Ketamine for Treatment-Resistant Depression
When standard depression treatments have not provided adequate relief, a licensed provider may consider ketamine within a closely monitored, individualized plan.
If you are in crisis or having thoughts of suicide, this is an emergency. Call or text 988 (Suicide & Crisis Lifeline) or call 911. Bravely Balanced is not an emergency service, and the candidate assessment is not a crisis intervention.
For many people, depression responds to psychotherapy and standard antidepressant medications. But for some, symptoms persist despite multiple adequate treatment trials. This is often described as treatment-resistant depression. It does not mean nothing can help — it means care needs to be individualized and sometimes expanded.
What "treatment-resistant" means
Treatment-resistant depression generally refers to depression that has not responded adequately to at least two adequate trials of standard antidepressant treatment. A provider confirms this through a careful review of your history, including which medications you have tried, at what dose, for how long, and how you responded. This matters because what looks like "resistance" can sometimes reflect undertreatment or a missed diagnosis.
What the evidence suggests
Research and clinical experience suggest ketamine may be associated with symptom improvement in some adults with treatment-resistant depression, sometimes sooner than with some traditional options. Responses vary, results are not guaranteed, and ketamine is not appropriate for everyone. It is used as part of a structured plan with required follow-up.
Why evaluation comes first
Bravely Balanced does not prescribe ketamine without a thorough psychiatric evaluation. Your provider confirms your treatment history, reviews current medications and safety considerations, and considers whether ketamine may be appropriate — or whether optimizing existing treatment, adding psychotherapy, or another approach is better suited to you.
An individualized plan
If your provider determines ketamine may be appropriate, you receive an individualized plan with a chosen formulation, strength, and frequency — all clinician-determined. Treatment is delivered through secure telehealth with at-home administration when appropriate, supported by a safety framework and required follow-up.
Not a cure, and not for everyone
Ketamine is not a cure for treatment-resistant depression, and individual results vary. Continuation is a clinical decision revisited at every follow-up based on your actual response, safety, and functioning. If ketamine is not appropriate, your provider will discuss alternatives and, when possible, referrals.
Related
See also ketamine for depression and our main ketamine therapy in Florida page.
Important context about ketamine. Ketamine is FDA-approved as an anesthetic. The use of compounded racemic ketamine for psychiatric conditions is off-label, and compounded medications are not FDA-approved products. Compounded ketamine nasal spray is not the same as FDA-approved esketamine (Spravato®).
Treatment is not appropriate for everyone. A licensed clinician independently determines whether prescribing is appropriate. No prescription is guaranteed, and completing an assessment does not equal clinical eligibility.
About this page
- Written by:
- Bravely Balanced Clinical Education Team
- Medical review:
- Pending — this content has not yet been reviewed by a licensed clinician.
- Last updated:
- 2026-08-27
This page is educational and is not a substitute for personalized medical advice. All treatment decisions are made by a licensed provider based on your individual evaluation.
Selected references for further reading
- Sanacora G, et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry. 2017;74(4):399-405.
- American Psychiatric Association. Consensus Statement on the Use of Ketamine in Psychiatric Disorders. 2017.
References are provided for educational purposes and do not constitute an endorsement.