About Ketamine Therapy

How Ketamine Therapy Works

Ketamine therapy uses a well understood anesthetic medication, at low doses and in a monitored setting, to help with conditions such as depression, PTSD, anxiety, and chronic pain. This page explains what ketamine is, how it is thought to work, who it may help, and what the research shows, in plain language.

What Is Ketamine?

Ketamine is a medication first approved by the FDA in 1970 as an anesthetic. It has a long record of safe use in hospitals and emergency departments. Over the past two decades, researchers have studied lower, carefully controlled doses for mood and pain conditions. That use is off label, which means the medication is FDA approved, but not specifically for these psychiatric and pain indications. We are transparent about this distinction because honesty is part of good care.

A Different Mechanism Than Traditional Antidepressants

Most antidepressants act on serotonin and related neurotransmitters and can take weeks to work. Ketamine acts mainly on the glutamate system, the brain's most abundant excitatory signaling network. By modulating NMDA receptors, which help regulate how brain cells communicate, ketamine is thought to promote synaptic plasticity. Synaptic plasticity is the brain's ability to form new connections, and many researchers believe this helps explain why some people experience relief on a faster timeline.

How Ketamine Works on the Brain

The current scientific understanding, while still developing, is that ketamine briefly blocks NMDA receptors, which sets off a downstream cascade involving another receptor system and the release of growth related signals. The result appears to be a strengthening of communication between brain cells in regions involved in mood regulation. Researchers at institutions including Yale have been central to this work (Yale School of Medicine).

Forms of Ketamine Therapy

There are several ways ketamine and its derivatives are delivered:

Intravenous (IV) infusion. A controlled dose delivered into a vein over a set period, with vital sign monitoring. This is the most studied route for depression and pain.
Intramuscular (IM) injection. A single injection into muscle, used in some settings.
Intranasal esketamine (Spravato). A nasal spray derived from one component of ketamine that is separately FDA approved for treatment resistant depression (FDA, Spravato).
Oral lozenge. A lower bioavailability form sometimes used in other programs. We do not offer unsupervised at home oral ketamine, because clinical monitoring is part of how we keep treatment safe.

At our Charlotte clinic, our focus is physician supervised, in clinic treatment. We discuss which approach fits your needs during your consultation.

Who Is a Candidate?

Ketamine therapy may be appropriate for adults with depression, including treatment resistant depression, as well as PTSD, anxiety, and certain chronic pain conditions, especially when standard treatments have not brought enough relief. The only way to know whether it fits your situation is a medical evaluation.

Who Is Not a Candidate?

Ketamine is not appropriate for everyone. Our physician screens for conditions that can make treatment less safe, which may include uncontrolled high blood pressure, certain heart conditions, active psychosis, some substance use concerns, and pregnancy, among others. If ketamine is not a safe fit, we will tell you honestly and discuss other directions. This screening is built into the consultation every patient completes first.

Is Ketamine Therapy Safe?

In a clinical setting with proper screening and monitoring, ketamine has a well established safety profile. Side effects during treatment can include temporary dissociation, mild nausea, dizziness, and a brief rise in blood pressure, all of which are monitored. You should not drive for the rest of the day after an infusion. Long term risks are linked mainly to frequent, high dose, or unsupervised use, which is one reason we provide care in a controlled, physician led program.

What the Research Says

The evidence base has grown substantially since the early 2000s. A few representative studies:

A National Institute of Mental Health trial reported rapid improvement in treatment resistant depression after a single infusion (Zarate et al., 2006).
A two site randomized controlled trial found that a meaningful share of participants responded to ketamine for treatment resistant depression (Murrough et al., 2013).
A meta analysis of individual patient data reported a rapid reduction in suicidal ideation after a single infusion (Wilkinson et al., 2018).
A randomized controlled trial reported reduced PTSD symptom severity after repeated infusions (Feder et al., 2021).
Randomized controlled trials reported pain reduction in complex regional pain syndrome (Sigtermans et al., 2009).

Taken together, the research is encouraging. It also shows that ketamine does not help everyone, that benefits can fade without a maintenance plan, and that careful patient selection matters. We share this context so your expectations are grounded in evidence.

What Treatment Involves

Most protocols begin with a short series of infusions over two to three weeks, followed by a personalized plan for maintenance and integration. Each visit includes preparation, the monitored infusion, and a supervised recovery period. Our page on what to expect walks through a session step by step, and our FAQ answers the most common questions.