IV Ketamine Treatment
The science of neuroplasticity. The art of recovery.
Ketamine works through a completely different pathway from traditional antidepressants — not by topping up serotonin, but by helping the brain physically rebuild itself. Here’s what that means, how it works, and what your treatment will actually look like.
- The Starting Point
Why 30% of people don't respond to antidepressants.
For more than thirty years, the dominant theory of depression was simple: a chemical imbalance in the brain. SSRIs and SNRIs were designed around it — keep more serotonin and noradrenaline active in the synapses, and the mood should follow.
For around 75%+ of patients, that works. But for the other 30%, it doesn’t — and no amount of dose adjustment or medication switching leads to full remission. Clinicians call this treatment-resistant depression.
Throughout the 1990s, researchers at Yale — led by John Krystal and Dennis Charney — began asking the question hiding in plain sight: what if the chemical-imbalance theory was missing the bigger picture?
- 01 · Discovery
Depression isn't just a chemical state.
When Yale researchers scanned the brains of patients with long-term depression, they found something unexpected: actual structural changes. The hippocampus — responsible for memory, emotion, and cognitive flexibility — had visibly shrunk. The prefrontal cortex, which governs decision-making and mood regulation, had thinned.
Depression, anxiety, PTSD and OCD weren’t simply imbalances waiting to be corrected. They were leaving real, measurable marks on the brain.
- 02 · Mechanism
Chronic stress prunes the brain like a tree losing its leaves.
Researchers exposed rats to two weeks of sustained stress — roughly equivalent to six months in a human life. Before: each neuron was a richly branching tree, with thousands of connections extending outward. After: those same neurons had lost almost all their branches. They could no longer reach out. They could no longer adapt.
The technical term is loss of neuroplasticity — the brain’s ability to change, learn, and rewire itself. In depression, anxiety, PTSD and OCD, this is the underlying problem.
- 03 · The Breakthrough
Ketamine restores what stress took away.
Of all the medications ever tested, only ketamine reliably reverses this damage. By acting on the glutamate system, it triggers the release of BDNF — brain-derived neurotrophic factor — the brain’s own growth signal.
Within hours of a single infusion, BDNF levels begin to rise. Over a full programme, pruned neurons regrow their branches. The brain becomes able to adapt again — and the symptoms that came with the loss begin to lift.
IV ketamine delivers the drug directly into the bloodstream, producing the most precise, controllable, and bioavailable form of treatment available. Unlike oral or nasal formulations, there is no absorption barrier — the full dose reaches the brain exactly as intended.
In 2019, the FDA granted esketamine — a nasal spray derivative — Breakthrough Therapy designation for treatment-resistant depression, recognising ketamine’s mechanism as the first genuinely novel antidepressant advance in decades.
2 hrs
to begin triggering BDNF release
100%
Bioavailability: IV delivers the full dose directly into the bloodstream, unlike oral or nasal alternatives
4–6 wks
for neural regrowth in a typical programme
2019
The year esketamine became the first antidepressant with a novel mechanism to receive FDA Breakthrough Therapy designation
- Facts
IV Ketamine — Evidence-Based Facts
Bioavailability
IV ketamine achieves ~100% bioavailability. Oral ketamine achieves only 16–24% due to first-pass hepatic metabolism. Intranasal esketamine achieves 25–50%. IV is the only route that eliminates absorption variability entirely.
Source: Peltoniemi et al. (2016), Basic & Clinical Pharmacology & Toxicology; Fanta et al. (2015), British Journal of Clinical Pharmacology
Speed of Response
IV ketamine produces antidepressant effects within 2–4 hours of a single infusion. Traditional antidepressants typically require 4–6 weeks to produce measurable benefit.
Source: Zarate et al. (2006), Archives of General Psychiatry — landmark NIH randomised controlled trial of IV ketamine in treatment-resistant depression
Response Rates in Treatment-Resistant Depression
Approximately 75%+ of treatment-resistant patients show a meaningful response to a course of IV ketamine infusions. Meta-analyses report response rates of 60–75%+ in patients who have failed multiple antidepressant trials.
Source: Murrough et al. 2015, Psychological Medicine; Newport et al. (2015), Journal of Clinical Psychiatry
Suicidal Ideation
Early RCT evidence suggests IV ketamine may reduce suicidal ideation within 48 hours in high-risk patients. A randomised controlled trial found a significant reduction in suicidal ideation at 48 hours in patients with mood and anxiety disorders presenting with clinically significant suicidal ideation, using ketamine versus active placebo (midazolam). The effect was independent of general antidepressant response. The authors noted the trial was small (n=24) and that larger, well-powered studies are warranted.
Source: Price et al. (2014), Biological Psychiatry — PMID: 24668760
BDNF and Neuroplasticity
IV ketamine triggers BDNF release within 2 hours, initiating structural neural repair. Preclinical and clinical studies confirm ketamine’s mechanism involves rapid BDNF upregulation via AMPA receptor potentiation and mTOR pathway activation.
Source: Autry et al. (2011), Nature; Duman & Aghajanian (2012), Science
Dose Precision — Unique to IV
IV infusion allows real-time dose adjustment — no other delivery route offers this. The treating clinician can titrate the infusion rate based on the patient’s response in real time, which is not possible with oral, intranasal, or intramuscular administration.
Source: Sanacora et al. (2017), JAMA Psychiatry — consensus statement on IV ketamine in clinical practice
Safety Record
Ketamine was approved as an anaesthetic in 1970 and remains on the WHO List of Essential Medicines. At sub-anaesthetic doses, adverse events are transient and mild — most commonly dissociation and nausea during infusion, resolving within 1–2 hours. No cases of addiction have been reported in medically supervised therapeutic use.
Source: World Health Organization Essential Medicines List; Aan het Rot et al. (2010), Biological Psychiatry
PTSD
A 2021 RCT found that a course of IV ketamine infusions produced significantly greater reductions in PTSD symptom severity than active placebo, with effects appearing within 24 hours.
Source: Feder et al. (2021), Nature Medicine
OCD
A randomised crossover trial found that a single IV ketamine infusion produced significant reductions in obsessive-compulsive symptoms within hours in unmedicated patients with near-constant OCD obsessions.
Source: Rodriguez et al. (2013), Neuropsychopharmacology
- The Delivery Method
Why intravenous infusion is the gold standard.
Ketamine can be taken several ways — as a tablet, as a nasal spray, or as an intramuscular injection. They all work to some degree, but they all share the same fundamental problem: absorption is unpredictable. Two patients on the same dose can end up with completely different levels of the drug in their bloodstream.
Intravenous infusion solves this. The dose enters the bloodstream directly, at a precise, controlled rate, over fifty minutes. Your consultant can adjust it in real time based on how you’re responding. The result is the most reliable, evidence-based, and well-tolerated delivery method we have — which is why every published clinical trial demonstrating ketamine’s benefit in depression has used IV infusion.
| Method | Absorption | Dose Precision | Real-time Adjustment |
|---|---|---|---|
| IV Infusion | Reliable, ~100% | High | Yes |
| Nasal spray | Variable, 25–50% | Moderate | No |
| Oral tablet | Variable, 16–24% | Low | No |
| Intramuscular | Reliable | Moderate | No |
- The Programme
A structured programme, adjusted to you.
Your full programme is typically 15–20 sessions over 4–6 months. Frequency is highest at the start and gradually tapers as your symptoms improve. Around 20–30% of patients then move to occasional maintenance sessions.
- INDUCTION
Weeks 0–6
Two sessions per week
The foundation of the programme. Sessions are close together to give the glutamate system a sustained signal to begin neural regrowth. Most patients begin to notice changes during this phase — sometimes within the first few sessions.
6–10 sessions
- CONSOLIDATION
Weeks 6–16
Tapering frequency
As symptoms improve, sessions space out — first weekly, then fortnightly. The brain consolidates the new neural patterns. Your consultant adjusts the schedule based on real-time mood and clinical data.
5–10 sessions
- MAINTENANCE
Weeks 16+ (optional)
Every 6–12 weeks
Around 20–30% of patients benefit from occasional maintenance sessions before transitioning to fully independent management. This phase is optional and based entirely on your response.
As needed
Every programme is individualised. Your consultant adjusts frequency, dosing, and duration based on how you respond.
- BEFORE
Preparation, not pressure.
Fasting
Clear fluids allowed up to 2 hours before; food up to 4 hours prior.
Medication
Continue all your current medications unless your consultant has specifically told you otherwise.
Transport
Arrange a trusted person to take you home, or use a taxi or Uber. You can’t drive after a session.
Filming
No photography or filming during treatment — for everyone’s privacy.
Bring
Comfortable clothing, your own playlist if you’d like, anything that helps you feel settled. We provide the rest.
- During
A 50-minute infusion. Continuous care throughout.
The setting
A private clinical suite. Reclining armchair, soft blankets, eye mask available, calming music playing.
The infusion
A small IV cannula in your arm. A low, precisely controlled dose of ketamine delivered over approximately 50 minutes.
What you’ll feel
Many patients describe a peaceful, slightly dreamlike state — sometimes a floating or dissociative sensation. A brief cold sensation at the infusion site is normal.
Your consultant
Always present and reachable throughout. You can communicate at any time. Heart rate, oxygen, and blood pressure are continuously monitored.
Recovery
After the infusion ends, you rest for around an hour as the dissociative sensation passes. You’ll leave feeling calm — most patients are ready to return to normal activities the next day.
- AFTER
The work doesn't end when you leave.
Daily mood tracking
Starting the day of your first session, you’ll receive a short daily check-in via our proprietary app. Two questions: mood, anxiety. Less than 30 seconds.
Clinical communication
With your consent, we share a treatment summary with your GP and psychiatrist so your wider care team is informed.
Going home
Most patients return to work or normal activities the next day. Driving is not permitted on the day of treatment itself.
Maintenance
Around 30–35% of patients benefit from occasional maintenance treatments at 6–12 week intervals once the main programme has finished.
Ongoing support
Your consultant remains available throughout — both during the programme and afterwards.
- Safety
Treatment is consultant-led, monitored, and adjusted in real time.
Ketamine has been used as an anaesthetic in operating theatres for more than fifty years. In therapeutic doses for mental health, it’s well below anaesthetic levels — but the same continuous monitoring standards apply.
Every session at Save Minds is delivered by Dr Yadhu, a dual consultant in Anaesthesia and Intensive Care Medicine at Royal Free London NHS Foundation Trust. He has personally delivered over 5,000 ketamine treatments. You’re never with a nurse, a junior, or a technician — you’re with the same consultant from your first session to your last.
- With Referral
- Adults aged 18 or over
- Treatment-resistant depression, anxiety, PTSD, OCD, or severe suicidal ideation
- At least two antidepressants tried at adequate doses
- Therapy attempted but symptoms remain
- Treatment isn't suitable for
- Uncontrolled high blood pressure
- Unstable cardiac conditions
- Active psychotic disorders or untreated bipolar I
- Current substance dependency
- Pregnancy
Every patient receives a thorough medical and psychiatric assessment before treatment begins. If we’re not the right fit, we’ll be honest about it.
- Built In-House
We measure everything that matters.
Our proprietary monitoring app sends a short daily check-in for mood and anxiety from day one. Combined with nine clinically validated questionnaires reviewed by your consultant throughout the programme, we build a real-time picture of what’s working.
You see your own progress. Your consultant adjusts your programme based on data, not impressions.
- PHQ-9
- GAD-7
- Y-BOCS
- RRS-10
- C-SSRS
- NSESSS
- QIDS-SR
- WEMWBS
- Daily Mood
- Outcomes
What the numbers actually say.
Based on our internal audit of 140 patients, awaiting peer-reviewed publication.
75%+
Good response rate
Across all conditions
50%
See significant change in first 10 sessions
Depression & anxiety
75%+
Of patients achieve good response by session 20
Complete programme
60%+
Of severely suicidal patients have ideation fully resolved within 6–8 sessions
C-SSRS
Aggregated outcomes across our patient cohort. Individual results vary.
- Common Misconceptions
What ketamine isn't.
- Misconception
- Reality
“Isn’t ketamine a club drug? Won’t I become addicted?”
Recreational ketamine use involves frequent, unmonitored, high-dose self-administration over months or years — that is a real cause of harm. Therapeutic ketamine is entirely different: low, precisely controlled doses delivered under medical supervision, weeks apart, for a limited treatment course. There is no published evidence of addiction from medically supervised ketamine therapy. Patients leave the clinic without cravings, and the treatment doesn’t produce a “high” worth chasing — most describe it as quietly transformative, not euphoric.
- Misconception
- Reality
“Isn’t this just an experimental treatment?”
Ketamine has been used as an anaesthetic in operating theatres since the 1960s. Its use for treatment-resistant depression is more recent but well-established — Yale began this work in 2000, and esketamine — a nasal spray derivative of ketamine — became the first antidepressant with a
genuinely novel mechanism to receive FDA Breakthrough Therapy designation in 2019. IV ketamine
itself remains a prescription treatment used off-label, with over two decades of published clinical
evidence behind it. NHS Oxford has been offering it for nearly a decade. We’ve been delivering it in
private practice for over five years and treated 900+ patients.
- Misconception
- Reality
“Will I lose control during treatment?”
The therapeutic dose used at Save Minds is well below anaesthetic levels. You remain conscious throughout, able to speak with your consultant, and able to ask for the infusion to be slowed or paused at any moment. Many patients describe the experience as introspective, peaceful, or slightly dreamlike. Some sessions feel emotionally significant; others feel like simply resting. You are in control throughout.
- Questions
Frequently asked questions about treatment.
How long is each session at the clinic?
Plan for 2 to 3 hours per session. The infusion itself takes around 50 minutes, with a check-in beforehand and roughly an hour of monitored recovery afterwards. You can return to most normal activities the next day.
How many sessions will I actually need?
Typical programmes are 15–20 sessions over 4–6 months. Around half of patients see significant change within the first 10 sessions. By session 20, around 75%+ have achieved a good response. Your consultant will continually adjust based on your data.
Will I feel "high" during treatment?
No. The therapeutic dose is well below anaesthetic levels. Most patients describe a calm, slightly dreamlike state — peaceful rather than euphoric. The dissociative sensation passes within an hour of the infusion ending.
Can I continue my current medications?
In almost all cases, yes. You should continue your current medications throughout treatment unless your consultant specifically advises otherwise. Decisions about reducing or stopping medications happen later, gradually, in collaboration with your prescribing doctor.
Is it covered by insurance?
No. Ketamine for mental health is currently classified as “off-label” use, which UK private medical insurers don’t cover. Fees are paid as you attend each session — no large upfront payment is required.
What if I don't respond?
Around 20–25% of patients don’t see significant improvement in the first 10 sessions. With continued treatment, fewer than 5% remain non-responsive at session 20. If you’re not responding, your consultant will be honest with you about that — and won’t continue to charge for sessions that aren’t working.
Can I stop treatment at any time?
Yes. There’s no commitment, no upfront package, and no penalty for stopping. You pay per session as you attend. Around 5% of patients discontinue treatment for various reasons, and that’s always your call.
Do you offer therapy alongside ketamine?
No. We deliver ketamine infusion therapy as a standalone treatment focused on neuroplasticity, not as part of ketamine-assisted psychotherapy. Many of our patients have already done years of therapy. If you want to continue or restart therapy alongside treatment, we’d encourage that — we just don’t provide it ourselves.
“I treat people who have tried everything else. They come in tired — not just from the depression, but from the years of being told to try one more pill. My job is to show them that there is a different mechanism, and a different way through. We’ve helped 500 of them do exactly that.”
Dr Rajalingam Yadhunanthanan · Founder, CEO & Lead Clinician · MBBS, MD, FRCA, DICM
Understand the science. Then take the first step.
If you’ve read this far, you know what’s possible. The next step is a quick eligibility check or a free, no-pressure call with our team.