When standard depression treatments have not provided lasting relief, you are not alone. At The Invictus Clinic in Marietta, Georgia, we offer IV ketamine infusion therapy as an off-label option for patients with treatment-resistant depression. There are still paths forward.
What Makes Depression “Treatment-Resistant”
Treatment-resistant depression is commonly defined as a major depressive episode that has not responded adequately to at least two antidepressant trials of appropriate dose and duration, although definitions can vary across studies (Gaynes et al., 2020).
Conventional antidepressants, including SSRIs, SNRIs, and TCAs, primarily target monoamine neurotransmitters such as serotonin, norepinephrine, and dopamine. These medications help many people, but they do not work for everyone. When these pathways have not provided enough relief, a different glutamate-based approach may be worth discussing with your provider.
How IV Ketamine Works Differently
Ketamine works through a fundamentally different neurochemical pathway than traditional antidepressants. Rather than primarily targeting monoamine neurotransmitters, ketamine acts as an N-methyl-D-aspartate, or NMDA, receptor antagonist. NMDA receptors are part of the glutamate system, which plays an important role in synaptic communication and neuroplasticity (Zanos & Gould, 2018).
In plain terms, glutamate is like part of the brain’s accelerator system, and NMDA receptors help process that signal. Research suggests that ketamine’s temporary effect on NMDA receptors is associated with downstream changes involving AMPA receptor activity, BDNF signaling, and synaptic plasticity.
BDNF, or brain-derived neurotrophic factor, supports the growth and maintenance of neural connections. We sometimes describe it as fertilizer for neural pathways. To understand more about how ketamine affects the brain, this mechanism may help explain why ketamine can produce antidepressant effects within hours to days for some patients, rather than the longer time course often associated with standard antidepressants. Individual response and timing vary (Fond et al., 2014; Murrough et al., 2013).
What the Research Shows
Clinical evidence for IV ketamine in treatment-resistant depression includes randomized controlled trials and systematic reviews reporting rapid reductions in depressive symptoms for some participants compared with placebo or active control conditions (Fond et al., 2014; Murrough et al., 2013).
At the same time, research continues to clarify the best dosing approaches, long-term outcomes, maintenance strategies, and patient-selection considerations. Ketamine should be approached carefully, with a full discussion of potential benefits, risks, and realistic expectations (Sanacora et al., 2017).
We do not take a one-size-fits-all approach. The number, timing, and duration of infusions we recommend depend on your history, treatment response, goals, and safety considerations.
IV Ketamine for Depression Is Used Off-Label
We want to be transparent: IV ketamine infusion therapy for psychiatric conditions, including depression, is used off-label. This means it is used for a purpose that is not included in its FDA-approved labeling. Evidence supports careful, individualized decision-making when considering off-label ketamine treatment for mood disorders (Sanacora et al., 2017).
SPRAVATO® treatment, or esketamine nasal spray, is different. SPRAVATO® is FDA-approved for adults with treatment-resistant depression, either as monotherapy or with an oral antidepressant. It is also approved for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior when used with an oral antidepressant (U.S. Food and Drug Administration [FDA], 2025).
Wondering how these two options compare? Our overview of SPRAVATO® vs. Ketamine Therapy walks through the key differences to help you have a more informed conversation with your provider. We offer SPRAVATO® for qualifying patients at our Marietta clinic. We accept Anthem BCBS, Aetna, and Medicare, and we verify benefits and eligibility before treatment begins.
Addressing Fear: What the Infusion Experience Is Like
We understand that ketamine therapy can feel unfamiliar or intimidating. One of the most common questions we hear is, “Will I feel out of control?”
During an IV ketamine infusion, you receive a subanesthetic dose. Some patients experience temporary dissociation or perceptual changes, but these effects are monitored closely and typically resolve after treatment. We provide care in a private, calm setting and remain focused on safety, comfort, and informed decision-making throughout the process.
You will need someone to drive you home after treatment. We encourage you to discuss any concerns about the experience during your consultation so we can help you understand what to expect. Our guide on what to look for in a ketamine clinic may also help you prepare for that conversation.
Addressing Cost: What IV Ketamine Infusions Cost in Atlanta
At our clinic, IV ketamine treatments range from $400 to $1,000 per session depending on the protocol. We offer a 15% discount when an initial infusion series is paid upfront and a 25% discount for active military personnel, veterans, and first responders. CareCredit financing is also available.
Coverage for IV ketamine can be limited and varies by plan. SPRAVATO® may be covered for qualifying patients, subject to diagnosis, benefits, and prior authorization. We encourage you to ask our team about current financial options during your consultation because cost should not be the reason someone stops pursuing care.
Who May Be a Candidate
IV ketamine infusion therapy may be appropriate for adults with a confirmed diagnosis of treatment-resistant depression who have not achieved adequate relief from prior treatment. It is not appropriate for everyone.
A comprehensive medical and psychiatric evaluation is required before treatment. We review your treatment history, current medications, medical conditions, and safety considerations before making recommendations. Results vary by individual.
Frequently Asked Questions
How many ketamine infusions are typically needed for depression?
Treatment schedules vary. Many patients begin with an initial series of infusions, and we determine the recommended schedule based on your history, response, and treatment goals. Some patients may later discuss maintenance treatment with their provider.
How quickly can I expect to feel results from ketamine therapy?
Research has found rapid antidepressant effects within 24 hours for some participants in clinical trials. Others experience more gradual change across a treatment series. Results vary by individual and are not guarantees of outcome (Fond et al., 2014; Murrough et al., 2013).
Is IV ketamine the same as SPRAVATO®?
No. IV ketamine uses racemic ketamine administered intravenously in a clinical setting and is used off-label for psychiatric conditions. SPRAVATO® is esketamine nasal spray and is FDA-approved for specific depressive-disorder indications (FDA, 2025).
Will my insurance cover ketamine infusions for depression?
Coverage for IV ketamine varies and is often limited. SPRAVATO® may be covered by Anthem BCBS, Aetna, or Medicare for qualifying patients. We will help you understand current coverage verification and financial options before treatment begins.
Can I continue my current antidepressants during ketamine treatment?
Medication decisions are individualized. We complete a full medication review before treatment and discuss any safety considerations with you and the clinicians involved in your care. Do not start, stop, or adjust prescribed medication without guidance from your provider.
For additional preparation, you may find our post on 5 Essential Tips Before You Book Ketamine Therapy a helpful resource before your first appointment.
Key Takeaways
- Treatment-resistant depression is commonly defined by inadequate response to at least two appropriate antidepressant trials.
- IV ketamine acts on the glutamatergic system through NMDA receptor antagonism and is associated with neuroplasticity-related pathways involving AMPA signaling and BDNF (Zanos & Gould, 2018).
- Ketamine may produce rapid antidepressant effects for some patients, but response, duration, and long-term outcomes vary (Fond et al., 2014; Murrough et al., 2013).
- IV ketamine for depression is used off-label. SPRAVATO® is FDA-approved for specific depressive-disorder indications.
- At our clinic, IV ketamine treatments range from $400 to $1,000 per session, with financing and discounts available for eligible patients.
If you or someone you love has been struggling with treatment-resistant depression and standard therapies have not brought lasting relief, we want to hear from you. At The Invictus Clinic, we take time to understand your history and work with you to find the right path forward. Call us at 770-580-1042 or schedule a consultation with our Marietta team.
References
Fond, G., Loundou, A., Rabu, C., Macgregor, A., Lançon, C., Brittner, M., Micoulaud-Franchi, J.-A., Richieri, R., Courtet, P., Abbar, M., Roger, M., Leboyer, M., & Boyer, L. (2014). Ketamine administration in depressive disorders: A systematic review and meta-analysis. Psychopharmacology, 231(18), 3663–3676. DOI: 10.1007/s00213-014-3664-5. https://pubmed.ncbi.nlm.nih.gov/25038867/
Gaynes, B. N., Lux, L., Gartlehner, G., Asher, G., Forman-Hoffman, V., Green, J., Boland, E., Weber, R. P., Randolph, C., Bann, C., Coker-Schwimmer, E., Viswanathan, M., & Lohr, K. N. (2020). Defining treatment-resistant depression. Depression and Anxiety, 37(2), 134–145. DOI: 10.1002/da.22968. https://pubmed.ncbi.nlm.nih.gov/31638723/
Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., Iqbal, S., Pillemer, S., Foulkes, A., Shah, A., Charney, D. S., & Mathew, S. J. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: A two-site randomized controlled trial. American Journal of Psychiatry, 170(10), 1134–1142. DOI: 10.1176/appi.ajp.2013.13030392. https://pubmed.ncbi.nlm.nih.gov/23982301/
Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., Summergrad, P., Nemeroff, C. B., & American Psychiatric Association Council of Research Task Force on Novel Biomarkers and Treatments. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405. DOI: 10.1001/jamapsychiatry.2017.0080. https://pubmed.ncbi.nlm.nih.gov/28249076/
U.S. Food and Drug Administration. (2025). SPRAVATO® (esketamine) nasal spray: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf
Zanos, P., & Gould, T. D. (2018). Mechanisms of ketamine action as an antidepressant. Molecular Psychiatry, 23(4), 801–811. DOI: 10.1038/mp.2017.255. https://pubmed.ncbi.nlm.nih.gov/29532791/
Medical Disclaimer
At The Invictus Clinic, we provide this information for educational purposes only and not as medical advice. IV ketamine infusion therapy and SPRAVATO® should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. SPRAVATO® is FDA-approved for specific indications, while IV ketamine for psychiatric conditions is used off-label. If you are experiencing a mental health crisis or thoughts of self-harm, call or text 988 to reach the Suicide & Crisis Lifeline or go to your nearest emergency room.
