Online Ketamine Treatment Available in: AZ, CA, CO, FL, GA, NY, OR, TX, and WA.
Online Ketamine Treatment Available in: AZ, CA, CO, FL, GA, NY, OR, TX, and WA.
Treatment-resistant depression (TRD) affects roughly one-third of people with major depressive disorder — an estimated 2.8 million adults in the U.S. who have tried multiple antidepressants without achieving adequate relief. TRD is associated with significant functional impairment, increased healthcare costs, and higher risk of suicidal ideation. Ketamine represents one of the most significant advances in depression treatment in decades, offering a fundamentally different approach for patients who have not responded to conventional medications.
The evidence base for ketamine in TRD is among the strongest of any off-label ketamine indication. A landmark meta-analysis by Marcantoni et al. (2020), analyzing 28 studies, concluded that a single ketamine infusion was effective in reducing depression scores in TRD patients, with effects observed as early as 4 hours post-infusion and peaking at 24 hours. A large retrospective analysis by Zheng et al. (2020), published in the Journal of Affective Disorders, examined over 9,000 patients who received ketamine infusions and found that 53.6% showed more than 50% reduction in depression symptoms, with 73% showing reduced suicidal ideation.
More recent real-world data from oral ketamine programs have also shown promising results. Hull et al. (2022) and Hassan et al. (2022) each published large retrospective chart reviews with over 1,000 patients receiving oral ketamine via telehealth, demonstrating significant reductions in depression and anxiety scores. While ketamine (racemic) is not FDA-approved specifically for TRD, the FDA approved intranasal esketamine (Spravato) for TRD in 2019 — a closely related compound. For more detail, visit our page on ketamine for depression.
1. Consultation
A 60-minute telehealth evaluation with a physician experienced in ketamine therapy. We review your depression history, prior medication trials, and overall health to determine if ketamine is appropriate.
2. Personalized protocol
Your physician creates a tailored oral ketamine treatment plan with dosing and frequency adjusted to your needs. Medication is delivered to your home from a compounding pharmacy.
3. Ongoing care
Regular follow-up appointments to monitor your response, adjust dosing, and ensure you are getting the best possible outcome from treatment.
Treatment-resistant depression (TRD) is generally defined as depression that has not responded adequately to at least two different antidepressant medications taken at appropriate doses for sufficient durations. It affects an estimated one-third of people with major depressive disorder.
Multiple clinical studies and meta-analyses have shown that ketamine can produce rapid and significant reductions in depression scores in patients with TRD. Response rates in studies have varied, with some reporting that over 50% of patients experience meaningful improvement. However, individual results vary, and ongoing treatment is typically needed to maintain benefits.
Esketamine (Spravato), a nasal spray form of the S-enantiomer of ketamine, was FDA-approved in 2019 for treatment-resistant depression in conjunction with an oral antidepressant. Racemic ketamine itself is FDA-approved as an anesthetic and is used off-label for depression. At Isha Health, we prescribe oral ketamine, which is used off-label for TRD.
Standard antidepressants primarily target the serotonin, norepinephrine, or dopamine systems and typically take 4-6 weeks to show effects. Ketamine works through a fundamentally different mechanism — NMDA receptor antagonism on the glutamate system — and may produce noticeable improvement within hours to days. This makes it a potentially valuable option for patients who have not responded to conventional approaches.
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