Ketamine is a medication that has been used safely as an anesthetic in medical settings for more than fifty years. In the last two decades, research has demonstrated that ketamine—at much lower doses than those used for anesthesia—produces rapid and meaningful antidepressant effects in patients with treatment-resistant depression, severe anxiety, PTSD, and acute suicidal ideation. It works through a different mechanism than traditional antidepressants, which is why it can help patients who haven’t responded to SSRIs or SNRIs.
How ketamine works in the brain. Most antidepressants work through the serotonin or norepinephrine systems. Ketamine works on the NMDA receptor and the glutamate system, which is a fundamentally different pathway. The current understanding is that ketamine promotes rapid changes in synaptic connectivity—the way brain cells communicate with each other—which appears to underlie its rapid antidepressant effect. This is why ketamine can produce improvement within hours when standard antidepressants take weeks.
Not an opioid. One of the most common patient questions is whether ketamine is an opioid. It is not. Ketamine is a dissociative anesthetic, specifically an NMDA receptor antagonist. It does not produce the kind of dependence pattern associated with opioids, and it doesn’t carry the same overdose risk profile when administered in a clinical setting. The recreational misuse of ketamine that occasionally appears in headlines involves uncontrolled, unmonitored use—very different from medically supervised infusion therapy.
Why ketamine therapy exists. Standard treatments help many patients, but about a third of depression patients don’t respond fully to the first medication tried, and many cycle through multiple medications without sustained benefit. For these patients—and for patients in active mental health crisis where conventional antidepressants are too slow—ketamine represents a different option with a different mechanism and a different timeline.
Ketamine therapy is most established for several specific conditions:
Treatment-resistant depression. This is the primary use of ketamine therapy. “Treatment-resistant” usually means depression that hasn’t responded fully to one or more antidepressant medications, typically with adequate doses and adequate trial durations. For these patients, ketamine offers a fundamentally different mechanism and can produce response when other treatments haven’t.
Acute suicidal ideation. Ketamine has one of the most distinctive features in psychiatry: rapid reduction in suicidal thoughts, often within hours. For patients in active suicidal crisis who can be safely managed in an outpatient setting, ketamine can provide rapid relief while longer-term treatment is being established. Ketamine therapy is not a replacement for emergency care during an acute crisis; if you are in immediate danger, please call 988 or go to your nearest emergency room.
Post-Traumatic Stress Disorder (PTSD). Growing evidence supports ketamine for treatment-resistant PTSD, particularly in survivors of mass-casualty events, veterans, first responders, hurricane survivors, and patients with severe trauma symptoms that haven’t fully responded to trauma-focused therapy and standard medications. Ketamine is typically used as part of a broader treatment plan that includes therapy.
Severe anxiety. Ketamine shows benefit for severe or treatment-resistant anxiety, particularly when it co-occurs with depression. Patients with disabling anxiety who haven’t responded to SSRIs, SNRIs, or benzodiazepines may benefit from ketamine.
Addiction and substance use disorders. Ketamine has shown promise for certain substance use disorders, particularly alcohol use disorder, when integrated with broader addiction treatment. This is an evolving area of practice.
Whether ketamine is right for your specific situation is a conversation we have during evaluation.
Many patients searching for ketamine therapy have heard about it but don’t know what to expect. Here’s what actually happens during a session:
You arrive at the clinic. Sessions take place in a private, comfortable treatment room. We typically recommend you eat lightly beforehand and avoid heavy meals immediately before treatment. You can bring a book, headphones, eye mask, or anything else that helps you settle in.
You meet with the nurse who administers your infusion. An experienced registered nurse establishes the IV, reviews your vitals, and discusses the plan for the session. We monitor blood pressure, heart rate, and oxygen throughout the session.
The infusion begins. Ketamine is delivered slowly through the IV over about 40 minutes. The dose is much lower than the dose used for surgical anesthesia—calibrated for therapeutic effect, not unconsciousness. You remain awake and able to communicate throughout.
What the experience feels like. Most patients experience a mild to moderate dissociative state during the infusion. This can include feeling detached from the body, time distortion, sensory effects (colors, music, or images feeling unusually vivid), or a sense of looking at thoughts and feelings from outside them. Some patients describe this as relaxing or even profound; some find it uncomfortable but tolerable; few find it overwhelming when properly dosed. The dissociation itself appears to be related to the antidepressant effect—the experience isn’t a side effect to tolerate, but appears to be part of how ketamine works.
The infusion ends. After the ketamine stops, the dissociative effects fade over the next 15-30 minutes. You’ll rest in the treatment room until you feel ready to leave, typically about an hour after the infusion ends. Most sessions are completed within two hours total.
You’re driven home. You cannot drive yourself home after a ketamine infusion. You must have someone trusted available to drive you. We may be able to help arrange Uber or Lyft if needed, but planning ahead is important.
The rest of your day. Most patients feel tired, mildly groggy, or quiet for the rest of the day. By the next morning, most feel back to normal—and many notice the antidepressant effect by then.
A standard course of ketamine therapy for depression typically involves about six infusion sessions, usually scheduled twice a week for the first two to three weeks. After the initial course, some patients benefit from periodic maintenance infusions—every few weeks to every few months—to sustain response. Others don’t need additional infusions and instead transition to maintenance approaches like medication, therapy, or TMS.
Why six sessions. A single infusion can produce notable improvement within hours, but the effect of one infusion typically lasts only days to weeks. The repeated sessions of the initial course are designed to produce a more sustained response—and patients who complete the full course generally maintain benefit longer than patients who do single sessions.
What patients typically notice during the course. Many patients notice improvement after the first infusion, often within 24 hours. Sleep often changes early. Mood and energy typically follow. Patients with active suicidal ideation often report rapid relief from the most intense thoughts. The full benefit of treatment is usually clear by the end of the standard course.
After the initial course. The duration of response varies significantly between patients—some maintain benefit for months without further treatment, others need periodic maintenance infusions, and others transition to other treatments to sustain the response ketamine produced. We work with you on the maintenance plan that fits your response and your situation.
Hurricane season scheduling. Between June and November, hurricane preparation, evacuation, and recovery occasionally affect session scheduling. The six-session course is more flexible to weather disruption than treatments requiring daily sessions, and we work with patients on rescheduling as needed when storms affect the metro.
The Pulse nightclub attack on June 12, 2016, killed 49 people and injured 53 others. It was, at the time, the deadliest mass shooting in U.S. history. Pulse was a gathering place for Central Florida’s LGBTQ+ community, and many of the victims were young Hispanic and Latino people who came to dance and be among their community. The attack left lasting impact on the survivors, the families of those killed, the first responders who answered that night, and the broader LGBTQ+, Hispanic, and Latino communities of Central Florida. We want to name this directly because patients searching for treatment-resistant PTSD care in Central Florida often have specific experiences in mind.
Who carries the trauma. Direct survivors. Family members of those killed. First responders from Orlando Police, Orange County Sheriff’s, Orlando Fire, Orange County Fire Rescue, and the FBI Hostage Rescue Team. Healthcare workers who received victims at Orlando Regional Medical Center and across the broader hospital system. Community members who lost friends or chosen family. The broader LGBTQ+, Hispanic, and Latino communities who have carried what happened in the years since, including through anniversary commemorations.
Why ketamine may help patients in this population. Many patients in this population have had years of trauma-focused therapy and medication that helped some but hasn’t been enough. For patients whose PTSD has been resistant to standard treatment, ketamine has growing evidence as a meaningful additional option. The rapid onset can be particularly important during anniversary periods, around news of new attacks elsewhere, or during specific reactivation triggers. The treatment course can be planned to support trauma-focused therapy that may be otherwise stalled.
How we approach this work. We provide care that is welcoming and affirming to LGBTQ+ patients, Hispanic and Latino patients, and the full diversity of Central Florida. We approach trauma care without sensationalizing, and in coordination with whatever other care you may already be receiving. Many patients in this population have specific clinicians, therapists, support groups, or community organizations they’ve worked with for years; ketamine is most effective as a complement to that care, not a replacement.
Central Florida lives with hurricane season every year, and the recent pattern of major storms—Ian in 2022, Helene and Milton in 2024, the broader stretch of intensifying storm seasons—has produced real cumulative trauma in this region. For some patients, a specific hurricane experience produced acute PTSD that has been resistant to standard treatment. For others, the accumulating effect of repeated evacuations, structural damage, financial stress, and the chronic state of preparedness has built into depression and anxiety that haven’t responded fully to medication.
Ketamine’s growing evidence for treatment-resistant PTSD and depression makes it a meaningful option for patients in this population—particularly when storm-related trauma overlaps with other vulnerabilities like prior trauma, occupational exposure (first responders, utility workers, healthcare workers during storm events), or the cumulative weight of multiple seasons of disruption.
Central Florida’s tourism and hospitality industry employs hundreds of thousands of workers, and the workforce experiences significant rates of depression, anxiety, and burnout. For workers whose depression has been resistant to standard treatment, ketamine has several practical advantages:
Treatment that fits a 2-3 week window. The six-session ketamine course typically completes over 2-3 weeks. For shift workers who can’t take 4-6 weeks of daily TMS sessions because of scheduling, the more compressed ketamine course is sometimes more achievable.
No side effects affecting guest-facing work. Antidepressants commonly cause fatigue, weight gain, sexual side effects, and emotional flattening—all of which can affect performance in roles that require energy, presence, and emotional engagement with guests. Ketamine doesn’t cause those effects between sessions.
The driver-home challenge. The honest tradeoff: the driver-home requirement creates real logistical challenges for hospitality workers who live alone, are part of a transplant workforce, or whose partner works opposite shifts. We discuss this during consultation and help patients work out a realistic plan. Options include coworkers or friends driving, sessions on days when a partner is off, or Uber/Lyft. We don’t move forward until the driver question is solved.
Confidentiality. No prescription record, no pharmacy fill, no medication record in benefit data. For workers concerned about prescription records for any reason, ketamine has advantages over medication.
Beyond Pulse, hurricane, and hospitality populations, several other patterns we see often in Central Florida benefit from ketamine therapy:
Patients with treatment-resistant depression after multiple medications. This is the largest ketamine patient population. Central Florida residents who have cycled through SSRIs from primary care, then second-line agents, and still haven’t found relief have a treatment option that works through an entirely different mechanism.
Patients with active suicidal ideation who can be safely treated outpatient. Ketamine’s rapid reduction in suicidal thoughts is its most distinctive clinical feature. For patients in significant suicidal distress who don’t require inpatient care, ketamine can provide rapid relief while longer-term treatment is being put in place. Anyone in immediate danger should call 988 or go to an emergency room first—ketamine therapy is outpatient care that works alongside, not instead of, emergency services.
Healthcare workers with treatment-resistant depression. Orlando Health, AdventHealth, Nemours Children’s, and the broader Central Florida healthcare workforce includes many clinicians whose depression or burnout hasn’t responded to standard treatment. Ketamine is one option for treatment-resistant cases, with the additional advantage of no prescription record for clinicians concerned about that.
Patients in Hispanic, Latino, and immigrant communities. Family attitudes toward psychiatric medication can be barriers to standard treatment in some cultural contexts. Ketamine’s finite course and absence of daily medication can sometimes fit better with family and cultural preferences. We provide care that is respectful of the cultural contexts patients bring with them and make therapy referrals in Spanish or another language when we can.
Veterans. The Orlando VA Healthcare System serves Central Florida veterans. For veterans whose treatment-resistant depression or PTSD hasn’t fully responded to VA medication management or trauma-focused therapy, ketamine offers a different mechanism that has growing evidence in veteran populations. We accept Champ VA and Tricare for evaluation and TMS, but ketamine infusions specifically are cash-pay.
Patients who need help faster than antidepressants can provide. SSRIs and SNRIs typically take 4-8 weeks to show full effect. For patients who can’t wait that long—a worsening trajectory, a life event making delay untenable, a treatment timeline that needs to be compressed—ketamine’s rapid onset matters.
Patients who haven’t responded to TMS. Many patients try TMS first because insurance covers it, and most respond well. For patients who don’t, ketamine represents a different mechanism that may help.
We want to address this directly because it matters: IV ketamine infusion therapy is generally not covered by most insurance plans, including Florida Blue, Tricare, Champ VA, Medicare, and most commercial plans. This makes ketamine primarily a cash-pay treatment, and the cost is real.
Why coverage is limited. Although ketamine has been used safely as an anesthetic for more than fifty years, the FDA has not separately approved IV ketamine for depression. (Spravato/esketamine, a related but different nasal spray formulation, is FDA-approved and insurance-covered, but is a separate treatment with separate requirements.) The lack of FDA approval for IV ketamine specifically means most insurance plans don’t cover the infusions, even when they cover other treatments for the same condition.
What patients typically pay. Costs vary by treatment plan and number of sessions. We walk through the full financial picture during consultation, including the total cost of the initial six-session course and any anticipated maintenance, so there are no surprises.
If cost is a barrier. For patients who would benefit from rapid-acting treatment but for whom ketamine isn’t financially feasible, TMS therapy is an alternative that most insurance plans cover, including Florida Blue, Tricare, and Champ VA. TMS works through a different mechanism but addresses many of the same patients (treatment-resistant depression, OCD, PTSD). We discuss both options during consultation and recommend the path that fits your situation, not just the path that’s most expensive.
Honest framing. Some patients value ketamine highly enough to invest in it; others find the cost makes it impractical regardless of clinical fit. Both responses are reasonable. We don’t push patients toward ketamine when other options might serve them well.
Ketamine, when administered in a controlled clinical setting with appropriate monitoring, has a strong safety record. The most common side effects:
During the infusion. Dissociation (detachment, time distortion, sensory effects) is expected and is part of the treatment experience. Other during-session effects can include mild nausea, dizziness, temporary increase in blood pressure or heart rate, and feeling sleepy. These are monitored continuously by the nurse administering the infusion.
Immediately after the infusion. Grogginess, mild fatigue, and continued mild dissociation can persist for an hour or so after the infusion ends. Most patients feel ready to leave the clinic about an hour after the infusion completes.
Later that day. Tiredness, mild quietness, and occasionally a transient mood lift. Most patients feel back to baseline by the following morning.
Less common. Headache, more pronounced nausea, vivid dreams the night following treatment, and—rarely—temporary increase in anxiety the day after a session. Most of these effects resolve quickly and are manageable with supportive care.
Long-term considerations. Long-term high-frequency unmonitored ketamine use (the kind sometimes seen in recreational misuse, not clinical care) has been associated with bladder problems and cognitive effects. Therapeutic ketamine delivered in a clinical setting at appropriate doses and intervals has a different and far more favorable safety profile, and we monitor for any concerning patterns across the treatment course.
Contraindications. Ketamine is generally not appropriate for patients with active psychosis or schizophrenia, uncontrolled high blood pressure, certain cardiovascular conditions, certain liver conditions, or active substance use disorders involving dissociative substances. We screen carefully during evaluation.
Ketamine therapy is appropriate for adults with significant depression, PTSD, anxiety, or related conditions that haven’t responded fully to standard treatments. Specific considerations:
Established diagnosis. A clear diagnosis of a condition for which ketamine is appropriate. We confirm this through our standard evaluation process before recommending ketamine.
Prior treatment history. Ketamine is typically reserved for patients who haven’t responded to at least one or two standard treatments, though there are exceptions—particularly for patients with rapid clinical needs or specific intolerances to standard medications.
Medical screening. Pre-treatment evaluation includes review of cardiovascular history, blood pressure, current medications (including any substances that could interact), and other medical conditions that affect ketamine candidacy. Most patients clear this screening, but some patients with specific medical conditions are not candidates.
Reliable transportation plan. Because you can’t drive yourself after a session, you need a reliable plan for getting home. This is non-negotiable for safety reasons.
Financial considerations. Because IV ketamine is generally not insurance-covered, patients need to consider the cost realistically before starting a course. We walk through this transparently during consultation.
Treatment integration. Ketamine works best as part of broader psychiatric care, not as a standalone treatment. Patients should be willing to engage with therapy, medication management, or other supports as part of the overall plan.
Ketamine isn’t the only option, and it isn’t always the best option. A few comparisons:
Ketamine vs antidepressant medication. Antidepressants work gradually (4-8 weeks to full effect), require daily dosing, are typically covered by insurance, and produce systemic effects including potential side effects. Ketamine works rapidly (hours to days), is delivered as a series of in-clinic sessions, is generally not insurance-covered, and produces a time-limited dissociative experience during sessions. For patients who can wait for medication to work and who can tolerate medication side effects, medication is often the first-line choice. For patients who can’t wait, who haven’t responded to medication, or who can’t tolerate medication side effects, ketamine is a meaningful alternative.
Ketamine vs TMS. Both treat treatment-resistant depression but through very different mechanisms and patient experiences. TMS is a brain stimulation treatment (no medication, no dissociation), delivered daily over 4-6 weeks, generally insurance-covered, with no driving restrictions and minimal side effects. Ketamine works faster, requires fewer sessions, but is not insurance-covered, requires a driver home, and produces a dissociative experience during treatment. Many patients are appropriate for one or the other; some are appropriate for both. We discuss which fits your specific situation.
Ketamine vs ECT. ECT remains an important treatment for severe and treatment-resistant depression, particularly in the most severe cases. It involves general anesthesia and induced seizures, typically in a hospital setting with significant recovery time. Ketamine is much less invasive but generally appropriate for somewhat less severe presentations. Patients who haven’t responded to ketamine and TMS sometimes do well with ECT.
Starting ketamine therapy isn’t a same-day decision. Here’s how the process typically unfolds:
Initial consultation. A thorough evaluation that includes review of your diagnosis, current symptoms, prior treatment history, medical history, and goals. We assess whether ketamine is likely to help your specific situation and answer your questions about what treatment involves, including the cost, the driver-home requirement, and the dissociative experience.
Medical screening. Review of cardiovascular history, blood pressure, medications, and other medical conditions to confirm ketamine is safe for you specifically.
Financial planning. Direct conversation about the cost of treatment and what your specific course is likely to involve. We don’t move forward until you understand the financial picture.
Treatment scheduling. Once you decide to proceed, we schedule your sessions to fit your schedule. Sessions typically run about two hours including the rest period, so plan accordingly.
Treatment course and follow-up. Typically six sessions over a few weeks, with check-ins to track response. End-of-course evaluation and planning for what comes next—whether maintenance infusions, continued medication or therapy, transition to TMS, or simply ongoing monitoring.
Ketamine therapy is most effective when delivered as part of comprehensive psychiatric care, not as a standalone procedure. Our approach integrates ketamine with medication management, therapy referrals, and ongoing clinical follow-up. We assess whether co-occurring conditions—anxiety, ADHD, sleep disorders, substance use, medical conditions—are affecting outcomes, and we adjust the broader plan as needed. For patients who prefer therapy referrals in Spanish or another language, we make those when we can.
Many patients arrive at ketamine after years of feeling stuck. Our goal isn’t just to deliver infusions; it’s to help patients build a sustainable approach to their mental health that works after the initial course ends.
Our Orlando clinic is led by a board-certified psychiatrist and a psychiatric nurse practitioner with training in mood, anxiety, PTSD, and related conditions, supported by experienced registered nurses who administer ketamine infusions:
Dr. Joshua Lotfallah, MD — Board-certified Psychiatrist. View profile.
Modupe “Mo” McIntosh, NP — Psychiatric Nurse Practitioner. View profile.
Our Orlando team takes a patient-first, evidence-based approach: careful evaluation, transparent conversations about what ketamine can and can’t do, honest discussion of cost and alternatives, welcoming care that affirms the diversity of our community, and a steady pace that respects how you’re actually doing. With same-day consultations, extended hours, Florida Blue, Tricare, and Champ VA accepted (for evaluation, medication management, and TMS—not for ketamine infusions, which are generally cash-pay), ketamine therapy delivered on-site in the Southpark Center area, and integrated psychiatric care, we’re committed to making this important treatment genuinely accessible for the Central Florida patients who can benefit from it.
If you or someone you love is experiencing a mental health crisis, immediate help is available:
988 Suicide & Crisis Lifeline. Call or text 988 for free, confidential support 24/7.
The Trevor Project (LGBTQ+ young people). Call 1-866-488-7386 or text START to 678-678.
Veterans Crisis Line. Call 988 then press 1, or text 838255.
911 or your nearest emergency room. For immediate danger.
Ketamine therapy is an outpatient treatment that requires evaluation, planning, and follow-through. It is a meaningful option for many patients, but it is not a substitute for emergency care during an acute crisis.
Our clinic is located at 9400 Southpark Center Loop, Suite 450 in Orlando, FL 32819, in the Southpark Center area off Sand Lake Road near Dr. Phillips. Ketamine therapy is delivered on-site by experienced clinical staff. We serve patients from across Central Florida, including Dr. Phillips, Lake Nona, Winter Garden, Winter Park, Oviedo, Kissimmee, Altamonte Springs, and the broader Orange, Seminole, and Osceola County areas.
IV ketamine therapy is most established for treatment-resistant depression—meaning depression that hasn’t responded fully to one or more antidepressant medications—and for treatment-resistant or severe PTSD. It is also used for severe anxiety, certain addiction conditions, and patients with acute suicidal ideation, where ketamine’s rapid onset of effect (often within hours) is particularly valuable. Ketamine therapy is generally reserved for situations where standard treatments haven’t been enough.
Yes. The Pulse nightclub attack on June 12, 2016, killed 49 people and injured 53, with lasting effects on Central Florida’s LGBTQ+ and Hispanic/Latino communities, the survivors, the family members of those killed, the first responders who answered that night, and the broader community that has carried what happened in the years since. For patients whose PTSD has been resistant to talk therapy and standard medications—and many in this population have had years of treatment that helped some but hasn’t been enough—ketamine has growing evidence as a meaningful additional option. We provide care that is welcoming and affirming.
You’ll receive ketamine through an IV in a comfortable, monitored setting. The infusion itself takes about 40 minutes, and most sessions are completed within two hours including the rest period afterward. During the infusion, most patients experience a mild to moderate dissociative state—a feeling of being detached from the body, time distortion, and sensory effects. These effects subside within an hour after the infusion ends. You’re monitored throughout by an experienced registered nurse. You must arrange for someone to drive you home afterward; you cannot drive yourself.
The driver-home requirement is one of the more practical challenges for hospitality and theme park workers, particularly those who live alone, are part of a transplant workforce, or whose partner works opposite shifts. Options include having a coworker, friend, or family member drive you, planning sessions on days when your partner is off, or arranging Uber or Lyft (we can help with this). The driver requirement is non-negotiable for safety reasons, but planning ahead makes it manageable. We discuss this during consultation.
We want to be honest about this: IV ketamine infusion therapy is generally not covered by most insurance plans, including Florida Blue, Tricare, Champ VA, Medicare, and most commercial plans. This makes it primarily a cash-pay treatment. Costs vary by treatment plan, and we walk through the full financial picture during consultation so there are no surprises. The treatment is valuable for the right patient, but the cost is real and should be part of your decision. For patients who need treatment-resistant depression care covered by insurance, TMS therapy is an alternative that most plans (including Florida Blue, Tricare, and Champ VA) do cover.
Yes. You cannot drive yourself home after a ketamine infusion. The dissociative and sedative effects of ketamine require a trusted person to drive you, and we typically recommend you have someone with you for the rest of the day. If you don’t have someone available, we may be able to help arrange Uber or Lyft transportation, but you should plan ahead for this.
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