Ketamine Therapy for Depression: What It Is, How It Works, Who It Helps, Risks & Costs

It’s a low dose of the anesthetic ketamine given through an IV, injection, nasal spray, or tablet by trained professionals in a medical clinic. The dose is high enough to alter consciousness but low enough to avoid losing consciousness. Once the medicine crosses the blood-brain barrier, it creates a powerful dissociative effect.

Physically, you may feel like your body is melting into the chair—weightless, numb, disconnected from pain. For many, chronic aches vanish completely. Mentally, you might feel detached from thoughts or emotions, like an observer watching yourself from afar. Time stretches or collapses. Shapes and colors may bloom behind closed eyes, often forming symbolic or emotionally charged visions.

Roughly half to two-thirds of people experience psychedelic imagery. These aren’t random “trips”—they’re messages from your subconscious. Taken seriously, they can uncover buried trauma, grief, or self-perceptions you didn’t know were holding you back. They’re not the medicine, but they’re part of how the medicine heals.

Once ketamine crosses the blood-brain barrier, you lose access to your usual mental and physical faculties. You may be unable to move your arms or speak. Your sense of time collapses. It feels like you mind detaches from your body. In that state, you can’t make decisions or protect yourself—so the clinic does it for you.

Clinics provide containment, not just medicine: a blood pressure check, oxygen monitoring, a recliner, a blanket, a blindfold. You’re not there to stay aware. You’re there to let go.

And if you’re using Spravato, the FDA requires you to take it in a certified clinic under their REMS program. It’s not optional. You must be supervised for two hours after dosing. Sometimes, difficult emotional baggage comes up during treatment. Having trained staff nearby ensures you’re supported—not just physically, but emotionally. You’re not alone in the experience. The clinic is there to keep you safe on every level.

When you arrive, you’ll fill out a short depression questionnaire so the clinic can track your progress over time. Then a clinician checks your blood pressure and oxygen levels to make sure you’re physically clear to begin.

A few minutes after the ketamine is administered—whether by IV, injection, or the Spravato nasal spray—you’ll enter an altered state that lasts about 40 to 60 minutes. With IV, your blood pressure is continuously monitored. With injection and Spravato, it’s typically checked at the halfway point, since ketamine is known to spike blood pressure.

After the journey ends, you may feel groggy, disoriented, or emotionally raw—which is why clinics build in a recovery period: 20 to 30 minutes for IV or injection, 60 minutes for Spravato (a federal requirement).

Total time for a ketamine therapy session is about 1 hour and 40 minutes for IV/injection, and about 2 hours and 15 minutes for Spravato—roughly 35 minutes longer.

A deep, physical relaxation spreads through you. Some people describe their bodies as weightless or hollow, as if they’ve lost mass altogether. Others feel too large, too small, or shaped wrong. Chronic pain often vanishes—back pain, joint pain, even long-term tension can go quiet, like the body’s alarms have been cut. Movement may feel impossible, like you’re fused to the chair.

Dissociation is at the core of the experience. Your sense of self detaches from your physical form. You might feel like you’re floating above yourself, or like the “you” inside your body is gone. Thought loops arise, but they don’t feel like yours. You’re present, but distant.

The visuals can be subtle or surreal: colors, landscapes, symbols, even entire scenes. They can feel meaningful—or terrifying. Fear, awe, confusion—they all surface without warning.

The one through line is disconnection: from your body, from time, from the person you think you are. For some, it’s a relief. For others, it’s disorienting. Often, it’s both.

Roughly 40–50% of patients report psychedelic effects during ketamine treatment. Some see vivid imagery—faces, symbols, entire dreamlike scenes. Others don’t see anything at all. But when visions happen, they can be intense—not like dreams or hallucinations, but like events you’re actually living through.

Psychedelic visions aren’t random “trips”—psychiatrists believe they act as a bridge between your subconscious and conscious mind, offering insights that might otherwise remain out of reach.

Often described as “watching a movie made by your subconscious,” psychedelic visions speak in the language of metaphor, and often require the help of an integration therapist to make sense of. Most researchers believe these visions serve as a portal to parts of the psyche that no conversation, analysis, or traditional therapy could ever reach.

Many patients who reach remission credit their psychedelic visions as instrumental to their healing.

Ketamine impairs your coordination, perception, and reaction time, making it unsafe and illegal to drive after treatment. Even after the peak effects fade, your brain is still under the influence. Depth perception is distorted. Reflexes are delayed. Your ability to assess risk and respond to sudden changes—pedestrians, traffic, swerving cars—is significantly reduced.

This isn’t a subtle shift. It’s a measurable impairment that persists for hours.

Many people experience what’s called an “afterglow”—a sense of calm, mild euphoria, or detachment. That emotional quiet can mask just how impaired your body still is. The dissociation that makes ketamine effective is also what makes it dangerous behind the wheel.

If you’re pulled over or in an accident, there’s no legal defense. Ketamine is a dissociative anesthetic, and visible signs of sluggishness or confusion are enough to count as impaired driving. Driving under ketamine isn’t just risky. It meets the legal definition of DUI.

Therapy is important during ketamine treatment because it helps patients process the emotional material that ketamine brings to the surface. Ketamine often loosens psychological defenses and allows unresolved trauma, grief, or fear to emerge—sometimes suddenly and without context. Therapy provides a structure for working with those moments instead of just moving past them.

During a session, ketamine may trigger memories, symbolic imagery, or intense emotional shifts. These experiences can be disorienting, surreal, or difficult to interpret. Without support, it’s easy to miss their significance or suppress them once the drug wears off. A therapist helps you slow down, sort through what came up, and identify what matters.

This isn’t traditional talk therapy. It’s about integration—making sense of what you saw or felt while under the influence of ketamine. It can also help you track patterns across sessions and notice emotional shifts that aren’t immediately obvious.

Ketamine opens the door. Therapy helps you walk through it with your eyes open. Without it, much of the emotional work risks being lost.

Eligibility depends on the form of ketamine therapy. Spravato is only approved for treatment-resistant depression. IV, injection, and oral ketamine can treat a broader range of diagnoses—including major depression, persistent depressive disorder, bipolar depression, and seasonal affective disorder.

Some medical conditions are automatic disqualifiers because they create immediate life-threatening risks: brain aneurysm, history of brain bleeding, severe heart disease, pregnancy, active psychosis, schizophrenia, or a current suicide plan.

Others are of high concern but might be manageable with proper medical oversight and extra precautions: uncontrolled high blood pressure, recent stroke, severe liver disease, seizures, serious breathing problems, or active substance abuse.

Some conditions might not be ruled out if treatment if they’re well-controlled: mild asthma, thyroid disorders, controlled blood pressure, eating disorders, anxiety, glaucoma, or bladder problems.

Medical eligibility isn’t the only barrier. For example, IV and injection therapy are expensive and entirely self-pay. Spravato is covered by insurance, but still costs around $8,000 out of pocket. And it must be administered in a REMS-certified clinic, which may not exist in your area.