Up To 70% Of People On Ketamine Therapy End Their Depression

1. Esketamine’s Real-World Remission Rate Tells Us What’s Possible When People Stick With It.

Across 20 of the systematic reviews and meta-analyses I analyzed, the remission rates for esketamine (Spravato) land between 32% and 58%. But there’s something crucial hidden inside those numbers: they reflect what happens when people stick with treatment—at least eight doses, often sixteen, sometimes twenty-four, over up to 12 months of care.

In other words, these are not “quick fix” numbers. They show what happens when patients keep going with the nasal spray long enough to give it a real shot. And up to 58% of them walk away in remission—no longer qualifying as depressed.

2. IV Ketamine’s Remission Rate Tells Us What’s Possible After Just One or Two Infusions

Now here’s where things get shocking—and where most people (even some doctors) get confused.

Those same 20 systematic reviews show IV ketamine’s remission rates ranging from 27% to 43%. But almost every single one of those studies stops after only 1 or 2 infusions—over the course of just a few days.

Let’s  pause for a moment and take this in because these numbers are breathtaking. 

Ending depression after 1 or 2 infusions? It leaves most scientists in awe.

When was the last time you heard of popping one or two Prozacs and having depression disappear?

When was the last time you heard of having one or two therapy sessions and walking away in remission?

NEVER.

Yet up to 43% of people walk away in remission after just one or two IV ketamine treatments. Now, to be fair we don’t know how long the remission lasts (studies hint it can last from a few day to a few months) so don’t go thinking that you can do one or two infusions and walk away cured. 

Still, those numbers are nothing less than astonishing.

Now again, because studies stop at 1 or 2 infusions, we never see what happens if people keep going, like they do with the esketamine nasal spray. If that many people recover after just one or two tastes of treatment, imagine what happens if they actually get a full course.

3. Studies Show IV Ketamine Isn’t Just Fast—It’s Much More Powerful Than The Esketamine Nasal Spray.

To be clear, there are no head-to-head studies comparing IV ketamine directly to the esketamine nasal spray (although Yale is starting one). But both drugs have been tested in placebo-controlled studies — meaning each was compared to a carefully designed fake treatment, like a saline infusion or an inactive nasal spray, to see how much better the real drug performed.

And when you look at those placebo-controlled studies side by side, IV ketamine has been shown to be 2.5 to 5 times more effective than the nasal spray. That’s not a gap, it’s a canyon.

This difference in potency is a critical part of how we estimated ketamine’s true, longer term remission rate.

4. Studies Show That Therapy Can Increase SSRI Outcomes By 25%. Meaning, It Should Do The Same For Ketamine.

For decades, studies have shown that combining antidepressants with therapy makes people 25% more likely to get better. That’s well established.

So if therapy improves outcomes for SSRIs, why would ketamine be any different?

Although the research on combining ketamine with therapy is still growing, the early signals are clear: therapy may help people make the most of ketamine’s effects, locking in changes and making recovery deeper and longer-lasting.

If ketamine alone can push remission rates as high as we think, therapy might be what carries people across the finish line—and keeps them there.

A Conservative Statistical Projection of Ketamine’s Long-Term Remission Rates

So what would happen if we took these four points — the real-world remission rate for esketamine when people complete treatment, the stunning remission rate of IV ketamine after just one or two infusions, the massive difference in effectiveness between IV ketamine and esketamine in placebo-controlled studies, and the fact that therapy has been shown to boost SSRI outcomes by 25% — and used them to build a statistical analysis to project ketamine’s true long-term remission rates? 

That’s exactly what I did. I worked with a statistician who looked at all these numbers and developed a conservative estimate based on the best available science. 

The Result?

68% remission for IV ketamine alone, and 72% when combined with therapy.

So when I say up to 70%, I’m not rounding up wildly—I’m splitting the difference, choosing the cautious middle of a very real range.

You can see the full model he used to arrive at these numbers by clicking the link below.

What Exactly Does Remission Mean?

Remission* means depression is gone—not just better, but fully lifted. You no longer meet the criteria for clinical depression. It’s the difference between functioning and thriving, between getting through the day and actually enjoying life again. It means your mood, energy, and sense of self return to a healthy baseline, free from the constant weight of depression.

Now, just because it’s gone doesn’t mean it won’t come back. Depression can be episodic, meaning it might return under certain conditions—just like someone with asthma can go symptom-free for years but still need treatment if triggers arise.

When I first reached remission, I wanted to jump up and down and yell, “I’m cured! I’m cured!” But remission isn’t a cure—it’s more like a truce in a long battle. A cure would mean the war is over, the enemy defeated, and the threat gone forever. Remission, on the other hand, is when the fighting stops, the skies clear, and you get to rebuild your life—but you know the enemy could return someday.

 * The American College of Neuropsychopharmacology Task Force on Response and Remission in Major Depressive Disorder recommends that remission be ascribed after 3 consecutive weeks during which minimal symptom status is maintained. 

 HOW CLINICIANS MEASURE REMISSION

What Remission Really Looks Like