How to Get a Ketamine Prescription: Step-by-Step Guide

Interest in ketamine therapy has grown quickly as more patients learn about its potential to relieve treatment-resistant depression, anxiety, post-traumatic stress disorder (PTSD), and even suicidal ideation. Stories of rapid symptom improvement have sparked curiosity, but they have also left many people wondering what it actually takes to begin this type of treatment. One of the most common questions is simple: how do you get a ketamine prescription?

This article provides a clear, step-by-step guide to the process. We will look at what conditions ketamine is used for, who may be a good candidate, how to find a qualified provider, and what happens during the evaluation and treatment process. We will also review practical considerations such as cost, insurance coverage, and ongoing monitoring so that patients and families know what to expect before starting.

Step 1: Understand What Ketamine Is Used For

Ketamine was first developed in the 1960s as a surgical anesthetic because of its safety, reliability, and relatively low risk of suppressing breathing compared to other anesthetics. For decades, it has been widely used in operating rooms, emergency departments, and even on the battlefield.

Over the past twenty years, however, researchers began to notice something remarkable: patients receiving ketamine for surgical or medical reasons often reported significant and rapid improvements in mood. Follow-up studies confirmed that ketamine has fast-acting antidepressant properties, making it especially valuable for people who have not responded to traditional medications. Unlike antidepressants such as SSRIs or SNRIs, which can take weeks to produce effects, ketamine can sometimes relieve symptoms within hours.

Today, there are two main ways psychiatrists use ketamine in mental health treatment:

• Esketamine (Spravato®): This is a nasal spray derived from ketamine that has received FDA approval for two specific conditions — treatment-resistant depression and major depressive disorder accompanied by suicidal thoughts or behaviors. Spravato must be administered in a certified clinic under the Risk Evaluation and Mitigation Strategy (REMS) program, and patients are monitored for at least two hours after each session.

• Off-label Ketamine Therapy: Psychiatrists and specialty clinics may also prescribe ketamine in forms that are not FDA-approved for depression, such as intravenous (IV) infusions, intramuscular (IM) injections, or oral lozenges. Although these uses are considered “off-label,” they are legally prescribed when supported by clinical evidence and patient need. Off-label prescribing is common in medicine and, in ketamine’s case, has been shown to help patients with depression, PTSD, and severe anxiety who have exhausted other options.

By understanding these two pathways — one FDA-approved and one off-label — patients can better grasp what options might be available to them and what type of provider or clinic they will need to see.

Step 2: Determine If You’re a Candidate

Ketamine therapy is not a universal solution, and psychiatrists take careful steps to determine whether a patient is an appropriate candidate. This evaluation process protects patient safety and ensures that ketamine is used where it has the greatest potential benefit.

Psychiatrists typically consider ketamine therapy in the following situations:

• Treatment-Resistant Depression
  If you have tried multiple antidepressants without significant improvement, you may fall into the category of treatment-resistant depression. Studies show that ketamine can provide rapid relief for this group, even when standard medications have failed.

• Severe Suicidal Thoughts
  One of ketamine’s most important uses is in cases of acute suicidal ideation. Because traditional antidepressants can take weeks to work, psychiatrists may turn to ketamine to reduce these thoughts within hours or days, creating a critical window of safety.

• Insufficient Response to Other Therapies
  Psychiatrists may recommend ketamine if approaches like psychotherapy, SSRIs, SNRIs, or lifestyle interventions (such as exercise, nutrition, or sleep hygiene) have not provided adequate relief. Ketamine is usually seen as a next step, not a first-line treatment.

• Ability to Participate in Structured Care
  Patients must be medically stable and willing to attend regular treatment sessions and follow-up visits. Ongoing monitoring is essential to track effectiveness, adjust dosage, and watch for side effects.

At the same time, ketamine therapy is not appropriate for everyone. It may be unsuitable for people with uncontrolled high blood pressure, significant cardiovascular disease, or certain psychiatric or substance use risks. Active substance misuse, for example, can raise concerns about dependency or inappropriate use of ketamine. Thorough screening is therefore required before moving forward (Wilkinson et al., 2018).

By assessing both potential benefits and risks, psychiatrists can determine whether ketamine therapy is a safe and effective option for each patient.

Step 3: Find a Qualified Provider

Not every mental health professional or medical office is equipped to provide ketamine treatment. Because ketamine is a controlled substance and its psychiatric uses require special expertise, it’s important to know which providers can legally and safely prescribe it.

The main options include:

• Psychiatrists (MD/DO)
  Psychiatrists are medical doctors with full prescribing authority. They can prescribe both esketamine (Spravato®), which is FDA-approved for treatment-resistant depression, and off-label ketamine therapies such as IV infusions or oral lozenges. A psychiatrist is often the best starting point, since they can evaluate your medical and psychiatric history, screen for risks, and determine which form of ketamine is most appropriate.

• Certified Spravato® Clinics
  Esketamine nasal spray is only available through REMS-certified clinics. These facilities must meet strict FDA requirements to ensure patient safety. Patients self-administer the nasal spray under supervision, and remain in the clinic for at least two hours afterward while healthcare professionals monitor for side effects such as dissociation, dizziness, or blood pressure changes.

• Specialty Ketamine Clinics
  Across the country, dedicated ketamine centers have opened that focus on off-label infusion therapy. These clinics are usually run under physician supervision and staffed with trained medical professionals. They provide IV or IM ketamine in carefully controlled doses, often in a calming environment designed to reduce stress and support the therapeutic process. Some also offer ketamine-assisted psychotherapy (KAP), which pairs medication with therapy sessions for deeper integration.

When choosing a provider, it’s essential to:

• Verify credentials and medical licensing.

• Ask about their experience with ketamine therapy and how many patients they have treated.

• Confirm whether they provide integrated therapy support, rather than only administering medication.

• Check whether they offer a structured treatment plan, including initial assessment, follow-ups, and monitoring.

Selecting the right provider is one of the most important steps in starting ketamine therapy. A qualified psychiatrist or clinic not only ensures safe administration but also maximizes the likelihood of lasting benefits by combining medical expertise with therapeutic support.

Step 4: The Evaluation Process

Before prescribing ketamine, psychiatrists and clinics conduct a thorough evaluation to ensure the treatment is safe, medically appropriate, and likely to benefit the patient. This process typically involves several important steps:

• Comprehensive Medical History
  Your provider will review your full health background, including past psychiatric diagnoses, medications you’ve tried, hospitalizations, and treatment responses. This helps determine whether your condition fits criteria for ketamine therapy, especially in cases of treatment-resistant depression or acute suicidal ideation.

• Psychiatric Assessment
  A formal psychiatric evaluation is usually completed to confirm diagnosis and assess the severity of symptoms. This may include structured interviews, mental health questionnaires, and discussion of how your condition impacts daily functioning.

• Screening for Medical Risks
  Because ketamine can temporarily increase blood pressure and heart rate, your provider will check for cardiovascular conditions or uncontrolled hypertension. They will also ask about any history of substance use disorders, since ketamine has the potential for misuse. Other contraindications, such as certain neurological or respiratory conditions, may also be assessed.

• Informed Consent
  Patients are given a clear explanation of what ketamine therapy involves, including the difference between FDA-approved esketamine (Spravato®) and off-label ketamine options. The provider will outline potential benefits, side effects, monitoring requirements, and costs so that you can make an informed decision.

This evaluation is not just a formality. It ensures that ketamine therapy is used responsibly, that patients are fully aware of their choices, and that the treatment plan is tailored to individual needs. For many people searching for how to get a ketamine prescription, this process provides peace of mind and clarity before moving forward.

Step 5: Begin Treatment Under Supervision

Once you have been evaluated and approved for ketamine therapy, the treatment itself is always administered under professional supervision. The format depends on whether you are receiving FDA-approved Spravato® (esketamine) or off-label ketamine therapy, but safety and monitoring are central to both approaches.

• Spravato® (Esketamine)
  Esketamine is delivered as a nasal spray in a REMS-certified clinic. Patients self-administer the spray under the guidance of medical staff, then remain in the clinic for at least two hours. During this time, clinicians monitor blood pressure, heart rate, and overall well-being. Some patients experience dissociation or dizziness, which typically resolve before discharge. Because of these effects, you cannot drive yourself home after treatment and must arrange transportation.

• Off-Label IV/IM Ketamine
  Off-label ketamine therapy is usually given as an intravenous (IV) infusion or intramuscular (IM) injection. IV infusions last about 40–60 minutes, while IM injections are shorter. Throughout the session, vital signs are closely tracked to ensure safety. These treatments are delivered in a quiet, controlled environment, often with supportive measures such as dim lighting or comfortable seating to help patients relax.

• Follow-Up Schedule
  Initial treatment often involves two sessions per week for the first two to four weeks, after which the frequency may taper to weekly or biweekly as symptoms improve. The exact schedule is individualized, based on response and clinical judgment.

• Integration with Psychotherapy
  Many psychiatrists and clinics combine ketamine sessions with psychotherapy, sometimes called ketamine-assisted psychotherapy (KAP). Because ketamine can reduce emotional barriers and increase openness, pairing it with talk therapy can help patients process underlying trauma, reframe negative thought patterns, and integrate insights into daily life (Feder et al., 2021).

Beginning treatment is not just about the medication itself — it’s about creating a structured, supportive setting that maximizes benefits while protecting patient safety.

Step 6: Understand Costs and Coverage

One of the most common concerns about ketamine therapy is how much it costs and whether insurance will help cover the expense. Coverage varies depending on the type of treatment and the provider’s setup.

• Spravato® (Esketamine Nasal Spray)
  Because Spravato® is FDA-approved for treatment-resistant depression and major depressive disorder with suicidal ideation, many insurance plans will cover it — but only when administered in a REMS-certified clinic. Even with coverage, patients may still be responsible for co-pays or coinsurance, depending on their plan. Prior authorization from the insurance company is often required, meaning your psychiatrist must submit documentation to confirm medical necessity.

• IV or IM Ketamine (Off-Label Use)
  Intravenous (IV) infusions and intramuscular (IM) injections are not FDA-approved for psychiatric conditions. For this reason, they are usually not covered by insurance, leaving patients to pay out of pocket. The cost typically ranges from $400 to $800 per infusion, with full treatment courses often involving 6–8 initial sessions followed by maintenance sessions. For many families, this adds up to several thousand dollars.

• Financing and Packages
  To make treatment more accessible, some clinics offer payment plans, bundled packages, or membership-style pricing. These options may lower upfront costs and allow patients to spread expenses over time. A few clinics also help patients submit out-of-network claims to insurers, which may result in partial reimbursement.

• Other Cost Factors
  Beyond the medication itself, costs may include initial psychiatric evaluations, therapy integration sessions, lab work, or medical monitoring. Patients should ask for a transparent breakdown of all fees before starting.

While the financial aspect can feel daunting, many patients who have not found relief with standard antidepressants consider ketamine therapy an investment in long-term well-being. Understanding the cost structure upfront helps avoid surprises and allows patients to plan realistically for ongoing care.

Conclusion

Getting a ketamine prescription is not as simple as asking your doctor to send medication to the pharmacy. It involves a careful process that starts with evaluation by a psychiatrist, includes detailed screening for safety, and continues with treatment in a structured clinical environment. This oversight is essential because ketamine is a powerful medication that requires professional monitoring to ensure it is both safe and effective.

For many patients, however, ketamine therapy has been a turning point. When traditional antidepressants and psychotherapy alone have not been enough, ketamine offers rapid relief, renewed hope, and the possibility of meaningful recovery. Whether delivered as FDA-approved esketamine in a certified clinic or as off-label infusion therapy, the key is that it is provided responsibly, within a comprehensive plan of care.

If you are considering ketamine therapy, the most important step is to schedule a consultation with a qualified psychiatrist or certified ketamine clinic. A professional evaluation will help determine whether you are a good candidate and what form of treatment best fits your needs. With the right guidance and support, ketamine can move from being a last-resort option to a life-changing resource on your path toward healing.

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.