What Is Ketamine Therapy? A Guide to How It Works: A Compassionate Approach to Mental Health.

By Zahida, MSN, AGNP-C, CCRN — Board-Certified Nurse Practitioner | Z&Z Wellness, Alexandria, VA

Understanding Ketamine as an Off-Label Treatment Option

Ketamine therapy is an evidence-based, off-label treatment that may provide rapid relief from treatment-resistant depression, PTSD, anxiety, OCD, and chronic pain — often within hours to days rather than the weeks required by traditional antidepressants. At Z&Z Wellness in Alexandria, VA, every treatment is medically supervised, individually dosed, and monitored with hospital-grade equipment.

If you're struggling with treatment-resistant depression or PTSD near Alexandria, VA, you're not alone. An estimated 30% of people with major depressive disorder do not respond adequately to two or more first-line antidepressant medications (Gaynes et al., STAR*D Trial, American Journal of Psychiatry). For these individuals, ketamine therapy offers a fundamentally different mechanism of action that may succeed where SSRIs, SNRIs, and talk therapy have not.

At Z&Z Wellness, we offer IV, IM, and oral ketamine therapy tailored to your specific condition, medical history, and treatment goals in a safe, medically supervised clinical setting.

What Is Ketamine Therapy?

Ketamine is a Schedule III anesthetic that has been used safely in medical settings for over 50 years. It was originally developed as a surgical anesthetic and remains on the World Health Organization's List of Essential Medicines. Over the past two decades, research from Yale University, Johns Hopkins, the National Institute of Mental Health, and the VA Medical System has demonstrated ketamine's potential for rapid relief from resistant depression, OCD, anxiety, PTSD, and chronic pain.

A 2018 study published in JAMA Psychiatry found that a single ketamine infusion produced significant antidepressant effects within 24 hours in patients with treatment-resistant depression. A 2023 meta-analysis reviewing over 30 clinical trials confirmed that ketamine consistently outperformed placebo for rapid reduction of depressive symptoms, with response rates between 50–70% in treatment-resistant populations.

Ketamine is not FDA-approved for psychiatric conditions such as depression, PTSD, anxiety, or OCD. However, thousands of clinicians nationwide legally prescribe it off-label based on a growing body of clinical evidence. At Z&Z Wellness, all ketamine therapy is provided following thorough patient screening and ongoing medical oversight.

Ketamine vs. Traditional Antidepressants: Key Differences

One of the most common questions patients ask is how ketamine compares to the antidepressants they've already tried. Here is a direct comparison:

Mechanism of Action Traditional antidepressants (SSRIs/SNRIs) target serotonin and norepinephrine, neurotransmitters involved in mood regulation. Ketamine works on the glutamate system — the brain's most abundant excitatory neurotransmitter. By blocking NMDA receptors, ketamine triggers increased production of brain-derived neurotrophic factor (BDNF) and promotes synaptogenesis — the formation of new neural connections. This is believed to be why ketamine can produce effects so much faster than conventional medications.

Speed of Relief Traditional antidepressants typically require 4–8 weeks before patients notice meaningful improvement. Ketamine may produce noticeable relief within hours to days. For patients experiencing severe depression or active suicidal ideation, this speed difference can be critical.

Response Rates First-line antidepressants have an estimated response rate of approximately 50% for initial treatment and declining rates with each subsequent medication trial. Ketamine has demonstrated response rates of 50–70% specifically in treatment-resistant populations — patients who have already failed other medications.

Duration of Effects A single ketamine treatment may produce effects lasting days to weeks. Maintenance protocols with repeated treatments can extend and sustain relief over months. Traditional antidepressants require continuous daily dosing to maintain their effects.

Side Effects SSRIs/SNRIs commonly cause weight gain, sexual dysfunction, emotional blunting, and withdrawal symptoms. Ketamine's side effects — mild dissociation, dizziness, nausea — are typically short-lived and resolve within 1–2 hours after treatment. Ketamine does not cause the chronic side effects associated with daily antidepressant use.

Administration Traditional antidepressants are taken daily as oral pills at home. Ketamine therapy is administered in a clinical setting under medical supervision, with sessions lasting 40–60 minutes depending on the route (IV, IM, or oral).

How Ketamine Works in the Brain

Ketamine works through a fundamentally different pathway than traditional psychiatric medications. It blocks NMDA receptors, which triggers a surge of glutamate activity in brain regions involved in mood and cognition. This surge activates AMPA receptors, releasing brain-derived neurotrophic factor (BDNF) — a protein essential for neuron growth and survival.

Elevated BDNF promotes synaptogenesis, the creation of new synaptic connections between neurons. Brain imaging research has shown ketamine can begin reversing synaptic damage caused by chronic stress and depression within 24 hours. This process — known as neuroplasticity — helps the brain form new neural pathways, breaking entrenched patterns of negative thought and chronic pain signaling. Unlike traditional antidepressants that require daily dosing, ketamine initiates a biological repair process that continues producing benefits after the medication has left the body.

Conditions Treated with Ketamine Therapy in Alexandria, VA

Ketamine therapy at Z&Z Wellness may help individuals experiencing the following conditions:

Treatment-Resistant Depression: When two or more antidepressant medications have failed to provide adequate relief, ketamine offers a different mechanism of action targeting the glutamate system rather than serotonin. The STAR*D trial found that with each failed medication, the likelihood of responding to the next one drops significantly — from about 50% with the first to under 15% by the fourth trial. Ketamine bypasses this cycle entirely by working through a different neurological pathway.

PTSD: Research published in JAMA Psychiatry (2018) demonstrated that ketamine produced significant reductions in PTSD symptom severity within 24 hours. The VA Medical System has conducted multiple studies on ketamine for combat-related PTSD, and a growing number of VA-affiliated clinics now offer ketamine treatment. Ketamine may help by disrupting the reconsolidation of traumatic memories and reducing hyperactivation of the amygdala.

Chronic Pain: Ketamine may interrupt pain signaling at multiple points in the nervous system, including the brain, spinal cord, and peripheral nerves. Conditions that may respond to ketamine include CRPS (complex regional pain syndrome), neuropathy, radiculopathy, fibromyalgia, migraines, Ehlers-Danlos syndrome, and small fiber neuropathy (SFN). A 2019 consensus statement from the American Society of Regional Anesthesia and Pain Medicine confirmed ketamine's role in treating chronic pain conditions resistant to conventional therapy.

Anxiety Disorders: Ketamine's effects on glutamate may help reduce the hyperactive neural circuits associated with generalized anxiety disorder and social anxiety. Emerging research suggests that ketamine's ability to promote neuroplasticity may help patients develop healthier stress response patterns.

OCD: Emerging evidence from Columbia University and other research institutions suggests that a single ketamine dose can rapidly reduce OCD symptoms, potentially by modulating glutamate transmission in the cortico-striato-thalamo-cortical circuit — the brain network most implicated in obsessive-compulsive behavior.

Are you a veteran or active-duty military member? We offer specialized support for service members dealing with PTSD, chronic pain, TBI-related symptoms, and combat-related mental health conditions. Read our dedicated veterans resource page to learn more. All military and healthcare workers receive 10% off treatment.

What to Expect During Ketamine Therapy at Z&Z Wellness

Before your first treatment: You will complete a comprehensive medical evaluation, including a review of your medical history, current medications, psychiatric history, and treatment goals. This screening determines whether ketamine therapy is safe and clinically appropriate for you. Ketamine is not recommended for individuals with uncontrolled high blood pressure, certain cardiac conditions, active psychosis, or active substance use disorders.

During treatment: Ketamine is administered in a calm, private clinical setting. Sessions typically last 40–60 minutes depending on the route of administration (IV, IM, or oral). You may experience a sense of deep relaxation, mild dissociation, or floating sensations. Many patients describe feeling a weight lifting or a sense of clarity they haven't experienced in months or years. Your vital signs — blood pressure, heart rate, and oxygen saturation — are monitored continuously throughout your session using VITALSTREAM ICU-grade noninvasive hemodynamic monitoring, the same technology used in hospital critical care units.

After treatment: You will rest briefly in our clinic while our clinical team monitors your recovery. Most patients are ready to leave within 30 minutes after the session ends. You will need a designated driver to take you home. You should plan to rest for the remainder of the day.

Treatment timeline: For mood disorders, a typical initial protocol involves a series of six treatments over approximately three weeks. Chronic pain protocols may require higher doses across additional sessions. After the initial series, maintenance treatments are scheduled based on your individual response, typically ranging from every 2–6 weeks.

Who Is a Good Candidate for Ketamine Therapy?

Ketamine therapy may be appropriate if you have been diagnosed with depression, PTSD, anxiety, OCD, or chronic pain and have tried two or more medications or therapy without adequate relief. Candidates should be medically stable with no contraindications.

Ketamine is not recommended for individuals with uncontrolled high blood pressure, unstable heart conditions, active psychosis or schizophrenia, untreated substance use disorders, pregnancy, or known allergy to ketamine. A medical evaluation is required before any treatment to confirm eligibility and safety.

Why Choose Z&Z Wellness for Ketamine Therapy in Alexandria, VA?

Clinical expertise: Z&Z Wellness is led by a board-certified nurse practitioner with over 16 years of critical care experience, including ICU and emergency medicine. This level of clinical training means your safety is managed by someone with extensive experience handling complex medical situations.

Hospital-grade monitoring: We use VITALSTREAM ICU noninvasive hemodynamic monitoring during every session — the same technology used in hospital critical care units. This is a higher standard of monitoring than many ketamine clinics provide.

Multiple treatment options: We offer IV, IM, and oral ketamine therapy, giving us the flexibility to match the treatment approach to your specific needs, comfort level, and clinical goals.

Personalized protocols: No two patients receive the same treatment. Dosing, frequency, and route of administration are customized based on your individual response and medical profile.

Integrated approach: We encourage patients to continue working with their therapist or psychiatrist during and after ketamine treatment for the best possible outcomes.

Transparent pricing: We publish our pricing openly so you can make informed decisions about your care without surprises.

Frequently Asked Questions About Ketamine Therapy

How quickly does ketamine therapy work? Many patients notice improvement within hours to days after their first treatment. This is significantly faster than traditional antidepressants, which typically require 4–8 weeks. However, individual responses vary, and some patients may need multiple sessions before experiencing the full benefit.

Is ketamine therapy safe? Ketamine has been used safely in medical settings for over 50 years. When administered by trained clinicians in a supervised clinical environment with proper monitoring, it has a well-established safety profile. Side effects are typically mild and short-lived, including temporary dissociation, dizziness, or nausea that resolve within 1–2 hours.

How long do the effects of ketamine therapy last? Effects from a single treatment may last days to weeks. A full initial series of treatments (typically six sessions over three weeks for mood disorders) can produce longer-lasting relief. Maintenance sessions every 2–6 weeks help sustain the benefits.

What is the difference between ketamine and Spravato (esketamine)? Spravato is an FDA-approved nasal spray containing esketamine, a component of ketamine. It is available only through certified healthcare facilities under a restricted program. Generic ketamine, which Z&Z Wellness uses, can be administered via IV, IM, or oral routes and is typically more affordable. Both work through similar mechanisms, but they differ in administration, cost, and availability.

Will ketamine therapy make me feel "high" or out of control? During treatment, you may experience mild dissociation, a floating sensation, or altered perception. These effects are temporary and typically resolve within 30–60 minutes after the session ends. You remain in a safe, monitored clinical environment throughout your treatment, and our clinicians are present to ensure your comfort and safety at all times.

Schedule Your Consultation in Alexandria, VA

If you have been struggling with depression, PTSD, anxiety, chronic pain, or OCD and have not found adequate relief with conventional treatments, ketamine therapy may be worth exploring.

Your first step is a consultation where we review your medical history, discuss your treatment goals, and determine whether ketamine therapy is a safe and appropriate option for you. Book your consultation at Z&Z Wellness or call us directly at (703) 988-5362.

Z&Z Wellness is located in Alexandria, VA, serving patients throughout Northern Virginia, Fairfax County, Arlington, Springfield, Annandale, Falls Church, Tysons, McLean, and the greater Washington, D.C. metro area for ketamine therapy in Alexandria VA.

Watch the video on Yale Medicine's findings to learn more about the science behind ketamine therapy.

https://www.youtube.com/watch?v=nW21-AYY_fs

Ketamine is not FDA-approved for psychiatric conditions including depression, PTSD, anxiety, or OCD. Compounded ketamine products are not FDA-approved and should only be used under healthcare provider supervision. Z&Z Wellness provides off-label ketamine therapy following thorough patient screening and medical oversight. This content is for informational purposes only and does not constitute medical advice. Individual results may vary.