Does Oral Ketamine Work for Depression? Are repeat Ketamine Infusions Effective for depression maintenance? Do ketamine infusions help antidepressants work more rapidly? Northern Virginia Ketamine Infusion Provider

If you are looking for more information on whether ketamine may help you with your condition, contact us through the web form below or call 703-844-0184. Leave your phone number in the web form and expect us to call you:


Repeated Oral Ketamine for Depression Treatment – Can Oral Ketamine be used to treat depression? 

Ketamine is a rapid-acting antidepressant that is FDA approved as Spravato for depression and suicidality. It was developed in 1962 and FDA approved for anesthesia in 1970 as a human drug first and foremost. IV Ketamine has been found to be effective in rapidly reducing depression and suicidality. It is generally given in a dose of 0.5 mg/kg IV over 40 minutes and produces remission or rapid depression reduction within several hours to days in 70% of treatment resistant patients (ones who have failed several medications, ECT, or even TMS).  

Why Use several ketamine infusions?  

It improves response and lengthens time to relapse of depression: 

Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression 

Shiroma PR, Johns B, Kuskowski M, Wels J, Thuras P, Albott CS, Lim KO. Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression. J Affect Disord. 2014 Feb;155:123-9. doi: 10.1016/j.jad.2013.10.036. Epub 2013 Oct 29. PMID: 24268616. 

Study Parameters: 

  • 14 patients on 2 months of antidepressants 
  • 6 infusions of 0.5 mg/kg over 40 minutes Monday/Wednesday/Friday schedule 
  • Monitored for four weeks after for relapse 

Results After 6 infusions: 

  • 91.6% achieved response 
  • 66.6% had remission of their depression 
  • 3/14 of patients responded after the first infusion 
  • After 6 infusions, 4 responded and 6 had remission of depression 
  • 60% remained as responders 4 weeks after the series of infusions 

At NOVA Health Recovery Ketamine Infusion Center, we utilize home based ketamine treatments after the initial series of infusions to maintain response and prevent relapse. Recall that ketamine infusions are frequently used in difficult-to-treat cases that have had long mental health journeys, and ketamine represents a viable option of improvement in mood and functionality whereas other options have failed. Recall the STAR*D Trial that demonstrated poor outcomes for each failed step of therapy in depression:  

Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report 

Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov;163(11):1905-17. doi: 10.1176/ajp.2006.163.11.1905. PMID: 17074942. 

Study Parameters of STAR*D: 

Created with 


  • The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. 
  • Cumulative Remission Rate: 67% 
  • Those requiring more treatment steps had higher relapse rates 
  • Those who responded with remission in the first three steps had lower relapse rates. 

Created with 

IV Ketamine Therapy is Highly effective for the treatment of resistant depression based on several meta-analysis: 

Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression 

Newport DJ, Carpenter LL, McDonald WM, Potash JB, Tohen M, Nemeroff CB; APA Council of Research Task Force on Novel Biomarkers and Treatments. Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression. Am J Psychiatry. 2015 Oct;172(10):950-66. doi: 10.1176/appi.ajp.2015.15040465. PMID: 26423481. 

“Ketamine (seven trials encompassing 147 ketamine-treated participants) produced a rapid, yet transient, antidepressant effect, with odds ratios for response and transient remission of symptoms at 24 hours equaling 9.87 (4.37-22.29) and 14.47 (2.67-78.49), respectively, accompanied by brief psychotomimetic and dissociative effects. Ketamine augmentation of ECT (five trials encompassing 89 ketamine-treated participants) significantly reduced depressive symptoms following an initial treatment (Hedges’ g=0.933) but not at the conclusion of the ECT course.” 

A recent meta-analysis also demonstrated efficacy of ketamine in depression: 

A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019 

Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019. J Affect Disord. 2020 Dec 1;277:831-841. doi: 10.1016/j.jad.2020.09.007. Epub 2020 Sep 7. PMID: 33065824. 

This meta-analysis included  twenty-eight studies in 35 publications. “A strong ketamine effect was observed within 4 hours following a single infusion, and peaked at 24 hours. Ketamine’s effectiveness was still present, yet somewhat diminished, 7 days post-infusion. Multiple infusions resulted in an enhanced and prolonged ketamine effect.” 

Efficacy of ketamine for major depressive episodes at 2, 4, and 6-weeks post-treatment: A meta-analysis 

Conley AA, Norwood AEQ, Hatvany TC, Griffith JD, Barber KE. Efficacy of ketamine for major depressive episodes at 2, 4, and 6-weeks post-treatment: A meta-analysis. Psychopharmacology (Berl). 2021 Jul;238(7):1737-1752. doi: 10.1007/s00213-021-05825-8. Epub 2021 Mar 31. PMID: 33787963. 

This meta-analysis evaluated ketamine therapy for Major Depressive Disorder (MDD) at 2,4 and 6 weeks post-infusion. The meta-analysis observed large effects at 2 weeks (g = −1.28), 4 weeks, (g = −1.28), and 6 weeks (g = −1.36) post-treatment. This analysis showed that  ketamine can be an effective pharmacologic intervention for major depressive episodes, with treatment effects lasting up to 6 weeks post-ketamine administration, which has many positive implications for treatment, 

The Real question is how to prolong the effectiveness of ketamine? 

Thus far, the best option is with booster infusions. Generally, between every 2-4 weeks, a repeat ketamine infusion may be effective in maintenance of remission for MDD. A recent study below addressed the utility of repeated ketamine infusions for relapse prevention in MDD: 

Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression 

McMullen EP, Lee Y, Lipsitz O, Lui LMW, Vinberg M, Ho R, Rodrigues NB, Rosenblat JD, Cao B, Gill H, Teopiz KM, Cha DS, McIntyre RS. Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression. Adv Ther. 2021 Jun;38(6):2795-2820. doi: 10.1007/s12325-021-01732-8. Epub 2021 Apr 30. PMID: 33929660; PMCID: PMC8189962. 

In this study, twenty-two articles were included: ten randomized controlled trials (RCTs), eight prospective open-label trials, one retrospective chart review, and three case reports. “Different treatment modalities including pharmacological interventions, manualized-based psychotherapies, electroconvulsive therapy, transcranial magnetic stimulation, and intravenous monotherapy were examined to determine their impact on the prolongation of antidepressant effects following acute ketamine treatment. No treatment modality, other than repeat-dose IV ketamine, has demonstrated ability to significantly prolong the acute efficacy of IV ketamine in Treatment Resistant Depression.” 

Other considerations to maintain efficacy of ketamine infusions is to utilize ketamine as home-based intranasal and oral ketamine troches. One study below demonstrates repeated oral ketamine can be effective in out-patient treatment resistant depression: 

Repeated oral ketamine for out-patient treatment of resistant depression: randomised, double-blind, placebo-controlled, proof-of-concept study 

Domany, Y., Bleich-Cohen, M., Tarrasch, R., Meidan, R., Litvak-Lazar, O., Stoppleman, N., . . . Sharon, H. (2019). Repeated oral ketamine for out-patient treatment of resistant depression: Randomised, double-blind, placebo-controlled, proof-of-concept study. British Journal of Psychiatry, 214(1), 20-26. doi:10.1192/bjp.2018.196 

  • Randomized Controlled Study of 22 patients for treatment and 19 for control 
  • Ketamine treated patients had a decrease in depression at all time points. 
  • 27 % of ketamine oral treated patients achieved remission versus none of the controls 
  • Number needed to treat is 3.7 (awesome) 
  • Few side effects 
  • Conclusions: Repeated oral ketamine produced rapid and persistent amelioration of depressive symptoms in out-patients with TRD and was well tolerated. These results suggest that add-on oral ketamine may hold significant promise in the care of patients suffering from TRD in the community. 

More Recently, Nature Magazine featured an open-label trial demonstrating efficacy of oral ketamine for chronic suicidality: 

Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study 

This study included 32 adults (aged 22–72 years; 53% female) with chronic suicidal thoughts that  participated in the Oral Ketamine Trial on Suicidality (OKTOS), an open-label trial of sub-anaesthetic doses of oral ketamine over 6 weeks. Participants began with 0.5 mg/kg of ketamine, which was titrated to a maximum 3.0 mg/kg. Follow-up assessments occurred at 4 weeks after the final dose. They utilized the Beck Suicidal ideation scale as a primary measure.  

  • Clinical improvement was 69% in the first 6 weeks 
  • 50% had significant improvement at week 10 
  • Conclusion: Six weeks of oral ketamine treatment in patients with chronic suicidality led to significant reduction in suicidal ideation. 

Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study   Hartberg J, Garrett-Walcott S, De Gioannis A. Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Psychopharmacology (Berl). 2018 Feb;235(2):393-398. doi: 10.1007/s00213-017-4786-3. Epub 2017 Nov 18. PMID: 29151192. 

  • This was a retrospective review of 37 patients receiving oral ketamine and demonstrated that inpatient hospital days were reduced by 70% and hospital admissions were reduced by 65%. 

Daily oral ketamine for the treatment of depression and anxiety in patients receiving hospice care: a 28-day open-label proof-of-concept trial 

  • This trial utilized 14 subjects receiving ketamine 0.5 mg/kg orally over 28 days and rated with the Hospital Anxiety and Depression Scale at days 3,7,14,21, and 28.  
  • Results showed improvement in depression and anxiety for 8 patients in the trial and 100 % of the patients had response. 
  • Improvements lasted throughout the 28 days. 
  • Side effects: Diarrhea, trouble sitting still, and insomnia 

Oral Ketamine for Depression, 1: Pharmacologic Considerations and Clinical Evidence 

The above article is a review of oral ketamine as well. 

Finally, ketamine infusions can be used at the beginning of depression therapy to make initial antidepressant therapy more rapidly effective. 

Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study 

  • 30 patients with MDD (HAMS-D scale>24) 
  • 4 weeks randomized double-blind treatment excitalopram (10 mg/day) and IV Ketamine (0,5 mg/kg over 40 minutes) or escitalopram 10 mg/day + placebo infusion. 
  • Depressive symptoms were measured using the Montgomery–Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. 
  • Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). 

Conclusion of Trial:  By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01–0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02–0.63, p = 0.01). 

At 4 weeks:  

  • 92% of ketamine+ escitalopram patients responded versus 57% escitalopram patients 
  • 76.9% of ketamine+ escitalopram patients remitted versus 14% of escitalopram patients. 
  • Remission and response occurred at a more rapid rate with ketamine treatment. 
  • Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy. 


  • Ketamine is rapidly effective in a significant number of patients with treatment resistant depression 
  • A series of infusions works best for depression response 
  • Booster infusions work for maintenance of antidepressant effect 
  • Oral ketamine (and home-based intranasal ketamine) can be used as a maintenance strategy as well. 
  • Ketamine IV can be used in early depression treatment to make antidepressant use more rapidly effective and increase remission rates. 

Northern Virginia Ketamine Infusion Center offers Ketamine infusion therapy for CRPS, depression, anxiety, OCD, PTSD, and other disorders. We use ketamine therapies for alcoholism and opiate addiction and offer addiction treatment services with suboxone, Sublocade, and the opiate-blocker Vivitrol.  Ketamine is extremely safe and can provide rapid relief for depression. We will do a consultation to assess your condition and the appropriateness of treatment. Ketamine infusions are done over a three-week period with infusions not more than 3-5 days apart and usually 6 sessions are needed. Each session lasts about an hour, and you cannot drive for several hours so a driver will be needed. You are awake during infusions, generally listening to ambient music, and most patients find the experience uplifting and insightful.  No referral is necessary, and we can manage other medications as well if needed. Although insurance does not directly cover the therapy, we provide superbills for you to submit to your provider. CareCredit is a medical credit card that we accept as well for services.  Call us today for more information or to schedule.  For a Ketamine infusion center near me chose NOVA Health Recovery 

NOVA Health Recovery is a Ketamine Treatment Center in Fairfax, Virginia (Northern Virginia Ketamine) that specializes in the treatment of depression, anxiety, bipolar disorder, OCD, and chronic pain such as CRPS, cluster headaches, and fibromyalgia using Ketamine therapies, both infusion and home-based ketamine nasal spray and oral tablets. We also offer addiction treatment services with Suboxone, Vivitrol, and Sublocade therapies for opiate addiction as well as alcohol treatment regimens. Contact us at 703-844-0184 or at this link: NOVA Health Recovery Ketamine Infusion Center Near me Ketamine Infusion 

Ketamine Provider | Ketamine near me | Psychedelic assisted therapy | Mushrooms | Ketamine assisted psychotherapy | Ketamine psychedelic therapy | KAP | K hole | New depression Treatments | Areas we serve: 

Maryland (MD): 

Bethesda 20814 – Bethesda 20816 – Bethesda 20817 – Chevy Chase 20815 – Colesville 20904 – Cabin John 20815 – Glen Echo 20812 – Gaithersburg 20855 – Gaithersburg 20877- Gaithersburg 20878 – Gaithersburg 20879 – Garrett Park 20896 – Kensington 20895 – Montgomery Village 20886 – Olney 20830 – Olney 20832 – Potomac 20854 – Potomac 20859 – Rockville 20850 – Rockville 20852 – Rockville 20853 – Silver Spring 20903 – Silver Spring 20905 – Silver Spring 20906 – Silver Spring 20910 – Takoma Park 20912 – Wheaton 20902 

Washington DC: 

Crestwood 20011- North Capitol Hill 20002 – Cathedral Heights 20016 – American University Park 20016 – Columbia Heights 20010 – Mount Pleasant 20010 – Downtown 20036 – Dupont Circle 20009 – Logan Circle 20005- Adams Morgan 20009 – Chevy Chase 20015 – Georgetown 20007 – Cleveland Park 20008 – Foggy Bottom 20037 – Rock Creek Park – Woodley Park 20008 – Tenleytown 20016 

Northern Virginia: 

McLean 22101- McLean 22102 – McLean 22106 – Great Falls 22066 – Arlington 22201 – Arlington 22202 – Arlington 22203 – Arlington 22205 – Falls Church 22041 – Vienna 22181 – Alexandria 22314 – 22308 -22306 -22305 -22304  Fairfax – 20191 – Reston – 22009 – Springfield – 22152  22015  Lorton 22199 

Fairfax, Va 

2303 –  22307 – 22306 – 22309 – 22308 22311 – 22310 – 22312 

22315 -22003 – 20120 – 22015 – 22027 20121 – 22031 –  20124 

22030 – 22033 – 22032 – 22035 – 22039 22041 – 22043 

22042 – 22046 – 22044 – 22060 – 22066 20151 – 22079 – 20153 – 22101 

22102 – 20171 – 20170 – 22124 – 22151 22150 – 22153 

22152 – 20191 – 20190 – 22181- 20192 22180 – 20194 –  22182 

Woodbridge – 22191 – 22192 -22193 -22194 – 22195  

Springfield – 22150 – 22151 -22152-22153-22154-22155 -22156 – 22157 -22158 -22159 -22160 – 22161  

Front Royal 22630 

Warren County 22610 22630 22642 22649 

Fredericksburg Va 22401 22402 – 22403 – 22404 -22405 -22406 -22407 -22408 – 22412  

Please call Sendi Hair Loss Center now at 703-574-0974 for quality Hair Restoration services in Alexandria, VA. 

20105 Aldie Loudoun County 20106 Amissville Culpeper County 20107 Arcola Loudoun County 

20108 Manassas Manassas City 20109 Sudley Springs Prince William County 

20109 Manassas Prince William County 20110 Manassas Manassas City 

20111 Manassas Prince William County 20111 Manassas Park Prince William County 

20112 Manassas Prince William County 20113 Manassas Park Manassas Park City 

20115 Marshall Fauquier County 20116 Marshall Fauquier County 

20117 Middleburg Loudoun County 20118 Middleburg Loudoun County 

20119 Catlett Fauquier County – 20120 Sully Station Fairfax County 

20120 Centreville Fairfax County – 20121 Centreville Fairfax County 

20122 Centreville Fairfax County – 20124 Clifton Fairfax County 

20128 Orlean Fauquier County -20129 Paeonian Springs Loudoun County 

20130 Paris Clarke County 

20131 Philomont Loudoun County 20132 Purcellville Loudoun County 

20134 Hillsboro Loudoun County 20134 Purcellville Loudoun County 

20135 Bluemont Clarke County 20136 Bristow Prince William County 

20137 Broad Run Fauquier County 20138 Calverton Fauquier County 

20139 Casanova Fauquier County 20140 Rectortown Fauquier County 

20141 Round Hill Loudoun County 20142 Round Hill Loudoun County 

20143 Catharpin Prince William County 

20144 Delaplane Fauquier County20146 Ashburn Loudoun County 

20147 Ashburn Loudoun County 20148 Brambleton Loudoun County 

20148 Ashburn Loudoun County 20151 Chantilly Fairfax County 

20151 Fairfax Fairfax County 20152 South Riding Loudoun County 

20152 Chantilly Loudoun County 20152 Fairfax Loudoun County 

20153 Chantilly Fairfax County 20153 Fairfax Fairfax County 

20155 Gainesville Prince William County 20156 Gainesville Prince William County 

20158 Hamilton Loudoun County 20159 Hamilton Loudoun County 

20160 Lincoln Loudoun County 20160 Purcellville Loudoun County 

20163 Sterling Loudoun County 20164 Sterling Loudoun County 

20165 Potomac Falls Loudoun County 20165 Sterling Loudoun County 

20166 Dulles Loudoun County 20166 Sterling Loudoun County 

20167 Sterling Loudoun County 20168 Haymarket Prince William County 

20169 Haymarket Prince William County 20170 Herndon Fairfax County 

20171 Oak Hill Fairfax County 20171 Herndon Fairfax County 

20172 Herndon Fairfax County 20175 Leesburg Loudoun County 

20176 Lansdowne Loudoun County 20176 Leesburg Loudoun County 

20177 Leesburg Loudoun County 20178 Leesburg Loudoun County 

20180 Lovettsville Loudoun County 20181 Nokesville Prince William County 

20182 Nokesville Prince William County 20184 Upperville Fauquier County 

20185 Upperville Fauquier County 20186 Warrenton Fauquier County 

20187 New Baltimore Fauquier County 20187 Vint Hill Farms Fauquier County 20187 Warrenton Fauquier County 

20188 Vint Hill Farms Fauquier County 20188 Warrenton Fauquier County 

20190 Reston Fairfax County 20190 Herndon Fairfax County 

20191 Reston Fairfax County 20191 Herndon Fairfax County 

20194 Reston Fairfax County 20194 Herndon Fairfax County 

20195 Reston Fairfax County 20195 Herndon Fairfax County 

20197 Waterford Loudoun County 20198 The Plains Fauquier County 

Loudon County: 

Loudoun County, VA – Standard ZIP Codes 

20105 | 20117 | 20120 | 20129 | 20130 | 20132 | 20135 | 20141 | 20147 | 20148 | 20152 | 20158 | 20164 | 20165 | 20166 | 20175 | 20176 | 20180 | 20184 | 20189 | 20197 | 22066