Ketamine Therapy FAQs

Thirty-eight patient-facing answers about ketamine therapy in Canada — what it is, who qualifies, what it costs, how it's regulated, what a session feels like, and how to access care. Each answer is current as of May 2026; verify with your provincial health regulator and your prescribing physician for your specific situation.

Basics & mechanism

Q1. What is ketamine therapy? Ketamine therapy is a medically supervised treatment that uses sub-anaesthetic doses of ketamine — a Health Canada-approved anaesthetic — to treat conditions including treatment-resistant depression, PTSD, anxiety, OCD, and chronic pain. It works through a different brain pathway than antidepressants and can produce effects within hours rather than weeks. In Canada, ketamine for psychiatric indications is prescribed off-label by physicians and nurse practitioners. Spravato (intranasal esketamine) is the only ketamine-class drug Health Canada approves for a psychiatric indication — treatment-resistant major depressive disorder, approved May 2020. Ketamine therapy is delivered in clinical settings under medical supervision.

Q2. How does ketamine therapy work in the brain? Ketamine blocks NMDA receptors on inhibitory interneurons, triggering a downstream surge of glutamate, AMPA receptor activation, and BDNF release that stimulates synaptogenesis — the formation of new neural connections within 24 to 72 hours of a dose (Kang et al., 2022). Where SSRIs gradually adjust serotonin signalling over weeks, ketamine acts on glutamate directly. Antidepressant effects can emerge within 2 to 72 hours of a single IV dose (Lullau et al., 2023).

Q3. Is ketamine therapy the same as ketamine-assisted psychotherapy? Ketamine therapy is the broad term covering any clinical use of ketamine for psychiatric or pain indications. Ketamine-assisted psychotherapy (KAP) — also called ketamine-assisted therapy (KAT) — refers specifically to the model where structured psychotherapy is delivered before, during, and after dosing. ATMA CENA uses the KAP model. Some clinics offer infusion-only ketamine without integrated therapy; both are legitimate, but the evidence supports better durability when psychotherapy is bundled (Drozdz et al., 2022).

Q4. What's the difference between ketamine and Spravato? Spravato (esketamine) is the S-enantiomer of ketamine, delivered as a nasal spray. Health Canada approved Spravato in May 2020 for treatment-resistant MDD; it must be administered in a certified clinical setting under direct healthcare supervision via the Janssen Journey program. Generic racemic ketamine is a 50/50 mixture of R-ketamine and S-ketamine, prescribed off-label, delivered IV/IM/sublingually/orally. Spravato has clearer insurance coverage pathways; generic ketamine has the deeper psychiatric evidence base.

Q5. How is ketamine therapy different from antidepressants? Conventional antidepressants (SSRIs, SNRIs) work on the serotonin and norepinephrine systems with daily dosing over 4 to 6 weeks before clinical benefit emerges. Ketamine acts on the glutamate system, can produce antidepressant effects within 2 to 72 hours, and is delivered as a course of clinical sessions rather than daily medication. CANMAT 2021 places IV racemic ketamine as a third-line treatment for adults with TRD (Swainson et al., 2021) — meaning it's used after multiple antidepressant trials have failed.

Q6. Why does ketamine work so fast? Because it bypasses the slow serotonin-receptor remodelling that conventional antidepressants depend on. NMDA antagonism produces immediate downstream effects: glutamate release, AMPA activation, and BDNF-mediated synaptogenesis within 24 to 72 hours of a dose (Kang et al., 2022). The window of heightened neuroplasticity that follows a dose is also why integration psychotherapy after each session is considered an important component of sustaining benefit (Wilkinson et al., 2017).

Conditions

Q7. What conditions does ketamine therapy treat? The most established indication is treatment-resistant major depressive disorder (CANMAT 2021). Other indications with RCT support include MDD with acute suicidal ideation (Wilkinson et al., 2018), bipolar depression with mood-stabilizer coverage, PTSD (Feder et al., 2014), social and generalized anxiety, OCD, and chronic pain conditions including CRPS and refractory neuropathic pain. Specific eligibility for any of these is determined at clinical assessment.

Q8. Is ketamine therapy for treatment-resistant depression? Yes — TRD is the strongest indication. CANMAT 2021 defines TRD as failure of at least two adequate antidepressant trials from different pharmacological classes plus at least one adjunctive medication, each at therapeutic dose for at least 6 weeks. Many Canadian patients in ketamine programs have tried significantly more — the Edmonton public ketamine program reports a mean of 8.1 prior antidepressant trials in early patients (Chrenek et al., 2024).

Q9. Does ketamine work for PTSD? Two RCTs support use in chronic PTSD. Feder et al. (2014) showed that single-dose IV ketamine produced significant reduction in PTSD symptoms versus midazolam; Feder et al. (2021) replicated this with repeated dosing showing durable effects. ATMA CENA accepts PTSD as a primary indication after clinical assessment.

Q10. Does ketamine work for anxiety, OCD, or chronic pain? Anxiety: emerging RCT data support use in social and generalized anxiety, particularly in treatment-refractory cases (Glue et al., 2017). OCD: one small RCT and open-label data show preliminary support (Rodriguez et al., 2013). Chronic pain (CRPS, refractory neuropathic): a systematic review documents IV ketamine reducing pain in conditions refractory to conventional analgesics (Niesters et al., 2014). Specific eligibility is case-by-case.

Q11. Can ketamine help with suicidal ideation? Wilkinson et al. (2018) — a meta-analysis of 167 patients with baseline suicidal ideation — showed ketamine produced rapid reductions in suicidal ideation within 24 hours, partially independent of antidepressant response. This is a recognized clinical use case. Active suicidal crisis requiring inpatient monitoring is a reason to defer outpatient ketamine until stabilized; if you're in immediate danger, contact a crisis line (Talk Suicide Canada: 1-833-456-4566) or emergency services.

Eligibility & screening

Q12. Who is a good candidate for ketamine therapy? Adults 18 or older with a diagnosis of TRD, MDD with suicidal ideation, bipolar depression with mood-stabilizer coverage, PTSD, anxiety, OCD, or chronic pain; medically stable; able to provide informed consent; willing to engage in preparation and integration sessions where the program includes them. Specific eligibility is confirmed at clinical assessment.

Q13. What disqualifies you from ketamine therapy? Absolute contraindications: active psychosis or schizophrenia spectrum disorder, uncontrolled severe hypertension, severe cardiovascular disease, increased intracranial pressure, current pregnancy, anaphylactic reaction to ketamine, active manic episode, active ketamine use disorder. Relative contraindications: history of substance use disorder (other substances), severe personality disorder with marked instability, recent stroke, untreated severe sleep apnea, concurrent MAOIs or high-dose benzodiazepines.

Q14. Do I need a doctor's referral?

Q15. How is treatment-resistant depression defined? The CANMAT 2021 definition: failure of at least two adequate antidepressant trials from different pharmacological classes plus at least one adjunctive medication trial. "Adequate" means therapeutic dose for at least 6 weeks per trial.

Q16. Can I do ketamine therapy if I'm on antidepressants? Most Canadian clinics keep patients on existing antidepressants during ketamine treatment. Some medications interact pharmacodynamically — particularly high-dose benzodiazepines (which may attenuate the antidepressant effect; Andrashko et al., 2021) and MAOIs. Discuss any medication adjustments with the prescribing physician at intake.

Q17. Can I do ketamine if I'm pregnant or breastfeeding? Pregnancy is an absolute contraindication. Breastfeeding is a relative contraindication; ketamine is excreted in breast milk and risks to the infant are not fully characterized. Discuss with your prescriber.

Cost & insurance

Q18. How much does ketamine therapy cost in Canada? IV ketamine sessions typically cost CAD $375–$1,000; 6-session course CAD $2,250–$5,400. Ketamine-assisted psychotherapy with bundled therapist time CAD $685–$1,400 per session. Spravato 4-week induction CAD $5,000–$7,000 without coverage. ATMA CENA's published KAT pricing: Psychedelic Pathway from CAD $1,585 + $795 per additional session; Psycholytic Pathway from CAD $1,530 + $740. Customized programs CAD $2,325–$6,930. See Ketamine Therapy Cost in Canada.

Q19. Does OHIP, MSP, or AHCIP cover ketamine therapy? Provincial public health plans do not cover ketamine for psychiatric indications. Exceptions: Edmonton's Misericordia/Grey Nuns hospital program (AHCIP-covered for eligible TRD patients via psychiatrist referral); Vancouver Coastal Health Ketamine Intervention Program at UBC Hospital (MSP-covered); QEII Halifax public hospital program; Yukon Health covers Spravato. The physician consultation is generally covered as a standard medical visit in all provinces.

Q20. Does private insurance cover ketamine therapy? Coverage varies. Spravato is the form most likely to be covered by Canada Life, Sun Life, Manulife, Green Shield, and others — typically with prior authorization for documented TRD. Generic IV/IM ketamine for psychiatric use is generally not covered. Alberta Blue Cross became the first Canadian insurer to cover psychedelic-assisted therapy including ketamine in March 2024. WCB Alberta and WSIB Ontario cover compensable injury cases. Veterans Affairs Canada covers service-related TRD or chronic pain on a case-by-case basis. See Insurance Coverage for Ketamine Therapy.

Q21. Is ketamine therapy tax-deductible in Canada? Generally yes. Physician-administered ketamine therapy and prescription drug costs typically qualify for the Medical Expense Tax Credit (Lines 33099/33199). Psychotherapy from a registered psychologist qualifies in all provinces; from a registered psychotherapist in Ontario. Confirm with a Canadian tax professional.

Q22. Is ATMA CENA program covered by Alberta Blue Cross? Coverage depends on your specific Alberta Blue Cross plan. ATMA CENA's clinical team can support insurance documentation. Verify with Alberta Blue Cross member services directly. See Alberta Blue Cross Coverage for Psychedelic Therapy.

Regulatory & legal

Q23. Is ketamine therapy legal in Canada? Yes. Ketamine is a Schedule I controlled substance under the Controlled Drugs and Substances Act, legally permitted for medical use when prescribed by a physician or nurse practitioner. Health Canada has approved ketamine as an anaesthetic; psychiatric use is off-label, a legal and common practice in Canadian medicine. Provincial physician colleges (CPSA, CPSM, CPSO, CPSBC) regulate where and how it can be administered.

Q24. Is ketamine a controlled substance in Canada? Yes — Schedule I CDSA. This is a regulatory classification, not a prohibition on medical use. Possession without a prescription is illegal. Therapeutic use under physician oversight is fully legal.

Q25. Is Spravato approved by Health Canada? Yes. Health Canada issued a Notice of Compliance for Spravato (intranasal esketamine) in May 2020 for treatment-resistant MDD in adults who have not responded to at least two antidepressant courses, in combination with an oral SSRI or SNRI (Health Canada DPD).

Q26. Why is ketamine off-label for depression? Ketamine was approved by Health Canada in the 1960s as an anaesthetic; pharmaceutical companies typically fund the trials needed for new indication approvals. Because generic ketamine is off-patent, no manufacturer has sought Health Canada approval specifically for depression. Off-label prescribing is legal and common in Canada when the prescribing physician determines it is clinically appropriate. The evidence base for ketamine in TRD is extensive (CANMAT 2021).

Modalities

Q27. What are the different ways ketamine therapy can be administered? Five clinical routes: IV infusion (~100% bioavailability; gold standard for evidence), IM injection (~93%; widely used in KAP), sublingual lozenge (~25–32%), oral (~20–30%), and intranasal — Spravato (Health Canada approved) or compounded racemic. IV is most studied; Spravato is the only route with Health Canada psychiatric approval. See What Is Ketamine Therapy? for the full modality breakdown.

Q28. What's the difference between IV and IM ketamine? IV ketamine is delivered through a vein over 40 minutes, typically at 0.5 mg/kg, with continuous monitoring. IM ketamine is a single injection into shoulder or thigh, lasting 45–60 minutes. IV has the larger psychiatric evidence base and tighter dose control; IM is logistically simpler and widely used in KAP protocols. Both are off-label for psychiatric indications.

Q29. What's the difference between ATMA CENA's psychedelic and psycholytic dosing? Psychedelic dosing uses a higher dose producing a more pronounced altered-state experience; clients typically recline with eye shades and music, minimizing external input to support an inward experience. Psycholytic dosing uses a lower dose producing a subtler shift; clients remain oriented enough to engage in active verbal therapy during the session. Both modes include preparation and integration; the right mode for an individual is determined at clinical assessment.

The session

Q30. What does ketamine therapy feel like? Patients commonly describe altered time perception, a floating or dreamlike quality, mild visual or auditory shifts, an emotional softening, and a sense of distance from habitual thought patterns. Clinical literature documents these as expected aspects of the dissociative state at sub-anaesthetic doses (van Schalkwyk et al., 2018). The experience is shaped by set, setting, and dose — not just the molecule. See Does Ketamine Therapy Get You High? for the full experience breakdown.

Q31. Does ketamine therapy get you high? Ketamine produces an altered state at therapeutic doses, but the word "high" carries recreational connotations that don't fit the clinical context. Doses are calibrated for therapeutic effect, not euphoria; the setting is supervised; the goal is psychological processing, not intoxication. The dissociative experience resolves within hours and patients return to ordinary cognition before leaving the clinic.

Q32. How long does a ketamine session last? The acute experience typically lasts 45 to 90 minutes. Full session including monitoring is 90–120 minutes for IV; Spravato requires a minimum 2-hour observation per Health Canada. Patients cannot drive for at least 24 hours after a session.

Q33. Will I be conscious during the session? Yes. Therapeutic ketamine doses are sub-anaesthetic — significantly lower than surgical anaesthesia doses. Patients remain awake, can communicate, and respond to the clinical team. The altered state is dissociation, not unconsciousness. The clinician or therapist remains present throughout.

Q34. Can I drive after a ketamine session? No. Patients cannot drive for at least 24 hours after a session. Arrange a designated driver or rideshare in advance. This applies to all clinical ketamine modalities.

Treatment course & safety

Q35. How many ketamine sessions are needed? Most acute IV protocols involve 6 sessions over 2 to 3 weeks. Spravato has a defined 4-week induction (twice weekly) followed by 4 weeks of weekly dosing. After the acute phase, many patients return for periodic maintenance every 1 to 3 months. The right number depends on individual response, durability, and clinical judgement.

Q36. Is ketamine therapy safe? At sub-anaesthetic doses with proper screening and supervised administration, ketamine has a well-established short-term safety profile (Murrough et al., 2015). Common short-term side effects: dissociation, mild nausea, transient blood pressure and heart rate elevation, dizziness, headache. Serious adverse events are uncommon at therapeutic doses with proper screening. Sessions are conducted with vital-sign monitoring throughout.

Q37. Is ketamine addictive? At therapeutic doses in supervised clinical contexts, dependency risk is low. Higher dependency risk is associated with frequent unsupervised recreational use at higher doses. Active ketamine use disorder is a contraindication for ketamine therapy. The CANMAT 2021 task force notes that misuse risk should be assessed but considers the risk low in well-screened patients on standard protocols (Swainson et al., 2021).

Q38. Can ketamine cause bladder problems? Ketamine cystitis is documented in long-term, high-dose recreational users. At therapeutic doses with proper monitoring, the risk is much lower. 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. See Does Ketamine Therapy Get You High? for the full recreational vs. therapeutic safety distinction.

Are you a healthcare provider with practice-related questions? See Practitioners FAQs.

Sources

1. ATMA CENA — Ketamine Therapy Hub: https://psychedelic.healthcare/ketamine-therapy/
2. ATMA CENA — Psychedelic-Assisted Therapy: https://psychedelic.healthcare/
3. Health Canada DPD — Spravato: https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=98903
4. CRA — Lines 33099 and 33199 Eligible Medical Expenses: https://www.canada.ca/en/revenue-agency/services/tax/individuals/topics/about-your-tax-return/tax-return/completing-a-tax-return/deductions-credits-expenses/lines-33099-33199-eligible-medical-expenses-you-claim-on-your-tax-return.html
5. Swainson J, et al. (2021). CANMAT racemic ketamine recommendations. Can J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/33174760/
6. Murrough JW, et al. (2015). Ketamine safety in TRD. J Clin Psychiatry. https://www.psychiatrist.com/jcp/ketamine-safety-tolerability-clinical-trials-treatment/
7. Wilkinson ST, et al. (2017). CBT after ketamine. Psychother Psychosom. https://pmc.ncbi.nlm.nih.gov/articles/PMC5516265/
8. Wilkinson ST, et al. (2018). Ketamine on suicidal ideation meta-analysis. Am J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/29064903/
9. Feder A, et al. (2014). Ketamine for chronic PTSD. JAMA Psychiatry. https://pubmed.ncbi.nlm.nih.gov/24499017/
10. Glue P, et al. (2017). Ketamine for social anxiety. Neuropsychopharmacology. https://pubmed.ncbi.nlm.nih.gov/28849779/
11. Rodriguez CI, et al. (2013). Ketamine in OCD proof-of-concept. Neuropsychopharmacology. https://pubmed.ncbi.nlm.nih.gov/23145663/
12. Niesters M, et al. (2014). Ketamine for chronic pain. Br J Clin Pharmacol. https://pubmed.ncbi.nlm.nih.gov/24419423/
13. Kang MJY, et al. (2022). Ketamine antidepressant mechanisms systematic review. Front Psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC9082546/
14. Drozdz SJ, et al. (2022). KAP systematic review. J Pain Res. https://pubmed.ncbi.nlm.nih.gov/35734507/
15. van Schalkwyk GI, et al. (2018). Acute psychoactive effects of IV ketamine. J Affect Disord. https://pubmed.ncbi.nlm.nih.gov/29045915/
16. Andrashko V, et al. (2021). Ketamine drug interactions systematic review. Int J Neuropsychopharmacol. https://pmc.ncbi.nlm.nih.gov/articles/PMC8538895/
17. Chrenek C, et al. (2024). Edmonton community ketamine program. Front Psychiatry. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1283733/full

Related articles

• Ketamine Therapy in Canada
• What Is Ketamine Therapy?
• Ketamine Therapy Cost in Canada
• How to Qualify for Ketamine Therapy in Canada
• Ketamine Therapy for Depression
• Does Ketamine Therapy Get You High?
• Insurance Coverage for Ketamine Therapy
• Ketamine vs Psilocybin Therapy
• Ketamine Therapy in Calgary
• Ketamine Therapy in Edmonton

Last updated: 2026-05-05