ketamine

Adjunctive therapy

Brands: Ketalar

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is ketamine?
Ketamine (brand Ketalar; generics) is a dissociative anesthetic (label) and non-competitive NMDA receptor antagonist. In psychiatry it is most often discussed as an off-label, rapid-acting option for treatment-resistant depression (TRD) delivered in a monitored setting (consensus).
What is Ketalar?
Ketalar is a brand name for ketamine.
What is Ketalar (ketamine) used for?
Label indications include: Anesthesia (label). Off-label: rapid-acting treatment in monitored settings for treatment-resistant depression and acute suicidal ideation (consensus/clinical).
What drug class is Ketalar (ketamine)?
Dissociative anesthetic and non-competitive NMDA receptor antagonist. Used clinically for anesthesia (label) and increasingly used off-label in monitored settings for rapid symptom relief in treatment-resistant depression (consensus/clinical).
What strengths does Ketalar (ketamine) come in?
Injectable solution for IV/IM administration (label).

Snapshot

Primary label indications include: Anesthesia (label).
Class: Adjunctive therapy
Common US brands: Ketalar
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Anesthesia (label). Off-label: rapid-acting treatment in monitored settings for treatment-resistant depression and acute suicidal ideation (consensus/clinical).

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Clinical Highlights

Ketamine (brand Ketalar; generics) is a dissociative anesthetic (label) and non-competitive NMDA receptor antagonist. In psychiatry it is most often discussed as an off-label, rapid-acting option for treatment-resistant depression (TRD) delivered in a monitored setting (consensus). Unlike Esketamine (Spravato), ketamine is not FDA-approved for depression. When ketamine is used for mood symptoms, clinicians usually document that the intended use is off-label and that safety monitoring is part of the treatment model (consensus/clinical).

The acute experience can include dissociation, perceptual changes, and short-lived sedation. The same session can temporarily improve mood symptoms for some people, but benefits are often time-limited and evaluated as part of a broader depression plan rather than a standalone intervention (consensus).
Ketamine can raise blood pressure and heart rate during administration. For that reason, most psychiatric protocols include on-site vital sign monitoring and screening for cardiovascular risk (label/consensus).
Ketamine is a controlled substance (Schedule III in the U.S.) and has misuse potential; long-term frequent recreational exposure is linked to urinary tract injury (cystitis) and cognitive harms (label/clinical).
The compare view, ketamine evidence feed, and ketamine print page support shared decision-making when “rapid relief” is being weighed against safety logistics and access.

Dosing & Formulations

Ketamine is supplied as an injectable solution for IV/IM use for anesthesia and procedural sedation (label). Depression use is off-label; published consensus statements describe commonly used subanesthetic infusion approaches (for example, weight-based dosing over a short infusion) with monitoring during and after the session (consensus).

Because ketamine’s antidepressant use is not FDA-labeled, dosing and frequency vary by clinic protocol; safety review generally focuses on blood pressure response, dissociation/sedation, and functional impairment after dosing (consensus/clinical).
If ketamine is combined with other antidepressant strategies, the long view usually includes relapse prevention planning (therapy, maintenance medications when appropriate, and reassessment of ongoing need for repeated dosing sessions) (clinical).

Monitoring & Risks

Acute CNS effects: dissociation, perceptual changes, dizziness, nausea, and sedation can occur during or shortly after administration (label/consensus). Cardiovascular: transient increases in blood pressure and heart rate are common; protocols often include baseline screening and session monitoring (label/consensus).

Functional safety: because psychomotor impairment can persist for hours after dosing, plans for transportation and activity restrictions are a routine part of counseling (consensus/clinical).
Long-term/high-frequency exposure is associated with urinary symptoms and cystitis; clinicians commonly ask about urinary symptoms and substance use history when ketamine is considered repeatedly (clinical).
Pregnancy/lactation: ketamine’s psychiatric use in pregnancy is not established; the label emphasizes limiting use in lactation to anesthesia, and risk-benefit discussions are typically individualized (label/clinical).

Drug Interactions

Additive sedation and impairment can occur with alcohol, benzodiazepines, opioids, and other CNS depressants (label/clinical). Strong CYP modulators may affect exposure (ketamine is metabolized primarily via CYP2B6 and CYP3A4); medication reconciliation is commonly used before treatment sessions (label/clinical).

Stimulants and other sympathomimetics can compound blood pressure and heart rate increases during dosing sessions (clinical).

Practice Notes

Consensus statements emphasize patient selection, monitored administration, and structured symptom tracking because ketamine can be both rapid-acting and short-lived (consensus). In TRD, ketamine is usually considered after standard antidepressant trials and augmentation strategies, and it is often discussed alongside other high-intensity options (for example, ECT, TMS, or FDA-approved esketamine) (guideline/clinical).

If dissociation or sedation is distressing, clinicians often adjust the protocol (dose, infusion rate, or supportive measures) rather than framing those experiences as required for benefit (consensus/clinical).

References

KETALAR (ketamine hydrochloride) injection prescribing information — DailyMed (2025)
A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders — JAMA Psychiatry (2017)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)