Can a Psychiatrist Prescribe Ketamine? Understanding Its Role in Therapy

The question “can a psychiatrist prescribe ketamine?” is becoming increasingly common as ketamine therapy gains wider attention in mental health care. Once recognized only as a surgical anesthetic, ketamine is now drawing interest for its potential to treat conditions such as treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Many patients want to know if psychiatrists, as medical doctors who specialize in mental health, are the professionals who can provide access to this form of treatment.

The straightforward answer is yes, psychiatrists can prescribe ketamine. The way they prescribe it depends on medical guidelines, clinical settings, and the needs of each patient. In some cases, this may involve FDA-approved esketamine (Spravato®), while in others it may involve off-label ketamine infusions or lozenges. Unlike traditional antidepressants that can take weeks to show results, ketamine often provides relief much faster, which makes it both promising and complex within psychiatric care.

This article will review ketamine’s medical background, explain how psychiatrists use it in therapy, outline the science behind its effects, and highlight the benefits and risks that patients should weigh before considering treatment. By the end, you will have a clear understanding of whether psychiatrists can prescribe ketamine and what role it plays in modern mental health care.What Is Ketamine?

• Developed in the 1960s as a surgical anesthetic.

• Known for safety and effectiveness in operating rooms and trauma care.

• Recently recognized for its fast-acting antidepressant effects, even in treatment-resistant depression.

• Forms: IV infusion, intranasal spray (Spravato®), oral lozenges, or intramuscular injection.

Can a Psychiatrist Prescribe Ketamine?

1. Psychiatrists’ Prescribing Authority

Psychiatrists are fully licensed medical doctors (MD or DO) who specialize in diagnosing and treating mental health conditions. Because of their medical training, they hold the same prescribing authority as other physicians. This includes the ability to prescribe controlled substances when clinically appropriate and legally permitted.

Ketamine falls into this category. It is classified as a Schedule III controlled substance by the U.S. Drug Enforcement Administration (DEA), which means it has recognized medical uses but also carries some potential for misuse. Psychiatrists with an active medical license and DEA registration can legally prescribe ketamine, provided they follow federal regulations and state-specific guidelines.

Importantly, psychiatrists are not limited to prescribing medications that are FDA-approved for psychiatric conditions. Like other physicians, they may also prescribe medications off-label when evidence supports their use. This is why ketamine may be given in two distinct ways in mental health care:

• FDA-Approved Form (Esketamine/Spravato®): Specifically approved for treatment-resistant depression, requiring administration in a certified clinic under a monitoring program.

• Off-Label Ketamine Treatments: Intravenous infusions, intramuscular injections, or lozenges, prescribed at the psychiatrist’s discretion when supported by clinical judgment and patient consent.

This prescribing authority allows psychiatrists to tailor treatment to individual needs, but it also places responsibility on them to carefully evaluate risks, monitor patients, and integrate ketamine into a broader therapeutic plan.

2. FDA-Approved Use: Spravato® (Esketamine)

Esketamine, sold under the brand name Spravato®, is the only form of ketamine that has received direct approval from the U.S. Food and Drug Administration (FDA) for psychiatric use. In 2019, the FDA approved it specifically for treatment-resistant depression in adults who have not responded to at least two other antidepressant therapies. It is also approved for major depressive disorder with acute suicidal ideation or behavior.

Unlike traditional antidepressants, which are taken at home and often require weeks to show results, esketamine works rapidly and is delivered in a nasal spray format. However, its use is tightly regulated. Because ketamine has potential for misuse and because patients can experience dissociation, dizziness, or sedation after dosing, the FDA requires that Spravato be administered only in certified clinics enrolled in the REMS (Risk Evaluation and Mitigation Strategy) program.

The REMS program ensures that:

• Only certified prescribers and treatment centers can dispense esketamine.

• Patients self-administer the nasal spray in a clinical setting under the supervision of a healthcare professional.

• Monitoring lasts at least two hours post-dose, during which vital signs, mental status, and side effects are assessed before discharge.

• Patients cannot take the medication home, reducing the risk of diversion or misuse.

Because of these safeguards, Spravato treatment typically involves regular clinic visits — often twice a week during the initial phase — followed by tapering sessions as symptoms improve. For many patients, this structure provides not only access to the medication but also built-in support and monitoring from a care team.

This FDA-approved pathway is currently the most standardized and widely accepted method for psychiatrists to prescribe ketamine-based therapy. It provides legitimacy, insurance coverage in some cases, and a clear safety framework, making it an accessible entry point for patients who may be hesitant about off-label ketamine infusions

3. Off-Label Use of Ketamine

While IV (intravenous) and IM (intramuscular) ketamine are not FDA-approved for the treatment of depression or other psychiatric conditions, they can still be legally prescribed by psychiatrists under what is known as off-label use. Off-label prescribing occurs when a physician uses an FDA-approved drug for a condition or in a manner that has not been specifically sanctioned by the FDA. This practice is not only legal but also quite common in medicine, especially in areas where research strongly suggests therapeutic benefit.

In the case of ketamine, a growing body of clinical studies supports its effectiveness in rapidly reducing symptoms of treatment-resistant depression, PTSD, anxiety disorders, and suicidal ideation. As a result, many psychiatrists and specialized clinics have adopted off-label ketamine therapy as part of their treatment offerings.

How Off-Label Ketamine Is Administered

• IV Infusions: The most studied method, usually delivered over 40–60 minutes in a controlled setting.

• IM Injections: Less common than IV but sometimes preferred for convenience or clinic workflow.

• Oral Lozenges or Sublingual Tablets: Occasionally prescribed for at-home use under strict guidance, often as part of ketamine-assisted psychotherapy (KAP).

Safety and Monitoring

Because these uses are off-label, psychiatrists must take additional steps to protect patients and themselves professionally:

• Informed Consent: Patients must be told that ketamine is not FDA-approved for their specific condition, but evidence supports its use.

• Strict Monitoring: Vital signs and mental status are monitored during and after treatment to prevent adverse reactions such as blood pressure spikes or dissociation.

• Treatment Integration: Many clinics combine off-label ketamine with psychotherapy, helping patients process insights and prevent reliance on medication alone.

Benefits and Challenges

• Benefits: Off-label ketamine is often more flexible than Spravato® and can be tailored to the individual’s needs. IV infusions, in particular, are considered the gold standard for research trials.

• Challenges: Lack of FDA approval means insurance coverage is limited, leaving many patients to pay out of pocket. Long-term effects are still under study, and treatment must be carefully monitored to reduce risks of dependency or misuse.

In short, while off-label ketamine use expands access and provides hope for patients who have exhausted other options, it also requires careful oversight and transparent communication between psychiatrist and patient.

How Psychiatrists Integrate Ketamine Into Therapy

Psychiatrists rarely view ketamine as a stand-alone solution. Instead, they integrate it into a broader therapeutic plan that combines medication with structured support and psychotherapy. This approach helps ensure that patients not only experience relief from symptoms but also learn how to build sustainable coping strategies and long-term resilience.

1. Ketamine-Assisted Psychotherapy (KAP)

One of the most well-known models is Ketamine-Assisted Psychotherapy (KAP). In this setting, patients receive ketamine under the supervision of a psychiatrist or trained clinician, followed by therapy sessions designed to help them process the thoughts, emotions, or insights that emerge. The altered state of consciousness produced by ketamine often allows patients to access emotions or memories that feel blocked in traditional talk therapy. With a therapist’s guidance, these experiences can be reframed in a way that supports healing and new growth.

2. Stabilization Tool for Acute Suicidality

Ketamine has also proven valuable as a rapid stabilization tool for individuals experiencing intense suicidal ideation. Traditional antidepressants often take weeks to show results, but ketamine can reduce suicidal thoughts within hours. Psychiatrists use this effect to create a critical safety window, giving patients and care teams the time to implement additional therapies, support systems, and safety planning.

3. Treatment for Resistant Depression

For individuals who have tried multiple antidepressants without success, ketamine offers a new option. Psychiatrists often prescribe ketamine as part of a multi-modal treatment plan that may also include psychotherapy, lifestyle changes, and, in some cases, other biological interventions like TMS (transcranial magnetic stimulation). The goal is not just symptom relief, but helping patients who previously felt “stuck” move forward in recovery.

4. Emerging Applications in PTSD and Anxiety

While research is still developing, early studies suggest that ketamine may help with post-traumatic stress disorder (PTSD) and certain anxiety disorders. Psychiatrists using ketamine in these contexts often combine it with trauma-informed therapy approaches such as EMDR (Eye Movement Desensitization and Reprocessing) or CBT (Cognitive Behavioral Therapy). This integrative approach helps ensure that patients not only experience temporary relief but also gain tools to manage symptoms in everyday life.

By combining ketamine with therapeutic processing, psychiatrists create treatment plans that go beyond symptom suppression. This integration helps patients build insight, strengthen emotional regulation, and translate short-term relief into long-term recovery.

The Science Behind Ketamine’s Effects

Ketamine stands out in psychiatry because it works through a different biological pathway than most traditional antidepressants. While selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) act primarily on the brain’s serotonin and norepinephrine systems, ketamine targets the N-methyl-D-aspartate (NMDA) receptors, which are part of the glutamate neurotransmitter system (Krystal et al., 2019).

Glutamate is the brain’s most abundant excitatory neurotransmitter and plays a key role in learning, memory, and mood regulation. By blocking NMDA receptors, ketamine increases the release of another receptor called AMPA, which in turn enhances the release of brain-derived neurotrophic factor (BDNF). BDNF is a protein essential for neuroplasticity — the brain’s ability to adapt, change, and form new connections.

This cascade of effects leads to synaptogenesis, the growth of new neural connections in areas of the brain that regulate mood and emotion. For people with depression, especially treatment-resistant depression, these pathways are often underactive or disrupted. Ketamine’s ability to stimulate rapid synaptic growth may help “reset” these circuits, allowing patients to break free from entrenched depressive patterns.

Another remarkable aspect is the speed of response. While SSRIs may take four to six weeks to produce measurable improvements, ketamine can alleviate depressive symptoms within hours to days. This rapid effect is especially critical in cases of acute suicidal ideation, where waiting weeks for relief can be dangerous.

Researchers are still investigating exactly why ketamine produces such fast and profound results, but most agree it represents a paradigm shift in depression treatment by targeting the glutamate system rather than relying solely on serotonin or norepinephrine pathways (Feder et al., 2021).

Benefits of Ketamine Treatment

Ketamine offers several unique advantages compared to traditional psychiatric medications, which is why it has gained so much attention in recent years:

• Rapid Relief of Symptoms
  Unlike SSRIs or SNRIs that may take weeks to build effect, ketamine can ease symptoms of depression within hours to days. This speed can be life-changing for individuals in crisis.

• Reduction of Suicidal Thoughts
  Research shows ketamine can reduce suicidal ideation much faster than conventional medications. This makes it a critical tool for psychiatrists working with patients in acute danger.

• Enhanced Psychotherapy Outcomes
  Many patients report that ketamine lowers emotional barriers, making it easier to access difficult memories and engage more fully in therapy. This can accelerate progress when combined with structured approaches such as CBT or trauma-focused therapy.

• A New Option for Treatment-Resistant Depression
  For those who have not responded to multiple antidepressants, ketamine provides a much-needed alternative. Its different mechanism of action offers hope when conventional treatments have failed.

Together, these benefits position ketamine as both a stabilizing intervention in emergencies and a catalyst for deeper healing when paired with ongoing therapy.

Risks and Considerations

While ketamine therapy has shown significant promise, it is not without important risks and limitations that patients and providers must carefully weigh.

• Side Effects
  Common short-term side effects include dizziness, nausea, increased blood pressure, and dissociation or a sense of being detached from one’s body or surroundings. While these effects typically resolve within hours, they can be distressing for some patients and require clinical monitoring during and after treatment (Wilkinson et al., 2018).

• Not Suitable for All Patients
  Ketamine may not be appropriate for individuals with uncontrolled cardiovascular conditions due to its impact on blood pressure and heart rate. Additionally, patients with a history of substance use disorders may face heightened risks of misuse or dependency, making careful screening essential before treatment.

• Limited Long-Term Data
  Although studies consistently demonstrate ketamine’s rapid antidepressant effects, there is limited evidence on its long-term safety and efficacy. Most research covers only several weeks to months of use, leaving questions about potential neurocognitive effects or dependency risks over years (Krystal et al., 2019).

• Access and Cost
  Financial accessibility is another consideration. Spravato® (esketamine), the FDA-approved version, may be covered by insurance but requires in-clinic administration under strict monitoring. By contrast, off-label IV ketamine infusions are often paid out of pocket, with costs ranging from several hundred to over a thousand dollars per session depending on location and provider.

These risks underscore the importance of thorough evaluation and close supervision by a qualified psychiatrist or clinic. For many patients, the potential benefits outweigh the risks, but ketamine should always be delivered within a structured treatment plan that includes medical oversight and therapeutic support.

Who Is a Candidate for Ketamine Therapy?

Ketamine therapy is not intended for everyone. Psychiatrists typically reserve it for patients who have specific needs and can benefit from its unique effects under medical supervision. Common candidate profiles include:

• Treatment-Resistant Depression
  Patients who have not responded to at least two or more trials of traditional antidepressants may be considered for ketamine. This group often experiences significant relief because ketamine works through a different mechanism than SSRIs or SNRIs.

• Acute Suicidal Thoughts
  Because ketamine can rapidly reduce suicidal ideation, it is sometimes used in urgent situations where waiting weeks for standard antidepressants to take effect would be unsafe.

• When Other Therapies Have Not Been Sufficient
  Psychiatrists may recommend ketamine when approaches such as psychotherapy, medication adjustments, or lifestyle interventions (like sleep, exercise, and nutrition improvements) have not produced adequate results.

• Ability to Commit to Ongoing Monitoring
  Candidates must be willing and able to attend scheduled treatment sessions and follow-up visits. Regular monitoring ensures safety, helps track progress, and reduces the risk of complications.

• Exclusion Considerations
  People with uncontrolled high blood pressure, serious heart conditions, active substance misuse, or certain psychiatric disorders may not be good candidates. A thorough evaluation is always required to weigh risks against potential benefits.

In short, psychiatrists look for individuals who both stand to benefit clinically and can engage safely in a structured treatment plan. Careful screening ensures that ketamine therapy is used where it has the best chance of success.

Alternatives to Ketamine Therapy

While ketamine can be a powerful tool, it is not the only treatment available for depression or other mental health conditions. Psychiatrists often consider a range of evidence-based alternatives depending on the patient’s symptoms, history, and preferences.

• Traditional Antidepressants
  Medications such as SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), and atypical antidepressants remain the frontline treatment for many patients. Though they may take longer to work than ketamine, they have decades of safety data and are effective for a wide range of mood and anxiety disorders.

• Psychotherapy
  Approaches such as Cognitive Behavioral Therapy (CBT), Internal Family Systems (IFS), or Narrative Therapy help patients identify and change negative thought patterns, resolve trauma, and strengthen emotional regulation. Therapy may be used alone for mild symptoms or combined with medication for more severe cases.

• TMS (Transcranial Magnetic Stimulation)
  This non-invasive procedure uses magnetic fields to stimulate areas of the brain involved in mood regulation. TMS is FDA-approved for treatment-resistant depression and is generally well tolerated, making it a good option for patients who do not want medication-based interventions.

• ECT (Electroconvulsive Therapy)
  For severe depression, especially when accompanied by suicidality or psychosis, psychiatrists may recommend Electroconvulsive Therapy. Despite its stigma, ECT is one of the most effective treatments for major depression, with rapid results in many patients.

• Lifestyle and Integrative Supports
  Foundational health practices — including exercise, sleep hygiene, balanced nutrition, mindfulness, and stress management — remain essential. While not a cure on their own, these strategies enhance the effectiveness of medical and therapeutic interventions.

Each of these alternatives may be used alone or in combination, depending on the individual case. Psychiatrists often create a personalized treatment plan that balances symptom relief, long-term stability, and quality of life.

FAQs

1. Can a psychiatrists prescribe ketamine?
Yes, but only some are trained and equipped to provide ketamine therapy. Many refer patients to specialized clinics.

2. Do psychologists prescribe ketamine?
No. Psychologists are not medical doctors and generally cannot prescribe medications (with rare state exceptions).

3. How is ketamine different from esketamine (Spravato®)?
Ketamine is a racemic mixture; esketamine is one enantiomer, developed into a patented nasal spray and FDA-approved.

4. Is ketamine safe long-term?
Research is ongoing. Current data supports short- to mid-term safety, but more studies are needed on extended use.

Conclusion

So, can a psychiatrist prescribe ketamine? The answer is yes. Psychiatrists have the medical training and prescribing authority to use ketamine in two ways: as FDA-approved esketamine (Spravato®) for treatment-resistant depression or as off-label ketamine therapy delivered through IV, IM, or oral formulations. Both options require careful oversight, but they open doors for patients who have struggled to find relief through conventional treatments.

Ketamine represents one of the most significant breakthroughs in modern psychiatry. For individuals living with severe depression, persistent anxiety, PTSD, or suicidal ideation, it offers something that traditional medications cannot — rapid symptom relief and the possibility of long-term improvement when combined with psychotherapy and structured follow-up care.

At the same time, ketamine is not a quick fix. It must be integrated into a comprehensive treatment plan that includes monitoring, informed consent, and ongoing therapeutic support. Used responsibly, ketamine can be a bridge toward stability and a catalyst for deeper healing.

For patients considering this option, the next step is to consult a qualified psychiatrist or a certified ketamine treatment center. A professional evaluation will determine whether ketamine is appropriate, safe, and likely to be effective. With the right guidance, ketamine therapy can move from being a last resort to a life-changing opportunity for recovery.

Solace Health Group conducts thorough research, includes trusted citations, and ensures all content is reviewed for accuracy. However, this article is not medical advice and should not replace professional evaluation or treatment. Always consult a licensed healthcare provider before making any medical or treatment decisions.

References

• Daly, E. J., et al. (2019). Efficacy of esketamine nasal spray plus oral antidepressant in treatment-resistant depression. JAMA Psychiatry, 76(9), 893–903.

• Feder, A., et al. (2021). Efficacy of repeated ketamine infusions in treatment-resistant depression. American Journal of Psychiatry, 178(3), 193–202.

• Krystal, J. H., et al. (2019). Ketamine: A paradigm shift for depression research and treatment. Neuron, 101(6), 774–778.

• Wilkinson, S. T., et al. (2018). The effect of a single dose of intravenous ketamine on suicidal ideation. Biological Psychiatry, 83(1), 70–78.