Ketamine for depression is an off-label treatment that acts on glutamate rather than serotonin. Research shows it can ease symptoms within hours to days for some people whose depression hasn’t responded to standard antidepressants. At SomaVerse in Lawrence, Kansas, we pair it with psychotherapy so relief has somewhere to go.
Most people who reach us have done the work: several medications, sometimes years of therapy. What they describe is a heaviness that hasn’t moved, or a numbness that medication swapped in for sadness. Ketamine-assisted psychotherapy (KAP) is one option for that place, not a first step and never a guarantee.
We’ll be straight with you from the first call. Ketamine troches are a compounded medication prescribed off-label, and the strongest research on ketamine for depression used IV infusions. Esketamine (Spravato) is the FDA-approved form for treatment-resistant depression, and for some people with good insurance it’s the better fit. Our job is to help you find the right path, even if it isn’t ours.
You might be here because…
- You’ve given two or more antidepressants a fair trial, at a real dose for long enough, and the fog never fully lifted.
- Mornings are the hardest part. Getting up and getting started takes everything you have before the day has even begun.
- You can’t remember the last time something felt genuinely good, not just less bad.
- Medication took the edge off but left you flat, foggy or emotionally muted, and you want more than “not crying.”
- Depression comes back in waves, and each episode seems to take a little more of you with it.
- You understand where your depression comes from, and the understanding hasn’t made it any lighter.
- A psychiatrist or therapist mentioned ketamine or Spravato, and you want to understand your options before you decide.
What is treatment-resistant depression?
Treatment-resistant depression (TRD) usually means major depression that hasn’t improved enough after at least two different antidepressants, each taken at an adequate dose for an adequate length of time. It’s the same definition the FDA uses for esketamine. It is common, and it says nothing about how hard you’ve tried.
The word “resistant” can sound like a verdict on you. It isn’t. It describes a mismatch between your brain and the medications built around one family of chemical messengers. Most standard antidepressants work on serotonin, norepinephrine or dopamine, and they take weeks to show whether they’ll help. When two or three of them haven’t, it makes sense to try something that works by a different mechanism altogether.
TRD also carries a second weight: discouragement. Each failed trial quietly teaches you that nothing will work, and part of preparation is naming that belief out loud.
How ketamine works differently on a depressed brain
Ketamine blocks NMDA receptors, part of the brain’s glutamate system, the main signaling network for learning and adaptation. In animal studies, this sets off a rapid release of growth factors and the regrowth of synaptic connections in the prefrontal cortex, an area that tends to thin out under chronic stress and depression.
That is one reason ketamine can act in hours instead of weeks. It’s also why many clinicians describe the days after a dose as a time of unusual flexibility, when habitual thought patterns feel less locked in. That idea comes mostly from animal research, and no one has measured how long the effect lasts in people. We plan integration in the days after dosing anyway, because that’s when clients tell us new choices feel most possible.
People often describe the session as stepping outside the usual weight for a while. Some feel tenderness toward themselves; some simply rest. A “bigger” experience doesn’t predict better results.
What the research says about ketamine for depression
The short answer: ketamine has some of the most consistent evidence of any newer depression treatment, but almost all of it comes from IV or nasal forms, and benefits often fade.
In 2000, a small Yale trial found that a single IV dose of ketamine improved depression within 72 hours, while saline did not. In 2006, a National Institute of Mental Health trial in people with treatment-resistant depression found effects beginning within two hours and lasting about a week. A 2021 meta-analysis of 24 randomized trials found that IV racemic ketamine produced higher response and remission rates than intranasal esketamine, though those trials weren’t head-to-head comparisons.
In 2023, the large ELEKT-D trial published in the New England Journal of Medicine compared IV ketamine with electroconvulsive therapy (ECT) in 403 people with nonpsychotic treatment-resistant depression. Ketamine was noninferior: 55% responded, compared with 41% after ECT, and only the ECT group showed short-term memory problems. On the regulatory side, the FDA approved Spravato nasal spray for TRD in 2019 and approved it as a standalone treatment, without a second antidepressant, in January 2025.
Where troches fit: sublingual and oral ketamine have been studied far less. Recent reviews of oral ketamine are encouraging but describe much of the evidence as early, small or open-label, and at least one 2026 trial of an oral tablet missed its main goal. We can’t promise that IV results translate directly to troches, and you deserve to know that before you start.
Why relief can fade, and why therapy matters
The biggest limitation of ketamine for depression is durability. In many studies, a single dose helps for days to about a week, and a course of treatments helps for weeks. Without something to build on, symptoms often drift back.
That’s the core reason SomaVerse is built around psychotherapy rather than medicine alone. In a 2017 pilot study at Yale, people who responded to IV ketamine and then received ten weeks of cognitive behavioral therapy were less likely to relapse than would be expected. A small 2021 randomized follow-up found more sustained improvement with therapy on one depression measure, but not on its main measure. The idea is promising, not proven, and we hold it that way.
Integration is where you take the lighter days and do something with them: restarting a routine depression stole, or noticing the thoughts that pull you back under. Your integration sessions and groups are timed to catch that momentum.
Ketamine, suicidal thoughts and what SomaVerse is not
Research does show that IV ketamine can reduce suicidal thinking quickly. A 2018 analysis pooling individual patient data found that a single infusion reduced suicidal thoughts within a day, with effects lasting up to a week. But no study has shown that ketamine prevents suicide, and the Spravato label says so directly.
SomaVerse is not a crisis or emergency service, and at-home troches are not an appropriate treatment for someone in acute danger. If you are thinking about ending your life right now, call or text 988, the Suicide & Crisis Lifeline, or go to the nearest emergency room. In Lawrence, Bert Nash Community Mental Health Center also offers crisis support.
If you live with ongoing, passive thoughts of not wanting to be here, please tell us during your evaluation. That honesty won’t automatically rule you out. It helps our medical provider and therapist decide whether KAP is safe now, what extra support you need, or whether a higher level of care should come first.
What about bipolar depression?
Some people with bipolar depression may be candidates for ketamine after a careful psychiatric evaluation. But any antidepressant treatment carries a risk of tipping some people toward hypomania or mania.
If you have bipolar disorder, our medical provider will want to know your full mood history, what stabilizes you, and who prescribes your current medications. Current mania or a recent manic episode is a reason to wait. Some mood stabilizers, including lamotrigine, may also blunt ketamine’s effects, so dose timing is planned with your prescriber, never on your own.
How SomaVerse approaches depression
Depression narrows life down: fewer people, fewer places, fewer reasons to move. Our programs are designed to widen it back out. You’ll have a trained ketamine team: medical care led by Angel Patterson-Tetuan, PMHNP-BC, our Psychiatry & Ketamine Medical Director, a ketamine-trained therapist and a wellness guide, plus integration groups where you sit with other people who know what this feels like from the inside. After you finish a program, our SomaVerse Booster Group is a way to revisit and deepen the work.
Everyone starts in office, and troche sessions are offered at all three of our offices. Once you’ve completed at least our main program with us and are medically approved, you may be approved to continue troche sessions at home with a sober support person. Our approach is somatic as well as cognitive: depression lives in the body as heaviness and collapse, and we pay attention to what your body does as the medicine works.
The program is directed by Anissa Pfannenstiel, LSCSW, who has more than 20 years of psychotherapy practice. If you’re new to all of this, our ketamine-assisted psychotherapy page explains the model in more depth.
Cost, insurance and getting here
The ketamine medication is self-pay. A single troche dose is $90. The Individual Ketamine Healing Package, $480 for six sessions, is our starting program and includes the prescription, a Journey Box, medical monitoring, a preparation session and sessions at any of our offices; evaluation, therapy or guide sessions and integration are billed separately. Some first-time clients choose Solo Ketamine, $1,505 with payment plans available, which bundles a medical assessment, therapy assessment, eight dosing sessions, three guide sessions and three integration groups. Eligible medical and therapy visits may be billed to insurance, with your usual copays. See every option on our pricing page.
If your insurance covers Spravato, it may cost you less out of pocket than KAP, and we’ll talk that through honestly. Our Spravato vs. ketamine guide compares them side by side.
Troche sessions happen in office at all three of our offices: our Lawrence office on West 6th Street, our Overland Park office for Johnson County and Kansas City clients, and our Topeka office on SW 28th Street. Therapy and integration are also available by telehealth in Kansas.
