Depression affects millions of Americans, and for many, traditional antidepressants simply don’t provide adequate relief.
When conventional treatments fail to work, ketamine therapy has emerged as a promising alternative that can offer rapid and significant improvements in depressive symptoms.
If you’re considering ketamine treatment for depression, one of your first questions is likely: how many treatments will I need? Let’s explore what the research shows and what you can expect from ketamine therapy.
What is Ketamine Therapy for Depression?
Ketamine therapy involves the controlled, medical administration of ketamine to treat depression and other mental health conditions. Originally developed as an anesthetic in the 1960s, ketamine has gained recognition in recent years for its remarkable ability to rapidly reduce depressive symptoms, often within hours rather than the weeks or months typically required by traditional antidepressants.
Unlike conventional antidepressants that target serotonin, norepinephrine, or dopamine systems, ketamine works through a completely different mechanism in the brain. When administered in carefully controlled doses under medical supervision, ketamine can provide relief for individuals who haven’t responded to other treatments.
There are several methods of ketamine administration for depression treatment:
Intravenous (IV) Ketamine: The most studied and commonly used method, IV ketamine allows for precise dosing and rapid absorption. Treatment typically takes place in a medical setting over 40-60 minutes.
Intranasal Esketamine (Spravato): This FDA-approved nasal spray contains a specific form of ketamine and is administered in a healthcare provider’s office under supervision.
Intramuscular (IM) Injections: Some clinics offer ketamine via injection, which provides similar benefits to IV administration.
Oral or Sublingual Ketamine: While less common for depression treatment, some practitioners prescribe ketamine in tablet or lozenge form for at-home use after initial treatments.
The Standard Ketamine Treatment Protocol
Research and clinical experience have established a generally accepted protocol for ketamine treatment for depression. The standard approach typically involves an initial series of six treatments administered over two to three weeks. Most commonly, patients receive two to three ketamine infusions per week during this induction phase.
This protocol developed from early studies that demonstrated the most consistent and sustained results came from multiple treatments rather than a single dose. The repeated administration appears to create cumulative benefits, with each treatment building upon the previous one to produce more lasting improvements in mood and depressive symptoms.
During each IV ketamine session, patients typically receive a dose of 0.5 mg/kg of body weight, administered slowly over 40 minutes. Throughout the infusion, medical staff monitor vital signs including blood pressure, heart rate, and oxygen levels to ensure safety and comfort.
It’s important to understand that while six treatments represent the standard initial protocol, this isn’t a rigid rule. Some patients experience significant improvement after just three or four sessions, while others may require additional treatments to achieve optimal results. The treatment plan should be individualized based on your response and specific circumstances.
How Does Ketamine Work?
Ketamine’s antidepressant effects involve a fascinating and complex mechanism that differs fundamentally from traditional antidepressants. While researchers continue to uncover the full picture, several key processes appear to drive ketamine’s rapid and powerful effects on depression.
NMDA Receptor Antagonism: Ketamine primarily works by blocking NMDA receptors in the brain, which are involved in glutamate signaling. Glutamate is the brain’s primary excitatory neurotransmitter, and its dysregulation has been implicated in depression. By temporarily blocking these receptors, ketamine triggers a cascade of neurochemical events that ultimately lead to improved mood.
Synaptic Plasticity and Neurogenesis: One of ketamine’s most remarkable effects is its ability to promote the growth of new neural connections. Depression is associated with the loss of synaptic connections in key brain regions, particularly the prefrontal cortex and hippocampus. Ketamine stimulates the release of brain-derived neurotrophic factor (BDNF), a protein that supports the survival of existing neurons and encourages the growth and differentiation of new ones. This process, called synaptogenesis, essentially helps the brain rewire itself and restore healthy neural networks.
Rapid Onset of Action: Unlike traditional antidepressants that can take four to six weeks to show effects, ketamine often produces improvements within hours to days. This rapid action makes it particularly valuable for individuals experiencing severe depression or suicidal thoughts.
Anti-inflammatory Effects: Emerging research suggests that ketamine may also reduce neuroinflammation, which has been increasingly recognized as a contributing factor in depression.
The combination of these mechanisms creates both immediate relief and longer-term structural changes in the brain that can sustain improvements in mood even after treatment ends.
Ketamine for Treatment-Resistant Depression
Treatment-resistant depression (TRD) is generally defined as depression that hasn’t adequately responded to at least two different antidepressant medications tried at adequate doses and durations. This affects approximately 30% of people with major depressive disorder, representing millions of individuals who continue to suffer despite trying multiple conventional treatments.
Ketamine has shown particularly impressive results for this challenging population. Clinical studies have consistently demonstrated that 50-70% of people with treatment-resistant depression experience significant improvement with ketamine therapy. This is remarkable considering these individuals had previously failed to respond to numerous other treatment attempts.
For many people with TRD, ketamine represents not just another treatment option, but a fundamentally different approach that bypasses the limitations of traditional antidepressants. Because it works through glutamate rather than monoamine neurotransmitter systems, ketamine can be effective even when SSRIs, SNRIs, and other conventional medications have failed.
The FDA’s approval of esketamine nasal spray (Spravato) in 2019 specifically for treatment-resistant depression underscored the medical community’s recognition of ketamine’s value for this population. However, many practitioners and patients find that IV ketamine offers advantages in terms of customizable dosing and broader clinical experience.
Beyond simply reducing depressive symptoms, ketamine therapy can break the cycle of hopelessness that often accompanies treatment-resistant depression. The rapid response many patients experience can restore hope and motivation, making it easier to engage with other therapeutic interventions like psychotherapy, lifestyle changes, and rehabilitation of social connections.
How Many Ketamine Treatments are Needed for Depression?
While the standard protocol involves six initial treatments, the actual number of ketamine treatments needed varies significantly from person to person. Several research-supported patterns have emerged:
Initial Response: Many patients notice some improvement after just one or two treatments. However, these early improvements are often temporary and incomplete. Continuing through the full initial series typically produces more robust and lasting results.
Standard Induction Phase: The six-treatment protocol over 2-3 weeks remains the most common recommendation based on research and clinical experience. Studies show that response rates and the magnitude of improvement tend to increase with each treatment during this initial phase.
Extended Induction: Some patients, particularly those with severe or complex depression, may benefit from 8-10 initial treatments. Your treatment provider will work with you to determine whether extending the initial series makes sense based on your response pattern.
Maintenance Treatments: Most patients who respond well to the initial series will need periodic maintenance or “booster” treatments to sustain their improvements. The frequency of maintenance varies widely, from every few weeks to every few months, depending on individual needs.
Duration of Effect: Research indicates that without maintenance treatments, the benefits of ketamine typically last for 1-2 weeks after a single infusion. However, with the full initial series and appropriate maintenance, many patients maintain significant improvements for months.
It’s crucial to approach ketamine therapy with realistic expectations. This isn’t typically a “cure” that provides permanent relief after a set number of treatments. Instead, it’s an ongoing therapeutic tool that requires initial investment and periodic maintenance, similar to how someone with hypertension might need ongoing medication management.
Your treatment team should assess your response throughout the process and adjust the plan accordingly. Some indicators that suggest you may need additional treatments include the rate of symptom improvement, how long benefits last between treatments, and whether you’re achieving your therapeutic goals.
What Factors Influence Ketamine Dosing?
The number and frequency of ketamine treatments needed depend on multiple individual factors:
Severity and Duration of Depression: Individuals with more severe depression or longer episodes may require more treatments to achieve significant improvement. Someone who has struggled with depression for many years may need a more intensive initial protocol than someone experiencing their first major depressive episode.
Treatment Resistance: If you’ve tried and failed multiple antidepressant medications, you may need more ketamine treatments initially. However, paradoxically, ketamine often works best for this population once treatment is established.
Co-occurring Conditions: The presence of anxiety disorders, PTSD, chronic pain, or substance use issues can influence both the number of treatments needed and the overall response to ketamine therapy.
Individual Biochemistry: Genetic factors, metabolism, and individual brain chemistry all affect how you respond to ketamine. Some people are rapid responders who need fewer treatments, while others require a more gradual approach.
Concurrent Treatments: Continuing psychotherapy, maintaining other medications, and implementing lifestyle changes alongside ketamine treatment can influence how many sessions you need. Integrated care often produces better outcomes than ketamine alone.
Response Pattern: Your treatment provider will closely monitor how quickly you respond, how substantial the improvements are, and how long benefits last between treatments. This information guides decisions about treatment frequency and duration.
Body Weight and Physical Health: Dosing is typically weight-based, and certain medical conditions may influence both the appropriate dose and treatment frequency.
Previous Ketamine Experience: If you’ve had ketamine treatment before, your response history will inform current treatment planning.
What Happens After The Initial Ketamine Treatment Series?
Completing the initial series of ketamine treatments is an important milestone, but it’s not the end of your treatment journey. Most patients require some form of ongoing care to maintain the improvements they’ve achieved.
Maintenance Treatment Schedule: After the initial series, most patients transition to a maintenance phase with less frequent treatments. Common maintenance schedules include:
- Monthly infusions
- Treatments every 2-3 weeks
- Treatments “as needed” when symptoms begin to return
- Gradually decreasing frequency as stability improves
Your provider will work with you to find the optimal maintenance schedule based on how long your improvements last and when you notice symptoms returning.
Monitoring and Adjustment: Regular check-ins with your treatment team help track your progress and adjust the treatment plan as needed. Some patients find they can gradually extend the time between treatments, while others need more consistent ongoing support.
Integration with Other Therapies: Ketamine works best as part of a comprehensive treatment approach. After the initial series, it’s important to continue or begin psychotherapy, maintain any beneficial medications, and implement lifestyle strategies that support mental health. Many patients find that psychotherapy becomes more effective after ketamine treatment, as they have more mental and emotional energy to engage in therapeutic work.
Long-term Outcomes: Research on long-term ketamine treatment is still developing, but available evidence suggests that many patients can maintain significant improvements with appropriate maintenance care. Some individuals eventually reduce or discontinue ketamine treatments while maintaining their recovery through other means, while others find that ongoing ketamine therapy remains an essential part of their treatment plan.
Relapse Prevention: Learning to recognize early warning signs of depression returning helps you and your treatment team respond quickly. Some patients find that scheduling a booster treatment at the first sign of symptoms slipping helps prevent a full relapse.
Who Is A Good Candidate for Ketamine Therapy?
Ketamine therapy isn’t appropriate for everyone with depression, but it can be life-changing for the right candidates. Good candidates typically include:
Individuals with Treatment-Resistant Depression: If you’ve tried at least two antidepressant medications without adequate relief, ketamine therapy may offer a new path forward.
People with Severe Depression: Those experiencing severe depressive symptoms that significantly impair functioning may benefit from ketamine’s rapid action.
Individuals with Suicidal Thoughts: Research shows ketamine can rapidly reduce suicidal ideation, making it valuable for people in acute crisis (though it should be part of comprehensive suicide prevention care).
People Who Can’t Tolerate Other Treatments: If side effects from traditional antidepressants are intolerable or if you have medical conditions that contraindicate other treatments, ketamine may be an option.
Those Seeking Rapid Relief: When waiting weeks for traditional antidepressants to work isn’t feasible, ketamine’s rapid action can be crucial.
However, ketamine therapy may not be appropriate if you have:
- Uncontrolled hypertension or cardiovascular disease
- History of psychosis or schizophrenia
- Active substance use disorder (particularly involving ketamine or dissociative drugs)
- Pregnancy or breastfeeding
- Certain medical conditions that could be worsened by ketamine’s effects
A thorough evaluation with a qualified provider is essential to determine if ketamine therapy is right for you. This should include a complete medical history, psychiatric assessment, and discussion of your treatment goals and expectations.
Ketamine Treatment at Atlanta Integrative Psychiatry
At Atlanta Integrative Psychiatry, we understand that depression affects every aspect of your life, and finding the right treatment can feel overwhelming, especially when conventional approaches haven’t worked. Our ketamine therapy program is designed to provide safe, effective, and compassionate care for individuals struggling with treatment-resistant depression and other mood disorders.
Our approach to ketamine treatment integrates this innovative therapy within a comprehensive mental health care framework. We don’t view ketamine as a standalone solution but as a powerful tool that works best alongside psychotherapy, medication management when appropriate, and lifestyle optimization. Our experienced team takes time to understand your unique history, symptoms, and goals to create a personalized treatment plan.
When you choose ketamine therapy at Atlanta Integrative Psychiatry, you can expect:
Thorough Evaluation: We begin with a comprehensive assessment to determine if ketamine therapy is appropriate for you and to establish baseline measures of your symptoms.
Individualized Treatment Plans: While we follow evidence-based protocols, we customize your treatment schedule, dosing, and ongoing care based on your specific needs and response.
Safe, Comfortable Environment: Our treatments take place in a calm, supportive setting designed to promote relaxation and healing. Throughout each session, our medical team carefully monitors your safety and comfort.
Integrated Care: We coordinate ketamine therapy with your other mental health treatments, working collaboratively with your therapist and other providers when appropriate.
Ongoing Support: From your initial consultation through maintenance care, we provide continuous support, monitoring, and adjustments to ensure you achieve and maintain optimal results.
Evidence-Based Practice: Our ketamine protocols are grounded in the latest research and clinical best practices, ensuring you receive the highest quality care.
If you’ve been struggling with depression despite trying multiple treatments, ketamine therapy may offer the relief you’ve been seeking. We invite you to contact Atlanta Integrative Psychiatry to schedule a consultation and learn more about whether ketamine treatment is right for you.
Depression doesn’t have to control your life. With innovative treatments like ketamine therapy, combined with comprehensive mental health care, lasting improvement is possible. Take the first step toward feeling better by reaching out to our team today.
