Ketamine Therapy: What to Know Before Your First Consultation

Ketamine therapy is a medically supervised treatment used in clinical settings for treatment-resistant depression and certain chronic pain conditions that have not responded to standard care. The nasal form of esketamine is FDA approved for adults with treatment-resistant depression when used together with an oral antidepressant, while intravenous ketamine is used off-label based on short-term evidence, mainly for depression. At Zest Regen Health in Columbia, Maryland, ketamine is evaluated and administered under medical supervision, and candidacy is determined strictly after a thorough medical review.

What ketamine is and how it is used

Ketamine is an anesthetic that, at much lower doses than are used for surgery, has been studied for rapid relief of depressive symptoms in some patients. It is not a first-line treatment. It is generally considered for people whose depression has not responded to at least two adequate trials of standard antidepressants, and in some clinical settings for specific chronic pain conditions.

What the evidence shows

For treatment-resistant depression, the short-term evidence is the strongest: a single subanesthetic infusion can relieve symptoms within about a day in some patients, with effects lasting roughly three to seven days, and a course of treatments is usually needed. Long-term data are more limited, and relapse after stopping treatment is common. For chronic pain, a 2025 Cochrane review found no clear evidence of benefit and noted an increased risk of adverse events with intravenous use, so the evidence for pain is considerably weaker than the evidence for depression.

How treatment is carried out

Ketamine is administered only in a clinical setting, never at home. Blood pressure and vital signs are monitored before, during, and after each session, and patients cannot drive afterward. The nasal form of esketamine requires in-clinic observation for about two hours after dosing. Any program that offers ketamine without supervised monitoring is not practicing within the standard of care.

Who may be evaluated

• Adults with treatment-resistant depression that has not responded to standard treatments
• Patients who can be safely monitored during and after each session
• No active psychosis, uncontrolled high blood pressure, or severe heart or respiratory disease, which are common reasons a person is not a candidate
• A clear discussion of alternatives and expected monitoring before any treatment begins

Side effects and what to expect

Common, usually temporary effects include feeling detached or dissociated during the session, dizziness, nausea, headache, and a temporary rise in blood pressure. Most resolve within the observation period after treatment. Because long-term safety data are still limited, responsible care includes ongoing clinical review rather than open-ended repeat dosing.

Questions to ask before you start

1. Who evaluates me, and what does the medical review include?
2. How many sessions are planned, and how is my response measured?
3. What monitoring happens during and after each session?
4. What are the costs, and is this treatment covered by my plan?
5. What happens if I do not respond to the treatment?

What to keep in mind

Ketamine is not a quick fix and it is not appropriate for everyone. Clinics that use it responsibly treat it as one tool within a broader plan that includes evaluation, monitoring, and follow-up. If you are considering ketamine therapy, the first step is a medical conversation about whether it is worth evaluating for your situation at all.

See how ketamine therapy is evaluated at the Columbia clinic

Learn how diagnostic testing and medical review guide treatment decisions at Zest Regen Health

Meet the physicians who evaluate candidates for ketamine therapy at Zest Regen Health

Find the clinic at 8860 Columbia 100 Parkway, Suite 216, Columbia, MD

Next step

If you or someone you care about is living with depression that has not responded to standard treatment, start with a conversation rather than a clinic search. Book a free 15-minute consultation at the Columbia clinic, and the clinical team can discuss whether ketamine therapy is appropriate to evaluate for your situation.