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Ketamine for Treatment-Resistant Depression
Quick Answer
Treatment-resistant depression usually means major depressive disorder that has not responded adequately to at least two antidepressants given at adequate doses for adequate time. It is the situation ketamine-based treatment was developed for: SPRAVATO® (esketamine) is FDA-approved for it and often insurance-covered, and physician-supervised ketamine therapy is used off-label as an alternative. At Denver Ketamine Clinic a psychiatrist confirms the diagnosis, checks eligibility, and recommends the pathway — with TMS available in the same clinic if neither is the fit.
What "treatment-resistant" means, and does not mean
It is a clinical description of what has been tried, not a verdict on the person. The usual working definition is inadequate response to two or more antidepressants from different classes, each taken at an adequate dose for several weeks. It does not mean nothing will work; it means the first-line tools have been used and the next tier is now appropriate. Documenting those trials is also what insurance plans look for before authorizing SPRAVATO® or TMS, which is why we collect that history carefully at the evaluation.
Why ketamine-based treatment is considered here
Conventional antidepressants act mainly on serotonin and related systems. Ketamine and esketamine act on the glutamate system, a different mechanism, which is the rationale for trying them after the first mechanism has not delivered. Research on both has focused specifically on people who had not responded to standard medication.
Two pathways
SPRAVATO® (esketamine nasal spray) is FDA-approved for treatment-resistant depression in adults, given in certified clinics under a restricted program, and covered by many plans when criteria are met. Ketamine therapy uses ketamine itself, is not FDA-approved for any psychiatric condition, is prescribed off-label, and is usually self-pay. Both are supervised and monitored here; see SPRAVATO® vs. ketamine therapy for the full comparison and side effects for what each involves.
Who may not be a candidate
Uncontrolled high blood pressure, certain cardiovascular conditions, a history of psychosis, active substance use disorder, and pregnancy are among the situations that require careful review and may rule out ketamine-based treatment. The screening is part of the evaluation, not a formality.
What a course looks like
A series of monitored sessions over weeks, individualized by response and reviewed on symptom scores rather than a fixed package; see how long ketamine therapy lasts. A ride home is required after every session.
If ketamine-based treatment is not the answer
FDA-cleared TMS and accelerated iTBS are available in this clinic, and the psychiatrist who evaluated you for ketamine is the same one who decides what follows.
Frequently asked questions
How many antidepressants do I need to have tried?
The usual working definition is two or more at adequate doses and durations. Your psychiatrist confirms where you stand at the evaluation, and that history also supports insurance authorization.
Is ketamine FDA-approved for treatment-resistant depression?
No. SPRAVATO® (esketamine) is FDA-approved for it. Ketamine itself is approved as an anesthetic and is used off-label for depression.
Will insurance cover it?
SPRAVATO® is covered by many plans when criteria are met; ketamine therapy is generally self-pay. We check both before you decide.
Can I do ketamine-based treatment and TMS?
Sequencing or combining treatments is a clinical decision your psychiatrist makes based on your history; both are available here.
Think your depression qualifies as treatment-resistant? One evaluation settles it and the next step.
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