Depression does not always respond to the first treatment prescribed. Some people continue to experience persistent sadness, loss of interest, poor concentration, disturbed sleep or thoughts of hopelessness despite trying appropriate antidepressants and psychotherapy. In selected cases, a psychiatrist may consider ketamine therapy as part of a carefully supervised treatment plan.
Ketamine was originally used as an anaesthetic. Research later showed that low-dose ketamine could produce relatively rapid antidepressant effects in some people with severe or treatment-resistant depression. A related medicine called esketamine is administered as a nasal spray in certain clinical settings.
When Is Ketamine Therapy Considered?
Ketamine is not generally the first treatment offered for depression. It may be evaluated when a person has:
- Tried more than one antidepressant without adequate improvement
- Experienced severe or persistent depressive symptoms
- Been unable to tolerate conventional medication
- Required a treatment approach with a potentially faster response
- Continued to struggle despite medication and psychotherapy
A lack of response to one or two treatments does not automatically mean ketamine is appropriate. The psychiatrist must first review the diagnosis, previous prescriptions, treatment duration, medication adherence and other medical or psychological conditions.
How Ketamine Differs from Regular Antidepressants
Most conventional antidepressants work gradually and may require several weeks before meaningful improvement becomes noticeable. Ketamine acts through different brain pathways and may produce symptom relief more rapidly in some patients.
However, a faster response does not mean permanent recovery or a guaranteed result. Some people may need multiple monitored sessions, while others may experience little improvement. Psychotherapy, lifestyle changes, sleep management and ongoing psychiatric care may still remain essential.
What Happens Before Treatment in Mumbai?
A psychiatric assessment should take place before ketamine is considered. For patients visiting from Breach Candy, Kemps Corner or other parts of South Mumbai, this evaluation may cover:
- Current depressive symptoms and their severity
- Previous medication and therapy history
- Bipolar disorder, psychosis or substance-use concerns
- Blood pressure and relevant medical conditions
- Current prescriptions and possible interactions
- Personal or family history of mental illness
- Safety concerns, including self-harm risk
Dr Milan Balakrishnan may also review whether the original diagnosis needs reconsideration. Conditions such as bipolar depression, anxiety disorders, thyroid problems, substance use or untreated sleep disorders can sometimes influence how depression presents and responds to treatment.
Why Clinical Monitoring Matters
Ketamine therapy should take place in a suitable clinical environment. Temporary effects can include dizziness, nausea, increased blood pressure, drowsiness, altered perception or a sense of detachment. Patients may require observation during and after administration.
Because alertness and coordination can be affected, independent travel or driving immediately after a session may not be advisable. Mumbai patients should plan transportation and allow sufficient recovery time before returning to work or other responsibilities.
Ketamine Is Part of a Broader Care Plan
Ketamine should not be viewed as an isolated procedure. Its role is usually considered within a wider treatment strategy that may include:
- Psychiatric follow-up
- Evidence-based psychotherapy
- Medication review
- Sleep and routine stabilisation
- Substance-use management
- Family support where appropriate
- Relapse-prevention planning
The most important question is not simply whether ketamine works quickly. It is whether the treatment is clinically suitable, safely administered and connected to a realistic long-term recovery plan. A thorough psychiatric assessment helps establish that context before any decision is made.
