The four kinds of ketamine
Only one ketamine product is FDA-approved for depression: esketamine nasal spray (SPRAVATO), given in certified clinics with at least two hours of monitoring. IV ketamine is an approved anesthetic used off-label for depression in clinics. Compounded at-home ketamine is not FDA-approved for any psychiatric use, and street ketamine is illegal and unregulated.
Esketamine (Spravato), IV ketamine, compounded at-home ketamine and street ketamine compared: what is FDA-approved, how each is given, and the risks.
Approved, off-label, compounded or illicit: the word 'ketamine' covers all four.
Key takeaways
- Esketamine (SPRAVATO) is the only form FDA-approved for depression.
- IV ketamine for depression is legal off-label use, with a strong research base but no standard protocol.
- The FDA has warned about compounded ketamine used for psychiatric conditions without proper oversight.
- Street ketamine has unknown contents and is linked to serious bladder damage with frequent use.
Esketamine nasal spray (SPRAVATO)
Esketamine is one half of the ketamine molecule. As SPRAVATO, it is FDA-approved for adults with treatment-resistant depression, either on its own (since January 2025) or with an oral antidepressant, and, with an oral antidepressant, for depressive symptoms in adults with major depression who have acute suicidal thoughts or behavior. It is only available through a restricted program (REMS): it is taken at a certified healthcare setting, under supervision, with monitoring for at least two hours afterwards. It cannot be taken home.
IV ketamine infusions
Racemic ketamine has long been an approved anesthetic. Doctors may legally prescribe it for depression 'off-label', usually as an infusion in a clinic with monitoring. The research base for treatment-resistant depression is substantial, including a large 2023 trial comparing it with ECT. Off-label means the FDA has not reviewed it for depression, so there is no depression-specific label or standard protocol, and insurance coverage is less common.
Compounded and at-home ketamine
Compounding pharmacies can make ketamine as tablets, lozenges or nasal sprays, sometimes prescribed through telehealth for use at home. In October 2023 the FDA warned that compounded ketamine is not approved for any psychiatric disorder, that safe and effective psychiatric dosing has not been established, and that sedation, dissociation and changes in vital signs without proper medical oversight may put patients at risk of serious adverse events.
Street or recreational ketamine
Ketamine is a controlled substance. Ketamine bought outside medicine has unknown strength and may contain other substances, and there is no one to help if something goes wrong. Frequent recreational use is linked to bladder inflammation (ketamine cystitis) and, with prolonged use, kidney damage. It is not a form of treatment.
Frequently asked questions
Is esketamine the same as ketamine?
Esketamine is one of the two mirror-image forms that make up ordinary (racemic) ketamine. They are related but are separate medicines with separate approvals.
Can I get SPRAVATO to use at home?
No. Under its restricted program it is only given at certified healthcare settings, with monitoring for at least two hours.
Related on Beiing
- At-home and telehealth ketamine - What the FDA warned about.
- Evidence by condition - Where the research is strong and where it is early.
- Ketamine for mental health - The hub for every page in this guide.
Sources
- SPRAVATO (esketamine) nasal spray, prescribing information - Janssen Pharmaceuticals, via DailyMed (U.S. National Library of Medicine)
- SPRAVATO approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression (21 January 2025) - Johnson & Johnson (manufacturer press release)
- FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders (October 2023) - U.S. Food and Drug Administration
- Ketamine comparable to ECT for many patients with refractory depression (ELEKT-D trial, New England Journal of Medicine, 2023) - Psychiatric News (American Psychiatric Association)
- Anderson DJ, et al. Ketamine-induced cystitis: a comprehensive review of the urologic effects of this psychoactive drug. Health Psychology Research, 2022 - Health Psychology Research, via PubMed Central
Written by Beiing Editorial Team · Editorially reviewed by Beiing Editorial & Research Review · Published · Last reviewed . Editorial and research review by Beiing writers and researchers. This is not medical or clinical review, and no clinician signs off on our content.
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