Why Do People Quit IV Ketamine Treatment?

What Is IV Ketamine Treatment?

IV ketamine treatment delivers ketamine into the bloodstream through an intravenous line, given in a medical setting. Doctors prescribe it for depression and, in some cases, other mental health conditions such as anxiety or PTSD. Ketamine has been an FDA-approved anesthetic since 1970 and is on the World Health Organization's List of Essential Medicines. Using it for mental health is off-label, which means a licensed clinician prescribes it based on clinical judgment rather than a specific FDA approval for that use (FDA).

A course of treatment is not a single visit. It usually involves a series of infusions over a few weeks, known as the induction phase, often four to eight sessions in that window (McInnes 2022).² Each appointment takes place in an outpatient clinic, where staff monitor the patient during the infusion and for a period afterward before discharge. Because patients cannot drive after an infusion, every visit also requires arranging a ride home.

A typical IV ketamine course involves:

• A series of infusions: often four to eight sessions during the induction phase.
• In-person clinic visits: appointments are scheduled during standard business hours.
• Monitoring at each visit: staff check vital signs during the infusion and observe the patient before sending them home.
• A ride home: driving is not permitted after a session, so patients arrange transportation each time.

Understanding what a full course asks of patients sets up the rest of this article. The repeated visits, the monitoring time, the cost of multiple sessions, and the need for a ride each time all add up, and for many patients they become the reasons treatment ends early.

How Many Patients Complete IV Ketamine Treatment?

In real-world care, roughly half of patients who start IV ketamine stop during or soon after induction, the first round of infusions.

In one outpatient study, 47.1% of patients discontinued during or right after the induction phase (Sakurai 2020).¹ A larger multi-site analysis of 9,016 patients found that just over half (52.5%) of the people who finished induction went on to maintenance treatment, meaning nearly half stopped after the initial course (McInnes 2022).² That same analysis found most patients leave treatment within six months, with wide variation from one person to the next.

This does not mean the treatment is not working. Among patients who completed induction, IV ketamine had a 53.6% response rate for depression (McInnes 2022).² The researchers were careful about why people stop, noting that "it is not clear whether patients exit treatment because they feel better or they can no longer afford the treatment" (McInnes 2022).² When patients do explain why they stopped, as the next sections show, the reasons are consistently practical.

Why Do Patients Stop IV Ketamine Treatment?

For most patients, stopping IV ketamine has little to do with whether it works. In interviews, patients who were getting better describe wanting to continue but being unable to, most often because of cost (Perepelkin 2025).³ The reasons people give are practical and structural, and they often overlap.

The barriers documented in the research include:

• Cost: IV ketamine is usually paid out of pocket, and the expense of repeated sessions is the most consistently reported reason patients stop (Perepelkin 2025).³
• Time and travel: attending infusions in person, often far from home and during work hours, takes time many patients cannot sustain (ICER 2019; Perepelkin 2025).^3,4
• Lack of ongoing support: many clinics deliver the infusion on its own, without the continuing care that helps patients stay with treatment (Walaszek 2026).⁵

These barriers rarely act alone. A patient weighing the cost of the next session is often also taking time off work and traveling to a clinic to get there, and the combination is what ends treatment. The sections that follow look at each reason, in the patients' own words where the research captured them.

How Does the Cost of IV Ketamine Affect Treatment Completion?

Cost is the most consistently cited reason patients give for stopping IV ketamine, and it is a combination of the direct costs of treatment and the indirect costs of getting to it. In one qualitative study of IV ketamine patients, every participant mentioned cost as a barrier or limitation, and the researchers called it "the most prevalent theme" in the study (Perepelkin 2025).³

The direct costs include:

• Out-of-pocket infusion fees, since insurance rarely covers ketamine for depression.
• That same fee repeated across a multi-week induction course of four to eight sessions.
• Ongoing maintenance infusions afterward, each at full cost.

Expert-consensus guidance names this directly: "although intravenous ketamine is generic, there are additional costs in its administration, often uninsured, that need to be considered" (McIntyre 2021).⁷

The indirect costs include:

• Rideshare fares both ways, because patients cannot drive after an infusion.
• Lost wages from taking time off work for each appointment.
• A companion's lost time or wages, when someone has to come along to drive.
• Lodging and travel costs for patients who do not live near a clinic.

Together these add up until they end treatment that is otherwise working. Patients reported stopping because of cost "regardless of the positive impact on their mental health" (Perepelkin 2025).³ As one put it, "If the cost of the treatment was reduced, I would like to have had more treatments but at the present time I lack the necessary funds" (Lascelles 2021).⁸

The pattern is not unique to ketamine. In a national survey of adults with a mood disorder, cost was the single most common barrier to trying a treatment they wanted, cited by 52%, and people without insurance were far more likely than insured people to stop because they could no longer afford it (61% versus 22%) (NAMI 2021).⁹

How Much Time and Travel Does IV Ketamine Treatment Require?

A course of IV ketamine is not one appointment but a series of them. Induction alone means four to eight separate clinic visits over a few weeks (McInnes 2022),² and each visit takes far longer than the infusion itself. A single trip typically includes:

• Travel to the clinic, which for many patients is not local.
• The infusion, given under medical supervision.
• A monitoring period afterward, while staff observe the patient before clearing them to leave.
• A ride home, since patients cannot drive after an infusion and must arrange a companion or transportation.

Once travel, the infusion, and observation are combined, a single visit commonly takes a few hours, and across four to eight sessions that becomes many hours over the induction course.

Access makes this harder. Infusion clinics are not available everywhere, so patients often travel well outside their area to reach one. One study found that many participants did not live in the city where they received treatment, "requiring time off from work which often included time off for a companion or caregiver as well, and many times accommodations" (Perepelkin 2025).³

Because clinics generally run during business hours and weekend slots are limited, each visit usually means taking time off work. For some patients the time alone is decisive: an independent evidence review found that "some patients who derived benefit from IV ketamine reported they couldn't work full-time because of the time involved in going to an infusion clinic for therapy" (ICER 2019).⁴

This burden returns with every appointment and compounds across the course. For patients balancing a job, caregiving, or a long trip to the nearest clinic, the time treatment requires can become the reason it ends early.

How Does the Lack of Follow-Up Affect IV Ketamine Continuation?

The third barrier is what happens between and after the infusions. Many IV ketamine clinics are built around the infusion itself, with little of the continuing care that helps people stay with treatment, such as:

• Follow-up and check-ins between sessions.
• Integration or therapy to help patients make sense of the experience.
• A consistent point of contact who tracks progress across the course.

Qualitative research points to this as a real gap. Reviewing what patients say about ketamine treatment, one synthesis concluded that the evidence argues for "embedding ketamine within ongoing, relational care with proactive monitoring and adjunctive psychological support, rather than as an isolated pharmacological procedure" (Walaszek 2026).⁵

When treatment is delivered as an isolated procedure, patients are often left to make sense of it on their own and to judge for themselves whether it is helping. That uncertainty, on top of the cost and the repeated trips, can wear down the motivation to keep going.

For many patients the infusion is only part of what they need. Without support around it, finishing a full course is harder, and stopping early becomes more likely.

How Long Do the Benefits of IV Ketamine Last After Patients Stop?

Symptom improvement from IV ketamine does not last indefinitely after the initial course of infusions ends.

Many people report noticeable symptom improvement within hours or days of their first session. More durable and cumulative benefits typically develop over a series of sessions. However, the duration of benefit after stopping varies considerably across individuals.

A systematic review of maintenance ketamine treatment found that after a course of repeated IV infusions is stopped, the median time to relapse is 18 to 19 days.³ After a single infusion, improvement typically fades within two weeks.³ Sustaining improvement therefore typically requires ongoing maintenance infusions.

Maintenance sessions carry their own cost and logistical burden, which is itself a documented reason patients discontinue. Durability is influenced by multiple factors, including the number of sessions completed, whether integration practices are in place, and whether ongoing support continues. Ketamine's neuroplastic effects may create a window for change, but sustaining that change often requires a broader therapeutic framework beyond the infusion itself.

What Are Alternatives to IV Ketamine Treatment?

IV ketamine is one of several ketamine-based treatment options. Ketamine itself is one of several evidence-based approaches for depression, anxiety, and PTSD. Those who discontinue IV ketamine due to practical barriers may find that a different delivery model or therapeutic modality is a better fit.

• At-home sublingual ketamine therapy: Sublingual tablets are held in the mouth and absorbed through the oral mucosa. Sessions take place at home with a required peer treatment monitor present. The at-home model eliminates clinic travel, reduces cost, and allows treatment in a familiar environment.
• At-home subcutaneous ketamine therapy: Subcutaneous injection delivers ketamine via a small needle into the abdomen. The injection provides higher bioavailability and more consistent absorption than sublingual tablets.
• Spravato (esketamine nasal spray): The FDA approved Spravato for treatment-resistant depression. Providers administer it in a certified healthcare setting under the REMS program. It requires in-office administration and a two-hour observation period.
• Non-ketamine options: TMS, ECT, medication adjustments, and psychotherapy remain evidence-based options depending on your needs.

Published outcomes from at-home ketamine programs are in line with what IV studies report. In a study of 11,441 Mindbloom patients, 89% reported symptom improvement, with a 56.4% response rate.¹⁰ That response rate is comparable to the 53.6% reported among IV ketamine patients who completed induction.² Cross-study comparisons should be read with care, since study design, patient populations, and outcome measures differ.

For patients whose IV ketamine ended because of cost, travel, or the clinical setting, an at-home program is built to remove those specific barriers, and the outcomes above show the at-home model reports comparable response rates.

Conclusion

IV ketamine is an evidence-based therapy with a 53.6 percent response rate among those who complete a full course. However, practical barriers including cost, time, travel, the medical setting, and the absence of integration support lead many patients to stop before finishing.

Discontinuation often reflects the delivery model's demands rather than the medicine's limitations. Choosing ketamine should be a collaborative decision with your provider.

Discuss your options, including alternative delivery models, with a licensed specialist. The right approach is one that fits your life well enough to complete.

Important Safety Information

Ketamine is not FDA-approved for PTSD, depression, or anxiety. Common side effects include dissociation, increased blood pressure, nausea, dizziness, and cognitive impairment. Ketamine has abuse potential and is not appropriate for patients with uncontrolled hypertension, psychotic disorders, or substance use disorders. Do not drive or operate machinery until the day after treatment. Individual results may vary. Full safety information: www.mindbloom.com/safety-information

Off-Label Use Disclosure

Ketamine is FDA-approved only as an anesthetic. Use for mental health conditions represents off-label prescribing by licensed clinicians based on clinical judgment. Schedule III Controlled Substance - DEA regulations apply.