Ketamine has been used as an anesthetic in hospitals for over fifty years. Its use as a psychiatric treatment is more recent, beginning in the early 2000s when researchers at Yale and the National Institute of Mental Health demonstrated that subanesthetic doses produced rapid antidepressant effects in patients with treatment-resistant depression.
Unlike traditional antidepressants such as SSRIs and SNRIs — which act on serotonin and norepinephrine systems and typically take four to six weeks to produce a clinical response — ketamine acts on the glutamate system, specifically the NMDA receptor. Many patients who respond notice changes within hours to days of the first infusion. The mechanism is thought to involve rapid synaptic plasticity and the restoration of neural connections that depression and chronic stress can degrade.
For patients who have not responded to multiple antidepressant trials, this difference matters clinically. A fundamentally different neurochemical target is often what allows ketamine to work when other medications haven’t.
Ketamine has demonstrated benefit for treatment-resistant depression, bipolar depression, PTSD, anxiety disorders with significant depressive features, and acute suicidality, with emerging applications in OCD and chronic pain syndromes. The strongest evidence is for treatment-resistant depression, where the FDA-approved esketamine (Spravato) and off-label IV ketamine have both been studied in randomized controlled trials.
Ketamine treatments at WIP take place in a private treatment room at our Spring Valley clinic. Total time on-site is typically about 90 minutes per session — the infusion itself lasts approximately 40 minutes, followed by a 20-30 minute recovery period.
During the infusion, you’ll be seated in a comfortable chair under continuous monitoring of vital signs by our nursing team. Temporary changes in sensation, perception, and emotion are common — most patients describe altered perception, time distortion, and a sense of mental distance from usual thought patterns. This dissociative experience is expected and is not a side effect to avoid; it may be part of how ketamine produces its antidepressant effect.
A WIP psychiatrist or nurse practitioner is present in the clinic throughout your treatment. After the infusion, you’ll remain in a private recovery space until the acute effects have resolved.
You cannot drive yourself home after ketamine treatment. Most patients arrange transportation with a family member or friend; a rideshare is also acceptable.
Candidacy is determined by a board-certified WIP psychiatrist during an initial evaluation. Several factors are considered together:
Not every patient who inquires about ketamine ends up receiving it. Sometimes the evaluation determines that a medication adjustment, additional psychotherapy, or a different interventional treatment — such as TMS, Spravato, or ketamine-assisted psychotherapy — is a better next step. The evaluation is where these clinical decisions get made.
Most clinics offering ketamine in Washington, DC are standalone mono therapy ketamine clinics — patients are evaluated and treated, and that’s the extent of the relationship. The patient’s broader psychiatric care happens elsewhere, with a separate provider.
WIP is structured differently. We are a psychiatry practice that operates its own interventional treatments. The psychiatrist who evaluates you for ketamine is qualified to provide your ongoing psychiatric care, and the decision about how ketamine fits into your broader treatment is made within a real clinical relationship — not handed off between providers.
For patients who already have an established outside psychiatrist, this structure is preserved: we provide the interventional treatment and coordinate directly with the referring clinician throughout. For patients who prefer a single provider managing both their interventional treatment and ongoing care, that’s available too. The right structure is decided in conversation with you, and with your referring clinician where applicable. See our referrals page for more on how we work with referring clinicians.
This integration matters clinically. Ketamine is medication and like other medications it is most effective when it’s part of a thoughtful treatment plan — combined with the right medication, the right therapy, the right timing — rather than delivered as a standalone procedure.
Ketamine is a medication that has been used as a general anesthetic in hospitals for over fifty years and has a long-established safety record. Its use as a psychiatric treatment is more recent — beginning in the early 2000s with research at Yale and the National Institute of Mental Health demonstrating that subanesthetic doses produced rapid antidepressant effects. The doses and delivery methods used in psychiatric treatment differ significantly from anesthetic use, which allows ketamine to be administered safely in an outpatient setting.
No. IV ketamine is used off-label for depression and other psychiatric conditions. The FDA-approved form is nasal esketamine (Spravato), approved for treatment-resistant depression. Esketamine and ketamine are closely related molecules with the same general mechanism; the differences are in molecular form, delivery route, and insurance coverage. Off-label use of ketamine in psychiatry is well-established in clinical practice and supported by a growing evidence base.
Yes. Ketamine infusions for depression are outpatient procedures and do not require hospital admission. Treatment takes place at our Spring Valley clinic in a private treatment room.
No. Mild to moderate depression is usually treated effectively with antidepressant medications and psychotherapy. Ketamine is generally reserved for patients with severe depression that has not responded to standard treatments — commonly called treatment-resistant depression. The evaluation process determines whether ketamine is appropriate for an individual patient based on diagnosis, treatment history, severity, and other clinical factors.
A referral isn’t required, but we generally want to confirm that adequate trials of standard antidepressants have been attempted before pursuing ketamine. If you haven’t yet tried oral medication, our consultation may identify medication options worth pursuing first. The initial consultation is where this is worked through — sometimes the answer is ketamine, sometimes it’s a medication adjustment, and the evaluation is how that decision is made.
Most patients we treat are considered treatment-resistant — they have not responded to multiple antidepressant medications, and many have not responded to ECT or TMS either. We cannot predict in advance who will respond. The induction phase of treatment generally reveals whether ketamine is working within the first few infusions. If there is no response, we say so and help develop an alternative plan, which may include ECT, TMS, or referral for clinical trial enrollment at NIH or other research centers.
Yes. Uncontrolled high blood pressure and heart failure need to be addressed before ketamine treatment can proceed. A history of certain psychotic disorders, current pregnancy, and several other conditions may also affect candidacy. The pre-treatment evaluation reviews your full medical history and identifies any contraindications.
Most antidepressants do not interfere with ketamine and can be continued. Two categories require attention: benzodiazepines (such as Klonopin, Xanax, and Ativan), particularly at higher daily doses, can blunt ketamine’s effect; and lamotrigine (Lamictal) at doses above 100mg/day can also reduce efficacy. These medications may need to be tapered or adjusted before starting ketamine, which is discussed during your evaluation.
Yes. The benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 100mg/day also can block ketamine efficacy. During your consultation with one of our physicians this will be discussed.
The initial protocol is six infusions over two to three weeks, which is designed to maximize ketamine’s effect during induction. Patients who respond then transition to maintenance — typically a single booster infusion when needed. The average duration of relief between booster infusions is three to four weeks, though this varies meaningfully patient-to-patient. The maintenance schedule is individualized based on response.
The honest answer is that long-term data on ketamine maintenance is still accumulating. Some patients use ketamine maintenance for extended periods; others transition off ketamine after a sustained response, with or without other treatments supporting them. We don’t yet have definitive answers about the optimal long-term course, and we discuss this openly during treatment planning.
True emergencies, with a psychiatric referral, can often be seen within a day. Routine consultations are generally scheduled within three to seven days.
The infusion itself lasts approximately 40 minutes, with total time on-site of about 75-120 minutes including recovery. During the infusion, temporary changes in sensation, perception, and emotion are common — patients often describe altered perception, time distortion, and a sense of mental distance from usual thought patterns. This dissociative experience is expected and is not a side effect to avoid; it may be part of how ketamine produces its antidepressant effect. Our clinical team is present and attentive throughout the session. After the infusion, most patients want to rest, and feel clear-headed again within an hour or two.
The most common side effects are dissociation during the infusion (expected, not concerning), nausea, transient elevation of blood pressure and heart rate, and short-term confusion. Rare but potentially significant side effects include interstitial cystitis (with prolonged use) and, exceptionally rarely, laryngeal spasm during the infusion. The full safety picture is reviewed during your evaluation. For a detailed walkthrough of what to expect, see our blog post on what to do before and after a ketamine infusion.
No. You cannot drive yourself home after ketamine treatment. Most patients arrange transportation with a family member or friend; a rideshare is also acceptable.
A few practical guidelines:
Both are forms of ketamine treatment. IV ketamine offers several advantages: faster onset, higher bioavailability, more precise dose control during the infusion, and lower overall cost (largely because of less frequent visits). Spravato is the FDA-approved nasal esketamine and is typically covered by insurance, which can be the determining factor for patients where insurance coverage is essential. Spravato’s other advantage is for patients where IV access is difficult. Visit frequency is higher with Spravato, which affects overall time commitment and cost. Which is the right choice depends on the clinical picture, insurance situation, and patient preference — a question worked through during the evaluation.
Ketamine-assisted psychotherapy (KAP) and standard IV ketamine are different in structure and goal. Standard infusions are oriented toward symptom reduction in depression, anxiety, and PTSD, with the patient resting through the experience under medical supervision. KAP integrates ketamine into active psychotherapy work — sessions are longer (about two hours), a licensed therapist is in the room for much of the session, and the experience is used to support psychological exploration around trauma, internal conflict, and patterns of distress. KAP is also more expensive than a standard infusion because of the therapist’s involvement. Which approach makes sense depends on your goals and clinical picture, and the evaluation is where that’s decided.
