High-Functioning Depression: The Hidden Signs When You Keep Showing Up
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If you've tried more than one antidepressant and still don't feel like yourself, you may have heard about ketamine for depression. It has drawn attention because research suggests it can ease depression symptoms quickly in some people who haven't responded to other treatments. This guide explains how it's thought to work, what the potential benefits and risks are, and how to talk with your provider about whether it's right for you.
Our practice does not offer ketamine or esketamine treatment. This article is for education only. If you're curious about ketamine, ask your psychiatric provider whether it's appropriate for you and where it's available.
Key takeaways
- Ketamine was first developed as an anesthetic and has been studied as a treatment for depression that hasn't improved with other options.
- Research suggests it may ease depression symptoms within hours to days, much faster than standard antidepressants.
- Common short-term side effects include feeling detached or "out of body," dizziness and nausea.
- Ketamine carries a risk of misuse and should only be given under medical supervision.
- The FDA has not approved generic ketamine for psychiatric conditions, though a related medication, esketamine, is approved as a nasal spray for treatment-resistant depression.
What is ketamine?
Ketamine is a medication first developed in the 1960s. The FDA approved it as an anesthetic for people in 1970.
Over time, researchers noticed that ketamine could also affect mood. That led to studies of ketamine for treatment-resistant depression, meaning depression that hasn't improved enough after trying standard treatments.
How ketamine is thought to work
Most antidepressants work on brain chemicals like serotonin. Ketamine works differently. It blocks a type of receptor in the brain called the NMDA receptor, which affects glutamate, one of the brain's main chemical messengers.
This action is believed to help the brain form and strengthen connections between nerve cells. Researchers think this may explain ketamine's fast effect on mood, but the full picture is still being studied.
Potential benefits of ketamine for depression
Fast relief for some people
The most talked-about benefit is speed. Standard antidepressants often take several weeks to work. In studies, ketamine has eased depression symptoms for some people within hours or days.
Research has also looked at ketamine's effect on suicidal thoughts. This is an active area of study, and ketamine is not a replacement for crisis care. If you're having thoughts of suicide, call or text 988, call 911 in an emergency, or visit our crisis resources page.
An option when other treatments haven't helped
For people with treatment-resistant depression, ketamine may offer a different path. Because it works on a different brain system than most antidepressants, some people who haven't responded to other medications do respond to ketamine.
Effects that can outlast the medication
Ketamine leaves the body fairly quickly, but its effect on mood can last after the medication itself is gone. How long that benefit lasts varies from person to person. Some people need follow-up treatments if symptoms return.
Potential risks and side effects
Like any medical treatment, ketamine has risks. Understanding them is an important part of making an informed decision.
Short-term side effects
During and shortly after a treatment, people may experience:
- Feeling detached, dreamlike or "out of body" (dissociation)
- Dizziness
- Nausea
Less commonly, more serious effects such as high blood pressure, slowed breathing or loss of consciousness can occur. This is why ketamine should only be given in a controlled medical setting with monitoring.
Misuse and dependence
Ketamine can be misused, and long-term use carries a risk of dependence. People receiving ketamine should be checked regularly for signs of dependence or other long-term effects. Ketamine should never be taken outside of medical supervision.
Regulatory status
The FDA has not approved generic ketamine for depression or other psychiatric conditions. When clinics use it for depression, it's considered off-label use. Esketamine, a closely related medication given as a nasal spray, is FDA-approved for treatment-resistant depression. Our guide to esketamine nasal spray for depression covers it in more detail.
It's not right for everyone
Ketamine is generally considered low risk when given under medical supervision, but it's not risk-free. Your medical history, other health conditions and current medications all affect whether it's a safe choice. The right approach is always individualized and decided with a qualified provider.
How ketamine treatment is given
Ketamine can be given in several ways, depending on the clinic and the patient:
| Method | How it's given |
|---|---|
| IV infusion | Through a vein, which lets the care team closely control the amount |
| Nasal spray | Esketamine, an FDA-approved nasal spray for treatment-resistant depression |
| Injection | Into a muscle (intramuscular) |
Treatment usually starts with a series of sessions over several weeks. Some people later need occasional "booster" treatments if symptoms come back. How often depends on how a person responds. Your provider is the right person to explain what a treatment schedule might look like for you.
Questions to ask your provider
If you're considering ketamine, bring these questions to your psychiatric provider:
- Is my depression considered treatment-resistant?
- Is ketamine or esketamine appropriate for my history and health?
- What are the risks for me specifically?
- How would it fit with my current medications?
- Where is it available, and is it covered by insurance?
Don't start, stop or change any medication without talking with your prescriber first.
Other options when depression treatment isn't working
If you're researching ketamine, you may already feel frustrated that treatment hasn't helped enough. That doesn't mean you're out of options. A fresh psychiatric evaluation can take a new look at your diagnosis, past medications and doses, and any medical factors that may be getting in the way.
Options may include adjusting your medication plan, checking lab work, or GeneSight testing to see how your genes may affect how you process certain medications. Our guide on what to do when antidepressants don't work is a helpful next read.
Frequently asked questions
How fast does ketamine work for depression?
In research, some people notice improvement within hours to days. That's much faster than standard antidepressants, which often take several weeks. Results vary, and not everyone responds.
Is ketamine FDA-approved for depression?
Generic ketamine is FDA-approved as an anesthetic, not for depression. Its use for depression is off-label. Esketamine, a related nasal spray, is FDA-approved for treatment-resistant depression.
What does ketamine treatment feel like?
Many people feel detached, dreamlike or disconnected from their surroundings during treatment. Dizziness and nausea are also common. These effects usually wear off after the session, and you're monitored by medical staff while they last.
Who might be a candidate for ketamine?
Ketamine is generally considered for people whose depression hasn't improved enough with other treatments. Whether it's right for you depends on your health, history and current medications. Ask your psychiatric provider whether it's appropriate and where it's available.
Talk with us about your depression treatment options
If depression treatment hasn't worked the way you hoped, our psychiatrist and psychiatric physician assistants can review your care and help you understand your options, including whether to explore treatments we don't provide. We see patients in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to get started.
