A good candidate for ketamine therapy is usually an adult with depression, anxiety, PTSD or a related mood condition who has tried two or more traditional treatments, such as antidepressants and talk therapy, without enough relief. Candidates also need a confirmed diagnosis from a full psychiatric evaluation and a medical history that makes ketamine a safe choice. At Allied Psychiatry and Mental Health in Newport Beach, board-certified psychiatrist Hadi Estakhri, MD, and our team use this standard to decide whether IV ketamine or Spravato nasal ketamine fits a patient’s needs.
This article covers how ketamine therapy works, which conditions it treats, who should consider it, who should not, and what the evaluation looks like.
Ketamine was first developed in the 1950s as an anesthetic and was often used on battlefields. Over time, researchers and clinicians found that, at much lower doses, it could ease symptoms of depression that had not improved with other treatments.
Today, ketamine therapy is a psychiatric treatment for hard-to-treat cases of depression and related conditions. It is not a first-line option. Most patients start with standard care, such as oral antidepressants and therapy, and move to ketamine only when those approaches fall short.
At our office, ketamine therapy is provider-led from start to finish. A trained member of our team oversees every session in a controlled clinical setting.
Most traditional antidepressants work on serotonin, norepinephrine or dopamine. These drugs often take several weeks to show any effect, and many patients do not respond to them at all.
Ketamine works through a different pathway. It acts on glutamate, the brain’s most common chemical messenger, which plays a role in learning, memory and mood. By affecting glutamate signaling, ketamine is thought to help the brain form new connections between nerve cells. Many experts believe this process helps break the rigid thought patterns linked to long-term depression.
Because ketamine uses a different route, it can help people whose symptoms have not changed after trying several serotonin-based medications. Some patients notice changes in mood within hours or days rather than weeks.
We offer two types of ketamine treatment, and our providers help each patient decide which option fits them.
IV Ketamine: IV ketamine treatment delivers a carefully measured dose through a vein. This method lets our team control the dose precisely and adjust it as needed. It is meant for patients with severe symptoms who have not responded to traditional medications.
Spravato Nasal Ketamine: Spravato nasal ketamine is an FDA-approved nasal spray. It is designed for adults who have not had adequate results with oral antidepressants. Patients use the spray themselves at our office under direct supervision, and they stay in a monitored setting until the effects wear off.
Both options require patients to come to our Newport Beach office for treatment. While we see many patients across California through telehealth for other services, ketamine sessions take place in person.
Ketamine therapy is not right for everyone, and that is by design. It works as a targeted option for people whose symptoms have resisted other care. Below are the conditions it treats and the traits that usually point to a good fit.
Major depressive disorder is the most common reason patients ask about ketamine. Depression goes far beyond temporary sadness. It can affect sleep, appetite, energy, focus and the ability to enjoy daily life. When these symptoms last for months or years despite treatment, the condition is often called treatment-resistant depression.
Patients with treatment-resistant depression are the core group for both IV ketamine and Spravato. If you have tried several antidepressants and still feel stuck, ketamine may offer a new path. Learn more about how we approach depression treatment.
Anxiety disorders involve more than ordinary stress. They can bring constant worry, racing thoughts, restlessness and physical symptoms such as a rapid heartbeat or tight chest. Many people with anxiety also have depression, and the two conditions often feed each other.
Hadi Estakhri evaluates patients for ketamine when anxiety symptoms are severe and have not improved with standard medications and therapy. For patients whose anxiety overlaps with depression, ketamine may help address both. Our page on anxiety treatment explains the full range of options we use.
PTSD can develop after a person experiences or witnesses a frightening event. Symptoms may include flashbacks, nightmares, avoidance, emotional numbness and being easily startled. These patterns can feel locked in place, even after years of treatment.
Ketamine’s effect on brain connections may help some patients loosen the hold of trauma-related thoughts. Hadi Estakhri considers ketamine for PTSD when evidence-based treatments have not brought enough relief. Many of our PTSD patients pair ketamine with ongoing therapy to make the most of this window.
Bipolar disorder involves shifts between depressive episodes and manic or hypomanic episodes.
Ketamine may be considered for some patients with bipolar depression, but this decision requires extra care. Our providers look closely at mood history, current mood stabilizers and any past manic or psychotic episodes. Read more about our approach to bipolar disorder.
Some patients with other conditions may also be evaluated for ketamine, often when depression is part of the picture. These can include:
Obsessive-compulsive disorder with depressive symptoms
Panic disorder that occurs alongside depression
Persistent suicidal thoughts linked to a mood disorder, under close psychiatric care
Each case is reviewed on its own. A diagnosis alone does not make someone a candidate. What matters is the full clinical picture and how a patient has responded to past treatment.
The clearest sign that ketamine may be worth exploring is treatment resistance. In general, a condition is called treatment-resistant when symptoms continue after a patient has tried at least two different medications at proper doses for an adequate length of time.
Signs that your symptoms may be treatment-resistant include:
You have tried two or more antidepressants with little or no change in mood
You felt some early improvement, but it faded
Your symptoms improved only partly and still disrupt work, school or relationships
You have been in therapy for some time but still struggle with daily function
If any of these sound familiar, it may be time to ask a psychiatric provider about next-step options such as ketamine.
Some patients do not respond to medication at all. Others respond but cannot handle the side effects, such as weight gain, sexual side effects, fatigue or emotional flatness. Stopping a medicine because of side effects is a real form of inadequate response.
For these patients, ketamine offers a different approach. Because it does not rely on the same brain pathways as most antidepressants, it may help people who have cycled through several prescriptions without success. Our medication management team often helps patients review their medication history to see whether ketamine makes sense as a next step.
A strong candidate has a clear, confirmed diagnosis. Ketamine is not used to treat vague stress or a rough patch. Patients should have a diagnosed condition such as major depressive disorder, an anxiety disorder or PTSD, confirmed through a full psychiatric evaluation.
This is why diagnosis comes first. If a past diagnosis was incomplete or inaccurate, earlier treatments may not have worked for that reason. A careful evaluation can reveal other factors, such as an undiagnosed sleep disorder, ADHD or substance use, that change the treatment plan.
Good candidates usually have symptoms that are moderate to severe and have lasted for a meaningful period of time. Common examples include:
Depression that has lasted months or years
Symptoms that make it hard to work, care for family or keep up with daily tasks
Ongoing hopelessness, low energy or loss of interest in activities you once enjoyed
Repeated episodes of depression despite treatment
Mild symptoms that have not yet been treated with standard care are usually better addressed with therapy or medication first.
Your treatment history tells our providers a lot. During an evaluation, they will ask about:
Which medications you have taken, at what doses and for how long
How you responded to each one, including side effects
Whether you have tried talk therapy and for how long
Any other treatments you have used, such as TMS
Past hospital stays or crisis care
It helps to bring a list of past medications if you have one. A thorough history allows our team to judge whether you have truly exhausted first-line options and which type of ketamine treatment may suit you.
Knowing who should not receive ketamine is just as important as knowing who should. Our providers screen every patient carefully before treatment.
Ketamine can raise blood pressure and heart rate for a short time during treatment. Because of this, some health conditions may rule out ketamine or require extra caution. These can include:
Uncontrolled high blood pressure
Certain heart conditions
Blood vessel problems, such as an aneurysm or a history of bleeding in the brain
Some lung or breathing conditions
Pregnancy or breastfeeding
Patients should tell Hadi Estakhri about any blood vessel health issues, since ketamine treatment can affect blood pressure.
Some psychiatric factors also call for caution or may make ketamine a poor fit:
A current or past psychotic disorder, such as schizophrenia
Active mania
Active substance use disorder, especially involving ketamine or other dissociative drugs
As a board certified addiction psychiatrist, Hadi Estakhri pays close attention to substance use history. A past history of substance use does not always rule someone out, but it does shape the plan and level of monitoring.
Even for good candidates, safety drives every part of ketamine care. Key safety points include:
Supervised sessions: Every IV ketamine and Spravato session takes place in our office under direct supervision.
Monitoring: Our team tracks vital signs, including blood pressure, before, during and after treatment.
No driving afterward: Ketamine can affect alertness and coordination, so patients should not drive on treatment days and should arrange a ride home.
Full medication review: Some medications can interact with ketamine, so providers review your full list of prescriptions and supplements.
Honest reporting: Patients do when they share all health details openly, including alcohol and drug use.
Every path to ketamine starts with a full psychiatric evaluation. This assessment looks at your symptoms, mental health history, medical history and life circumstances. The goal is to confirm an accurate diagnosis and understand why past treatments may not have worked.
Hadi Estakhri performs thorough evaluations before prescribing ketamine for depression, anxiety or PTSD.
During the evaluation, you can expect a conversation about:
Your current symptoms and how they affect daily life
How long you have had these symptoms
Your past treatments and how you responded
Your physical health and current medications
Your goals for treatment
You will leave with a clearer sense of your diagnosis and whether ketamine, another treatment or a combination may fit your needs.
When deciding whether ketamine is a good fit, our providers weigh several factors together:
Diagnosis: Is there a confirmed condition that ketamine is known to help?
Treatment resistance: Has the patient tried standard treatments without enough relief?
Symptom severity: Are symptoms serious enough to justify a next-step treatment?
Medical safety: Are blood pressure, heart health and other conditions safe for ketamine?
Psychiatric safety: Is there any history of psychosis, mania or substance misuse?
Practical fit: Can the patient attend in-person sessions and arrange safe transportation?
Treatment type: Would IV ketamine or Spravato better match the patient’s needs and history?
No single factor decides the outcome. Our providers look at the whole person to build a plan that is both safe and likely to help.
For the right patient, ketamine therapy can offer several advantages over traditional options:
Faster relief: Many patients notice changes in mood within hours or days, compared to the weeks that standard antidepressants often take.
A different pathway: Because ketamine acts on glutamate, it can help people who did not respond to serotonin-based medicines.
Relief from hopelessness: Some patients find that ketamine eases the heavy, stuck feeling of long-term depression, which can make it easier to engage in therapy and daily life.
Two delivery options: Having both IV ketamine and Spravato allows our providers to match the method to each patient.
Supervised care: Every session takes place in a monitored clinical setting with a trained provider.
Results vary from person to person. Some patients respond strongly, others more gradually, and some do not respond. Our team tracks progress over time and adjusts the plan as needed.
Ketamine can cause some unusual sensations during treatment. Patients describe a range of experiences, including:
A floating or out-of-body feeling
Tingling in the hands, feet or face
Mild visual changes or mild hallucinations
Feeling relaxed or drowsy
Mild nausea or dizziness
These effects are temporary. They usually wear off soon after an IV infusion ends, or within an hour or so after using the Spravato nasal spray. Patients are under supervision the whole time, and our team stays nearby to monitor comfort and vital signs.
Ketamine therapy usually involves a series of sessions rather than a single visit. Your provider will explain the recommended schedule and how progress will be measured. Many patients find it helpful to keep a simple mood log between sessions, noting sleep, energy and outlook, so they can share changes with their provider.
Ketamine is one tool among several. For some patients, another treatment or a combination works better. We offer a range of mental health services that can stand alone or pair with ketamine:
TMS therapy: TMS therapy is a non-invasive treatment for depression that uses magnetic fields to stimulate areas of the brain tied to mood. We use BrainsWay technology for TMS. It can be a strong choice for patients who are not good candidates for ketamine or who prefer a non-medication option.
Talk therapy: Talk therapy helps patients build coping skills and work through the thoughts and experiences behind their symptoms. Many patients find therapy more productive while ketamine is easing their depression.
Medication management: Ongoing medication care helps patients balance their current prescriptions alongside ketamine or other treatments.
Online therapy: For patients elsewhere in California, online therapy and telehealth visits offer support without travel.
If ketamine is not the right fit, our providers will walk through these alternatives so patients still leave with a clear plan.
Ketamine therapy works as part of a long-term plan. After an initial series of treatments, our providers check in regularly to track how symptoms are changing. Follow-up care may include:
Regular visits to review mood, sleep and daily function
Adjustments to medication when needed
Maintenance sessions for some patients to help sustain results
Continued therapy to strengthen coping skills
Screening for any new health changes that affect safety
Because our team includes a board-certified psychiatrist, patients have access to consistent care throughout treatment and beyond.
So, who is a good candidate for ketamine therapy? In most cases, it is an adult with a confirmed diagnosis of depression, anxiety, PTSD or a related condition whose symptoms have not improved after two or more standard treatments. Good candidates also have a medical and psychiatric history that makes ketamine safe, and they can attend supervised sessions in person.
People with uncontrolled blood pressure, certain heart or blood vessel conditions, a history of psychosis, active mania or active substance misuse may need a different approach. When ketamine is not a fit, options such as TMS, therapy and medication management remain available.
The only way to know for sure is through a full psychiatric evaluation. Hadi Estakhri and our providers review each patient’s history, symptoms and safety factors before recommending IV ketamine, Spravato or another treatment. This careful process helps make sure ketamine is used where it can do the most good.
Ketamine therapy is a next-step option for treatment-resistant mental health conditions. A thorough evaluation with our team in Newport Beach, CA is the clearest way to learn whether it fits your needs.
About the Author
Hadi Estakhri, MD - Founder
October 5, 2026
