Ketamine Therapy
A different treatment for depression, PTSD, anxiety, OCD, addiction, and chronic nerve pain — delivered under medical supervision in our Beachwood, Ohio office.
Psychiatry & Pain Medicine · Beachwood, Ohio
When Traditional Treatments Aren’t Enough
CarePoint Infusion Center uses IV ketamine for two broad categories of patients. The first is people living with psychiatric conditions that have not responded to conventional treatment: treatment-resistant depression, PTSD, anxiety disorders, obsessive-compulsive disorder, and selected substance use disorders. The second is people with chronic pain such as complex regional pain syndrome, where the nervous system itself has become the source of the pain. The protocols for these two groups are quite different, and we explain how below.
About off-label use
Ketamine is approved by the FDA as an anesthetic. Its use for depression, PTSD, anxiety, OCD, substance use disorders, and chronic pain is off-label, meaning the FDA has not reviewed and approved it for those specific conditions. Prescribing an approved medication off-label is common in medicine when supported by published evidence and clinical judgment. The information on this page summarizes findings from peer-reviewed research; it is not a promise of any particular result, and individual response varies. SPRAVATO® (esketamine), which we also offer, is FDA-approved for treatment-resistant depression.
How ketamine works
Conventional antidepressants adjust how much serotonin or norepinephrine sits in the synapse, then wait for the brain to adapt over four to eight weeks. Ketamine does something structurally different, and understanding it explains both why it acts quickly and why the benefit can outlast the drug itself.
Rebuilding connections in the brain
Prolonged stress, depression, and trauma physically change brain tissue. The branching connections between neurons in the prefrontal cortex and hippocampus retract, and the density of synaptic spines falls. Imaging studies show measurable volume loss in these regions in people with long-standing depression and PTSD. This is part of why the illness becomes self-sustaining: the circuitry needed to regulate mood has degraded.
Ketamine blocks the NMDA receptor, one of the main receptors for glutamate, the brain's primary excitatory signal. Research indicates that it does this preferentially on inhibitory interneurons, which briefly removes a brake on nearby neurons and produces a short surge of glutamate. Because the NMDA receptors are occupied, that glutamate acts instead on AMPA receptors, setting off an intracellular cascade involving brain-derived neurotrophic factor (BDNF) and the mTORC1 pathway.
The practical result of that cascade is synthesis of new synaptic proteins and the growth of new dendritic spines — within hours, in animal studies. This is why researchers describe ketamine as producing rapid structural neuroplasticity rather than simply altering a chemical signal, and why symptom relief can persist for days or weeks after the drug has cleared the bloodstream.
Quieting the rumination network
There is a second effect that patients tend to notice more directly. The default mode network is the set of brain regions most active when you are not focused on a task — the circuitry of self-reflection and mind-wandering. In depression it becomes overactive and produces relentless negative rumination. In anxiety it drives future-focused worry, in PTSD intrusive re-experiencing, and in OCD the loop of intrusive thought followed by compulsion.
Functional imaging shows that subanesthetic ketamine temporarily reduces connectivity within this network. Patients often describe being able to observe a thought that normally overwhelms them without the usual emotional charge attached to it. That temporary loosening is thought to open a window in which new patterns can be established, which is the rationale behind pairing infusions with psychotherapy.
Why the same drug helps nerve pain
Chronic neuropathic pain involves a process called central sensitization, in which the spinal cord and brain become amplifiers rather than neutral relays. Pain signaling continues, and intensifies, even without ongoing tissue damage. NMDA receptors in the dorsal horn of the spinal cord are central to maintaining that amplified state.
By blocking those same receptors, ketamine can interrupt the sensitized signaling pattern. This is a different therapeutic goal from the psychiatric use — resetting an over-amplified pain pathway rather than promoting synaptic regrowth in mood circuits — and it requires a different dosing approach, which is why our pain and psychiatric protocols are not interchangeable.
Conditions we treat with ketamine
Each condition below has its own evidence base, protocol, and realistic expectations. Follow the links for a fuller discussion of any one of them.
Treatment-resistant depression
Depression that has not responded to two or more adequate antidepressant trials. Across clinical trials roughly 50–70% of patients respond to a course of IV ketamine, meaning at least a 50% reduction in symptom scores; real-world registries report somewhat lower figures, closer to 45–50%.
Research also shows rapid reductions in suicidal thinking, sometimes within 24 hours and partly independent of the general antidepressant effect.
PTSD and trauma
PTSD involves a hyperreactive amygdala alongside reduced hippocampal volume. By supporting plasticity in the hippocampus and prefrontal cortex, ketamine may make it easier to process traumatic material without triggering the usual hyperarousal and avoidance.
Trials using the CAPS-5 and PCL-5 scales report rapid, statistically significant symptom reductions.
Anxiety disorders
Generalized and social anxiety frequently travel with depression and share the same circuitry changes. Studies using the GAD-7 and Liebowitz Social Anxiety Scale report improvement that can begin within hours of an infusion.
Benefit is typically maintained with periodic booster infusions rather than a single course.
Obsessive-compulsive disorder
SSRIs leave a substantial share of OCD patients without adequate relief. Research points to glutamate dysregulation in the cortico-striato-thalamo-cortical loop as a driver of the condition, which is the system ketamine acts on.
Crossover trials using the Y-BOCS scale report rapid anti-obsessional effects within hours that can last about a week. Evidence is promising but earlier-stage than for depression, and the most sensible use is alongside exposure and response prevention therapy, where the reduced distress can make exposure work tolerable.
Substance use disorders
Used alongside structured psychotherapy, ketamine has been studied for alcohol and opioid use disorders. Proposed mechanisms include repair of prefrontal circuits governing impulse control and interference with the reconsolidation of cue-driven reward memories.
Neither ketamine nor esketamine is FDA-approved to treat substance use disorder, and ketamine is used here only within a supervised, therapy-integrated program.
Chronic and neuropathic pain
For pain driven by central sensitization rather than ongoing injury: complex regional pain syndrome, post-herpetic neuralgia, diabetic neuropathy, fibromyalgia, refractory headache, and some severe treatment-resistant back, neck, and joint pain.
Consensus guidelines from ASRA and AAPM support IV ketamine for chronic pain, noting the strongest evidence is for short-term relief in neuropathic pain.
Ketamine is an addition to your care, not a replacement
Across every indication above, outcomes are better when infusions sit inside an ongoing plan that includes therapy and psychiatric follow-up. We coordinate with your existing prescriber and therapist rather than working around them, and we do not ask patients to stop their current medications in order to be treated here.
Why mental health and pain protocols are not the same
Patients sometimes arrive expecting a single standard "ketamine treatment." In practice, the protocol for depression looks very little like the protocol for CRPS. Knowing which one applies to you sets realistic expectations about time, cost, and what the sessions will feel like.
| Psychiatric indications | Chronic pain indications | |
|---|---|---|
| Typical dose | Subanesthetic and weight-based, commonly starting near 0.5 mg/kg | Higher cumulative dose, built up gradually across the session |
| Session length | 40–60 minute infusion; about 2 hours in the clinic | Substantially longer infusions, sometimes several hours |
| Schedule | About six infusions over two to three weeks, then periodic maintenance | Often consecutive days rather than spread over weeks |
| Therapeutic goal | Rapid synaptic plasticity and a reduction in rumination | Reversing central sensitization in pain pathways |
| Role of dissociation | A tolerated, sometimes useful part of the session | A side effect to be minimized, occasionally with additional medication |
Scroll the table sideways to compare both columns.
Because pain protocols use higher cumulative doses over longer periods, the likelihood of dissociative effects and transient blood pressure elevation rises, and monitoring is correspondingly more involved. Your specific dose and schedule are set by your provider after evaluation, not by a fixed formula.
IV ketamine or SPRAVATO®?
Ketamine exists as a pair of mirror-image forms. The infusions described on this page use racemic ketamine, which contains both. Esketamine is the isolated S-form of that same molecule, delivered as a nasal spray under the brand name SPRAVATO®. Both act on the NMDA receptor and the glutamate system, so they share the same underlying mechanism and largely the same in-session experience.
The differences that actually affect your decision are practical rather than pharmacological:
- Regulatory status. SPRAVATO is FDA-approved for treatment-resistant depression and for MDD with acute suicidal ideation. IV ketamine is off-label for every psychiatric use.
- Insurance. SPRAVATO is generally billable to commercial plans, Medicare, and Ohio Medicaid managed care with prior authorization. IV ketamine is usually self-pay.
- Range of use. IV ketamine can be used for conditions outside those approved indications, including OCD, chronic pain, and CRPS, and the dose can be adjusted in real time during the infusion.
- Logistics. SPRAVATO requires a two-hour monitoring period after every dose under its REMS program, and twice-weekly visits during the first four weeks.
We offer both and have no reason to push you toward one. For a full side-by-side comparison see IV ketamine vs. intranasal esketamine, or our guide to ketamine therapy that takes insurance if coverage is the deciding factor.
What treatment is actually like
Ketamine produces a temporary altered state, and knowing what to expect makes it considerably easier. During an infusion people commonly report a feeling of lightness or warmth, dream-like or free-associative thinking, a distorted sense of time, and a sense of detachment from the body or surroundings. Some find it pleasant, some find it strange, and a minority find it uncomfortable. It is dose-dependent, it is monitored, and it ends as the infusion wears off.
You will need someone to drive you home, and you should plan to rest for the remainder of the day.
Medical and psychiatric screening, records review, and goal setting
Fasting and medication instructions, plus arranging your ride home
Private recliner, continuous monitoring, provider on site
Observation until effects resolve and vitals return to baseline
Symptom scores tracked across the series to guide the plan
Our full walkthrough of the experience is here: what does ketamine therapy feel like?
Safety, monitoring, and who should not have ketamine
Ketamine has a long safety record in supervised medical settings, which is precisely the qualifier that matters. Blood pressure and heart rate rise transiently during infusion, and dissociation can be disorienting. Both are manageable when someone is watching and can intervene; neither is something to handle alone at home.
Common, temporary effects
- Dissociation or a dream-like, detached feeling during the infusion
- Dizziness, nausea, or a floating sensation
- A short-lived rise in blood pressure and heart rate
- Blurred vision, sedation, or fatigue for the rest of the day
When ketamine is not appropriate
Ketamine is generally avoided, or requires careful specialist evaluation, in people with:
- Uncontrolled hypertension or unstable cardiovascular disease
- Increased intracranial pressure, or certain aneurysmal vascular conditions
- Active psychosis, or a history of schizophrenia or a related psychotic disorder
- Pregnancy, or while breastfeeding
- Active substance misuse, or a previous problem with ketamine specifically
- Severe liver disease, or untreated hyperthyroidism
Every patient is screened before the first infusion. If ketamine is not a safe or sensible option for you, we will say so and help you think about what else might be.
If you are in crisis right now
This page is not for emergencies. If you are having thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline), call 911, or go to your nearest emergency department.
Cost and insurance
Because IV ketamine is used off-label, most plans do not cover it and it is generally a self-pay treatment. We provide an itemized superbill and supporting documentation if you want to pursue out-of-network reimbursement, but approval is uncommon and we would rather tell you that now than after you have started.
If insurance coverage is essential, SPRAVATO® is the option to discuss, and our team handles prior authorization in-house. Our guide to ketamine therapy that takes insurance breaks down what each type of plan typically pays for, what documentation gets an authorization approved, and what to do about a denial. You can also read about our general prior authorization process.
Common questions
What conditions is ketamine infusion therapy used for?
We use IV ketamine for treatment-resistant depression, PTSD and trauma-related conditions, generalized and social anxiety, obsessive-compulsive disorder, selected substance use disorders, and chronic neuropathic pain including CRPS, fibromyalgia, diabetic neuropathy, and refractory headache. Ketamine is FDA-approved as an anesthetic, so all of these uses are off-label and rest on published research rather than an FDA indication.
Is IV ketamine FDA-approved for depression?
No. IV racemic ketamine is FDA-approved only as an anesthetic, so using it for depression is off-label. It is legal, widely practiced, and supported by more than two decades of research, but it does not carry an FDA indication for psychiatric conditions. SPRAVATO® (esketamine) is the related medication that is FDA-approved for treatment-resistant depression, and we offer it as well.
How quickly does ketamine work for depression?
Trials report measurable reductions in depressive symptoms within four to twenty-four hours of a single subanesthetic infusion, compared with four to eight weeks for conventional antidepressants. Response is not universal, and the benefit from any one infusion is usually temporary, which is why treatment is given as a series.
How effective is ketamine for treatment-resistant depression?
Across clinical trials, roughly 50–70% of patients respond to a course of IV ketamine, meaning at least a 50% reduction in symptom scores. Real-world registries report somewhat lower figures, closer to 45–50%. Response is not the same as remission, and ketamine works best as one part of an ongoing care plan rather than as a standalone fix.
How many infusions will I need?
For psychiatric indications the standard induction series is about six infusions over two to three weeks. We then assess your response together and decide whether periodic maintenance infusions are worthwhile. Chronic pain protocols differ and often use longer infusions on consecutive days.
How long does an infusion take?
For psychiatric indications the infusion runs about 40 to 60 minutes, and you should plan on roughly two hours in the clinic including check-in, recovery, and monitoring. Pain infusions use higher cumulative doses over longer sessions, so those visits are considerably longer. You cannot drive yourself home after any infusion.
Who should not receive ketamine therapy?
Ketamine is generally not appropriate for people with uncontrolled high blood pressure, unstable cardiovascular disease, increased intracranial pressure, active psychosis or a history of schizophrenia, or during pregnancy. Active substance misuse, prior ketamine misuse, severe liver disease, and certain aneurysmal vascular conditions also require careful evaluation. Every patient is screened before the first infusion.
Does insurance cover IV ketamine infusions?
Usually not, because the use is off-label, so IV ketamine is generally self-pay. We provide an itemized superbill for out-of-network reimbursement attempts, though approval is uncommon. SPRAVATO is FDA-approved and is generally billable to commercial insurance, Medicare, and Ohio Medicaid managed care plans with prior authorization. See our insurance coverage guide.
Is in-office ketamine safer than at-home telehealth ketamine?
In-office administration allows continuous monitoring of blood pressure, heart rate, and oxygen saturation, immediate intervention if dissociation or a blood pressure rise becomes uncomfortable, and precise dose control. The FDA has warned that compounded ketamine products used at home without monitoring carry risks including sedation, dissociation, breathing problems, and misuse. We administer ketamine only in our office with a provider present.
Is ketamine addictive?
Ketamine is a Schedule III controlled substance with recognized misuse potential, which is why dosing, frequency, and supply stay under clinical control. Published studies of medically supervised subanesthetic infusion courses have not found that they produce ketamine dependence or cross-addiction. The picture is very different for frequent unsupervised or recreational use, which is associated with dependence and with ketamine-induced cystitis.
Serving Cleveland and Northeast Ohio
CarePoint Infusion Center is located in Beachwood, Ohio, roughly 20 minutes from downtown Cleveland and convenient to communities across Cuyahoga County and Summit County. We work closely with referring psychiatrists, therapists, and pain specialists throughout the region.
We also offer Abilify Maintena (aripiprazole) long-acting injections for schizophrenia and bipolar I disorder.
Related pages
- SPRAVATO® (esketamine) — the FDA-approved, insurance-billable nasal spray
- IV ketamine vs. intranasal esketamine — detailed side-by-side comparison
- Ketamine therapy that takes insurance — coverage by plan type
- What does ketamine therapy feel like?
- Ketamine vs. traditional antidepressants
- At-home vs. in-office ketamine
- Ketamine for PTSD & trauma · anxiety · substance use disorders
- Chronic pain research · oral ketamine for pain · CRPS
- Cleveland · Westlake · Akron location pages
Take the next step
If depression, PTSD, anxiety, OCD, or chronic pain has not responded to what you have already tried, we would like to hear from you. We will review your history, explain both IV ketamine and SPRAVATO honestly, and tell you if we do not think this is right for you.
Selected references
- Berman RM, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000. PubMed
- Zarate CA, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry. 2006. PubMed
- Cohen SP, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain. Reg Anesth Pain Med. 2018. PubMed
- U.S. Food and Drug Administration. Compounding Risk Alerts — including the October 2023 alert on compounded ketamine products for psychiatric disorders. fda.gov
- National Institute of Mental Health. Depression — overview and treatment options. nimh.nih.gov
Medical disclaimer: This page is general educational information and does not replace medical advice from a qualified provider. Ketamine is FDA-approved as an anesthetic; its use for psychiatric and chronic pain conditions described here is off-label and is not FDA-evaluated for those indications. Ketamine is a Schedule III controlled substance. Research findings summarized here describe group results in studied populations and are not a prediction or guarantee of individual outcome. Eligibility, dosing, and response vary and are determined by your treating provider after evaluation. SPRAVATO® is a registered trademark of Janssen Pharmaceuticals, Inc.