The Problem With 'Good Enough' in Depression Treatment
A new clinical review in Psychiatric Times makes a pointed argument: when it comes to treatment-resistant depression (TRD), clinicians and patients too often settle. They stop at "somewhat better" rather than pushing toward full remission — and that gap has real consequences. The piece argues that optimizing more efficacious treatments requires three interlocking practices: systematic symptom measurement, proactive dose adjustment, and aggressive management of side effects that cause patients to quit early.
These aren't abstract quality metrics. They describe exactly the kind of care infrastructure that separates a ketamine clinic doing things right from one going through the motions. Ketamine and esketamine (Spravato) sit squarely in the category of "more efficacious" options the review is discussing — treatments that work differently, and often faster, than traditional antidepressants. The question the article raises isn't whether they work. It's whether the way clinicians use them is actually optimized to get patients to remission.
What Optimization Actually Looks Like in Ketamine Care
The Psychiatric Times review centers on a principle called measurement-based care (MBC) — using validated symptom scales at regular intervals to track patient progress objectively, rather than relying on subjective impressions. Clinicians who practice MBC consistently catch non-response earlier, adjust doses sooner, and avoid months of ineffective treatment before changing course.
For ketamine patients, this is directly applicable. The standard induction series of six IV infusions over two to three weeks is a starting point, not a fixed formula. Patients who show only partial response may benefit from additional infusions, adjusted dosing, or modified timing between sessions. Clinics that track outcomes with tools like the PHQ-9 or MADRS — rather than relying on informal check-ins — are far better positioned to make those calls with actual data.
The second pillar the review emphasizes is side effect management, which matters enormously in ketamine treatment. Dissociative effects during infusions are common and, for some patients, unsettling enough to prompt early dropout. When clinicians don't address this proactively — through adjusted infusion rates, pre-session preparation, or adjunctive medications — patients sometimes stop before treatment has had a genuine chance to work. The review frames early discontinuation as one of the most preventable barriers to remission in TRD, and it's a barrier that good clinical infrastructure can largely eliminate.
Why the Field Is Maturing Beyond Just 'Does Ketamine Work?'
The broader context here matters. Treatment-resistant depression affects roughly 30% of people diagnosed with major depressive disorder — millions of patients who have cycled through multiple antidepressants without adequate relief. For many of them, ketamine represents a genuine inflection point: a treatment that operates through NMDA receptor antagonism and rapid synaptogenesis rather than the monoamine pathways that already failed them.
But clinical trial efficacy doesn't automatically translate to real-world outcomes. That translation depends on how treatments are administered and managed over time. This is the quality argument the Psychiatric Times review is making, and it's one the ketamine field needs to take seriously as the treatment becomes more widely available across a range of clinic settings and price points.
The growing availability of ketamine — through IV clinics, Spravato-certified providers, and telehealth-adjacent oral ketamine programs — means patients now have more choices than ever. But more choices also means more variation in quality. How a clinic tracks your response, manages side effects, and adjusts your protocol based on data is not a secondary consideration. It is the mechanism through which a pharmacologically promising treatment becomes a lasting clinical benefit.
Key Takeaway
Before starting ketamine treatment for TRD, ask your provider how they measure and track your response between sessions. Clinics that use validated symptom scales, discuss maintenance planning upfront, and actively manage side effects are practicing the kind of care the evidence increasingly supports — and it can make the difference between partial relief and full remission.
Practical Questions to Ask Any Ketamine Provider
If you're evaluating ketamine clinics or currently in treatment, the findings in this review translate into a few concrete questions worth asking:
- How do you track my symptoms between infusions? Standardized scales, not just verbal check-ins, are the benchmark.
- What happens if I have a partial response? A good answer involves protocol flexibility — adjusted doses, additional sessions, or modified timing — not a rigid six-and-done approach.
- How do you handle dissociation or side effects during infusions? The answer reveals whether the clinic prepares patients proactively or simply waits to react.
- What does success look like beyond the initial series? Providers who talk about remission — not just symptom reduction — and who have a maintenance plan are thinking about your long-term outcome.
Ketamine's pharmacology is real and well-documented. What's evolving now is the clinical science around how to deploy it most effectively for the patients who need it most. For anyone navigating treatment-resistant depression, that evolution is worth paying attention to.
Source: Optimizing the Use of More Efficacious Treatments in Treatment Resistant Depression, Psychiatric Times, April 2026.
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