Evidence-Based CareWhat Medical Research Says About Ketamine Therapy
Peer-reviewed studies have evaluated ketamine and esketamine for treatment-resistant depression and related symptoms. Treatment is not appropriate for everyone, and eligibility is determined after medical evaluation.
Peer-reviewed research has studied ketamine-based treatments for treatment-resistant depression and other complex mood symptoms. Some studies suggest that ketamine may produce rapid antidepressant effects in certain carefully selected patients, particularly when administered under medical supervision. However, results vary, treatment is not appropriate for everyone, and ketamine therapy should only be considered after a medical evaluation.
Below is a plain-language look at the ketamine infusion research most relevant to patients considering medically supervised ketamine therapy — including how IV ketamine infusions in Miami compare with Spravato and ketamine troches.
Off-labelIV Ketamine Infusions
Intravenous racemic ketamine has been studied as an off-label treatment option for treatment-resistant depression.[2] Because IV administration delivers medication directly into the bloodstream, bioavailability is considered approximately 100%, allowing clinicians to control dosing and monitor patients closely during treatment. Research suggests IV ketamine may provide rapid symptom improvement for some patients, though response varies and ongoing follow-up is important.[1][3]
- ✓Administered by IV infusion in a monitored clinical setting
- ✓Approximately 100% bioavailability by route of administration
- ✓Studied off-label for treatment-resistant depression
- ✓Dosing and monitoring are individualized
- ✓Not appropriate for every patient
FDA-approved (esketamine)Spravato® / Esketamine Nasal Spray
Spravato® is the brand name for esketamine nasal spray. Unlike IV racemic ketamine, Spravato® is an FDA-approved medication for certain adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, depending on current labeling.[4] Spravato® must be administered under medical supervision and is only available through a restricted REMS program because of risks including sedation, dissociation, increases in blood pressure, respiratory depression, and the potential for abuse and misuse.[4][5] Its bioavailability is lower than intravenous administration.[2]
- ✓FDA-approved esketamine nasal spray for specific depression indications
- ✓Administered intranasally in a certified/monitored setting
- ✓Requires REMS program compliance
- ✓Patients are monitored for at least two hours
- ✓Bioavailability is lower than IV administration
Compounded / off-labelKetamine Troches / Sublingual Ketamine
Ketamine troches are dissolvable oral/sublingual formulations that are sometimes prescribed off-label.[7] Compared with IV ketamine and Spravato®, troches may be more convenient, but the evidence base is less established, absorption can be more variable, and dosing may be less predictable.[2] Published research and pharmacokinetic literature suggest sublingual ketamine has lower and more variable bioavailability than IV administration.[6] Troches should only be used under the direction of a qualified provider with appropriate screening and follow-up.
- ✓Usually compounded and prescribed off-label
- ✓Often used sublingually or buccally
- ✓Absorption may be more variable than IV
- ✓Evidence base is less robust than IV ketamine and FDA-approved esketamine
- ✓Should only be used under medical supervision
Comparing Ketamine Treatment Modalities
Comparison of IV ketamine infusion, Spravato esketamine, and ketamine troches by route, regulatory status, typical setting, key difference, and monitoring considerations.| Modality | Route | Regulatory Status | Typical Setting | Key Difference | Monitoring Considerations |
|---|
| IV Ketamine Infusion | Intravenous infusion | Used off-label for depression | Medical clinic / infusion setting | Direct IV delivery with high bioavailability and clinician-controlled dosing | Vitals and clinical response are monitored during and after treatment |
| Spravato® / Esketamine | Intranasal spray | FDA-approved for specific depression indications | Certified REMS healthcare setting | FDA-approved esketamine product with structured REMS requirements | Requires at least two hours of monitoring after administration |
| Ketamine Troches | Sublingual / buccal dissolvable formulation | Compounded and commonly used off-label | Often prescribed for at-home use depending on provider protocol | More convenient but absorption and response may be more variable | Requires provider oversight, screening, and clear safety instructions |
No single modality is right for every patient. The best option depends on diagnosis, treatment history, medical risk factors, medication use, response to prior treatment, cost, access, and provider recommendation. Infinity Medical Wellness evaluates patients individually before recommending ketamine therapy.
Our Approach: Why We Focus on IV Ketamine
Infinity Medical Wellness specializes in intravenous (IV) ketamine infusions. We do not currently offer Spravato® (esketamine) or compounded ketamine troches — the comparison above is provided purely for education, so you can understand how the options differ and discuss them with a qualified provider.
We focus on the IV route because it offers approximately 100% bioavailability and precise, clinician-controlled dosing in a fully monitored setting. This lets your provider deliver the intended therapeutic dose consistently and use the lowest effective amount, rather than relying on the more variable absorption of oral or sublingual formulations. Minimizing unnecessary cumulative exposure is part of our philosophy as well, since long-term organ health is a recognized clinical consideration with frequent, unsupervised ketamine use.
Why Medical Supervision Matters
Ketamine-based treatments can cause temporary changes in perception, sedation, blood pressure changes, nausea, dizziness, and other side effects. Medical screening and monitoring help determine whether treatment is appropriate and whether additional precautions are needed.
This information is for educational purposes only and is not medical advice. Ketamine therapy eligibility is determined after medical evaluation by a qualified provider. Results vary, and treatment is not appropriate for every patient. If this is a medical emergency, call 911 or go to the nearest emergency room. If you may harm yourself or someone else, call or text 988 in the United States for immediate crisis support.
References
- 1.Zolghadriha A, et al. Rapid and sustained antidepressant effects of intravenous ketamine in patients with major depressive disorder and suicidal ideation. 2024. View source ↗
- 2.McIntyre RS, Rosenblat JD, Nemeroff CB, et al. Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression. Am J Psychiatry. 2021;178(5):383-399. View source ↗
- 3.Seshadri A, et al. Efficacy of intravenous ketamine and intranasal esketamine in treatment-resistant depression: a systematic review and meta-analysis. J Affect Disord. 2024. View source ↗
- 4.U.S. Food and Drug Administration. SPRAVATO® (esketamine) nasal spray prescribing information. View source ↗
- 5.Bahr R, Lopez A, Rey JA. Intranasal esketamine for treatment-resistant depression. P T. 2019;44(6):340-375. View source ↗
- 6.Rolan P, Lim S, Sunderland V, Liu Y, Molnar V. The absolute bioavailability of racemic ketamine from a novel sublingual formulation. Br J Clin Pharmacol. 2014;77(6):1011-1016. View source ↗
- 7.Hassan K, et al. Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: a retrospective study. Front Psychiatry. 2022. View source ↗
