Ketamine, an anesthetic, can lift severe depression and suicidal thinking within hours, much faster than standard antidepressants. That speed has made it a major option for people who haven't responded to anything else. For PTSD itself, the evidence is still early.
Esketamine (Spravato) nasal spray is FDA-approved for treatment-resistant depression, not PTSD. Small trials of IV ketamine for PTSD show rapid improvement that often fades within weeks without further treatment. Results look best when ketamine is combined with therapy.
| Model | What it is | Watch for |
|---|---|---|
| Esketamine (Spravato) | Nasal spray in a certified clinic with monitoring | Approved for depression; often covered by insurance and the VA |
| IV infusion clinic | Series of infusions, typically six | Usually out of pocket; quality varies widely |
| Ketamine-assisted psychotherapy | Ketamine sessions paired with a therapist | Most promising format for trauma; fewer providers |
| At-home telehealth | Lozenges mailed for home use | Least supervision; highest risk |
| 01 | Confirm medical oversightA physician screens you, and vital signs are monitored during every session. |
| 02 | Ask about integrationWho helps you make sense of sessions afterward? Ketamine without therapy fades faster. |
| 03 | Get the full costTotal for the series, plus maintenance sessions. |
| 04 | Check exclusionsA good clinic screens for psychosis history, uncontrolled blood pressure and substance misuse. |
Not for people with a history of psychosis, uncontrolled high blood pressure, or certain heart conditions. Ketamine can be misused; tell your provider about any substance use history. Never use it outside a medical setting.
| ✕ | Fault: Treating it as a one-time cureCorrection: Effects often fade. Plan for therapy alongside it. |