Ketamine for Treatment-Resistant Depression: Reducing Suicidal Ideation and More
Written by Colter Bloxom, LPC
Colter is a licensed psychotherapist and the owner and Executive Director of Thrive Therapy. He specializes in the treatment of anxiety, OCD, identity issues, and more.
Living with depression can make you feel hopeless. But if you have treatment-resistant depression, that weight can feel even heavier. Treatment-resistant depression means your depressive symptoms haven’t improved enough even after trying two or more standard treatments. It can start to feel like nothing will ever work.
But there’s good news: ketamine and esketamine (a nasal spray form of ketamine) are newer treatment options that have shown enormous promise in helping people with treatment-resistant depression find relief, even when their symptoms are severe.
In this blog, I’m answering common questions people have about ketamine for treatment-resistant depression, including how it works, side effects, and how to get started.
Benefits of esketamine for treatment-resistant depression
Esketamine is a form of ketamine that’s FDA-approved for patients with treatment-resistant depression. Research shows that for people with severe depression who have tried multiple medications without success, esketamine and ketamine therapy can work even if nothing else has.
These are some of the main benefits of ketamine for depression.
Works quickly
One of the most unique benefits of ketamine therapy is how quickly it can work. Unlike traditional antidepressants, which can take weeks to start taking effect, ketamine can begin reducing depressive symptoms within days or even hours.
If you’re experiencing a severe depressive episode or suicidal thoughts, waiting weeks for relief may not feel possible. In some clinical trials, people with depression noticed mood improvements after just one infusion. This relief can mean everything if you’ve been living with severe depression for a long time.
Even when these improvements don’t last, this quick response can create an important window of time where people feel more stable and better able to engage in therapy or other support.
Reduces suicidal thoughts
Research shows that ketamine may help reduce suicidal thoughts in people with severe depression. This is especially important because suicidal thinking can feel overwhelming and urgent — and your life may literally be at risk. Many standard medications may not feel like they work fast enough to help.
There’s no miracle cure, and no treatment can completely eliminate suicidal thoughts overnight. But ketamine can make them feel less intense and less frequent. This relief, even when it’s temporary, can give you and your psychiatry team more time to focus on longer-term strategies for recovery and safety planning.
Works for severe depression
Many people included in ketamine clinical trials have symptoms so severe that they wouldn’t even qualify for other studies. Severe depression symptoms could include strong suicidal thoughts, extreme hopelessness, and a deep sense of disconnection from life. When you’re living with symptoms like these, one session of traditional treatment might not feel like enough.
Despite this, ketamine therapy has helped many people with severe treatment-resistant depression feel better. This relief can provide the momentum and hope that’s needed to continue with therapy, reconnect with loved ones, or simply keep going for one more day.
Works when nothing else has (treatment-resistant depression)
Treatment-resistant depression, diagnosed as persistent depressive disorder, can feel incredibly isolating. You might have tried multiple antidepressants, therapy, lifestyle changes, and still feel stuck. This type of depression often involves changes in the brain that make it harder for traditional medications to work.
Ketamine works differently. There’s some evidence that instead of focusing on serotonin (like many other antidepressant medications), ketamine targets glutamate and can create new connections in the brain. This process could help “reset” certain patterns that could be keeping you in depressive cycles.
Strengthens the benefits of therapy
Ketamine-assisted therapy isn’t just about taking a dose and walking away. One of the most important parts of this treatment is the integration phase. Integration means talking through your experiences during your dosing with a licensed therapist and applying the insights you gained to your everyday life.
After a ketamine dose, many people feel more open and flexible, which can make therapy more effective. You might feel more able to explore difficult emotions or revisit painful memories that felt too overwhelming before.
At Thrive, we believe that the combination of ketamine dosing and guided therapy is what makes this treatment actually effective. We’ll spend time with you before and after each session to help integrate your experiences and support your overall mental health.
How many ketamine treatments for depression?
The number of ketamine treatments needed can vary from person to person. In one clinical trial, after just three ketamine infusions over 11 days, more than half of the participants reached remission. Two-thirds of the people who responded after only one infusion went on to achieve remission eventually.
Some people continue to do maintenance sessions to help sustain the effects. Others find that after an initial series of infusions, they’re able to transition into therapy and other supports without additional doses.
Your care team will work with you to create a treatment plan that meets your unique needs and helps you feel as safe and supported as possible.
Side effects of ketamine treatment for depression
Like any depression treatment, ketamine therapy can come with side effects. Some of the most common ones include:
- Nausea
- Dizziness
- Blurred vision
- Vertigo
- Prickling or numbness in the skin
Dissociation — a feeling of being disconnected from your body or environment — is also common. While dissociation can sound scary, it’s a normal part of the psychedelic effects of ketamine. Many people describe it as feeling like they’re floating or observing themselves from outside their body.
However, studies have also found that side effects with one dose of ketamine for depression tend to be mild and brief. In other words, most of the time, they’re not serious enough to need to stop treatment.
It’s important to receive ketamine in a controlled setting with trained mental health professionals to avoid side effects as much as possible. At Thrive, we make sure you’re closely monitored during each session and provide a safe, calm space to recover afterward.
Is ketamine FDA-approved for depression?
Yes — esketamine (the nasal spray form of ketamine) is FDA-approved for patients with treatment-resistant depression. The brand name for esketamine is Spravato, and it needs to be administered under strict supervision in a clinic setting.
Other forms of ketamine, like intravenous or oral ketamine, are used off-label to treat depression. This means they’re not officially FDA-approved for depression but can be prescribed by a psychiatrist when they believe it’s appropriate.
Talk to us about whether ketamine-assisted therapy is the right treatment for you
If you live with severe depression, treatment-resistant depression, and suicidal thoughts, ketamine therapy can help. But it’s not a one-size-fits-all approach, and it’s about so much more than just taking the drug.
At Thrive, we take the time to understand your unique needs and make sure you feel supported every step of the way. Our ketamine-assisted psychotherapy program combines ketamine dosing with guided integration sessions, so that you’re using the benefits of ketamine to further your healing and self-awareness.
If you’re ready to explore a new treatment option (or if you feel like you’ve tried everything else), talk to us. We can help you decide if ketamine therapy is the right next step on your path to overcoming depression.
