What Is Ketamine Maintenance Therapy?

Ketamine maintenance therapy means continuing ketamine treatment after an initial course, with the aim of holding on to any improvement in depression rather than letting it fade. It is a question many people ask once they have started reading about ketamine: if it helps, what happens next?

This article explains what "maintenance" means, what the research does and does not show, how ketamine differs from esketamine, and how decisions about ongoing treatment are made at Colorado Mental Health Services.

Before going further, the key facts about ketamine here. At CMHS, ketamine is given by our medical team as intramuscular (IM) treatment, meaning an injection into a muscle. It is used off-label for depression. It is self-pay, and it is separate from our intensive outpatient program. Whether it is right for you, and what any ongoing treatment looks like, is decided by our medical team after screening.

What "maintenance" means

Research on ketamine for depression has consistently found that its antidepressant effects can be real but often do not last on their own. Researchers have proposed different ways to extend them, and continuing treatment over time, often called maintenance, is one of them.

In practice, maintenance simply describes what happens after the first phase of treatment: whether to continue, and if so, how. There is no single agreed approach. That is why it has to be an individual decision made with a medical team, not a standard plan you can look up.

What the research shows, and what it does not

A 2022 systematic review in The Lancet Psychiatry brought together the evidence on maintenance ketamine treatment for depression. It found that maintenance ketamine appeared effective in sustaining antidepressant effects in treatment-resistant depression, across several ways of giving it, and that serious problems such as addiction or bladder and kidney complications seemed uncommon.

But the same review is clear about the limits. It found only three randomized controlled trials, alongside smaller open-label studies and case reports, and noted that little is known about maintenance ketamine's long-term efficacy, safety and tolerability. The authors called for larger studies with long-term follow-up before its place in routine care can be settled.

That echoes an earlier consensus statement from the American Psychiatric Association's research task force, which noted small study sizes, a lack of longer-term data and limited safety data, and warned that these gaps matter precisely because ketamine is being used off-label.

Put simply: maintenance ketamine is promising for some people, but the evidence is still developing. Be cautious of any promise about exactly how many treatments you will need or what result to expect. The research does not support that kind of certainty yet.

Ketamine and esketamine are not the same

People often see "ketamine" and "Spravato" used interchangeably. They are related, but they are different.

• Ketamine is not FDA-approved for depression. When it is used for depression, it is used off-label, meaning it is prescribed for a use its FDA approval does not cover.
• Esketamine, sold as Spravato, is a nasal spray made from a closely related form of ketamine. It is the FDA-approved form for depression, specifically for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal thoughts or behavior. It can only be given under the supervision of a healthcare provider through a restricted program.

Most of the strongest evidence on maintenance comes from esketamine. In a randomized trial, people with treatment-resistant depression who had improved on esketamine plus an oral antidepressant, and then continued esketamine, went longer without relapsing than those who were switched to a placebo spray. That finding is specific to esketamine and cannot simply be carried over to ketamine.

How ketamine treatment works at CMHS

Our ketamine treatment in Lakewood follows the same order for everyone:

• Medical screening first. Our medical team reviews your health, your history and everything you take. Eligibility is decided after screening, not before.
• Preparation. You get instructions ahead of time, and you will need a ride home.
• The IM treatment itself, given by our medical team, with monitoring throughout.
• Rest before you leave, until the immediate effects have worn off.

Whether continuing treatment makes sense after that, and what it would look like, is not decided in advance. Our medical team, led by Dr. Arshad William, M.D., makes that call with you, based on how you have responded and what else is going on in your care. If ketamine is not a good fit, we will say so.

Ketamine is self-pay. Pricing can change, so admissions will give you current pricing and what it includes before you commit to anything.

Who it may not be right for

Ketamine is not right for everyone. Some medical and psychiatric conditions rule it out, and some medications need to be reviewed first, which is why it matters to tell us everything you take, including anything prescribed elsewhere. It is also not a cure, and it does not help everyone who tries it.

Screening is where these questions get answered properly. It is a real decision point, not a formality.

Part of a wider plan

At CMHS, ketamine treatment is for adults whose depression has not improved enough with other treatment, such as antidepressants or therapy. It works best thought of as one part of a wider plan rather than a replacement for everything else.

At CMHS, ketamine is separate from our intensive outpatient program, and you do not need to be enrolled in the program to ask about it. If you need more support than ketamine alone, the program offers group and individual therapy with psychiatry on the same team, and individual therapy can sit alongside whatever else you are doing. Our psychiatric services page explains how the medical team works.

If you are still working out whether what you are feeling is depression, our articles on depression without sadness and when weekly therapy is no longer enough are good places to start.

If you are struggling right now

If you are in crisis, do not wait for a screening appointment. If you are having thoughts of suicide or harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, any time. If you or someone else is in immediate danger, call 911.

When you are ready to ask about screening, contact admissions. Bring a list of everything you currently take.