Skip to content
Richmond Brain & Behavior

IV Ketamine · Infusion therapy

IV ketamine for depression that hasn't responded to anything else.

Ketamine infusion is used off-label for treatment-resistant depression, administered and monitored by a physician in our Northside Richmond office. We offer both ketamine and Spravato, so the recommendation you get here isn't shaped by only having one of them.

Request an appointment Call (804) 476-8274
Calm, comfortable monitored-care setting for ketamine infusion

Medically reviewed by C. Britt Beasley, MD · Last reviewed June 10, 2026

The regulatory picture, first

Off-label, and why that matters to you

Ketamine is FDA-approved as an anesthetic, not as an antidepressant. Using it for depression is off-label. Physicians may legally prescribe approved drugs for unapproved uses when clinical judgment supports it, and this is common practice across medicine — but it has two consequences worth stating plainly rather than burying: insurance generally does not cover it, and the treatment does not carry the FDA's review of that specific use.

Spravato (esketamine) is the FDA-approved route for treatment-resistant depression, and it usually has an insurance pathway. We offer both. Which one is right for you depends on your history, your medical picture, and practical realities like cost and schedule — and that is a conversation, not a webpage.

What the infusion involves

Ketamine is delivered intravenously in the office, with the dose calculated by body weight and the rate controlled throughout — which is the practical advantage of the infusion route over a nasal spray, where absorption varies more between people and between sessions.

You are monitored during the infusion and for a period afterward. You cannot drive afterward, so arrange a ride for every session. Dr. Beasley will walk you through exactly what a session looks like before you commit to anything.

Speed, and why it's given as a series

Conventional antidepressants generally take four to six weeks to show meaningful benefit. Ketamine's effect commonly appears far sooner. For someone who has spent years cycling through six-week medication trials, that difference is the difference between another year of trial-and-error and knowing relatively quickly whether a treatment is going to help.

The effect of a single dose is typically temporary. That is why treatment is given as a series rather than once, and why maintenance is planned for from the start. Anyone describing ketamine as a one-time cure is not describing this treatment.

Safety

What we watch for, honestly

Ketamine has a long safety record in anesthesia at much higher doses than are used for depression, and antidepressant dosing sits well below anesthetic dosing. That is genuinely reassuring, and it is not the whole picture.

During and shortly after treatment, expect the possibility of dissociation, transient blood-pressure and heart-rate elevation, nausea, and dizziness. This is why monitoring is not optional and why treatment happens in a medical setting.

Longer term, the risks warranting real attention are bladder and urinary-tract effects and cognitive effects, both documented primarily with frequent high-dose recreational use. Whether — and at what threshold — they apply to therapeutic dosing over extended maintenance is not fully characterized. That is an argument for a physician tracking it over time, not an argument for pretending the question is closed.

Candidacy

Who this is worth discussing for

  • Treatment-resistant depression — typically two or more adequate antidepressant trials without adequate response
  • You have not responded to, or cannot access, the FDA-approved alternatives
  • You want the option discussed by a physician who offers more than one of them

There are also situations where Dr. Beasley will steer you elsewhere. Deep TMS may be the better first move if you want a non-drug option, have cardiovascular concerns, or prefer to avoid a controlled substance. Certain cardiovascular conditions, active psychosis, and pregnancy all require separate consideration. Deciding between these is the actual work, and it takes an evaluation.

See the conditions we treat

Common questions

Straight answers about ketamine

Is IV ketamine FDA-approved for depression?
No. Ketamine is FDA-approved as an anesthetic; using it for depression is off-label. Off-label prescribing is legal and common across medicine when clinical judgment supports it, but it has two direct consequences: insurance generally does not cover it, and the treatment does not carry the FDA's review of that specific use. Spravato (esketamine) is the FDA-approved option for treatment-resistant depression.
Does insurance cover ketamine infusions?
Generally no, because the use is off-label — infusions are typically self-pay. Spravato is the route with an insurance pathway, usually with prior authorization. If cost is a deciding factor, say so early: it legitimately changes which treatment is the better choice for you.
Can I drive myself home afterward?
No. Ketamine causes temporary effects on alertness and perception, so you cannot drive after a session. Plan for someone to take you home each time.
What does it feel like?
Most people experience some dissociation — a temporary sense of detachment from your body or surroundings. Most find it manageable, and it resolves as the dose wears off. Temporary increases in blood pressure and heart rate, nausea, and dizziness can also occur, which is why you are monitored in the office rather than treated at home.
How is this different from Spravato?
Spravato is FDA-approved esketamine, given as a nasal spray in a certified office under a REMS safety program, and is often insurance-covered. IV ketamine is the full ketamine molecule given intravenously, off-label, with dosing controlled by weight and infusion rate. We offer both, and Dr. Beasley will help you decide which fits your situation.
Is ketamine safe if I have a history of substance use?
A substance use history does not automatically rule you out, but it does make the assessment more careful. Ketamine is a controlled substance with misuse potential. Dr. Beasley is board-certified in addiction medicine, which means that conversation happens with someone who treats both conditions rather than one in isolation.

Now accepting new patients

Ask whether ketamine is the right option — or whether something else is.

Request an evaluation and Dr. Beasley will review your history, screen for safety, and tell you honestly which treatment fits, including if the answer is none of them. New patients are typically seen within days.

Request an appointment Call (804) 476-8274