Treatment-resistant depression affects an estimated one-third of people diagnosed with major depressive disorder, yet many patients spend years cycling through medications that never fully work. The misconception that simply trying more antidepressants will eventually lead to remission keeps many people from exploring treatments that work through entirely different neurobiological mechanisms. At our Bellaire practice, we have spent over a decade helping Houston-area patients understand that when the conventional path stalls, another road exists.
How IV Ketamine Works and What the Evidence Shows
IV ketamine therapy represents one of the most significant advances in psychiatry over the past two decades. Unlike traditional antidepressants that target the serotonin or norepinephrine systems and often require weeks to show effect, ketamine works primarily on the glutamate system — specifically at NMDA receptors — and can produce noticeable changes in mood within hours to days of an infusion. This rapid mechanism has been studied extensively, with research published in journals such as JAMA Psychiatry and the American Journal of Psychiatry consistently demonstrating response rates in the 50 to 70 percent range for patients whose depression has not responded to two or more prior antidepressant trials. It is important to note that ketamine’s use for psychiatric conditions is considered off-label, meaning it has not received FDA approval for depression specifically, and we discuss this openly with every patient we see. For a deeper look at treatment-resistant depression and the latest clinical thinking, our overview of what we now know offers useful context.
IV Ketamine Therapy at Dr. Prashad’s Bellaire, TX Practice
A course of IV ketamine treatment in Houston at our practice typically begins with a thorough psychiatric evaluation, during which Dr. Sandhya Prashad reviews your complete medication history, prior treatment responses, and any comorbid conditions that may shape your individual protocol. This intake process is what separates thoughtful interventional psychiatry from simple infusion delivery. We are not simply administering a medication — we are constructing a plan built around the specific neurobiological and psychosocial factors that have defined your illness. This includes consideration of seasonal patterns, environmental stressors, and genetic predisposition to treatment response, all of which Dr. Prashad has developed extensive expertise in evaluating over her career.
The infusion itself is administered intravenously over approximately 40 to 60 minutes in a calm, supervised clinical setting. Most patients receive a series of six infusions spread over two to three weeks for the initial treatment phase, a protocol grounded in the clinical research showing that this spacing optimizes neuroplastic changes in key brain regions, including the prefrontal cortex and hippocampus. During the infusion, patients may experience perceptual changes — a sense of dissociation, altered sense of time, or visual effects — that resolve fully as the medication clears the system. Our clinical team monitors vital signs throughout and is present to support patients through any discomfort. We encourage patients to have a trusted person available to drive them home and to plan for a restful remainder of the day.
Managing Common Concerns: Fear, Cost, and Long-Term Maintenance
One of the barriers we most frequently help patients work through is fear of the experience itself. Patients who have read about ketamine’s history as a dissociative anesthetic or recreational substance sometimes arrive with significant apprehension. What we find, almost universally, is that when the infusion is delivered in a calm, structured clinical environment by an experienced psychiatric provider who has contextualized the experience for the patient in advance, the discomfort is far less than anticipated. Dr. Prashad has personally administered over 9,000 treatments, and that volume of experience translates directly into a clinical environment that patients describe as reassuring rather than clinical or impersonal. Patients curious about the subjective experience can also read our guide on who should try ketamine therapy and what it feels like.
A second barrier that keeps many Houston-area patients from pursuing ketamine therapy is the question of cost. IV ketamine is not covered by most insurance plans for psychiatric indications, and the out-of-pocket cost for a full initial series is a real consideration. We do not obscure this reality. What we encourage patients to weigh is the cumulative cost of treatment approaches that are not working — both in direct medication and healthcare costs and in the far-greater personal and professional costs of unresolved depression. We are happy to discuss the specifics of fees during a consultation and to help patients understand what the treatment path looks like financially before they commit.
Maintenance therapy is an important part of the longer-term picture. Many patients who respond well to an initial series benefit from periodic booster infusions — sometimes monthly, sometimes less frequently — to sustain their gains. This maintenance phase is highly individualized. Some patients maintain response over many months with minimal continued treatment; others benefit from more regular intervals. We approach this calibration collaboratively, based on how you are feeling and on objective markers we track over time. Results vary by individual, and we are honest about the range of responses we see. For a detailed walkthrough of the process from start to finish, our post on the IV ketamine therapy timeline in Houston walks through each phase in depth.
Other Treatments Available at Our Houston Practice
We are also careful to discuss with every patient that IV ketamine is not the only option at our practice. For patients who prefer or require a different administration route, SPRAVATO® treatment — a nasal spray form of esketamine — is FDA-approved for treatment-resistant depression and MDD with acute suicidal ideation or behavior and is available at our Bellaire office under the FDA-mandated REMS protocol. We also offer Deep TMS, a transcranial magnetic stimulation technology with FDA clearance, and the combination of ketamine plus Deep TMS for patients whose conditions may benefit from a multi-modal approach. Discuss with your provider which path makes sense given your history, goals, and practical circumstances.
Frequently Asked Questions
How do I know if I qualify for IV ketamine therapy for depression?
Most patients who are candidates have tried at least two antidepressant medications without achieving adequate relief, a clinical standard often described as treatment-resistant depression. During an initial evaluation at our Bellaire practice, Dr. Prashad reviews your full psychiatric and medical history to determine whether ketamine is appropriate and safe for you individually. Certain conditions — including active substance use disorder or specific cardiovascular concerns — may affect candidacy, and this is discussed transparently at intake.
How quickly does IV ketamine work for depression?
Many patients notice a shift in their depressive symptoms within 24 to 48 hours of their first infusion, though the full depth of response typically builds across the series of six infusions. This speed of onset is one of the features that distinguishes ketamine from traditional antidepressants, which may take four to six weeks to produce meaningful effects. That said, results vary by individual, and not everyone responds in the same way or on the same timeline.
Is IV ketamine covered by insurance?
IV ketamine for psychiatric indications is not currently covered by most commercial insurance plans or Medicare. We provide detailed fee information during the consultation process so patients can make an informed decision. SPRAVATO®, which is a different FDA-approved medication administered as a nasal spray in our supervised clinical setting, has different insurance coverage pathways and may be covered under certain plans.
How many ketamine infusions will I need?
The initial treatment protocol most commonly involves six infusions administered over approximately two to three weeks. After that, maintenance infusions may be recommended at intervals that are calibrated to your individual response — anywhere from monthly boosters to less frequent sessions. The maintenance schedule is something we evaluate together based on your ongoing symptoms and functional wellbeing.
What are the risks or side effects of IV ketamine therapy?
The most common side effects during the infusion include dissociation, perceptual changes, nausea, and elevated blood pressure, all of which are monitored and managed during the session. These effects resolve as the medication clears. Longer-term risks, including the small potential for psychological dependence with chronic use and the effects on blood pressure over multiple sessions, are discussed thoroughly during your consultation. We prioritize informed consent and ongoing safety monitoring for every patient.
Key Takeaways
- IV ketamine targets the glutamate system via NMDA receptors, producing mood effects within hours to days rather than weeks.
- Psychiatric use of ketamine is off-label; it has not received FDA approval for depression specifically.
- A standard initial course involves six infusions over two to three weeks, often followed by individualized maintenance therapy.
- Cost is a genuine barrier since most insurance plans do not cover IV ketamine for psychiatric use; discussing fees in advance is standard practice at our clinic.
- Other options at Dr. Prashad’s Bellaire practice include SPRAVATO® (FDA-approved for TRD), Deep TMS (FDA-cleared), and combination ketamine plus Deep TMS therapy.
Dr. Prashad’s team is available to discuss whether IV ketamine is an appropriate next step for your specific situation. We have walked hundreds of Houston-area patients through this decision, and we meet every person where they are in that process — without pressure, without oversimplification, and with complete honesty about what the evidence supports and what it does not. If you are ready to explore whether ketamine therapy belongs in your treatment picture, we welcome you to schedule a consultation at our Bellaire office.
References
American Journal of Psychiatry: https://ajp.psychiatryonline.org/
JAMA Psychiatry: https://jamanetwork.com/journals/jamapsychiatry
National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/depression
FDA Drug Safety Communication — Ketamine: https://www.fda.gov/drugs/drug-safety-and-availability
American Society of Ketamine Physicians, Psychotherapists & Practitioners: https://www.askp3.org/
About Dr. Sandhya Prashad
Dr. Sandhya Prashad, MD, is a board-certified psychiatrist who has been treating patients in the Houston area since 2011, specializing in treatment-resistant depression and interventional psychiatric care. She has personally administered over 9,000 treatments for patients whose depression has not responded to traditional antidepressants, developing deep expertise in the neurobiological factors — including seasonal triggers, environmental stressors, and genetic predisposition — that shape treatment response. Dr. Prashad’s practice offers IV ketamine therapy, SPRAVATO® (esketamine), and comprehensive psychiatric evaluation, with a commitment to finding a path forward even for the most complex and long-standing cases.
Medical Disclaimer
The information provided in this article is intended for educational purposes only and does not constitute medical advice. It is not a substitute for professional psychiatric evaluation, diagnosis, or treatment. Results vary by individual, and not all patients will experience the same outcomes from IV ketamine therapy. Always discuss your treatment options with a qualified medical provider before making any changes to your care plan. If you are experiencing a psychiatric emergency or thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room immediately.