Ketamine Therapy in Canada: A Complete Patient Guide

Ketamine therapy uses sub-anaesthetic doses of ketamine — a Health Canada-approved anaesthetic — to treat conditions including treatment-resistant depression, PTSD, anxiety, OCD, and chronic pain. In Canada, ketamine for mental-health indications is prescribed off-label by physicians and nurse practitioners, with one Health Canada-approved formulation (intranasal esketamine, Spravato) for treatment-resistant major depressive disorder. This guide explains how ketamine therapy works, what it costs, who qualifies, the legal and regulatory framework province by province, and how to access care.

Key takeaways

• Ketamine is a Health Canada-approved anaesthetic. Its use for depression, PTSD, anxiety, and chronic pain is off-label, prescribed by licensed physicians or nurse practitioners.
• Spravato (intranasal esketamine) is the only ketamine-class drug Health Canada approves for psychiatric use — specifically for treatment-resistant major depressive disorder (May 2020).
• Most Canadians pay out-of-pocket. Provincial health plans do not cover ketamine for psychiatric indications; private insurers typically cover Spravato (with prior authorization), not generic IV ketamine.
• The most-studied indication is treatment-resistant depression. CANMAT 2021 lists IV ketamine as a third-line treatment for adults with TRD (Swainson et al., 2021).
• Provincial physician colleges (CPSA Alberta, CPSM Manitoba, CPSO Ontario, CPSBC BC) regulate where and how ketamine can be administered. Most IV ketamine in Canada is delivered in accredited non-hospital facilities.

What is ketamine therapy?

Ketamine is a dissociative anaesthetic synthesized in 1962 and approved as a human anaesthetic in 1970. It produces sedation and analgesia at higher doses; at the much lower sub-anaesthetic doses used in mental-health treatment, it produces a brief altered-state experience and rapid antidepressant effects. The first peer-reviewed psychiatric observation came from Khorramzadeh and Lotfy in 1973; the first placebo-controlled randomized trial in depressed patients was published by Berman et al. in 2000.

When ketamine is paired with structured psychotherapy before, during, and after dosing, the treatment is called ketamine-assisted psychotherapy (KAP) or ketamine-assisted therapy (KAT). When it is delivered as an IV infusion without integrated therapy sessions, it is sometimes called ketamine infusion therapy. Both fall under the broader umbrella of "ketamine therapy" used on this page.

Atomic answer. Ketamine therapy uses a controlled dose of ketamine — a Health Canada-approved anaesthetic — to treat conditions such as treatment-resistant depression, PTSD, and anxiety. It works through a different brain pathway than antidepressants and can produce antidepressant effects within hours rather than weeks. In Canada, ketamine for mental-health indications is offered as off-label IV, IM, oral, sublingual, or as Health Canada-approved Spravato (intranasal esketamine) nasal spray for severe MDD.

How does ketamine work in the brain?

Ketamine acts on the brain's glutamate system — not the serotonin system targeted by SSRIs. Its primary mechanism is antagonism at NMDA (N-methyl-D-aspartate) receptors on inhibitory interneurons. Blocking these receptors triggers a downstream surge of glutamate, activation of AMPA receptors, and release of brain-derived neurotrophic factor (BDNF) along with mTOR signalling. The cumulative effect is rapid synaptogenesis — the formation of new neural connections — within 24 to 72 hours of a single dose.

A 2022 systematic review of 141 studies concluded that "ketamine induces an increase in molecules involved in modulating neuroplasticity" paired with rapid mood improvements (Kang et al., 2022). Aleksandrova and Phillips (2021) describe ketamine as "resetting" disrupted neural connectivity in depression by counteracting synaptic deficits and restoring connections between the prefrontal cortex and limbic structures (Aleksandrova & Phillips, 2021).

This mechanism explains the timeline difference between ketamine and conventional antidepressants. SSRIs and SNRIs gradually adjust serotonin signalling; clinical benefit typically emerges over four to six weeks. Ketamine acts on glutamate directly — antidepressant effects can emerge within 2 to 72 hours of a single IV dose (Lullau et al., 2023) and last days to weeks after a single session, longer with serial dosing.

What conditions does ketamine therapy treat in Canada?

The strongest evidence base is for treatment-resistant major depressive disorder. Other indications are supported by smaller randomized trials, meta-analyses, or open-label data. Canadian clinics select patients based on diagnostic fit, severity, prior treatment failures, and contraindications.

Treatment-resistant depression is the most common entry point for Canadian ketamine clinics. CANMAT defines TRD as failure of at least two adequate antidepressant trials from different pharmacological classes (each minimum 6 weeks at therapeutic dose) plus at least one adjunctive medication trial. Many Canadian patients in ketamine programs have tried significantly more than two — the Edmonton public ketamine program reported a mean of 8.1 prior antidepressant trials among patients receiving ketamine (Chrenek et al., 2024).

What types of ketamine therapy are available in Canada?

Five delivery routes are used clinically. Each has a different bioavailability, evidence base, regulatory status, and cost profile.

IV infusion remains the gold standard for evidence: most psychiatric RCTs used IV ketamine. KAP-style protocols using IM and sublingual ketamine are also widely used in Canadian clinics, often with integrated psychotherapy. Spravato is the only ketamine-class drug Health Canada has approved for a psychiatric indication, and it is the form most likely to attract private insurance coverage with prior authorization.

Spravato (esketamine) versus generic ketamine: what's the difference?

The two are not interchangeable.

Spravato (esketamine) is the S-enantiomer of ketamine, delivered as a nasal spray. Health Canada issued a Notice of Compliance in May 2020. It is approved, in combination with an oral SSRI or SNRI, for the treatment of MDD in adults who have not responded adequately to at least two separate antidepressant courses of adequate dose and duration in the current moderate-to-severe depressive episode (Health Canada DPD). Spravato must be administered in a certified clinical setting under direct healthcare supervision; the Janssen Journey program controls distribution. Some private insurers and federal programs (Veterans Affairs Canada, WSIB Ontario, WCB Alberta) cover Spravato with prior authorization. Most provincial drug plans do not — Canada's CADTH Common Drug Review recommended against public reimbursement in December 2020 (CDA-AMC).

Generic racemic ketamine is a 50/50 mixture of R-ketamine and S-ketamine. It is approved in Canada only as an anaesthetic. Use for depression, PTSD, anxiety, OCD, and chronic pain is off-label — a legal and common practice in Canadian medicine. It is delivered IV, IM, sublingually, or orally, typically priced out-of-pocket, and has the largest psychiatric evidence base because most RCTs used IV ketamine.

The choice between Spravato and generic ketamine is a clinical decision driven by indication, prior treatment history, insurance coverage, and what's available locally. For Canadian clinicians, Spravato has a clearer regulatory and coverage pathway for treatment-resistant MDD; IV ketamine has a deeper evidence base across more indications and remains the most widely used form.

Is ketamine therapy legal in Canada?

Yes. Ketamine is a Schedule I controlled substance under the Controlled Drugs and Substances Act (CDSA), legally permitted for medical use when prescribed by a licensed physician or nurse practitioner. There is no federal or provincial prohibition on off-label drug prescribing in Canada — physicians may prescribe an approved drug for indications beyond its original approval based on clinical judgment and evidence, with appropriate informed consent.

Provincial physician colleges have published specific ketamine guidance:

• Alberta — CPSA issued Ketamine Prescribing, Administration and Oversight Expectations in March 2026. IV ketamine for psychiatric indications must be prescribed by a psychiatrist or by a physician in consultation with a psychiatrist, and administered in a CPSA-accredited non-hospital facility. Subcutaneous, intramuscular, oral, sublingual, and intranasal routes may be administered in community settings.
• Manitoba — CPSM updated guidance January 20, 2026: "The administration of ketamine for off-label purposes is now only permitted in CPSM-accredited, non-hospital medical or surgical facilities or in hospitals" (CPSM, 2026).
• Ontario — CPSO governs IV/IM ketamine through the Out-of-Hospital Premises Inspection Program (OHPIP). CPSO does not have a specific position on off-label ketamine; "patients receiving [ketamine] must receive care consistent with deep sedation even if moderate sedation is intended" (CPSO OHP Standards).
• British Columbia — CPSBC issued interim guidance for IM/oral/sublingual/intranasal ketamine in community settings (August 2025) and a separate accreditation standard for IV ketamine: "Ketamine assisted therapy is currently an uninsured service" (CPSBC, 2025).

Health Canada's Special Access Program governs psilocybin and MDMA — not ketamine. Ketamine does not require SAP authorization because it has existing medical licensure.

Who is a candidate for ketamine therapy?

Most Canadian ketamine clinics use a multi-step screening process to evaluate candidacy. Typical inclusion criteria:

• Adults 18 years or older
• Diagnosis of treatment-resistant major depressive disorder (failed 2+ antidepressant trials at adequate dose and duration), bipolar depression with mood stabilizer coverage, PTSD, anxiety disorders, OCD, or chronic pain (CRPS, neuropathic)
• Medically stable
• Able to provide informed consent
• Willing to engage in preparation and integration psychotherapy where the program includes it

Absolute contraindications — conditions that disqualify treatment — include active psychosis or schizophrenia spectrum disorder, uncontrolled severe hypertension, severe cardiovascular disease (recent MI, decompensated heart failure), increased intracranial pressure, severe hepatic impairment, current pregnancy, anaphylactic reaction to ketamine, and active manic episode.

Relative contraindications — conditions that require careful evaluation but do not automatically exclude — include history of substance use disorder, severe personality disorder with marked instability, untreated severe sleep apnea, recent stroke (under 6 months), and concurrent use of MAOIs or high-dose benzodiazepines.

For a full breakdown of qualification criteria and the screening process, see How to Qualify for Ketamine Therapy in Canada.

What happens during a ketamine therapy session?

A typical ketamine therapy program includes preparation, dosing sessions, and integration.

Preparation. One to three sessions before the first dose. The clinical team reviews medical history, screens for contraindications, sets intentions, and discusses what to expect. For KAP-style programs, a therapist establishes the relationship that will support the dosing experience.

The dosing session. Patients arrive at a clinical setting having fasted (typical for IV protocols) or eaten lightly per program instructions. Vitals are checked. The dose is administered — IV over 40 minutes, IM as a single injection, sublingual held under the tongue for ~10 minutes, or Spravato self-administered as a nasal spray under HCP supervision. The acute dissociative experience typically lasts 45 to 90 minutes. Patients commonly describe altered time perception, mild visual or auditory shifts, an emotional softening, and a sense of distance from habitual thought patterns. The therapist or nurse stays with the patient throughout.

After the dosing window, patients rest in a recovery setting for another 30 to 60 minutes (longer for Spravato — Health Canada requires a minimum 2-hour observation). Patients cannot drive for at least 24 hours and need an escort home.

Integration. Sessions in the days and weeks after dosing where the patient and therapist process material that surfaced during the experience and translate insights into behavioural change. Wilkinson et al. (2017) showed that adding 12 weeks of CBT after a 4-session IV ketamine course extended the antidepressant effect — relapse occurred in only 25% of responders by week 8 (Wilkinson et al., 2017).

A 2022 systematic review of 17 KAP studies (n=603) concluded: "Psychotherapy, provided before, during, and following ketamine sessions, can maximize and prolong benefits" (Drozdz et al., 2022).

How many sessions do you need?

Most acute protocols involve 4 to 8 sessions over 2 to 4 weeks. Spravato has a defined induction phase: twice weekly for 4 weeks, then weekly for 4 weeks, with maintenance dosing weekly or every 2 weeks thereafter (Daly et al., 2018). IV ketamine protocols vary by clinic — 6 infusions over 2 to 3 weeks is the most common acute pattern.

After the acute phase, many patients return for periodic maintenance sessions. The right number depends on individual response, durability, and clinical judgement. Discuss timeline expectations with the prescribing physician at intake.

How much does ketamine therapy cost in Canada?

Most Canadian patients pay out-of-pocket for ketamine therapy. Provincial public health plans do not cover ketamine for psychiatric indications. Private insurance typically covers Spravato with prior authorization but does not cover off-label IV or IM ketamine. The major exception is Alberta Blue Cross, which became the first Canadian insurer to cover psychedelic-assisted therapy in March 2024.

Typical Canadian ranges as of 2026:

Workers' Compensation coverage exists in Alberta (WCB) and Ontario (WSIB) for compensable injuries that result in TRD or chronic pain. Veterans Affairs Canada covers ketamine for service-related TRD or chronic pain on a case-by-case basis. For a full breakdown of pricing, insurance, financing, and tax treatment, see Ketamine Therapy Cost in Canada.

Safety and side effects

Ketamine has a 60-year clinical safety record at anaesthetic doses. At the sub-anaesthetic doses used in psychiatric treatment, the safety profile is well-established for short-term use. Common short-term side effects:

• Dissociation or perceptual changes (peaks during dosing, resolves within 1–3 hours)
• Mild nausea
• Transient elevation in blood pressure (typically 10–30 mmHg) and heart rate
• Dizziness or unsteadiness
• Headache
• Mild dysphoria in a minority of sessions

Serious adverse events are uncommon at therapeutic doses with proper screening. Long-term safety considerations from heavier or unsupervised use — bladder toxicity (cystitis), hepatic effects with biliary involvement, dependency risk with frequent recreational use — are important reasons that ketamine therapy occurs in supervised clinical settings with screening. Health Canada has issued a safety review noting hepatotoxicity and cholangiopathy risk with extended ketamine exposure; baseline and ongoing liver function monitoring is appropriate for patients receiving maintenance infusions.

How does ketamine therapy compare to traditional antidepressants?

Conventional antidepressants — SSRIs, SNRIs, atypicals, MAOIs — work primarily on the serotonin and norepinephrine systems. They take 4 to 6 weeks to produce clinical benefit, work for roughly 50–60% of patients on a first trial, and require ongoing daily dosing. Ketamine works on the glutamate system, can produce antidepressant effects within 24 to 72 hours, and is delivered as a course of sessions rather than daily medication.

The two are not interchangeable. CANMAT 2021 places IV racemic ketamine as a third-line treatment for adults with treatment-resistant depression — meaning after failure of multiple first-line antidepressants (Swainson et al., 2021). Most Canadian patients in ketamine programs continue their existing antidepressants while undergoing ketamine treatment.

Accessing ketamine therapy at ATMA CENA

ATMA CENA operates corporate clinics in Edmonton and Calgary and a member-clinic network across additional Canadian cities including Winnipeg (NeuroMed), Saskatoon, London, Hamilton, Mississauga, Vaughan, North Bay, Sarnia, Oakville, Kitchener-Waterloo, Windsor, and Montreal. The clinical team includes regulated psychiatrists, physicians, nurse practitioners, registered psychologists, registered psychotherapists, and other regulated mental-health professionals.

ATMA CENA's approach combines ketamine sessions with structured preparation and integration psychotherapy — the KAP model. Two dosing modes are offered: psychedelic (higher dose, altered-state experience) and psycholytic (lower dose with patient engaged in talk therapy). Pricing for KAT programs is published transparently: Psychedelic Pathway from CAD $1,585 initial + $795 per additional session; Psycholytic Pathway from CAD $1,530 initial + $740 per additional session; customized programs CAD $2,325–$6,930. A non-refundable deposit of CAD $300 applies to all treatment programs.

Frequently asked questions

Is ketamine therapy legal in Canada? Yes. Ketamine is a controlled substance under the CDSA, legally prescribed by physicians and nurse practitioners. Off-label use for depression, PTSD, anxiety, and chronic pain is permitted under Canadian off-label prescribing rules. Spravato (intranasal esketamine) is the only ketamine-class drug Health Canada approves for a psychiatric indication (treatment-resistant MDD).

Does ketamine therapy get you high? The dissociative experience at therapeutic doses differs from recreational drug use. Patients report altered time perception, mild visual or auditory shifts, and an emotional softening. The experience occurs in a supervised clinical setting, peaks during the 45–90 minute dosing window, and resolves within hours. It is not equivalent to being "high" in the recreational sense.

Is ketamine therapy covered by insurance in Canada? Provincial health plans do not cover ketamine for psychiatric use. Private insurers typically cover Spravato with prior authorization for treatment-resistant MDD; they generally do not cover off-label IV/IM ketamine. Alberta Blue Cross covers psychedelic-assisted therapy including ketamine for eligible plans (effective March 2024). Workers' Compensation in Alberta and Ontario covers ketamine for compensable injuries with prior authorization.

How quickly does ketamine therapy work? Antidepressant effects can emerge within 2 to 72 hours of a single IV dose. Peak effect for a single session is typically 24 to 48 hours post-infusion. Durability of a single session is days to weeks; serial dosing extends durability. This timeline is markedly different from the 4-to-6-week onset typical of SSRIs.

How is ketamine therapy different from recreational ketamine use? Therapeutic ketamine is administered in a clinical setting at sub-anaesthetic doses by trained medical staff, with screening for medical and psychiatric contraindications and structured psychotherapy support before and after. Recreational use occurs without medical screening, dose control, monitoring, or integration. The bladder toxicity, hepatic effects, and dependency risk associated with recreational ketamine are linked to high-frequency, high-dose, unsupervised exposure — not the controlled clinical dosing used in therapy.

Can I drive after a ketamine session? No. Patients cannot drive for at least 24 hours after a ketamine session. An escort home is required.

How long do the effects of ketamine therapy last? A single dose typically produces antidepressant effects lasting days to a few weeks. Repeated sessions during the acute phase (4–8 sessions over 2–4 weeks) extend durability. Many patients return for periodic maintenance sessions. Adding structured psychotherapy after the acute phase appears to extend the effect — a 2017 RCT found that adding 12 weeks of CBT after IV ketamine reduced 8-week relapse to 25% in responders (Wilkinson et al., 2017).

What's the difference between IV ketamine and Spravato? Spravato is the S-enantiomer of ketamine, delivered as a Health Canada-approved nasal spray for treatment-resistant MDD. IV ketamine is racemic (50/50 R and S), prescribed off-label for a wider range of indications, with a deeper psychiatric evidence base. Spravato has clearer insurance coverage pathways; IV ketamine is typically self-pay. They are different molecules administered through different routes.

Do I need a doctor's referral?

Is ketamine addictive? Ketamine has a low dependency risk at therapeutic doses in supervised clinical contexts. Higher dependency risk is associated with frequent unsupervised recreational use, particularly at recreational doses. Active ketamine use disorder is a contraindication for ketamine therapy.

Sources

1. ATMA CENA — Psychedelic-Assisted Therapy: https://psychedelic.healthcare/
2. CPSA Alberta — PAPT Facility Accreditation: https://cpsa.ca/facilities-clinics/accreditation/psychedelic-assisted-psychotherapy/
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5. CADTH / CDA-AMC — Esketamine Reimbursement Review: https://www.cda-amc.ca/esketamine-hydrochloride
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Related articles

• What Is Ketamine Therapy?
• Ketamine Therapy Cost in Canada
• How to Qualify for Ketamine Therapy in Canada
• Ketamine Therapy for Depression
• Ketamine Therapy in Calgary
• Ketamine Therapy in Edmonton
• Ketamine Therapy in Winnipeg
• Insurance Coverage for Ketamine Therapy
• Ketamine vs Psilocybin Therapy
• Alberta Blue Cross Coverage for Psychedelic Therapy
• Workers' Compensation Coverage for Psychedelic Therapy in Alberta
• Ketamine-Assisted Psychotherapy Training in Canada (for clinicians)

Last updated: 2026-05-05