Is ketamine therapy safe? The honest answer depends on who is asking. For some people with severe depression, ketamine therapy has brought relief when nothing else worked. For others, especially people who are struggling with addiction, it is often not the best solution. Ketamine is getting a lot of attention currently, and the headlines rarely emphasize its tradeoffs and risks. This guide walks through both sides of the issue, so that you can talk with your care team from an informed place.
Key Takeaways
- Ketamine therapy can help some people with treatment-resistant depression where other treatments have not worked
- Ketamine can be safe to use in a medically supervised setting, but it is a controlled substance and it carries real risks of addiction
- Only the nasal spray form, esketamine, is FDA-approved for depression, and the FDA tightly restricts how clinics administer it
- Our clinical team generally considers ketamine therapy inappropriate for people who are struggling with addiction
- When depression and addiction exist together, integrated treatment offers a safer path to healing
What Is Ketamine?
What is ketamine? Doctors initially used it as an anesthetic, and they still use it that way today. In lower doses, ketamine affects glutamate, a chemical messenger in the brain. The Cleveland Clinic notes that providers may use low doses to treat depression, anxiety, and some chronic pain that has proven resistant to other treatments.
Ketamine is also a controlled substance. This detail is crucual for safety, and we come back to the safety risks below.
How Ketamine Therapy Works and Who May Benefit
Ketamine therapy usually enters the picture after standard care does not offer relief. Doctors often refer to this as treatment-resistant depression. Typically, people first try evidence-based treatment, such as therapy and prescribed antidepressants, and ketamine treatment becomes an option when those steps do not help enough.
The FDA has approved one form of ketamine to treat depression: esketamine nasal spray, sold as Spravato, first approved for use in 2019. It is also approved for major depression with suicidal thoughts or actions. In 2025, the FDA cleared ketamine as a standalone treatment for adults who have not responded to at least two oral antidepressants.
Spravato treatment typically begins with two sessions a week for the first four weeks, each one inside a certified clinic. Some people notice relief quickly, often within days. The speed of this effect is a significant reason many people experience real hope when they hear about ketamine therapy, and we respect that hope.
Is Ketamine Therapy Safe?
When a qualified team administers ketamine therapy with careful screening and monitoring, many people respond positively. However, the treatment carries risks. Dissociation, for example, means feeling detached from your body or surroundings, which is a known effect of the medication. The FDA limits Spravato to certified healthcare settings because of the risks of sedation, dissociation, slowed breathing, abuse, and misuse. According to the FDA prescribing information, providers must monitor people for at least two hours after each session.
Proper ketamine care usually includes:
- A full medical and mental health screening before the first dose
- Treatment in a clinical setting, never at home for the FDA-approved spray
- Monitoring for at least two hours after each session
- Coordination with your psychiatrist or prescriber
- Honest conversations about any history of substance use
Clinics that offer other forms of ketamine do not belong to that restricted program, so oversight varies. Cleveland Clinic also cautions that ketamine treatment is not safe or recommended for everyone.
Is Ketamine Safe for Someone Struggling With Addiction?
For people who struggle with addiction, the risks involved with ketamine increase. Our clinical team’s general consensus is that ketamine therapy is not appropriate in these situations, for several reasons.
Ketamine carries a risk of abuse and misuse. Someone in active addiction or early recovery already faces a higher risk of misusing any substance. Adding one more medicine that a person can misuse may put hard-won progress in jeopardy.
Depression that shows up alongside addiction is also rarely a stand-alone problem. This depression often connects to trauma, grief, or the effects of substance use itself. Treating it requires a plan that addresses both conditions together, which is the heart of dual diagnosis treatment. Building effective coping skills for substance abuse gives people lasting tools that no medicine can offer.
If you are unsure where you stand, a conversation with a provider who understands both depression and addiction is a good place to start. The concerns we’ve raised do not take anything away from the many people who benefit from ketamine. It simply means the right treatment depends on understanding the whole picture of an individual’s struggle, and safety looks different for someone with addiction.
What Helps When Depression and Addiction Exist Together
Integrated care treats depression and addiction at the same time, through one coordinated team. Our guide to co-occurring disorder treatment explains the warning signs of addiction and what this kind of care looks like. At Sana at Stowe, it can include:
- Psychiatric care to treat depression safely alongside addiction
- Trauma-informed therapy that addresses what lies beneath both conditions
- Holistic drug rehab practices, such as movement, nutrition, and time outdoors
- Structured days that give early recovery a steady foundation to build upon
Stepping away to a calm setting for recovery has immense value, which is one reason many people travel to rehabs in Vermont to receive care.
One of our recent clients shared about their own treatment journey, saying “I feel I got a lot out my care here at Sana! The staff along with other residents were great. I never felt ashamed being here. I appreciate the care everyone gave.” (Former Client, March 2026)
It is worth highlighting here, no one should feel shame about seeking treatment for addiction, depression, or both conditions. Seeking treatment is a healthy, responsible step, not a reason to feel shame.
Questions to Ask Before Starting Ketamine Therapy
If you are considering ketamine therapy, these questions can help you sort out whether a program is safe for you:
- Does a licensed physician oversee treatment?
- Will the team screen me for substance use, heart conditions, and other risks first?
- Is this treatment FDA-approved for my condition, or is it off-label?
- Who monitors me during and after each session?
- How does this fit with my current therapy and medications?
- What happens if I have side effects or want to stop?
If you have any history of addiction, it is important to tell every provider about this up front. Our addiction treatment guide can help you understand what to look for in a program. This article is for general information and does not replace advice from your own medical provider.
Frequently Asked Questions
Is ketamine safe to use outside a medical setting?
No. Sedation, dissociation, and slowed breathing are real risks. That is why the FDA limits the approved nasal spray to certified clinics with monitoring.
Can someone in addiction treatment also use ketamine therapy?
Our team’s general consensus is that it is not appropriate while someone is struggling with addiction. Care that treats both the addiction and the depression, such as residential treatment, is typically a safer place to start healing.
Is ketamine therapy FDA-approved?
Only esketamine nasal spray, sold as Spravato, is FDA-approved for depression. Doctors usually prescribe other forms, such as IV infusions, off-label.
How do I know if ketamine therapy is right for me?
Talk with a psychiatrist who knows your full history, including any substance use. This conversation is the safest first step.
You Deserve a Safe Path to Feeling Better
If depression and addiction are both part of your story, you do not have to sort out treatment alone. Sana at Stowe works with in-network providers, including Aetna, to help make care accessible. Call us at 866-575-9958 to talk with our team about a plan that treats the whole person.
If you are having thoughts of suicide, please call or text 988 to reach the 988 Suicide and Crisis Lifeline. Support is available right now.
