Best Ketamine Therapy

Mental health can be a hard hill to climb. Take, for instance, treatment-resistant depression (TRD), a diagnosis given when at least two different antidepressants haven’t been able to sufficiently help a patient despite adequate treatment durations and dosage adjustments.2 Out of the 8.9 million adults in America with medication-treated major depressive disorder, 2.8 million of them (about 31%) have this condition.1 What can help them?

Ketamine therapy might. As an off-label treatment, it has grown rapidly in popularity in the past few years.3 And not just for TRD, as it’s also yielded positive outcomes for a multitude of mental and physical health concerns. PTSD, anxiety, substance use disorders, and chronic pain are just a few.4

In this guide, we cover everything you need to know about ketamine therapy and compare the top online platforms in terms of their cost, treatments, safety, convenience, availability, and more. If you’re short on time, check out our summary of recommendations below.

Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions involving staying healthy and living healthier lifestyles.

For our guide to the best online ketamine therapy, we spent over 100 cumulative hours researching ketamine therapy and the marketplace of platforms. Our deep dive into the science behind ketamine therapy included investigating its history, benefits, safety, side effects, legal status, and more. Our team also gained hands-on experience with each of the platforms in this guide to accurately detail the patient experience.

Additionally, like all health-related content on this website, this review was thoroughly vetted by one or more members of our Medical Review Board for accuracy. As research on ketamine therapy evolves, we’ll update this guide accordingly.

When evaluating online ketamine therapy platforms across the competitive landscape, we considered five key patient-centric criteria:

• Safety measures
• Value for your money
• Geographic availability
• The convenience of the overall therapy experience

Let’s see how each of our top picks fared.

Safety

Advantage: Innerwell

Since ketamine is a dissociative anesthetic with some hallucinogenic properties, a ketamine therapy service ought to prioritize its patients’ safety and comfort to be considered one of the best.5 Each of our recommendations satisfies the baseline criterion for safe treatment: requiring an initial health consultation to validate candidacy. Among them, Innerwell, Mindbloom, and Better U go steps further, and Innerwell goes the furthest length of them all.

ID verification is probably the first measure any online ketamine patient should face. Since ketamine is a controlled substance, it’s important to ensure that the person being prescribed the treatment is who they say they are, and that they’re at least 18 years old. (Some telehealth platforms have gotten in trouble for verifying IDs but not ages before approving treatments.)6 Innerwell, Mindbloom, and Joyous all outright say that your ID will need to be verified. Better U and Kalm, on the other hand, state only that patients may be asked to verify ID.

Then there are sitter requirements. A sitter is a trusted person over the age of 18 who basically “babysits” you during your ketamine sessions. Innerwell, Mindbloom, and Better U all require this, which is appreciated, as it means patients have someone nearby to spot any major changes in the patient’s status. (Joyous and Kalm don’t require sitters because their low-dose treatment approach obviates the risk of a meaningful anesthetic or hallucinogenic effect.)

It’s integration that really gives Innerwell the edge over Mindbloom and Better U on safety. Innerwell’s integration sessions are led by licensed mental health professionals — psychiatric clinicians, to be precise — which provides the patient with a more informed level of oversight. Moreover, each patient meets with their assigned clinician multiple times over the course of their treatment, not just once. This close, repeated contact with a licensed mental health care professional means that safety concerns can be more easily reported, or else caught by the clinician if unnoticed by the patient.

Cost

Advantage: Better U

Even though Joyous isn't the least expensive on our list, we feel that it offers patients the best value for their financial investment. To better understand what we mean, first check out this chart comparing the total costs and per-dose prices of our top picks (all prices refer to self-pay, not with insurance):

If you examine only the treatment costs, Kalm and Joyous would appear to be the clear winners. But the reason they’re so affordable is that they don’t provide as much as the competition:

• Treatments use low-dose ketamine.
• Sessions are independent, not guided by a coach or clinician.
• Peer support isn’t offered.
• You aren’t given any extras, like a blood pressure cuff or journal.

Better U, on the other hand, uses standard ketamine therapy dosing and does give patients access to the above-mentioned extras, all at a lower price than its closest competitors. It also offers a pay-as-you-go financing option that can reduce costs to as low as $54 per month. (All Better U patients can apply for financing, but approval is guaranteed only for patients who sign up for the nine-session “Transformation” package. The five-dose “Introduction” plan can still be financed, but your application may not be approved.)

If you aren’t eligible for financing, Better U also offers the option to pay using the installment service Affirm or Afterpay.

Availability

Advantage: Kalm

Mindbloom used to be our winner here, but it has since been overtaken multiple times over. Innerwell added a grip of states to its service range and is now tied with Mindbloom, while Better U gained a half dozen more territories and now serves 37.

But none of them, at this time, can compete with Kalm’s 50-territory range.

• Kalm: 50 territories
• Better U: 37 territories
• Innerwell: 34 territories
• Mindbloom: 34 territories
• Joyous: 28 territories

Mind, these counts are current as of April 2026, and they may change. With practically all telehealth platforms, service ranges fluctuate constantly.

Convenience

Advantage: Joyous

The question of convenience comes down to this: Which platform can most seamlessly integrate into a person’s schedule?

Two platforms, actually. They’re Joyous and Kalm.

The reason is that neither one requires patients to have a “sitter,” or a trusted adult who is physically present as a sort of spotter throughout the duration of all sessions.

To clarify, we are not against the idea of a sitter requirement. Quite the opposite, in fact. Since ketamine is a drug with mind-altering effects, sitters are great for ensuring the patient’s safety and comfort, especially.7 But not every eligible ketamine candidate can easily fill the sitter role. Someone with a depressive disorder, for example, might have just a small social group or inadequate social support: hence, slim pickings for a reliable sitter.8 With Joyous and Kalm, the ketamine doses are very low, meaning that there shouldn’t be any psychedelic effects.

Another point goes to Joyous for its consultation appointment system. Say that you want to set your appointment for some future date but don’t know exactly when a good day or hour will be. All you need to do is provide a phone number, and every morning Joyous will text you a link to available times. For some prospective patients, this system allows for a greater degree of flexibility since it lets them set same-day appointments when they’re more certain to have free time. As a cherry on top, Joyous’ consultations are thorough but relatively brief at around 15 minutes (as opposed to the near-hour with Innerwell), making it easier to slot them into a day’s agenda.

Below is a chart comparing our top ketamine therapy platforms across key points, including pricing, insurance eligibility, and location availability (the listed prices are for self-pay options).

This next chart shows which online ketamine therapy services are available in which U.S. territories (as of April 2026):

Ketamine (a.k.a. ketamine hydrochloride), a Schedule III controlled substance, is a mixture of two “mirror-image” molecules called R-ketamine (arketamine) and S-ketamine (esketamine). When we refer to ketamine therapy, it’s this dual-molecule form we mean. It’s not to be conflated with the esketamine-only variant called Spravato.

Currently, ketamine is FDA-approved only for the “induction and maintenance of general anesthesia,” but it may also be prescribed off-label to treat various psychological and physical health conditions, including but not limited to:9 10 11 12

• Depression (particularly TRD)
• Anxiety
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Substance use disorders
• Chronic pain

(Note: Aside from its mono-molecular structure, Spravato stands apart from ketamine for having FDA approval for TRD.)

When ketamine is prescribed off-label for such concerns, it’s administered at doses far lower than what’s used for anesthesia. To put it in perspective, for depression, therapeutic ketamine is most commonly administered at a quantity of 0.5mg/kg, whereas the average dose needed to induce 5–10 minutes of anesthesia would be 2mg/kg.13 14 In a 190lb adult, the exact doses would amount to 43mg for the former but 172mg for the latter — a fourfold difference.

While in-person ketamine clinics ordinarily administer ketamine via injection, online ketamine therapy platforms more often use orobuccal routes of administration. Typically, it’s a troche, a sort of lozenge that you let dissolve in your mouth for a specified length of time and then spit out the excess (swallowing your troche or ketamine-infused saliva may result in overdose.)15

That being said, some online platforms give their patients the choice between orobuccal administration and injections. The injection route usually requires that one lives nearby one of the platform’s brick-and-mortar clinics, but not always. Mindbloom, for example, offers at-home subcutaneous injections as an alternative to its troches.

Much of ketamine’s therapeutic potential is attributed to its apparent ability to promote increased neuroplasticity (a.k.a. neural plasticity or brain plasticity), which entails “adaptive structural and functional changes to the brain.”30 31

Basically, neuroplasticity is your nervous system’s ability to adapt and change its structure, functions, and connections in response to different stimuli, both internal (e.g., hunger, body temperature, emotions) and external (e.g., sounds, lights, smells, injuries). Two major mechanisms are at play:

• Neuronal regeneration/collateral sprouting: This is when neurons generate additional branches to create new connections between existing neurons.32
• Functional reorganization: After a head injury, the brain undergoes changes that let its other parts take over control of the injured area’s functions. Though how this happens isn’t yet fully understood, the prevailing theory is that (a) the opposing side of the brain sustains lost function (equipotentiality) or (b) the brain can reorganize portions of itself to take on other functions (vicariation).33

But how is neuroplasticity tied to the mental and even physical health concerns that ketamine might treat? Let’s break it down.

No two people have identical experiences with online ketamine therapy, but there are some common touchstones and checkpoints:

When used as directed, low-dose ketamine therapy should be relatively safe for anyone who doesn’t have a contraindicating health status, such as:

• Pregnancy or breastfeeding16
• Heart disease, low blood pressure, or high blood pressure17 18 19
• Serious mental health conditions, like borderline personality disorder (BPD) or psychotic disorders20 21
• Liver or kidney disease22 23
• Seizures or epilepsy (either a personal or family history)24
• Use of certain drugs, such as antidepressants, anti-anxiety drugs, or narcotics19

That being said, ketamine, like other controlled substances, isn’t without risks.26 The United States Drug Enforcement Administration (DEA) classifies ketamine as a Schedule III drug,5 defined as any substance “with a moderate to low potential for physical and psychological dependence.”27 For reference, here’s a glimpse at other drugs in the same and other classes:

• Schedule I (highest risk of abuse): LSD, heroin, MDMA, psilocybin, methaqualone
• Schedule II: Vicodin, cocaine, methamphetamine, oxycodone, fentanyl, Adderall, Ritalin
• Schedule III: Testosterone, anabolic steroids, Tylenol with codeine
• Schedule IV: Xanax, Ambien, Ultram, Valium, Provigil
• Schedule V (lowest risk of abuse): Lyrica, Parepectolin, Robitussin AC, Motofen

So, while ketamine doesn’t have as high an addiction risk as, say, fentanyl or heroin, it still has “moderate” potential for dependence, particularly in higher doses.28 That’s why it’s important that you adhere to the proper dose and dosing frequency prescribed by your prescribing clinician. If you feel that you’re becoming dependent on ketamine, at any point during therapy, you should notify your clinician promptly.

Ketamine side effects

Being a sedating, dissociative drug, ketamine can cause a variety of short-term, usually transient adverse effects:29

• Dreamlike states
• Hallucinations
• Sedation
• Difficulty learning, paying attention, and remembering
• Confusion
• Memory loss
• Muscle stiffness or numbness
• Problems moving (sometimes to the point of being immobile)
• Problems speaking
• Increased blood pressure
• Nausea or digestive upset
• Unconsciousness
• Slowed breathing (that, in severe cases, can lead to death)

Also, although therapeutic ketamine is typically used on a short-term basis, it’s worth mentioning the potential adverse outcomes from long-term use, such as:29

• Bladder pain or ulcers
• Kidney problems
• Stomach pain
• Poor memory
• Flashbacks
• Depression

Many of these risks are associated with higher ketamine doses than what you’d get from an online platform. Per a 2024 review, ketamine taken as directed, with “judicious dosing” under medical supervision, is relatively safe.50 Still, if you experience any unpleasant or persistent side effects during treatment, make sure to share your concerns with your prescribing physician; they’ll be able to determine what’s normal versus what’s worrisome.

Ketamine therapy may be suitable for generally healthy, nonpregnant, non-breastfeeding people who (a) live within a platform’s service range and (b) have a health concern that the drug has shown potential in treating:11

• Depression
• Anxiety
• Substance use disorders
• Eating disorders
• PTSD
• OCD
• Chronic pain12

If your health issue isn’t included in the above list but you’re still curious whether you might benefit from ketamine therapy, we recommend speaking with your doctor or a clinician from one of our recommended platforms. Several of our recommendations offer free or refundable virtual consultations.

Who should look elsewhere?

There are several contraindicated populations for ketamine therapy:

• Women who are pregnant or breastfeeding (ketamine could harm the fetus or baby)16
• People with blood pressure concerns or heart disease17 18 19
• People with serious mental health disorders (e.g., BPD, schizophrenia, schizoaffective disorder)20 21
• People with liver or kidney disease22 23
• People on certain medications (anxiolytics, muscle relaxants, antiepileptic drugs, anticonvulsants, narcotics, bronchodilators, some antidepressants, etc.)19
• Anyone who has attempted suicide or has recently had suicidal thoughts
• Anyone with a family or personal history of seizures or epilepsy24
• Anyone who has not yet tried other, more conventional therapeutic approaches (it’s often advised to do so before trying ketamine therapy)25

Additionally, we’d be remiss not to acknowledge that ketamine therapy can be pretty expensive. Even Kalm, at $124 per month, can pose a major financial burden to some. If you have insurance, it could be worth trying covered alternatives first (Spravato, the FDA-approved esketamine nasal spray, may be an option if you go this route). Even if you don’t have insurance, some telehealth platforms offer affordable alternatives. Hims, Hers, and Nurx, for example, all offer prescription medications for a variety of mental health conditions.

Best for most people, best patient support

Innerwell provides a range of online mental health services: psychiatry, talk therapy, EMDR, psychedelic integration, and ketamine therapy.

A few standout aspects of Innerwell’s ketamine treatment cemented it not only as our top pick for most people but also as the platform with the best patient support. The most notable highlights are as follows:

• Psychiatric clinicians: Innerwell is the only service in this guide with integration sessions run by a psychiatric clinician instead of a coach. This means that you’ll be able to discuss your treatment experiences with an expert, not just someone who works for the company.
• Treatment lengths: Patients can choose from an eight-dose treatment program or a 24-dose one, the latter of which is the longest plan of any of our top picks (Mindbloom comes in second with an 18-dose option).
• Real therapy sessions: Both Innerwell plans include one psychotherapy session in addition to the regular psychiatric clinician consultations. While competitors may offer apps with guided programs, an actual therapy session with a mental health professional can offer patients a truly personalized treatment experience. (Additional therapy sessions, EMDR, or psychiatry services can also be added on.)
• Insurance coverage: While the selection is a bit limited, Innerwell does accept certain insurance plans. None of our other picks accept insurance.

Innerwell’s biggest drawback is its relatively limited availability. Currently, it’s available in 34 states — an increase from 25 last year, but still fewer than Better U and Kalm.

On the other hand, Innerwell, like Better U, has a couple of brick-and-mortar treatment facilities, with its New York office offering in-person consultations, follow-up visits, and therapist-led ketamine treatment sessions.

Also of note, Innerwell provides what we found to be the most comprehensive consult among our recommendations. Whereas other platforms held only brief consults no longer than 15 minutes, our Innerwell consult lasted nearly an hour, during which the clinician covered practically everything we wanted to know about the ketamine therapy program. By the end, we had only two questions, both of which were follow-ups to details the clinician had given us, not anything we’d had in mind going into it.

Innerwell ketamine therapy pricing and accepted insurance plans

Innerwell offers two different ketamine therapy treatment plans: The Foundation Program (eight doses) and The Extended Program (24 doses). During sign-up, patients can add on any extra services (talk therapy, psychiatry, or EMDR) for an additional cost.

You can pay for your Innerwell plan in full or in monthly installments, either entirely out of pocket or with some assistance from an accepted insurance plan.

Here’s how Innerwell’s two ketamine therapy plans compare:

With either plan, part of the total expense is the $350 nonrefundable clinician consult. The only way to get that back is to cancel your plan before your consult takes place. If you cancel afterward, you get back only what you’ve paid in excess of $350. Future refund amounts depend on how many prescriptions have been fulfilled and how many check-ins you’ve completed. With the Foundation, for example, canceling your plan after your first ketamine shipment but before your first check-in, amounts to a total charge of $550, and you get a refund for however much you’ve already paid above that amount. Additional details of Innerwell’s refund policy can be found in the website’s FAQ section.

On the flip side of finances, Innerwell is the only one of our recs that accepts health insurance. Its list of providers, as well as of eligible states, has expanded since we last checked. Below are the eligible plans at the time of this writing:

Even if your insurance provider isn’t named in the eligible plans list, you may still be qualified for a reimbursement upon submission of an itemized bill.

Best budget option

Available in 37 territories, Better U is an online wellness platform that offers psychiatry, talk therapy, longevity treatments, sexual health support, and weight loss medications in addition to ketamine therapy.

Better U’s ketamine therapy plans are relatively short compared to those offered by competitors. The company offers two plans: five doses and nine doses. These plans are short compared to our other standard-dose recommendations, but Better U still offers a generally more affordable ketamine therapy experience without compromising on patient support. Like Innerwell and Mindbloom, Better U gives all patients a free starter kit that includes a blood pressure cuff, eye mask, journal, and a pair of heart diffraction glasses. (The glasses make lights look like hearts, which we imagine is a measure to make treatment sessions more “fun.”)

Similar to Mindbloom, Better U has a companion app. It includes:

• Structured sessions for use during treatments (categories include Heal, Grow, Love, Transcend, Healing from Sexual Trauma, PTSD, and Processing Grief)
• Meditations
• Breathwork exercises
• Trackers for your progress, moods, and symptoms

In the app, you can also message your Better U care team and attend one-on-one virtual sessions (e.g., integration coaching).

Additionally, if you live in New York, California, or Florida, you can go in person to a Better U clinic for your ketamine therapy sessions. In addition to the lozenges, the clinics offer ketamine infusions and injections. Note that in-office treatments may be more expensive than at-home ones.

Better U ketamine therapy pricing

Better U offers two plans for at-home ketamine therapy:

• Introduction (five doses/sessions): intended for people with mental health challenges within the last year
• Transformation (nine sessions): for people whose concerns have been affecting them for longer than a year

Here’s how the options compare on price:

When your plan ends, you can resume treatment with Better U at the reduced price of $79 per session. In comparison, Mindbloom charges $129–$159 per session for returning clients, or up to $80 more than Better U.

As with most of our recs, Better U is not covered by insurance. It does accept HSA/FSA, but make sure to check with your plan administrator first.

If you aren’t approved for financing, Better U offers installment payments at checkout through Affirm or Afterpay. This variety of flexible payment options can improve treatment accessibility, and it’s one of the driving factors behind our choosing Better U as the best budget ketamine therapy platform.

Best injectable ketamine therapy

Mindbloom offers a pretty supportive platform overall:

• Your sessions can be customized through the Mindbloom app to fit your area of concern (e.g., depression, grief, PTSD, burnout, etc.).
• You have access to a clinician, guide, and peer community to help you along your treatment journey.
• You also receive a starter kit (“Bloombox”) similar to those of Innerwell and Better U. It contains a journal, a welcome guide, an eye mask, and a blood pressure monitor.

Mindbloom used to be the most widely available option, but has since been overtaken several times over. Still, it remains distinguished on the landscape for offering subcutaneously injectable ketamine in addition to oral treatment.

Why choose a subcutaneous injection over an oral form? Other than a sizable portion of ketamine studies having centered on injection-based delivery, some people may find that a quick needle poke is actually less unpleasant than holding a dissolvable tablet in their mouth for upwards of ten minutes. It’s also potentially more absorptive and a bit more predictable than a tablet, whose rate of dissolution can vary depending on the amount of saliva in the mouth.52 Predictability mitigates the theoretical risk of overdose that comes with troches.

Yet predictable absorption relies on proper preparation of the syringe, while the preparation itself introduces the risk of human error. If an improperly filled syringe leads to an erroneously high dose, it could yield adverse effects and possibly even a higher risk of overdose or dependence. If you aren’t confident in your ability to self-administer an injection, you’re better off sticking with the oral route.

To learn more about Mindbloom, check out our full review.

Mindbloom lawsuit

Another, less favorable way that Mindbloom stands apart is that it’s the only platform in this guide to be the subject of a wrongful-death lawsuit.

In 2025, the family of a North Carolina man named Phillip Ward filed the lawsuit alleging that Mindbloom’s clinical negligence led to Ward’s death by ketamine toxicity two years earlier. The lawsuit centers on the fact that Ward had presented as a risky patient — being a current Spravato patient at the time of intake, and then skipping clinician appointments and missing payments — which should have compelled Mindbloom to undertake a clinical review, which it did not.51

The circumstances are unfortunate, but also not exactly rare. In any line of work, negligence occurs. That’s to say that Mindbloom isn’t the only telehealth entity susceptible to poor oversight at times, and with a platform as popular as Mindbloom’s, there’s a greater likelihood of this happening. So, should you consider trying ketamine therapy, you can see that it’s important to loop your primary care provider into your medical decisions, to get a multi-angle view of your suitability for treatment.

Mindbloom ketamine therapy pricing details

Mindbloom is the most expensive online ketamine therapy service in this guide. There are three purchasing options for new clients and two for returning ones. Here’s how the pricing breaks down (tablets and injectables cost the same):

Like Innerwell, Mindbloom requires customers to pay the first installment of their plan at checkout, even before the consultation appointment. Also, because clients pay for two sessions per installment, the cost of the installments is not the same as the costs per session detailed in the chart above:

• 6 sessions: $430 per month for three months
• 12 sessions: $370 per month for six months
• 18 sessions: $330 per month for nine months

Therefore, no matter which program you choose, you’ll need at least $330 available just to book an evaluation.

But at least Mindbloom will refund your installment if you don’t qualify, so there’s at least some degree of risk-freedom, and it’s one major notch above Innerwell’s no-refund-for-a-consultation policy.

Best very-low-dose ketamine therapy

Joyous takes a different approach to ketamine therapy compared with most competitors. Its primary distinguishing point is that it administers very-low-dose (“psycholytic”) ketamine, beginning at around 10mg, whereas most platforms give you several hundred milligrams to start.

The very-low-dose approach circumvents the dissociative experience normally associated with psychedelic therapy. The authors of a 2022 research article explain:

“Unlike psychedelic therapy, psycholytic therapy aims at a less deeply altered state, with less loss of core self-identity. It does not aim at a dissolution of the ego, but only at a temporary change or softening of ego experience.”41

This is why Joyous doesn’t require patients to have a sitter or guide with them during daily treatment sessions. The risk isn’t high enough to require it.

There’s a shortcoming to be found here. A very-low-dose, psycholytic approach is supposed to go hand-in-hand with psychotherapy,42 but Joyous does not offer any. At most, it has you complete automated daily post-dose check-ins and monthly follow-ups with a nurse practitioner. So, while the Joyous journey is convenient for the degree of independence it permits, it may also be less predictable in its therapeutic outcomes.

Joyous ketamine therapy pricing

Joyous poses the lowest barrier to entry among our recommendations. For one thing, the program costs just $129 per month with a minimum three-month commitment. Even without the commitment, it’s only $159 for the first three months before the price drops to $129. For another thing, consultation is free. So, while Kalm may have a lower starting price point, it’s with Joyous that you’ll have fewer financial restraints to get started.

Remember, for that price, there’s a lot you don’t get with Joyous. You get much lower doses compared with competitors, no starter kit, and no support infrastructure. Still, if you’d prefer Joyous’ hands-off approach, then you might look into one of the best online therapy platforms as an adjunct to your treatment.

Most widely available ketamine therapy

Kalm stands out in a couple of ways. One is that it’s currently licensed in all 50 states, giving it the largest service area among our recommendations. Second is that it offers two dose tiers:

• Micro-dose: similar to Joyous’ very-low-dose option
• Low-dose: closer to what you’d get with Innerwell, Better U, or Mindbloom — for experienced users

With its combination of a broad service range and tiered dosing, Kalm effectively removes two major limitations of most online ketamine therapy platforms. With our other recommendations, many U.S. residents simply don’t have access to treatment, or else they have to commit a while to a platform that may not offer the dose strength they need. In that regard, Kalm presents itself as a compelling starting point for people who are new to online ketamine therapy.

But it has the same shortcomings as Joyous. You won’t get any integration support, for example, so it’s largely an independent care journey.

Kalm ketamine therapy pricing

The micro-dose plan costs $124 per month and comes with 30 daily doses. The low-dose plan costs $174 per month, is billed only every two months ($348 per payment), and may vary in dose quantity. These prices, by the way, aren’t exactly fixed, as Kalm has a kind of low-price guarantee. If you find a platform that costs less, Kalm will beat it by 20%.

First-month’s payment precedes your consultation, so you’ll need at least $124 to get started. Should you decide not to move forward with treatment, or you’re deemed ineligible, you get your money back.

At the time of this writing, there are two main alternatives to telehealth ketamine therapy services: Spravato nasal spray and in-person ketamine therapy infusion clinics. Let’s go over how these options differ from the services in this guide, including how they might better suit some people’s needs.

Spravato nasal spray

If you’re suffering from TRD and you have health insurance, then it may be worth investigating whether or not your plan covers the FDA-approved nasal spray Spravato.

Traditional ketamine (ketamine hydrochloride) is made up of two “mirror-image” molecules: arketamine and esketamine. Spravato, in contrast, contains esketamine only.9 Clinical trials have found that intranasal esketamine can “provide significant short-term symptom improvement in TRD, with only transient and mild-to-moderate side effects” experienced by most patients.44

However, a 2024 review notes that arketamine (the other molecule) “exhibits superior and longer-lasting antidepressant effects” compared to esketamine in animal models of depression.45 Similarly, another 2024 review explains that arketamine performs better as an antidepressant and anti-inflammatory treatment.46 So, at least for some people, Spravato may not provide as strong a therapeutic effect as ketamine hydrochloride.

Also, Spravato needs to be administered in-office under the guidance of a healthcare provider. After administration, the patient must be closely monitored for at least two hours and until potential side effects like sedation, dissociation, and respiratory depression resolve. Once the two hours are up and the patient is stable, they’re permitted to leave, but they are not allowed to drive themselves.43 In other words, it’s certainly less convenient than the platforms we recommend in this guide.

In-person ketamine therapy infusion clinics

In-person clinics typically administer ketamine via intravenous infusion (probably the most widely studied form) under strict clinical oversight (the safest environment). They tend to be far more expensive than telehealth, most likely because brick-and-mortar clinics also need to cover costs of the facility, staff, equipment, and so on. But for people who prefer to minimize the human-error element of ketamine therapy, they’re the place to go.