Ketamine itself has been FDA-approved as an anesthetic since 1970. What isn't FDA-approved is its use as a depression treatment specifically, which makes that use technically off-label. That's a legitimate disclosure, not a hidden risk. Off-label prescribing is common, legal, and supported by decades of clinical research - roughly one in five prescriptions in the US is off-label. Spravato (esketamine) is the FDA-approved version, and we offer that too.

Same brain target (NMDA receptors), different delivery. Spravato is a nasal spray; IV ketamine is an infusion. Spravato is FDA-approved and usually insurance-covered; IV ketamine is off-label and self-pay. The infusion produces broader pharmacological exposure, which is one reason it's sometimes used after Spravato hasn't worked. Both involve a few hours of supervised time and a driver home.

Often faster than Spravato or oral antidepressants. Some patients notice a shift within hours of the first infusion. Most who are going to respond do so within the first three to four sessions of the induction series. A meaningful portion don't respond at all — we'll know early, and we won't keep going if nothing's moving.

Ketamine has potential for misuse outside of medical settings, which is why infusions are always done in-clinic and never sent home with patients. At the doses we use for depression treatment, with the cadence we recommend, the addiction risk in supervised clinical use is low. The published research has not shown a consistent pattern of dependency in supervised ketamine treatment for depression.

Because the FDA hasn't approved ketamine for depression specifically — only for anesthesia. Insurance plans generally don't cover off-label uses of any drug. Spravato is the FDA-approved alternative that does get insurance coverage; for most patients with treatment-resistant depression, Spravato is the better starting point financially. We're transparent about that.

You won't be the first patient that's true for, and we won't push you to keep going. If you're not responding by the third or fourth infusion, Dr. Blair reviews the data with you and talks honestly about alternatives — sometimes that's TMS, sometimes Spravato, sometimes a different medication strategy, sometimes a referral elsewhere. The goal is your outcome, not selling you on a treatment that isn't working.

Optimum is led by Dr. Mark Blair, an ABPN board-certified psychiatrist with over 24 years in practice. He's a US Air Force veteran, founded Optimum TMS in 2017, and personally oversees every patient's treatment plan. Initial consultations are conducted by Dr. Blair or one of our psychiatric nurse practitioners.