Ketamine for Depression: Why Your GP Stays Silent

A Proven Option That Most Patients Never Hear About

A recent piece from Private Therapy Clinics, published in June 2026, puts a sharp question on the table: if ketamine is producing meaningful results for people with treatment-resistant depression, why aren't general practitioners bringing it up? It's a fair question — and the answer says as much about how mental healthcare is structured as it does about the drug itself.

Treatment-resistant depression (TRD) is typically defined as major depressive disorder that has not adequately responded to at least two different antidepressant treatments tried at adequate doses and durations. Estimates suggest that somewhere between 30 and 50 percent of people diagnosed with major depression will fall into this category at some point. For them, the standard pathway — try one SSRI, wait six weeks, try another, repeat — can stretch into years of partial relief or no relief at all, often accompanied by worsening function and quality of life.

Ketamine, and its close relative esketamine (marketed as Spravato), works differently from every antidepressant most GPs are trained to prescribe. Rather than targeting serotonin or norepinephrine reuptake, ketamine acts primarily as an NMDA receptor antagonist, triggering a rapid increase in synaptic plasticity — essentially helping the brain rebuild connections that depression tends to erode. The clinical signal is hard to ignore: many patients report meaningful mood improvement within hours to days of a first infusion, not weeks.

Why This Treatment Rarely Comes Up at a GP Appointment

The gap between ketamine's evidence base and its visibility in primary care reflects several overlapping structural realities, not a single failure.

It sits outside routine prescribing authority. In the UK, IV ketamine for depression is administered almost exclusively through specialist private clinics and a small number of NHS-adjacent services. It is not on the standard formulary that a GP would reach for when managing depression in a ten-minute appointment. Esketamine nasal spray (Spravato) received regulatory approval in both the US and Europe, but NHS coverage remains limited, and prescribing still requires specialist oversight under a risk management protocol. A GP who wanted to refer a patient for ketamine would need to know which services exist locally, how to frame the referral, and what the patient should expect — infrastructure that most primary care practices simply don't have in place.

Training has not kept pace with the evidence. Medical education on ketamine in psychiatric contexts has historically been sparse, and the drug's dual identity — as both a licensed anesthetic and a controlled substance with a history of recreational misuse — has contributed to hesitation at the prescriber level. Clinicians who trained before the current wave of ketamine research may hold out-of-date assumptions about its risk profile or appropriate patient population.

Stigma still operates in both directions. Patients may not ask because they associate ketamine with party culture and assume their GP will dismiss the idea. GPs may not raise it for similar reasons, or may worry about patient perception. The result is a mutual silence that keeps a potentially useful option off the table for people who need it most.

Cost and access create an equity gap. In the UK context, IV ketamine treatment is largely delivered through private clinics, with a typical course of infusions running into the hundreds or thousands of pounds. That cost barrier means ketamine is most accessible to patients who can already navigate and afford private care — not necessarily those with the most severe or long-standing treatment-resistant presentations.

What the Evidence Actually Supports

It's worth being precise about what is established and what remains under study. Randomized controlled trials and a substantial body of observational data support ketamine's acute antidepressant effect in TRD populations, with response rates that compare favorably to other augmentation strategies. Esketamine (Spravato) holds regulatory approval from the FDA and the European Medicines Agency specifically for TRD in adults, administered in certified healthcare settings with post-dose monitoring.

What is less settled is the long-term picture. Most ketamine research focuses on short-term response — days to weeks — and the field is still working out optimal maintenance schedules, predictors of who responds best, and how ketamine fits alongside or after other treatments like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). The antidepressant effect from a single infusion or nasal spray session tends to fade over days without follow-up, which is why clinicians typically structure treatment as a series of sessions rather than a one-time intervention.

Side effects during and immediately after treatment — dissociation, perceptual changes, elevated blood pressure, nausea — are well-documented and generally transient when treatment is delivered in a supervised clinical setting. Serious adverse events are uncommon in carefully screened patients. Longer-term concerns, including the risk of bladder damage seen in heavy recreational use, are considered low at the doses and frequencies used therapeutically, though monitoring practices vary between providers.

Practical Steps for Anyone Considering Ketamine for Depression

For readers who are navigating TRD themselves or supporting someone who is, a few practical points are worth highlighting.

First, document your treatment history carefully. A clear record of which medications you have tried, at what doses, and for how long is essential when making a case for specialist referral. Most clinical definitions of TRD require failure of at least two adequate antidepressant trials, and having that information organized strengthens your position in any conversation with a GP or psychiatrist.

Second, ask specifically. If you believe you meet criteria for TRD and want to explore ketamine options, ask your GP to refer you to a psychiatrist who has experience with it, or ask directly about specialist clinics that offer ketamine infusion or Spravato. The referral infrastructure is thin in many areas, but the request is legitimate and worth making explicitly.

Third, evaluate providers carefully. Because most ketamine treatment in the UK takes place in the private sector, quality and protocols vary. Look for clinics that screen patients thoroughly before treatment, monitor vitals during sessions, use licensed clinical staff, and offer integration support or follow-up care. Ketamine is not a standalone fix — how it is embedded in a broader treatment plan matters.

Finally, cost and financing are real barriers worth investigating early. Some private medical insurers are beginning to cover esketamine in specific circumstances; NHS access, while currently limited, is an evolving area. Asking directly about funding options before committing to a private course of treatment is reasonable and expected.

The conversation about ketamine and depression is finally reaching a wider audience. The next step is making sure patients don't have to discover this option on their own.

Source: Private Therapy Clinics, June 2026.