Is Ketamine Therapy Safe? Why At-Home Ketamine Is a Different Story

Ketamine is an anesthetic, a medication used to put people to sleep for surgery. The doses used for mental health care are much lower and are not meant to anesthetize or cause loss of consciousness, but they still change how the brain and body work for a few hours. According to an FDA safety warning about ketamine, known safety concerns include:

• Sleepiness or sedation, sometimes deep enough that a person cannot stay awake
• Dissociation, a feeling of being disconnected from your body, your thoughts, or your surroundings
• Spikes in blood pressure
• Slowed or shallow breathing
• Misuse and abuse
• New or worsening mental health symptoms
• Bladder and urinary problems

Is ketamine addictive? It can be. Ketamine is a controlled substance because it can be misused, and people who have struggled with substance use are at higher risk.

None of these risks go away at lower doses. What changes is whether someone trained is there to catch a problem early.

If ketamine carries these risks, why is it used at all? Because for some people with severe depression, it may help when nothing else has.

Most antidepressants take weeks to start working. For people living with treatment-resistant depression, meaning depression that has not improved after trying at least two different antidepressants, those weeks can feel endless. In an early study from the National Institute of Mental Health, participants with hard-to-treat depression showed significant improvement within about two hours of a single ketamine infusion. These improvements held steady for a full week afterward.

That speed and efficacy when other treatments have failed is why ketamine is considered for some people. It is also why the setting matters so much. Ketamine itself is FDA-approved only as an anesthetic, so using it for depression is off-label. The FDA has not set a safe or effective ketamine dose for any mental health condition.

In short, ketamine is still prescribed because it may offer faster relief for some people with severe depression, but only when a provider weighs the potential benefits carefully against the risks.

A different kind of ketamine prescription has become easy to find online. Some telehealth companies prescribe ketamine as troches or lozenges, small tablets that dissolve under the tongue or between the cheek and gum, and mail them to an individual’s home. Others offer ketamine nasal sprays mixed by a compounding pharmacy.

These products are compounded, meaning a pharmacy mixes them rather than a drug company making an FDA-approved version. The FDA has not reviewed compounded ketamine for safety, quality, or the right dose for any mental health condition. The strength can vary from one product to the next.

The same FDA warning notes that taking ketamine at home, with no health care provider there to watch for sedation, dissociation, and changes in blood pressure or heart rate, may put people at risk for serious harm. In one case reported to the agency, a person taking compounded oral ketamine at home for PTSD developed slowed breathing, with a ketamine blood level about twice what is typically seen during anesthesia.

Why At-Home Ketamine Carries Extra Risk

• No one is there to check breathing, blood pressure, or heart rate
• Extra doses are within reach, which makes it easy to take more than planned
• Mixing ketamine with alcohol, opioids, sleep aids, or anti-anxiety medications can deepen sedation
• Being alone while dissociated can raise the risk of falls and other accidents

This is why LifeStance does not prescribe ketamine for use at home. LifeStance providers offer in-clinic ketamine therapy or esketamine, and every dose is given on-site and supervised by a care team.

The phrase “ketamine-assisted therapy” gets used in many ways, so it helps to know what separates supervised treatment from a prescription taken alone at home.

Ketamine-assisted therapy, sometimes called ketamine-assisted psychotherapy, pairs carefully dosed ketamine with support from trained professionals. In a supervised clinic, that usually includes:

• A full evaluation before treatment, covering medical history, current medications, and any past substance use
• Screening for conditions that can make ketamine riskier, such as high blood pressure, heart disease, psychosis, or bipolar disorder
• Treatment given on-site, with the dose controlled by a care team
• Monitoring of breathing, blood pressure, and heart rate during and after each session
• A team trained to respond quickly if something goes wrong
• Going home only once the care team confirms the person is stable
• Talk therapy alongside treatment, which can help people make the most of the relief ketamine may bring

At-home ketamine removes most of these safeguards. Some online programs pair lozenges with a video check-in or ask a friend or family member to stay nearby. But a video call cannot take a blood pressure reading, and a well-meaning friend is not trained to manage slowed breathing.

In short, the medication may look similar on paper, but the level of care is not.

Esketamine is a close chemical relative of ketamine. It is sold as Spravato, a nasal spray, and it is the only medication in the ketamine family that the FDA has approved for depression.

According to the FDA label for Spravato, it is approved for adults with treatment-resistant depression, either on its own or with an oral antidepressant. Together with an oral antidepressant, it is also approved for adults with major depressive disorder who are having suicidal thoughts or behaviors.

What sets Spravato apart is not just the approval. It is the rules that come with it. Because of the risks of sedation, dissociation, slowed breathing, and misuse, Spravato is only available through a strict FDA safety program called a REMS (Risk Evaluation and Mitigation Strategy). Under that program:

• Spravato is only dispensed to certified health care settings and is never sent home
• Individuals use the nasal spray themselves under the direct watch of a health care provider
• Blood pressure is checked before and after each dose, and breathing is monitored with a pulse oximeter
• Every individual is monitored for at least two hours after each dose
• Driving is not allowed until the next day, so individuals are required to have a ride home

Common side effects, such as dizziness, nausea, and feeling disconnected, usually show up right after a dose and go away the same day.

This is the clearest line in the ketamine conversation. Spravato comes with built-in supervision. At-home compounded ketamine does not. Spravato treatment is offered at select LifeStance locations, and services vary by location.

Ketamine and esketamine are not right for everyone. A provider will look closely at health history before recommending either one. Treatment may not be a good fit, or may call for extra caution, for people with:

• A history of substance use or addiction, including alcohol
• High blood pressure that is not well controlled, or certain heart and blood vessel problems
• A history of bleeding in the brain
• Current psychosis or mania
• Pregnancy, plans to become pregnant, or breastfeeding
• Bladder conditions such as interstitial cystitis

Substance use history deserves special attention. Because ketamine can be misused, people who have struggled with addiction face higher risks. Any decision about ketamine for someone with that history belongs with a provider who knows the full picture, in a setting with close oversight, and alongside addiction treatment when needed.

There is no one-size-fits-all treatment for depression. For many people, antidepressants and talk therapy help. For those whose depression has not improved after several tries, supervised options such as in-clinic ketamine, Spravato, or TMS may be worth considering.

A psychiatrist can help weigh the potential benefits against the risks, review other medications, and decide whether an in-clinic option makes sense as part of medication management. A therapist can help turn early relief into lasting change.

The right care can make a real difference. According to a recent LifeStance outcomes data report, 79% of LifeStance patients* showed clinically significant improvement in anxiety symptoms and 73% in depression symptoms with evidence-based care.

If recent headlines about ketamine have left you worried, the answer is not to give up on getting help. It is to get help where someone trained is in the room. Working with a qualified mental health care provider gives depression its best chance of loosening its grip.

If you or someone you love is having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline.

*amongst 140,000 LifeStance patients with at least moderate anxiety and 150,000 with at least moderate depression

Ketamine and esketamine are prescribed only when clinically appropriate and should be taken only as prescribed under the guidance of a qualified healthcare provider. Treatment availability may vary by location. Individuals should confirm availability and insurance coverage before beginning treatment.