Ketamine therapy has rapidly gained attention as an innovative treatment for individuals struggling with depression—especially those who have not responded to traditional antidepressants. Known for its fast-acting effects, ketamine offers hope to patients with treatment-resistant depression (TRD). However, the treatment also comes with significant costs, potential risks, and complex insurance considerations.
If you’re considering ketamine therapy, understanding the financial, medical, and insurance landscape is essential before starting treatment.
What Is Ketamine Therapy for Depression?
Ketamine was originally developed as an anesthetic. In recent years, researchers discovered that at lower, controlled doses, it can produce rapid antidepressant effects—sometimes within hours or days.
Unlike traditional antidepressants that target serotonin or norepinephrine and may take weeks to work, ketamine acts on the brain’s glutamate system. This mechanism appears to promote neural connectivity and synaptic repair, which may explain its fast symptom relief.
There are two primary treatment approaches in the U.S.:
- IV (intravenous) ketamine infusions
- Esketamine nasal spray (brand name Spravato)
Spravato is FDA-approved specifically for treatment-resistant depression, while IV ketamine is prescribed off-label for depression.
How Much Does Ketamine Therapy Cost?
Cost is one of the biggest barriers to accessing ketamine treatment.
IV Ketamine (Self-Pay)
Most IV ketamine treatments are not covered by insurance and are paid out of pocket.
Typical costs per session:
- $425–$750 (IV infusion)
- $300–$550 (intramuscular injection)
A standard initial protocol usually includes 6–8 sessions over several weeks.
Total initial cost:
- $3,300–$13,500
Many patients also require maintenance sessions, which can add several hundred dollars per month.
Spravato (Esketamine Nasal Spray)
Without insurance, a full Spravato treatment course can cost:
- $16,800–$27,300
However, because Spravato is FDA-approved for depression, insurance coverage is far more common (discussed below).
Risks and Side Effects of Ketamine Therapy
While ketamine therapy can be effective, it is not risk-free. All treatments are administered under medical supervision due to potential side effects.
Common Short-Term Side Effects
Most effects occur during or shortly after treatment and typically resolve within hours:
- Dissociation (feeling detached from reality)
- Dizziness
- Nausea
- Drowsiness
- Elevated blood pressure
- Slowed breathing
Patients are monitored in a clinic setting during treatment and observed before being discharged.
Psychological Effects
Ketamine may cause temporary perceptual disturbances or psychotomimetic symptoms, such as altered sensations or unusual thoughts. These are typically short-lived.
In rare cases, patients may experience a temporary worsening of anxiety or suicidal thoughts, which is why psychiatric evaluation and follow-up are essential.
Risk of Misuse and Dependency
Ketamine has a history of recreational misuse. Although therapeutic doses are carefully controlled, repeated exposure may carry some risk of psychological dependence. Reputable clinics follow strict protocols to minimize misuse and ensure safe administration.
Long-Term Safety
Long-term data on ketamine use for depression is still evolving. Current research suggests that when administered in controlled medical settings at antidepressant doses, ketamine is generally well tolerated. However, ongoing studies are examining potential long-term cognitive and urinary effects.
Insurance Coverage in the United States
Insurance coverage depends heavily on whether the treatment is FDA-approved.
Spravato: Higher Likelihood of Coverage
Because Spravato is FDA-approved for treatment-resistant depression, it is often covered by:
- Commercial/private insurance plans
- Medicare
- Some Medicaid programs
Most insurers require prior authorization, which typically includes:
- Diagnosis of major depressive disorder
- Failure of at least two antidepressants
- Use alongside an oral antidepressant
- Treatment in a certified healthcare facility
With insurance approval, patients may pay:
- $0–$62 per session, depending on their plan
- Approximately $0–$1,300 total for a full treatment course
Without insurance, however, the cost remains high.
IV Ketamine: Rarely Covered
IV ketamine for depression is considered off-label use. Because it is not FDA-approved for depression specifically, most insurance companies classify it as:
- Experimental
- Investigational
- Not medically necessary
As a result, coverage is uncommon, and most patients pay out of pocket.
In rare situations, partial reimbursement may be possible with strong medical documentation, but approval rates remain low.
Is Ketamine Therapy Worth It?
For patients with severe, treatment-resistant depression, ketamine therapy can be transformative. The rapid relief it provides—particularly in cases involving suicidal thoughts—makes it a powerful option in modern psychiatry.
However, the financial commitment is substantial, especially for IV treatment without insurance coverage. Even with coverage, prior authorization requirements can delay access.
Before starting ketamine therapy, patients should:
- Speak with a board-certified psychiatrist
- Confirm insurance coverage and total expected costs
- Understand the full treatment protocol, including maintenance
- Review potential risks and side effects
Ketamine therapy represents a major advancement in depression treatment, offering rapid symptom relief where traditional medications have failed. Yet, it remains a high-cost treatment with varying insurance support.
For most U.S. patients, FDA-approved Spravato provides the best chance of insurance coverage. IV ketamine, while widely available, is usually self-pay.
As research continues and more data becomes available, insurance policies and access may evolve. For now, informed decision-making and financial planning are critical steps in determining whether ketamine therapy is the right option for you.