A Patient’s Guide to Ketamine Clinics

Ketamine has emerged as a promising treatment for some mental health conditions, particularly depression that has not responded to traditional treatments. Apart from Spravato (esketamine), which is FDA-approved for depression, ketamine is prescribed off-label for mental health conditions, and the evidence is strongest for depression; for anxiety it is thinner. As the popularity of ketamine therapy has grown, so has the variety of clinics offering these services. Here’s a deeper look into the different types of ketamine clinics and how they vary in approach and methodology.

First, let's clarify what ketamine is and how it works. Ketamine is a dissociative anesthetic, which can make patients feel detached from both the physical and psychological aspects of pain while inducing general anesthesia at higher doses. Ketamine primarily works by changing neurotransmitters in the brain, such as increasing glutamate. Researchers think these changes may support the growth of new connections between brain cells, which may help ease depressive symptoms. Compared to traditional antidepressants, which can take weeks to take effect, ketamine can relieve symptoms within hours or days for some people. That speed is one reason it has drawn interest for treatment-resistant depression.

Intravenous (IV) infusion clinics are perhaps the most traditional and widely recognized type of ketamine clinic. In these settings, patients receive a controlled dose of ketamine through an IV line. Sessions typically last between 40 minutes to an hour, during which patients receive ketamine without any guided therapy, but in the safety of a clinical environment. Patients are continuously monitored throughout the infusion for side effects or adverse reactions. Sessions are usually sold as a series of infusions (often six sessions over two to three weeks) followed by maintenance treatments as needed. The IV method allows for precise dosing, which can be tailored to the patient, based on their response. These clinics primarily concentrate on giving ketamine without therapeutic integration, which may suit patients seeking a medication-only approach. IV ketamine for depression is prescribed off-label and is usually self-pay.

Spravato (esketamine) is a nasal spray containing esketamine, a form of ketamine. It is FDA-approved for treatment-resistant depression, and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. Spravato is offered only in certified clinics under the REMS safety program: the patient uses the spray under supervision and is monitored for at least 2 hours afterward, and cannot drive until the next day. It is not typically given in the context of therapy. Spravato differs from generic ketamine, in that Spravato isolates one enantiomer, or structural type of ketamine, while generic ketamine is an equal mixture of both enantiomers. Since Spravato is FDA-approved, it may be covered by many insurance policies, while generic ketamine is much less frequently covered. It has long been used alongside an oral antidepressant, and since January 2025 it is also approved on its own, though many insurance plans still expect the combination. Using a nasal spray is less invasive than an IV infusion, which may suit patients who are apprehensive about needles but want the safety of a clinic setting.

With the rise of telemedicine, some clinics now offer ketamine therapy through virtual platforms. These telehealth clinics provide consultations, assessments, and follow-up appointments remotely, making it easier for patients to access care from the comfort of their homes. Patients can receive initial evaluations and ongoing support without needing to travel, which is particularly beneficial for those in remote locations or with mobility issues. Some telehealth providers prescribe ketamine to take at home, usually as oral lozenges, which the patient takes without a clinician in the room. Some providers check in over a video call or ask for a sober adult to be present. This is a meaningful safety trade-off: at home, no one is directly measuring blood pressure or other vital signs, and if something goes wrong, help is a phone call away rather than in the room. Unsupervised use also carries risks of taking more than prescribed and of misuse. At-home ketamine is not a good fit for people with significant medical or psychiatric conditions, a history of substance use problems, or anyone who would feel safer with clinical staff nearby. If you are considering it, ask exactly how you will be screened and monitored, and never adjust your dose on your own. While some telehealth clinics primarily focus on pharmacotherapy, many also provide access to therapists for integrated care after ketamine sessions, for a more complete approach to mental health treatment. Telehealth clinics often offer more flexible scheduling.

Some ketamine clinics take a more holistic approach by integrating psychotherapy into their treatment plans. This method, known as ketamine-assisted psychotherapy (KAP), acknowledges that mental health issues often require comprehensive care. Patients receive generic ketamine through various routes of administration, such as intramuscular (IM) injections or oral lozenges, in conjunction with psychotherapy sessions. During these sessions, a patient is actively guided through the experience by a provider trained in KAP. These sessions typically include one or more preparation sessions in which the patient and provider discuss intentions with the treatment, and an integration psychotherapy session post-treatment to most effectively apply lessons or discoveries into a patient's life. Early research suggests psychotherapy provided before, during, and after ketamine sessions may help benefits last longer. Like other ketamine treatment for mental health, KAP is prescribed off-label and is usually self-pay.

In addition to traditional psychotherapy, these clinics may offer different techniques such as cognitive-behavioral therapies, mindfulness practices, or other therapeutic methods. The clinic setting is often designed to facilitate relaxation and openness, creating a safe and comfortable space for patients to explore their thoughts and feelings during or after their treatment. Clinicians often customize treatment plans based on individual patient needs, focusing on both pharmacological and psychological support. By combining medication with therapy, this approach may suit patients who want the medicine paired with ongoing psychological work.

Choosing the right type of ketamine clinic depends on your individual needs, treatment goals, and comfort level with different methods of administration. IV infusion clinics provide a standard medical environment; Spravato clinics offer an FDA-approved, often insurance-covered option with required monitoring; telehealth clinics offer flexible scheduling but less direct supervision; and KAP-focused clinics pair the medicine with psychotherapy. Always consult a qualified healthcare professional to discuss your options and determine the most appropriate treatment path for your specific circumstances. With the right screening, support, and environment, ketamine treatment can be a helpful option for those who qualify. At Mystic Health in Santa Monica, we offer Spravato and in-clinic ketamine-assisted psychotherapy, and eligibility for either is decided in a medical consultation. If you are in crisis, call or text 988.