Ketamine for Mental Health: A Deep Look into Science-Based Treatment

Ketamine’s history would probably surprise most readers. From the Vietnam War, to modern-day hospitals, to a rise in recreational use, ketamine’s place in medical and therapeutic history continues to evolve. Today, ketamine therapy is gaining mainstream acceptance as a mental health treatment and is now an FDA-approved treatment for depression. 

As research accelerates and access expands, ketamine therapy is emerging as a promising option for people struggling with depression, PTSD, and other conditions. We explore the science, the benefits, and the concerns surrounding one of today’s most talked-about psychedelic therapies.

This article is for educational purposes only and does not constitute medical advice. Always consult a licensed healthcare provider before beginning any treatment. Effects and legality vary by region, diagnosis, and individual needs.

What is Ketamine? A Brief History

Developed in the 1960s, ketamine was approved by the FDA in 1970 as an anesthetic. The drug soon became a commonly-used emergency medicine and surgical settings due to its fast-acting effects and other useful qualities (no cardiovascular and respiratory depression associated with other anesthetics). It was widely used during the Vietnam War, where medics appreciated its ability to sedate wounded soldiers without complex monitoring.

But ketamine had another property: at certain doses, it could create vivid hallucinations, distort sensory perception, and induce a sense of dissociation or out-of-body experience. These effects led to its rise as a recreational drug, and has grown in popularity in party and nightlife scenes. Ketamine is classified as a “dissociative anesthetic”. When administered, ketamine can produce sedation (a calm, relaxed state), temporary immobility, and pain relief.

While the ketamine compound doesn’t fall under the same chemical class as psilocybin or LSD, its dissociative and hallucinogenic properties mean it is often grouped with them in discussions of psychedelic therapy.

The term “psychedelic” comes from the Greek psyche (mind) and deloun (to manifest) — giving the term “mind manifesting” — and in this sense, ketamine certainly qualifies. It facilitates altered states that, when combined with therapy, can help patients access repressed emotions, gain perspective on trauma, and experience a sense of detachment from negative thought loops.

Ketamine Therapy: A Legal Psychedelic Treatment

Ketamine and ketamine therapy occupy a unique space in the world of psychedelic medicine. While ketamine therapy is being studied alongside other psychedelics for the treatment of depression, PTSD, anxiety — these other compounds are currently under legal restriction. Ketamine and ketamine therapy, on the other hand, are already FDA-approved and available for therapeutic use.

Other psychedelic compounds (LSD, psilocybin etc.) remain Schedule I drugs in the U.S. (the most restricted classification), still subject to strict regulations and criminal penalties. Ketamine is a Schedule III controlled substance, meaning it can be prescribed by licensed physicians for both anesthesia (its original use) and “off-label” prescriptions for other conditions.

What is off-label drug use?
Prescribing an FDA-approved medication for a purpose other than its original approved indication. While the FDA regulates drug approval, it doesn’t control how doctors prescribe medications. This means clinicians can legally prescribe approved drugs — like ketamine — for other conditions based on clinical judgment and emerging research, even if those uses haven’t been formally endorsed by the FDA.

Ketamine was FDA-approved in the 1970s as an anesthetic, providing the opportunity for doctors and clinicians to prescribe it for other conditions. This practice has exploded in popularity, as people looked for new options to mental health conditions like depression. The number of telehealth and at-home ketamine therapy companies using this service has increased substantially.

Another legal option for ketamine therapy comes with Spravato. In 2019, the FDA approved Spravato (esketamine), a nasal spray derived from the S-enantiomer of ketamine. Produced by Janssen Pharmaceuticals, Spravato was a watershed moment for the industry — the first-ever psychedelic drug approved for mental health treatment. 

Spravato is indicated for adults with treatment-resistant depression and must be administered in a certified medical office under supervision. This year, the FDA approved Spravato as a monotherapy, meaning this ketamine therapy can be taken alone and not in conjunction with SSRIs or other antidepressants.

Is ketamine an opioid?
No, ketamine is not an opioid. It is a dissociative anesthetic that works primarily by blocking NMDA receptors, unlike opioids which act on the brain’s opioid receptors to relieve pain.

Therapeutic Use: Ketamine for Depression, PTSD, and more

Ketamine therapy shows promising potential for those in search of help. To date, the majority of major studies and regulatory approvals have been focused on ketamine for depression and more severe conditions like treatment-resistant depression (TRD). However, off-label use has allowed people with other conditions like anxiety and PTSD to access the potential benefits of ketamine therapy. 

Here’s a look at some of the major research on the benefits of ketamine therapy:

Ketamine for depression: In addition to the clinical trials that led to Spravato’s ketamine product receiving FDA approval for depression, this review and meta-analysis of 28 studies added further support for using ketamine for depression. The study found that intravenous ketamine infusions produced rapid and significant improvements in patients with treatment-resistant depression (TRD). Clinical benefits were noticeable within 4 hours and peaked around 24 hours after a single dose. While effects diminished slightly over a week, they remained present, especially with repeated treatments. 

Ketamine for post-traumatic stress disorder (PTSD): Ketamine is also being explored as a treatment for PTSD. A randomized and controlled clinical trial demonstrated that individuals with chronic PTSD experienced substantial symptom reduction after just one ketamine infusion. The ketamine group showed a significantly greater improvement in symptoms versus the placebo group, with positive results starting less than 24 hrs after dosing.

Ketamine for obsessive-compulsive disorder (OCD): A recent clinical study found that a single dose of ketamine led to a rapid reduction in obsessive thoughts and compulsive behaviors. The decrease in OCD symptoms occurred within one to two hours after the ketamine therapy and persisted for at least 24 hours. The measure — defined as 50% or greater reduction in OCD symptoms after 24 hours – shows that ketamine therapy as a treatment for OCD offers some promising possibilities.

Ketamine for anxiety: Generalized anxiety disorder (GAD) is another area being studied for ketamine therapy. This review of 18 studies showed that single-dose infusions of ketamine showed significant positive results for patients with anxiety disorders, with reduced symptoms like irritability and panic. Higher doses showed greater effects on anxiety reduction. The effects showed to be temporary, with anxiety symptoms returning after 2 weeks, showing that continued treatments of ketamine therapy is beneficial for certain patients. 

This growing body of research shows ketamine therapy’s potential as a versatile tool in psychiatric and neurological care. With a caveat. Larger studies are still needed to replicate some of these findings and ensure efficacy and safety for all patient groups. 

Does ketamine therapy get you high?
Ketamine therapy at higher doses will alter your perception and sense of self, often causing psychedelic visualisations. So yes, technically, you’re “high”. Which is why ketamine therapy should always be delivered in a safe and supported therapeutic setting.

The Rise of Ketamine Telehealth

As interest in ketamine therapy grows, a new model of care is reshaping how — and where — people receive treatment. Ketamine telehealth services are expanding rapidly, offering at-home options that aim to make this promising therapy more accessible and less expensive.

In jurisdictions with legal ketamine therapy, patients are prescribed low-dose ketamine lozenges or tablets after an online consultation. Treatment is typically paired with virtual therapy sessions, guided journaling, and digital integration tools to support mental health goals.

This approach is helping to break down several barriers to care:

• Geography: For patients in rural or underserved areas, access to brick-and-mortar ketamine clinics may be limited or non-existent. Telehealth removes the need for in-person visits, extending treatment into the home.
  
• Affordability: In-clinic ketamine infusions often cost hundreds or thousands of dollars per session. At-home models are typically priced more affordably, sometimes under $150 per session, making ketamine more accessible.
  
• Convenience & Privacy: For those hesitant to seek in-person mental health care — or who face mobility, work, or caregiving constraints — telehealth provides a discreet and flexible alternative.

This model is not without challenges. Critics point to the lack of standardized regulations, potential for overprescription, and inconsistent integration of psychotherapy, which many experts view as essential to maximizing ketamine therapy’s therapeutic benefit.

Still, the potential of telehealth ketamine therapy is significant. The study, published in Journal of Affective Disorders in September 2024, compiled data from over 11,000 depressed patients who receive four doses of ketamine at home over four weeks (with supporting digital health). The results show that telehealth ketamine therapy was safe and effective: “At-home, telehealth-supported ketamine administration was largely safe, well-tolerated, and associated with improvement in patients with depression”. Considering the very large sample size, these results go a long way in supporting the thesis behind ketamine telehealth therapy.