Ketamine Clinics Are Multiplying. The Standard of Care Has Not Caught Up.
The drug works quickly for some people with severe depression. What happens around the infusion varies enormously from clinic to clinic.
By Elena Marchetti · June 9, 2026 · 7 min read
Ketamine's antidepressant effect is among the better-replicated findings in modern psychiatry: measurable improvement within hours in a substantial minority of people with treatment-resistant depression, including those with active suicidal ideation. Esketamine has regulatory approval in the US and Europe under restricted dispensing.
Racemic ketamine given off-label in private clinics is a different situation. Dose, route, session frequency, psychiatric screening, and follow-up all vary, and there is no binding standard governing them. Some clinics coordinate closely with a treating psychiatrist. Others deliver an infusion to a self-referred patient and schedule the next one.
The durability problem
Response typically fades within one to two weeks without maintenance. This makes the treatment economically self-sustaining and clinically ambiguous: repeat dosing over months has limited long-term safety data, particularly regarding bladder toxicity and dissociative tolerance at higher cumulative exposure.
A rapid response is not the same as a durable one, and the gap between them is where the business model lives.
The clinics worth trusting are the ones that require a referral, screen for psychosis and cardiovascular risk, set a defined course rather than an open subscription, and integrate the treatment with ongoing therapy.
Sources / Further reading
- Daly et al., Efficacy of esketamine nasal spray plus oral antidepressant, JAMA Psychiatry (2018)
- Wilkinson et al., The effect of a single dose of intravenous ketamine on suicidal ideation, Am J Psychiatry (2018)
- American Psychiatric Association, consensus statement on ketamine use in mood disorders
