Jeffrey Panko NP Psychiatry · Patient education
Ketamine
Supervised off-label psychiatric treatment / FDA-approved anesthetic formulations
A guide for adults considering or receiving ketamine treatment.
Follow the instructions from your treating healthcare team.
Formulations: Psychiatric care may use a supervised IV or other clinician-directed regimen. Compounded oral or nasal preparations differ in absorption, quality controls, and evidence. Do not convert between routes yourself.
What it is used for
Ketamine is FDA-approved as an anesthetic. Clinicians use it off-label for some difficult-to-treat depression and other conditions. Compounded ketamine formulations have not been FDA-approved for psychiatric treatment.
Ketamine and the supervised esketamine nasal spray Spravato are different treatments with different evidence and requirements.
How it works
It blocks NMDA receptors involved in glutamate signaling. Psychiatric effects can occur relatively quickly, but an early response does not guarantee lasting benefit.
What to expect over time
Some people improve within hours to days. Benefits may fade and require a continuing treatment plan; others do not respond. Follow-up should assess mood, functioning, safety, and adverse effects.
Taking your medication
- Follow the treating program’s preparation, food, medication, and monitoring instructions.
- Arrange transportation and follow the specified period without driving or hazardous activity.
- Do not add doses or change route to extend an effect.
- Tell the team about alcohol, sedatives, and other substances before treatment.
When to get help
Emergency symptoms. Call 911 for severe breathing problems, inability to wake, chest pain, collapse, or a severe allergic reaction. During a supervised treatment, alert staff immediately.
Prompt medical advice. Report persistent frightening dissociation, new hallucinations outside treatment, urinary pain or blood, or worsening mood promptly.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Dissociation or altered perception
- Dizziness, nausea, or vomiting
- Sedation or impaired coordination
- Increased blood pressure or pulse
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Monitoring should address blood pressure, breathing, alertness, and mental state. Repeated exposure also calls for review of urinary symptoms, cognition, and misuse or dependence.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss cardiovascular disease, uncontrolled blood pressure, psychosis, substance use, bladder symptoms, and liver disease. Review pregnancy and breastfeeding before treatment.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Alcohol, opioids, benzodiazepines, and other sedatives can increase sedation and respiratory risks. Stimulants and other medicines may add blood-pressure effects. Do not independently stop prescribed medicines to prepare for treatment.
Everyday tips
Use one coordinated treatment plan and keep the team informed about other psychiatric care.
Record benefit and adverse effects between sessions.
Your questions answered
Is compounded ketamine FDA-approved for depression?
No. Off-label clinical use and an FDA-approved psychiatric formulation are different. Discuss the evidence, route, monitoring, and follow-up plan.
Does rapid improvement eliminate suicide risk?
No. Ongoing safety assessment and treatment are still necessary, including emergency care when indicated.
Storage and safety
If any take-home formulation is prescribed, follow its exact label, keep it locked away, and never share it. Do not use a nonmedical or unverified preparation.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.