Intravenous Ketamine Therapy

Intravenous (IV) ketamine therapy is a rapid-acting, evidence-supported intervention for major depressive disorder (MDD) and treatment-resistant depression (TRD). Ketamine is administered as a subanesthetic intravenous infusion, typically at a dose of 0.5 mg/kg over approximately 40 minutes, under close medical supervision. This treatment may provide rapid antidepressant effects, often within hours, and is particularly relevant for patients with severe symptoms or acute suicidal ideation.

Ketamine acts primarily as an N-methyl-D-aspartate (NMDA) receptor antagonist, enhancing glutamate signaling and promoting neuroplasticity in brain regions involved in mood regulation, including the prefrontal cortex and hippocampus. This mechanism differs from traditional monoaminergic antidepressants and may benefit patients who have not responded to standard treatments.

At the UTHealth Houston Center for Interventional Psychiatry, IV ketamine therapy is delivered within a structured, medically supervised clinical program, integrated with comprehensive psychiatric care and matched to the appropriate level of care.

Who May Be Appropriate for IV Ketamine Therapy

IV ketamine therapy may be considered for patients who:

  • Have major depressive disorder or treatment-resistant depression with inadequate response to multiple evidence-based treatments
  • Experience severe depressive symptoms or suicidal ideation requiring rapid symptom relief
  • Have not tolerated or benefited from standard pharmacologic options
  • Are not appropriate candidates for, or have not responded to, other interventional treatments

All patients undergo a comprehensive evaluation to confirm diagnosis, review prior treatment history, and assess medical and psychiatric appropriateness for IV ketamine therapy.

Treatment Process and Dosing Schedule

IV ketamine is administered by trained clinical staff in a monitored medical setting. Treatment follows a phased protocol:

  • Induction phase: twice-weekly infusions for 4 weeks
  • Taper phase: once-weekly infusions for an additional 4 weeks
  • Maintenance phase: individualized treatment, typically weekly or biweekly, based on symptom stability and clinical response

Each infusion session includes continuous monitoring of vital signs and clinical status during and after treatment. Patients are observed following infusion and must arrange transportation home.

Safety and Monitoring

IV ketamine therapy is delivered with a strong emphasis on safety. Common side effects include transient dissociation, dizziness, nausea, sedation, and mild increases in blood pressure, which typically resolve shortly after infusion. Potential risks, benefits, and alternatives are reviewed carefully with patients before initiation and throughout treatment.

Integration With Ongoing Care

IV ketamine therapy is not a standalone intervention. It is integrated with:

  • Ongoing psychiatric evaluation and medication management
  • Psychotherapy, when indicated
  • Measurement-based outcome monitoring and longitudinal follow-up

Depending on symptom severity and clinical needs, IV ketamine therapy may be provided within outpatient, IOP, PHP, or inpatient settings.

Through this structured, closely monitored, and integrated approach, the Center aims to provide safe and effective access to IV ketamine therapy as part of comprehensive care for individuals with severe and treatment-resistant depression.