When traditional antidepressants fail to provide relief, many people living with treatment-resistant depression feel isolated and hopeless. If you’ve tried multiple medications without meaningful improvement, you’re not alone—and there are evidence-based alternatives. Nushama’s physician-led intravenous (IV) ketamine program in Manhattan combines precision medical titration, comprehensive psychiatric assessment, and structured integration support—the process of translating ketamine insights into lasting behavioral change—to deliver outcomes that exceed national benchmarks. Our 2025 published study demonstrates that this comprehensive approach can make the difference between symptom management and genuine remission.
Understanding ketamine for treatment resistant depression (TRD)
Ketamine offers a fundamentally different mechanism of action from traditional antidepressants. While standard medications target serotonin, norepinephrine, or dopamine (the “monoamine” neurotransmitters thought to regulate mood), ketamine works through the glutamate system and promotes neuroplasticity—the brain’s ability to form new neural connections. This shift in approach explains why people who haven’t responded to conventional treatments may find relief with ketamine therapy for depression . The science moves beyond adjusting brain chemistry levels and instead focuses on rebuilding synaptic architecture damaged by chronic stress and depression.
Treatment-resistant depression , defined as failure to respond to two or more antidepressant regimens at adequate dose and duration, affects 10–30% of people with major depressive disorder. For many who cycle through selective serotonin reuptake inhibitors (SSRIs, a class of antidepressants that increase serotonin in the brain) without relief, the emotional toll includes loss of hope, persistent side effects like weight gain and emotional blunting, and mounting frustration. A reanalysis of the landmark STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression) found that only 35% achieved remission after up to four optimized antidepressant treatments—far lower than the originally reported 67%. This validates what many people with TRD already know: standard medications often fall short.
IV ketamine vs oral antidepressants: why precision and medical supervision matter
Intravenous ketamine delivers 100% bioavailability—meaning the full dose reaches your bloodstream and brain—compared to oral ketamine’s 20–25% absorption rate . This pharmacological precision matters for both safety and efficacy. When ketamine is administered through an IV line, clinicians can adjust the infusion rate in real-time or stop treatment instantly if a member experiences discomfort, elevated blood pressure, or excessive dissociation (a temporary altered state of consciousness where you may feel detached from your body or surroundings).
Oral and sublingual formulations offer no such control. Once you consume a lozenge, the unpredictable absorption continues regardless of your response, and there’s no medical intervention available to halt the effects. The FDA has explicitly warned about compounded at-home ketamine products, stating that “at-home administration of compounded ketamine presents additional risks because a health care provider is not available onsite to monitor for serious adverse outcomes resulting from sedation and dissociation.” The agency identified concerns including abuse potential, psychiatric events, respiratory depression, and dangerous increases in blood pressure—all risks that in-clinic medical supervision can mitigate.
At Nushama, every infusion includes continuous vital-sign monitoring and instant intervention capability. Our medical team tracks blood pressure, heart rate, and oxygen saturation every 10 minutes, adjusting your dose to maintain both therapeutic depth and physical safety. Telehealth-only providers and at-home lozenge services leave members unsupervised during a vulnerable altered state, with no on-site medical response capability. This level of precision and safety is why we exclusively use IV administration and why we encourage prospective members to read our detailed in-clinic vs. at-home comparison before choosing a treatment path.
Ketamine clinical outcomes in NYC: Nushama’s 2025 study data
Nushama’s physician-led model delivers measurably superior outcomes compared to national benchmarks for IV ketamine treatment. In our 2025 study “Rapid and sustained reduction of treatment-resistant PTSD symptoms after intravenous ketamine in a real-world, psychedelic paradigm” published in the Journal of Psychopharmacology , lead author Dr. Henry MacConnel and co-authors Dr. Mitch Earleywine and Dr. Steven Radowitz (Nushama’s Chief Medical Officer) tracked 117 outpatients with treatment-resistant PTSD who received IV ketamine in a supportive psychedelic-paradigm environment. The results showed that 75.21% of participants experienced clinically meaningful improvement and 61.54% achieved full remission—outcomes that far exceed typical infusion-only models.
For context, a systematic review and meta-analysis of real-world ketamine effectiveness across 79 studies and 2,665 members found response rates of 45% and remission rates of 30%. Nushama’s protocol nearly doubles these benchmarks, suggesting that our comprehensive framework—which includes preparation sessions, evocative music, eye shades, one-on-one therapeutic guidance, and structured integration support—amplifies ketamine’s biological effect. The difference isn’t just the medicine; it’s how the medicine is delivered and supported.
While the published study focused on PTSD, the methodology applies across mood disorders including treatment-resistant depression, anxiety, and major depressive disorder with suicidal ideation. Our care team has administered thousands of journeys, and the evidence now exists in peer-reviewed literature. You can read more about these findings in our published study summary .
Ketamine infusion success stories: real-world impact
Beyond clinical data, Nushama’s outcomes are reflected in the lived experiences of members who have completed treatment. One member shared: “I’m sharing my story because I know people are suffering like I was. This treatment helps rediscover the joy within you. Journeys bring you back to who you are and the feelings you deserve—feelings you forgot because you haven’t felt them in so long.” These testimonials validate what the research demonstrates: when IV ketamine is paired with preparation and integration, the potential for lasting transformation increases significantly.
Our member success stories consistently highlight the value of the therapeutic framework surrounding the infusion itself. Members describe not only rapid symptom relief but also profound shifts in perspective, improved relationships, and renewed capacity for self-compassion. While outcomes vary by individual, the common thread across accounts is the importance of environment, medical safety, and guided integration in sustaining relief long after the infusion series ends.
How our psychedelic-paradigm model differs from infusion-only centers
Nushama offers a comprehensive psychedelic-assisted therapy framework, not just medication delivery. While infusion-only centers focus solely on dose administration—often in clinical settings with minimal therapeutic support—our model addresses the full healing process: preparation, the medicine journey itself, and integration support that translates ketamine insights into lasting cognitive and behavioral changes.
The psychedelic paradigm recognizes that ketamine’s therapeutic potential extends beyond its pharmacology. Set (your mindset and intentions) and setting (the physical and emotional environment) profoundly influence outcomes. Nushama’s Manhattan location features serene, private infusion rooms designed to reduce anxiety and support introspection. We provide eye shades and carefully curated evocative music to deepen the therapeutic experience, and a licensed therapist or trained integration coach remains present to guide the beginning and end of your session.
Infusion-only clinics may deliver the IV but often skip comprehensive psychiatric assessment and offer no integration coaching—letting the neuroplastic window ketamine opens close without guided support. Ketamine’s mechanism—blocking NMDA receptors, triggering a surge in glutamate, and activating brain-derived neurotrophic factor (BDNF)—promotes the growth of new synaptic connections. This process, known as synaptogenesis, is the biological foundation for lasting mood improvement. However, without integration, the profound insights or emotional shifts during a ketamine journey may fade as the neuroplastic effects wear off.
Integration is the bridge between the medicine experience and daily life. Nushama’s integration coaches help you process what emerged during the session, identify actionable next steps, and weave those realizations into your ongoing therapy, relationships, and self-care practices. This is why our outcomes exceed the national average—we don’t just administer medicine; we support the entire healing arc.
The treatment timeline: what to expect at our Manhattan center
Nushama’s standard protocol involves six IV ketamine infusions administered over 2–3 weeks, typically twice weekly, to maximize the cumulative neuroplastic benefit. Each infusion lasts 40–60 minutes, and you can expect to depart our Manhattan center within 90 minutes of arrival—significantly faster than the two-hour observation period required for Spravato (esketamine, the FDA-approved intranasal ketamine formulation). Dosing is individualized based on your body weight, prior psychedelic experience, and comfort level, starting at 0.8 mg per kilogram and potentially increasing by 0.2 mg/kg per session as your tolerance and therapeutic needs evolve.
Relief can begin remarkably quickly. Published research shows that the antidepressant effects of a single ketamine infusion may appear within 2–4 hours and last up to two weeks. However, the strongest cumulative benefit emerges after completing the full six-session series. Ketamine’s rapid mechanism promotes the growth of new synaptic connections, which is the biological foundation for lasting mood improvement.
Before your first infusion, you’ll meet with a member of our care team for a preparation session. We’ll discuss your intentions for treatment, explain what dissociation may feel like, and establish a safety framework so you can surrender to the experience with confidence. On infusion days, you’ll arrive at our serene Manhattan location, settle into a private room with comfortable seating, and receive an IV line placed by our medical staff. We’ll provide eye shades and curated music designed to facilitate introspection, and a licensed integration coach or therapist will guide you at the beginning and end of your session.
After each infusion, we’ll monitor your vital signs and ensure you’re stable before departure. Most members feel ready to leave within 30–60 minutes after the IV ends, though we ask that you arrange for a companion to accompany you home. In the days following each session, you may notice shifts in mood, energy, or perspective—and your integration coach will help you make sense of these changes during follow-up sessions. For a more detailed walkthrough, visit our page on what to expect .
Spravato vs. IV ketamine: understanding your options
A meta-analysis comparing IV racemic ketamine to intranasal esketamine across 24 randomized controlled trials and 1,877 participants found that IV ketamine demonstrated significantly higher response rates (relative risk or RR = 3.01 vs. 1.38 for esketamine) and remission rates (RR = 3.70 vs. 1.47) with lower dropout rates (RR = 0.76 vs. 1.37). These numbers suggest that IV ketamine may be more effective overall, though individual results vary and both modalities have distinct advantages.
Nushama is one of the few Manhattan clinics offering both FDA-approved Spravato (esketamine) and IV racemic ketamine under one roof, which means we have no financial incentive to push one modality over the other. Instead, we can help you choose based on your clinical needs, insurance coverage, and timeline for relief.
Spravato offers distinct advantages for certain members. It’s FDA-approved specifically for treatment-resistant depression and major depressive disorder with suicidal ideation, and it’s covered by most major insurance plans including Oxford, UnitedHealthcare, Cigna, and Aetna—often with manageable copays. Administration occurs intranasally (through the nose) rather than intravenously, which some people find less invasive. However, Spravato requires adherence to a Risk Evaluation and Mitigation Strategy (REMS, a strict FDA safety protocol) that requires two-hour on-site observation after each dose to monitor for sedation, dissociation, and potential blood pressure changes. You can learn more on our Spravato treatment page.
IV ketamine, by contrast, offers broader clinical applications—our physicians prescribe it not only for treatment-resistant depression but also for PTSD, anxiety, existential distress related to terminal illness, and alcohol use disorder. The onset of antidepressant effects is often faster, and members in acute distress frequently choose IV for its speed advantage. While IV ketamine is generally not covered by insurance, Nushama provides superbills for possible out-of-network reimbursement and offers flexible payment plans. Our Hero’s Journey scholarship program also provides pro-bono treatment for veterans and first responders who might otherwise face financial barriers.
Many members start with IV ketamine for rapid relief and then transition to Spravato for maintenance once their insurance authorization is approved. During your initial psychiatric consultation, we’ll review your treatment history, discuss the trade-offs between modalities, and recommend the path most likely to support your goals. For a side-by-side breakdown, see our detailed Spravato vs. IV ketamine comparison .
FAQs
Nushama provides answers to common questions about insurance, safety, and treatment protocols to help members navigate their care.
Is ketamine therapy covered by insurance?
Spravato (esketamine) is covered by most major insurance plans including Oxford, UnitedHealthcare, Cigna, and Aetna, typically requiring prior authorization and copays that vary by plan. IV racemic ketamine is generally considered off-label for depression and is not covered, though Nushama provides superbills that members can submit for potential out-of-network reimbursement. We also offer payment plans to make treatment more accessible. Our Hero’s Journey scholarship program provides pro-bono IV ketamine treatment for veterans, first responders, and others facing financial hardship. For a full breakdown of costs and financing, visit our pricing options page.
Do I need a referral from my psychiatrist?
No referral is required to begin treatment at Nushama. We conduct our own comprehensive psychiatric and medical intake to ensure ketamine therapy is safe and appropriate for you. That said, we welcome collaboration with your existing treatment team—therapists, psychiatrists, and primary care providers. Our care model is designed to integrate with ongoing therapy, and we provide quantitative and qualitative follow-ups to referring clinicians so they can coordinate care effectively. If you’re a healthcare provider interested in referring a member, learn more at our provider information page.
How long do the effects of an infusion last?
The antidepressant effects of a single ketamine infusion can persist for one to two weeks, but the full six-infusion protocol combined with integration support often produces durable changes lasting months. Ketamine temporarily opens a neuroplastic window—a period of heightened brain adaptability—during which new neural connections can form. Integration coaching helps you translate the insights and emotional shifts from your journeys into lasting cognitive patterns and behaviors. Some members return for periodic booster infusions every few months; others maintain their gains through therapy and lifestyle changes alone. The durability of results varies based on individual factors, co-occurring conditions, and the consistency of integration work.
Is the treatment safe if I have high blood pressure or other medical conditions?
Nushama performs thorough medical screening before treatment, including a review of your blood pressure, heart rate, cardiovascular history, and any medications you currently take. Ketamine can cause a temporary increase in blood pressure and heart rate during the infusion, so we monitor your vital signs every 10 minutes and can adjust the infusion rate or pause treatment if needed. Most medical conditions can be safely managed with proper precautions, but certain contraindications—such as uncontrolled hypertension, active ischemic heart disease, or a history of psychosis—may require additional evaluation or alternative treatment options. During your intake, our medical team will assess your specific situation and ensure ketamine therapy is safe for you.
What makes Nushama different from other ketamine clinics in Manhattan?
Nushama combines physician-led medical oversight with licensed therapeutic support, offering both IV ketamine and
