Treatment-resistant depression is defined as major depressive disorder that has not responded adequately to at least two different antidepressant medications taken at adequate doses and durations—and it affects roughly one-third of all people diagnosed with depression, according to the National Institute of Mental Health. If you are one of those people, you already know that the standard clinical response—”let’s try another antidepressant”—stops feeling like a meaningful answer after the fourth or fifth medication that has disappointed you. At Albany Ketamine Infusions, we work specifically with patients who have reached that point, and we offer IV ketamine therapy as a scientifically grounded alternative for those struggling with depression.
Understanding Why Some Depression Doesn’t Respond to Antidepressants
The prevailing model of depression for most of the twentieth century focused on serotonin—the idea that low serotonin caused depression and SSRIs corrected it. That model has been progressively revised. Contemporary neuroscience understands depression as a complex condition involving multiple neurotransmitter systems, inflammatory pathways, stress hormones, and structural changes in brain regions like the prefrontal cortex and hippocampus. Antidepressants that work on serotonin or norepinephrine are effective for many patients, but they leave others behind precisely because their depression involves different biological systems.
Patients with treatment-resistant depression (TRD) often show patterns consistent with impaired glutamatergic signaling, reduced BDNF levels, and diminished synaptic connectivity in regions involved in mood regulation. These are not features that SSRIs or SNRIs address. Ketamine, by contrast, directly targets the glutamate system and has been shown in clinical research to promote rapid synaptogenesis—the regrowth of synaptic connections in the prefrontal cortex and hippocampus—in ways that may explain its antidepressant effects. To understand more about the neuroscience involved, see our overview of ketamine & depression science.
The Clinical Evidence for Ketamine in TRD
The research on IV ketamine for treatment-resistant depression is among the most compelling in psychiatric pharmacology. Studies published in journals including the American Journal of Psychiatry and the Archives of General Psychiatry have demonstrated rapid and significant reductions in depression scores in TRD patients, with effects observed within hours of the first infusion. This rapid onset distinguishes ketamine from every other antidepressant in the clinical toolkit—standard antidepressants require weeks before producing measurable benefit.
It is important to be precise about what the evidence shows. IV ketamine is used off-label for TRD—it does not carry FDA approval for depression, and we communicate that clearly to every patient. The FDA-approved medications for TRD in this class are SPRAVATO® (esketamine nasal spray), which is a distinct drug from ketamine and operates through a related but different mechanism. We do not offer SPRAVATO® at our clinic; our focus is IV ketamine and at-home ketamine programs. We want patients to understand both options clearly so they can make informed decisions about their care.
What to Expect From a TRD Protocol at Our Clinic
Our standard approach for treatment-resistant depression begins with a detailed consultation. We review your psychiatric history, prior antidepressant trials, current medications, and overall health. We are looking for clinical appropriateness, medical safety, and the kind of thorough understanding of your situation that allows us to provide personalized care rather than a generic protocol.
The typical loading series consists of six IV ketamine infusions delivered over two to three weeks, each lasting approximately 45 to 60 minutes. Many patients with TRD begin to notice something different within the first two or three sessions—a lightening of mood, a renewed ability to feel interest or pleasure in daily life, reduced suicidal ideation in patients for whom that has been part of the picture. We monitor your response after each session and adjust our approach based on what we observe.
After the loading series, we discuss the path forward with every patient. Some patients experience lasting benefit from the initial series. Others benefit from ongoing maintenance infusions, spaced at intervals that are determined by their individual response pattern. We do not prescribe maintenance infusions on a rigid schedule—we base the plan on clinical evidence of benefit and ongoing dialogue with each patient. For a deeper look at duration and maintenance, our guide on how long ketamine treatment lasts covers this topic in detail.
For patients who cannot travel to Albany regularly, our at-home ketamine treatments in Albany, NY extend access for residents of New York, New Jersey, Florida, and Texas. Dr. Hansen provides the same physician oversight through telehealth visits, and the at-home format is appropriate for certain patients as a maintenance strategy after completing an in-office loading series.
The Weight of Long-Untreated Depression
We want to acknowledge something that does not always get said in clinical contexts: living with treatment-resistant depression for years—sometimes decades—is a different experience from struggling with depression that responds to the first medication tried. Patients who arrive at our door have often endured an extended process of being told by various providers that the answer is just another medication, another dosage adjustment, another waiting period. That experience erodes hope in a way that is distinct from the depression itself.
We approach TRD patients with explicit awareness of this history. We do not promise outcomes we cannot guarantee, and we do not inflate expectations. What we do promise is a thorough, honest clinical evaluation, individualized care, and a physician who takes your history seriously. Results vary by individual, and ketamine does not produce a response in every patient. But for many patients with TRD, it has produced something that no prior treatment had: a meaningful change. You can read more about patient experiences on our how Albany’s ketamine infusion therapy is changing lives page.
Barriers Worth Addressing Directly
Two barriers stand between many TRD patients and ketamine therapy. The first is cost. Insurance coverage for IV ketamine for psychiatric indications is limited, and many patients pay out of pocket. We are direct about our pricing during the consultation process and do not hide the financial reality. We discuss health savings accounts and flexible spending accounts as options some patients use.
The second barrier is the difficulty of trusting another treatment after so many have failed. We understand why. We ask only that patients approach the consultation with enough openness to hear the science and evaluate it honestly. We are not asking for hope—we are asking for a conversation.
FAQ
What qualifies as treatment-resistant depression?
The standard clinical definition of TRD is major depressive disorder that has not responded adequately to at least two antidepressant medications at appropriate doses and durations. Some clinicians use a broader definition. We discuss your history during the consultation to determine whether ketamine is appropriate for your situation.
How quickly does ketamine work for treatment-resistant depression?
Many patients with TRD notice a shift within hours or days of their first infusion—sometimes within 24 hours. This is one of ketamine’s most significant distinctions from standard antidepressants. However, results vary by individual, and not every patient experiences rapid or complete response.
Can I stop my antidepressants when I start ketamine?
No—please do not change your medications without guidance from your prescribing physician. We review all current medications during intake and discuss any interactions or considerations. Medication decisions during ketamine treatment should involve your existing psychiatric provider.
Is IV ketamine safer than ECT for TRD?
Electroconvulsive therapy (ECT) and ketamine have different safety and side-effect profiles. ECT carries risks related to anesthesia and can produce short-term memory effects. Ketamine is generally considered to have a favorable side-effect profile when administered by an experienced clinician. The right choice depends on your individual situation. Please discuss with your provider.
What happens if ketamine doesn’t work for my depression?
Not every patient with TRD responds to ketamine. If you do not experience benefit after an adequate trial, we discuss that outcome honestly and talk about other options. We do not continue treatment that is not producing meaningful benefit.
Key Takeaways
- Treatment-resistant depression affects roughly one-third of people with MDD and is defined as inadequate response to at least two antidepressant trials.
- IV ketamine works through the glutamate system rather than serotonin and can produce rapid antidepressant effects within hours.
- IV ketamine for TRD is used off-label; it does not carry FDA approval for psychiatric indications.
- Albany Ketamine Infusions offers a standard six-infusion loading series, with maintenance protocols individualized to each patient’s response.
- Results vary by individual; patients should discuss with their provider whether ketamine is appropriate given their full clinical history.
Conclusion
Treatment-resistant depression is one of the most burdensome conditions in all of medicine, and the patients who carry it deserve treatment that takes their full history seriously and offers a genuine biological alternative when conventional approaches have failed. We built Albany Ketamine Infusions around precisely that patient population, and we approach every consultation with the gravity that warrants. If you are ready to explore IV ketamine for treatment-resistant depression, we encourage you to schedule a consultation with our team. Please discuss your full psychiatric and medical history with Dr. Hansen—and with your existing providers—as you consider your options.
About Dr. Philip Hansen
Dr. Philip Hansen is a board-certified anesthesiologist who trained at Albany Medical Center. He established Albany Ketamine Infusions in partnership with Dr. Brooks, building on his training at NY Ketamine Infusions. Dr. Hansen graduated from the University of Kansas School of Medicine and holds membership in the American Society of Anesthesia, the American Medical Association, and the New York State Society of Anesthesiologists. He provides medical oversight for both in-office IV ketamine infusions and at-home telehealth ketamine programs for patients across New York, New Jersey, Florida, and Texas.
References
National Institute of Mental Health — https://www.nimh.nih.gov/health/topics/depression
American Journal of Psychiatry — https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2006.06081252
National Institutes of Health — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053216/
Archives of General Psychiatry — https://jamanetwork.com/journals/jamapsychiatry/article-abstract/209748
Medical Disclaimer
This content is provided by Albany Ketamine Infusions for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. IV ketamine for treatment-resistant depression and other psychiatric conditions is an off-label use. Individual results vary, and not all patients will respond to ketamine therapy. This information should not replace consultation with a qualified medical provider. If you are experiencing suicidal thoughts or a mental health crisis, please call or text 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.