is made from pharmaceutical ketamine by evaporating off the liquid, the agency notes, and while it is mainly found in isolation it has also turned up combined with MDMA, methamphetamine, cocaine, or carisoprodol. What a buyer cannot know is the strength or what else is in it.
The National Institute on Drug Abuse points to a NIDA-funded study finding that ketamine problems called in to poison control centers rose 81% from 2019 to 2021. That is a large jump off a base the DEA puts at a few hundred exposures a year. NIDA adds that the worst outcomes, some life-threatening, came when ketamine was combined with other drugs, especially opioids or GHB. Long-term heavy use is linked to memory problems, depression, anxiety, and ketamine-induced uropathy, a bladder condition.
Ketamine as a wellness product
Liquid ketamine, troches, and nasal sprays are sold online. The FDA’s June 2026 warning letter targeted that market, citing “significant risks associated with unapproved ketamine products, especially in the absence of appropriate medical supervision,” and warning that such products may be contaminated, counterfeit, or contain different ingredients.
| What differs | Anesthetic | Illicit | Direct-to-consumer |
| Status | FDA-approved, 1970 | Diverted; illegally sold | Unapproved; FDA warning letter |
| Contents | Known | Adulterants found, per DEA | May vary, per FDA |
| Supervision | Clinician-administered in office | None | Remote at best, per FDA |
One thing does not change. Ketamine sits in Schedule III of the Controlled Substances Act, per the DEA, and it stays there when a clinician holds the syringe.
What happens during a ketamine infusion in a medical office
A typical infusion at our practice lasts about 40 minutes, followed by a monitored recovery period. Before it starts you sign a consent form, discuss benefits, limits, risks, and alternatives, and ask questions. You can withdraw that consent at any time, including mid-infusion.
Blood pressure is a reason some people are turned down. The FDA label for KETALAR notes that transient increases in blood pressure and heart rate are frequently observed after administration. It also contraindicates ketamine outright for anyone in whom a significant rise in blood pressure would be a serious hazard.
Outside guidance runs the same direction. The 2021 Canadian Network for Mood and Anxiety Treatments task force lists poorly controlled hypertension and unstable cardiovascular or respiratory disease among the factors that weigh against treatment. A 2021 international expert group in the American Journal of Psychiatry would exclude uncontrolled hypertension, aneurysmal disease, significant valvular disease, a cardiovascular event in the past six weeks, or advanced heart failure. That is outside guidance, not a description of our office, but screening happens before the IV goes in.
Some people feel detached from their body or surroundings during an infusion, an effect clinicians call dissociation. That same expert group concluded that for this off-label, investigational use, feeling that way is neither required for the antidepressant effect nor a sign that it is working. If that worries you, say so before you start.
As our service page states, a responsible adult (age 18+) must bring you, stay in the waiting area throughout your visit, and drive you home. Not alone, not a rideshare or taxi, and not a driver who left and came back. That is a patient-safety requirement, not a preference.
Our published list of common short-term effects is dizziness, nausea, temporary increases in blood pressure, vivid dreams or perceptual changes, confusion, mood changes, or increased libido. They usually begin during or soon after the infusion and often improve within about 80 minutes, though longer for some.
Is ketamine addictive?
It would be easy to write that ketamine is not addictive when a clinician gives it. The evidence is not that clean.
Three things are true at once.
First, ketamine has recognized misuse potential. That is why it is a controlled substance, and heavy recreational use causes documented harm. The 2021 international expert opinion in the American Journal of Psychiatry reports that lower urinary tract symptoms affect roughly 20% to 40% of people who use ketamine recreationally, improving in most after they stop but persisting or progressing in about 5%.
Second, those findings belong to chronic, high-dose recreational use. The Canadian task force notes that antidepressant-dose infusions have not been associated with neurocognitive changes or excessive urinary symptoms in depression trials, but calls these possible long-term side effects. NIDA puts it this way: regular use is associated with symptoms of addiction, “however, more research is needed to determine how addictive ketamine might be.”
Third, that unresolved question is why the decision belongs in a room with a clinician. Substance use history changes the answer, and the Canadian task force counts substance use and dependence among the factors weighing against treatment. It also recommends reassessing maintenance patients for urinary symptoms, cognitive changes, and substance misuse.
Ketamine clinic vs Spravato: not the same product
Esketamine, one of the two mirror-image forms of the ketamine molecule, was first approved by the FDA in March 2019 for treatment-resistant depression, initially alongside an oral antidepressant. It is marketed as Spravato, a nasal spray, not an infusion.
Its label carries a boxed warning, the FDA’s strongest, covering sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. It is available only through a restricted program, the SPRAVATO REMS, approved March 5, 2019, requiring a certified setting and monitoring for at least two hours after each dose.
We provide intravenous ketamine. We do not offer Spravato, and the two are not interchangeable.
Is ketamine therapy safe in a medical setting?
We are not going to tell you it is safe here. That is a bigger claim than anyone should make about a Schedule III drug. The narrower claim is enough: someone else controls the dose, the route, what is in the bag, the monitoring, and who takes you home.
Whether this off-label use helps is a separate question. Our own ketamine infusion therapy page says a substantial proportion of treatment-resistant patients benefit, that not everyone responds, and that improvements are often short-term, commonly around two weeks. A 2021 Cochrane review of 64 studies and 5,299 participants found ketamine may increase response and remission compared with placebo at 24 hours, while rating that evidence very low certainty. That is where the science sits for treatment-refractory depression.
Frequently asked questions
Is medical ketamine the same drug as the club drug?
It is the same molecule, and the pharmacology travels with it. What does not travel is the dose, the purity, or the person watching you. The DEA reports illicit powder is made from pharmaceutical ketamine and has been found combined with MDMA, methamphetamine, or cocaine, so a buyer knows neither the strength nor the contents. An office infusion means a known product and monitoring.
Is ketamine addictive?
Ketamine is a Schedule III controlled substance with recognized misuse potential. NIDA states that regular use is associated with symptoms of addiction, while adding that “more research is needed to determine how addictive ketamine might be.” The Canadian task force says the true risk when ketamine is used as an antidepressant is unknown. Tell your prescriber about any substance use history.
Is ketamine a routine treatment for bipolar depression?
No. Bipolar disorder changes the whole treatment plan, and it fixes the order of operations: the diagnosis gets settled first, then the medication, because an antidepressant given without a mood stabilizer can precipitate mania or hypomania. That sequence covers ketamine too. The 2021 American Journal of Psychiatry expert group calls the evidence for IV ketamine in treatment-resistant bipolar disorder preliminary, from small controlled trials, and the use investigational. If the diagnosis is unsettled, sorting that out comes first.
Does insurance cover ketamine infusions?
We are a self-pay practice and do not bill insurance. Current infusion prices are on our Price List, and prices change, so check that page. Some patients seek out-of-network reimbursement from their own plan, but we cannot promise a result.
The bottom line
Medical ketamine vs street ketamine comes down to who sets the dose, who watches your blood pressure, what you signed, and who drives you home. Use of IV ketamine for depression is off-label and investigational, the benefit is often short-lived, the misuse potential is real, and some people are not candidates. It can still be a reasonable option for some people, and knowing all of it is how you decide.
Talk with us
If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.
Sources
- Institute for Advanced Psychiatry. “Ketamine Infusion Therapy.” Accessed 2026. https://www.psychiatryfortworth.com/services/ketamine-infusion-therapy/
- U.S. Food and Drug Administration. “Drugs@FDA: NDA 016812, KETALAR (ketamine hydrochloride).” Original approval February 19, 1970; record accessed 2026. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=016812
- DailyMed / U.S. National Library of Medicine. “KETALAR – ketamine hydrochloride injection (FDA-approved label).” Label revised March 27, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14e8f864-8b8a-4e7e-8439-e510d3107063
- U.S. Drug Enforcement Administration, Diversion Control Division. “Ketamine (Drug & Chemical Evaluation Section fact sheet).” March 2025. https://www.deadiversion.usdoj.gov/drug_chem_info/ketamine.pdf
- U.S. Food and Drug Administration. “Warning Letter: Ketamine Store / www.ketaminestore.org, MARCS-CMS 725147.” June 23, 2026. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/ketamine-store-wwwketaminestoreorg-725147-06232026
- National Institute on Drug Abuse. “Ketamine (Research Topics).” Accessed September 2026. https://nida.nih.gov/research-topics/ketamine
- Canadian Journal of Psychiatry (CANMAT Task Force). “The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder.” 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC7918868/
- American Journal of Psychiatry. “Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.” 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC9635017/
- Cochrane Database of Systematic Reviews. “Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder.” 2021. https://pubmed.ncbi.nlm.nih.gov/34510411/
- DailyMed / U.S. National Library of Medicine. “SPRAVATO – esketamine hydrochloride solution (FDA-approved label).” Label revised March 31, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d81a6a79-a74a-44b7-822c-0dfa3036eaed
- U.S. Food and Drug Administration. “Approved Risk Evaluation and Mitigation Strategies (REMS): SPRAVATO (esketamine), NDA 211243.” REMS approved March 5, 2019. https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm?event=IndvRemsDetails.page&REMS=386
- Institute for Advanced Psychiatry. “Price List.” Accessed 2026. https://www.psychiatryfortworth.com/price-list/
Medical disclaimer
This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.