Getting Started with Ketamine Therapy: Frequently Asked Questions

Getting started with ketamine therapy begins with a clinical screening, usually a consultation with a licensed prescriber who reviews your mental health and medical history, current medications, and treatment goals before deciding whether ketamine is an appropriate option. For most people considering ketamine for treatment-resistant depression, anxiety, PTSD, or certain chronic pain conditions, the process moves through a few predictable steps: an intake screening, a medical and psychiatric evaluation, a treatment plan review with informed consent, and then the first dosing session. This guide answers the questions people ask most often when getting started with ketamine therapy, from candidacy and referrals to what to expect at the first visit.

Who Is a Candidate for Ketamine Therapy?

Ketamine therapy is most often considered for adults with treatment-resistant depression, anxiety, PTSD, or certain chronic pain conditions who haven't had an adequate response to standard treatments such as antidepressants or talk therapy. Clinics offering ketamine, whether IV infusion, intramuscular injection, or the FDA-approved esketamine nasal spray Spravato, typically require candidates to be adults, generally 18 and older, though some clinics treat adolescents under specific protocols with parental involvement. According to the FDA, esketamine is approved for treatment-resistant depression in adults and must be administered under the supervision of a health care provider in a certified medical office. A prescriber will also screen for conditions that can make ketamine unsuitable, such as uncontrolled high blood pressure, certain heart conditions, active psychosis, or a history of ketamine misuse. If you're unsure whether you qualify, the intake consultation is designed to answer that question rather than something you need to determine on your own. See our guide on preparing for treatment for more on what clinics typically screen for.

Do You Need a Referral to Start Ketamine Therapy?

Most ketamine clinics don't require a formal referral from a primary care doctor or psychiatrist before scheduling an initial consultation. You can typically self-refer by contacting a clinic directly and completing an intake questionnaire. That said, clinics usually ask permission to request records from your current prescriber or therapist, both to confirm your diagnosis and treatment history and to coordinate care going forward. If you're already working with a psychiatrist or therapist, looping them in early can help the ketamine provider build a more complete plan, especially if your regular provider will keep managing other medications during your ketamine course. Our guide on questions to ask a ketamine provider about continuity of care covers what to ask about how the two providers will communicate.

What Happens During the Evaluation, and Can You Keep Taking Your Current Medications?

The evaluation process before starting ketamine therapy typically includes a medical history review, a psychiatric assessment, blood pressure and cardiovascular screening, and sometimes lab work. Timelines vary by clinic: some can complete screening and schedule a first session within about a week, while others take several weeks if they need psychiatric records, lab results, or insurance prior authorization. Ask your clinic directly what its timeline looks like, since there's no single standard across providers.

Whether you can continue your current medications depends on what you're taking. Some medications, including certain benzodiazepines, can blunt ketamine's effects, while others may need dose adjustments or timing changes around your session. A prescriber will review your full medication list during intake and tell you specifically what, if anything, needs to change. Don't stop or adjust a prescribed medication on your own before discussing it with the provider who manages it. Our ketamine safety and side effects guide and treatment process overview cover what a typical course looks like once you're cleared to begin.

What If You've Tried Ketamine Before and It Didn't Help?

A prior course of ketamine that didn't produce the results you hoped for doesn't necessarily rule out trying again. Response can depend on dose, route of administration (IV, intramuscular, sublingual, or intranasal esketamine), session frequency, and whether treatment was paired with therapy or integration support. A new provider may recommend a different formulation, such as switching between generic ketamine and FDA-approved esketamine, or adjusting the treatment schedule. Our comparison of ketamine versus esketamine explains how the two differ, and our guide on what happens when ketamine stops working covers questions to raise with a provider if a prior course fell short.

How Do You Find a Reputable Ketamine Provider?

Look for a clinic where a licensed physician, nurse practitioner, or psychiatrist directly oversees screening, dosing, and monitoring, rather than one that dispenses treatment with minimal clinical oversight. Reputable providers conduct a real evaluation before your first session, monitor vital signs during dosing, and have a clear plan for follow-up care. Regulators have raised concerns about some online and at-home ketamine sellers that provide limited screening; our coverage of the federal investigation into online ketamine sellers outlines what investigators have said about that part of the market. The National Institute of Mental Health notes that ketamine and esketamine use for depression should happen under medical supervision. Before booking, ask who will be in the room during your session, what happens if you have a reaction, and how the clinic handles follow-up between sessions.