Roughly one-third of people diagnosed with major depressive disorder do not respond adequately to two or more antidepressant trials — a condition clinicians call treatment-resistant depression. At Minnesota Ketamine & Wellness Institute, we work with many patients who have reached that point, patients who have spent years cycling through medications that offered little relief. Ketamine therapy represents a different approach, one that works on a separate receptor system altogether and has shown meaningful promise where conventional treatments have not.
Understanding How Ketamine Works
Understanding why ketamine acts differently from standard antidepressants begins at the level of neurotransmitters. Most antidepressants work by modulating serotonin, norepinephrine, or dopamine — systems that regulate mood over weeks of gradual adjustment. Ketamine instead targets the NMDA receptor, a component of the glutamate system that governs rapid communication between neurons. By blocking this receptor in a dose-dependent way, ketamine appears to trigger a cascade that promotes the growth of new synaptic connections, a process called synaptogenesis. Research published by the National Institute of Mental Health has linked this rapid synaptogenesis to the fast-onset relief that many patients report, sometimes within hours of a single session.
We often describe the mechanism using a neuroplasticity framework: years of chronic depression can physically diminish the density and connectivity of neurons in regions like the prefrontal cortex and hippocampus. Brain-derived neurotrophic factor, or BDNF, plays a central role in maintaining those connections. Ketamine appears to increase BDNF activity and stimulate mTOR pathways, essentially prompting the brain to rebuild communication infrastructure that depression has eroded. This is not a permanent cure, and results vary by individual, but it explains why the therapeutic window can open quickly — and why integration work matters so much afterward.
How We Deliver Care at Minnesota Ketamine & Wellness Institute
At our institute, we offer ketamine therapy as part of a structured, multidisciplinary program. Christy Hatcher, MSN, APRN, CRNA founded this practice with a clear intention: to bring rigorous anesthesia-level pharmacology expertise together with genuine mental health integration support. As a certified nurse anesthetist, Christy draws on deep clinical knowledge of ketamine’s pharmacokinetic profile — how the drug distributes, peaks, and clears — to tailor each session safely and purposefully. Our team brings over 40 years of combined experience in mental health and anesthesia services, and several of our therapists hold certification as Clinical Trauma Professionals and Somatic Psychedelic Facilitators. Learn more about our providers on our Meet the Team page.
For patients who may also be candidates for esketamine nasal spray, we offer SPRAVATO® at our institute. SPRAVATO® is a distinct drug from IV ketamine — it is FDA-approved specifically for treatment-resistant depression and for major depressive disorder with acute suicidal ideation or behavior. Importantly, SPRAVATO® is covered by most major insurance plans for eligible patients, making it our primary recommended starting point for those who meet the criteria for treatment-resistant depression and are seeking an insurance-accessible option. SPRAVATO® is administered in our certified healthcare setting under direct clinical supervision, and patients must remain on-site for a monitoring period following each dose as required by the SPRAVATO® REMS program. Understanding the difference between IV ketamine and SPRAVATO® is important, and we take time during consultations to explain both options in full so patients can make an informed choice with their provider. Discuss with your provider which modality is clinically appropriate given your history, diagnosis, and current medications.
Ketamine-assisted psychotherapy (KAP) is an additional layer of support we offer that distinguishes our approach from clinics that provide infusions alone. During a KAP session, a licensed therapist works alongside the pharmacological experience to help patients process material that emerges — memories, patterns, somatic sensations, and emotional content. This integration work, both during and after sessions, is grounded in evidence suggesting that the neuroplastic window opened by ketamine may be most effectively used when therapeutic processing accompanies it. We collaborate with therapists who are licensed clinical social workers certified in psychedelic-assisted therapy, and that expertise shapes the depth and safety of the work we do together.
Addressing Common Barriers to Care
One barrier that stops many people from exploring ketamine therapy is the concern that it requires a psychiatric hospitalization or extended inpatient stay. That is not the case here. Our outpatient sessions are completed in a calm, private clinical environment, and most patients return home the same day with a support person. We walk through the logistics with every prospective patient during an initial consultation so that scheduling and practicalities do not become obstacles to care. We also encourage questions about what to expect during the session itself — the perceptual shifts, the timeframe, and how our clinical staff maintains safety throughout — because informed patients consistently report better experiences. If you’d like an overview of what your first month may look like, our blog post on the first month of ketamine therapy in Minnesota offers a helpful perspective.
Cost is the second barrier we hear most often, and we want to address it honestly. IV ketamine therapy is not widely covered by insurance for psychiatric indications because its psychiatric uses are off-label — meaning it has not received FDA approval specifically for depression, anxiety, or PTSD, even though a substantial and growing body of peer-reviewed research supports its clinical utility. However, there are meaningful pathways to access. Veterans referred to our clinic through the VA’s Community Care Network (VCA contract) can receive ketamine infusions with VA coverage — our institute holds a VCA contract, and the VA will refer eligible patients and cover the cost of their infusions. For patients outside the VA system, we encourage a direct conversation with our team about financial options. And for those who meet criteria for treatment-resistant depression, SPRAVATO® offers a route to FDA-approved, insurance-covered care. For a detailed breakdown of what to expect financially, see our resource on ketamine therapy cost in Minnesota. Our goal is to make the conversation about cost straightforward, not evasive.
Frequently Asked Questions
How many ketamine sessions are typically needed for depression? Most treatment protocols begin with a series of six infusions completed over two to three weeks, based on research protocols that found this induction schedule produced the most durable early response. The right number of sessions depends on an individual’s diagnosis, history, and response — discuss with your provider whether a maintenance protocol makes sense after the initial series. Results vary by individual.
Is ketamine therapy FDA-approved for depression? No. The use of IV ketamine for psychiatric conditions including depression, anxiety, and PTSD is considered off-label. SPRAVATO® (esketamine nasal spray) is FDA-approved for treatment-resistant depression and for major depressive disorder with acute suicidal ideation — these are separate indications from general depression treatment. Our team explains this distinction clearly during every intake consultation. You can find more answers to common questions on our FAQs: Everything You Should Know About Ketamine in MN page.
What does ketamine feel like during an infusion? Most patients describe a dissociative, dream-like state during the session. Perceptual shifts — including altered sense of time, mild visual changes, and emotional openness — are common and typically resolve within an hour of the infusion ending. Our clinical team maintains direct observation throughout every session, and patients are encouraged to discuss any concerns before or during treatment.
Can I drive home after a ketamine session? No. Patients must arrange a trusted adult to drive them home after every session. We confirm this logistics requirement during the intake process and do not discharge patients who lack transportation support.
Does ketamine therapy work if antidepressants haven’t helped? Clinical studies have specifically enrolled patients who did not respond to multiple prior antidepressant trials and found meaningful response rates in that population. Because ketamine works on a different receptor system than conventional antidepressants, prior non-response does not predict poor response to ketamine. That said, results vary by individual, and we encourage a thorough intake evaluation to assess candidacy.
Key Takeaways
- Ketamine targets NMDA receptors in the glutamate system, a mechanism distinct from serotonin-based antidepressants, which may explain its faster onset of action
- Psychiatric uses of IV ketamine are off-label; SPRAVATO® is FDA-approved for specific indications, covered by most major insurance plans for eligible patients, and is our primary recommended option for those who qualify
- Veterans referred through the VA Community Care Network (VCA contract) may be eligible to receive ketamine infusions at our institute with VA coverage
- Minnesota Ketamine & Wellness Institute provides nurse anesthetist–led care with integrated psychotherapy support
- Results vary by individual; discuss all options with your provider before beginning treatment
If conventional antidepressants have not worked for you, ketamine therapy — or SPRAVATO® for those who qualify — may open a new clinical pathway worth exploring carefully with the right team. At Minnesota Ketamine & Wellness Institute, we bring the pharmacology expertise of a certified nurse anesthetist together with licensed mental health professionals trained in trauma-informed, integration-focused care. Whether your path leads toward IV ketamine, SPRAVATO®, or a combined approach, schedule a consultation and begin a real conversation about what fits your clinical picture.
References
National Institute of Mental Health — https://www.nimh.nih.gov/health/topics/depression
American Psychiatric Association — https://www.psychiatry.org/patients-families/depression/what-is-depression
Janssen Pharmaceuticals (SPRAVATO® Prescribing Information) — https://www.spravato.com/
American Society of Ketamine Physicians, Psychotherapists & Practitioners — https://www.askp3.org/
About Christy Hatcher, MSN, APRN, CRNA
Christy Hatcher, MSN, APRN, CRNA is the owner and lead provider at Minnesota Ketamine & Wellness Institute. She specializes in ketamine infusions as an alternative or adjunct treatment for depression, anxiety, PTSD, and suicidal ideation. The Institute offers a multidisciplinary team with over 40 years of combined experience in mental health and anesthesia services, including therapists who are Certified Clinical Trauma Professionals, Somatic Psychedelic Facilitators, and licensed clinical social workers certified in psychedelic-assisted therapy. The clinic integrates ketamine-assisted psychotherapy (KAP) and integration therapy alongside infusion services, holds a VA Community Care Network (VCA) contract for eligible veterans, and offers SPRAVATO® as its primary FDA-approved, insurance-covered option for treatment-resistant depression.
Medical Disclaimer
The content of this article is provided by Minnesota Ketamine & Wellness Institute for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Ketamine’s use in psychiatric conditions is off-label and not FDA-approved for those indications. SPRAVATO® is FDA-approved for specific conditions only. Individual results vary. Always discuss treatment options, risks, and benefits with a qualified healthcare provider before making any medical decisions.