For many people living with depression, the path to relief has felt like an endless series of adjustments — a new medication here, a dosage change there, and all the waiting that comes between. When conventional treatments fail to provide adequate relief, or stop working after years of effectiveness, it can feel as though the options have simply run out. That sense of exhaustion is real, and it is also more common than many realize.
Ketamine infusion therapy has received growing attention in psychiatric research because it works differently from many traditional antidepressants and may offer a different timeline for symptom improvement for some patients. At Initia Nova, we provide this option in a carefully supervised clinical setting for residents of Wilmington, Delaware, and the surrounding New Castle County region. Our name, “Initia Nova,” means “new beginning,” reflecting our commitment to helping patients explore a path forward when other approaches have not delivered adequate relief.
Here, we explain what ketamine infusion therapy is, how it may work for depression, who may be a candidate, and what patients can generally expect when they begin care with us.
Understanding Treatment-Resistant Depression
When First-Line Treatments Are Not Enough
Major depressive disorder affects tens of millions of people in the United States. In 2021, an estimated 21 million U.S. adults experienced at least one major depressive episode (National Institute of Mental Health [NIMH], 2023).
Treatment-resistant depression is commonly used to describe depression that has not responded adequately to multiple treatment attempts, though exact definitions can vary across clinical settings and studies (Sanacora et al., 2017). For many patients in this situation, the conventional treatment landscape can begin to feel like diminishing returns — the same medication classes, gradual titration timelines, and uncertainty about whether the next attempt will finally help.
At Initia Nova, we begin with a thorough review of each patient’s psychiatric history, medical history, current medications, and treatment goals before recommending any path forward.
The Glutamate Hypothesis
Most traditional antidepressants primarily affect monoamine signaling, including serotonin, norepinephrine, or dopamine. Ketamine works differently. It acts on NMDA receptors in the brain’s glutamate system, and researchers continue to study the downstream effects that may involve AMPA signaling and synaptic plasticity (Zanos & Gould, 2018).
A growing body of research suggests that depression may involve more than a neurochemical imbalance alone. Ketamine may influence pathways related to synaptic signaling and neuroplasticity, although its full antidepressant mechanism remains an active area of research (Zanos & Gould, 2018). Our blog post on how ketamine clinics are revolutionizing depression treatment explores this evolving science in greater depth.
This mechanistic difference is one reason ketamine has been studied for a potentially faster antidepressant effect. Some patients may notice changes in mood within hours or days, though timing and degree of response vary substantially from person to person (Seshadri et al., 2024).
Individual Results Vary
It is worth stating clearly: individual results vary considerably. Not every person with depression will respond to ketamine infusion therapy, and the degree of response, its onset, and its duration differ from patient to patient. Ketamine used for psychiatric purposes is an off-label use of an anesthetic medication, and the available evidence does not guarantee a specific outcome (Sanacora et al., 2017).
What the research does support is that ketamine infusion therapy may offer an additional option for some patients with difficult-to-treat depression. We use a comprehensive evaluation to help determine whether the potential benefits and risks are appropriate for each individual.
How Ketamine Infusion Therapy Works
The IV Infusion Protocol
IV ketamine for depression is typically administered as a series of infusions, though timing and scheduling should be individualized. At our Wilmington location, we currently begin with an initial series of eight infusions, initially twice each week, then adjust the schedule based on each patient’s response and treatment plan. Patients can review our ketamine treatment FAQs before beginning care.
Each infusion generally lasts about 40 minutes, followed by an observation period. We monitor patients throughout treatment and ask them to arrange transportation home, since driving is not permitted for the remainder of the day.
During an infusion, patients may experience mild perceptual changes, dissociation, lightness, or dreamlike thoughts. Temporary changes in blood pressure, nausea, dizziness, and dissociation are among the effects that may occur and are part of why appropriate screening and monitoring matter (Short et al., 2018).
At our Wilmington location, we aim to make the infusion experience calm and supportive. We encourage patients to share questions or concerns before their first session so we can walk through what to expect.
The Response Timeline
One of the most notable features of ketamine infusion therapy is its potential speed of onset relative to many conventional antidepressants. Research has documented reductions in depression symptoms within hours or days for some patients, while others experience more gradual changes or may not respond (Seshadri et al., 2024). For a closer look at how long results typically last, see our overview of how long ketamine treatment lasts.
This reflects an important reality in ketamine care: rapid symptom improvement is possible, but it is not universal. We discuss realistic expectations during the evaluation process and encourage patients to ask questions about the timeline that may be appropriate for them.
Maintenance and Long-Term Planning
For patients who respond to an initial series of infusions, maintaining that benefit may involve some form of ongoing care. Research suggests that ketamine’s antidepressant effects may not be indefinitely sustained after a single series for many patients, and maintenance approaches remain an active area of study (Smith-Apeldoorn et al., 2022).
At Initia Nova, we work with each patient to develop an individualized plan that accounts for treatment history, response pattern, and overall goals. The aim is not simply to address symptoms acutely, but to support a thoughtful and sustainable plan for ongoing care.
Who May Be a Candidate
Evaluating Appropriateness
Not everyone with depression is an ideal candidate for ketamine infusion therapy, and responsible clinical practice begins with a thorough evaluation. We may consider ketamine therapy for patients with major depressive disorder or bipolar depression who have had an inadequate response to previous treatment and do not have medical or psychiatric factors that would make ketamine inadvisable.
Active psychosis, uncontrolled hypertension, certain cardiovascular conditions, pregnancy, and substance use concerns are among the factors that may require careful assessment. This is not a complete list, and treatment decisions should be made through an individualized review of each patient’s medical and psychiatric history (Sanacora et al., 2017).
The Role of Psychiatric History
We do not view ketamine infusion therapy in isolation from a patient’s broader psychiatric care. It may be one component of a comprehensive approach that also includes psychotherapy, medication management, and lifestyle-based strategies.
For some patients, we may also discuss whether Ketamine-Assisted Psychotherapy (KAP) is appropriate as part of a broader treatment plan. We encourage patients to consult with a provider who understands their full psychiatric and medical history before pursuing any treatment.
Access in Wilmington, Delaware
At our Wilmington office, located at 3512 Silverside Road, Suite 13, we provide access to psychiatric evaluation and advanced treatment options for patients in northern Delaware and nearby communities.
Patients who are exploring care can also review our guide to choosing a ketamine infusion clinic before scheduling an evaluation.
What Sets Initia Nova Apart
Evidence-Based and Comprehensive
At Initia Nova, we approach psychiatric care with an emphasis on individualization, comprehensive assessment, and thoughtful clinical decision-making. Alongside ketamine infusion therapy, we offer SPRAVATO® therapy, NAD+ therapy, KAP, and specialized individual appointments.
This breadth of offerings allows us to discuss options in light of each patient’s history, goals, and clinical needs rather than applying a one-size-fits-all protocol. Professional guidance on ketamine treatment emphasizes the importance of appropriate screening, monitoring, and individualized decision-making (Sanacora et al., 2017).
A Supportive Clinical Environment
Beyond the clinical protocol itself, we know that patients need space to ask questions and understand what to expect. At our Wilmington location, we aim to provide a calm, respectful setting for evaluation and treatment.
We encourage patients to ask about the process, the evidence, and their individual treatment plan. While results vary, our commitment to a thorough, respectful, and individualized process remains consistent.
Parting Thoughts
Depression that has resisted conventional treatment for months or years can feel permanent. Ketamine infusion therapy has expanded the options that may be considered for some patients with difficult-to-treat depression, though careful screening, monitoring, and individualized planning remain essential (Seshadri et al., 2024; Short et al., 2018).
If you or someone you care about in the Wilmington area is living with depression that has not responded adequately to other treatments, we invite you to learn more about our Wilmington location. We are available to answer questions, provide thorough evaluations, and work collaboratively with patients to identify appropriate next steps. Schedule a consultation or call us at (302) 599-6286 to begin the conversation.
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy, TMS, SPRAVATO®, and other treatments described should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
References
National Institute of Mental Health. (2023, July). Major depression. National Institutes of Health. https://www.nimh.nih.gov/health/statistics/major-depression
Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., Summergrad, P., & Nemeroff, C. B. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405. doi:10.1001/jamapsychiatry.2017.0080 https://pubmed.ncbi.nlm.nih.gov/28249076/
Seshadri, A., Prokop, L. J., & Singh, B. (2024). Efficacy of intravenous ketamine and intranasal esketamine with dose escalation for major depression: A systematic review and meta-analysis. Journal of Affective Disorders, 356, 379–384. doi:10.1016/j.jad.2024.03.137 https://pubmed.ncbi.nlm.nih.gov/38537759/
Short, B., Fong, J., Galvez, V., Shelker, W., & Loo, C. K. (2018). Side-effects associated with ketamine use in depression: A systematic review. The Lancet Psychiatry, 5(1), 65–78. doi:10.1016/S2215-0366(17)30272-9 https://pubmed.ncbi.nlm.nih.gov/28757132/
Smith-Apeldoorn, S. Y., Veraart, J. K. E., Spijker, J., Kamphuis, J., & Schoevers, R. A. (2022). Maintenance ketamine treatment for depression: A systematic review of efficacy, safety, and tolerability. The Lancet Psychiatry, 9(11), 907–921. doi:10.1016/S2215-0366(22)00317-0 https://pubmed.ncbi.nlm.nih.gov/36244360/
Zanos, P., & Gould, T. D. (2018). Mechanisms of ketamine action as an antidepressant. Molecular Psychiatry, 23(4), 801–811. doi:10.1038/mp.2017.255 https://pubmed.ncbi.nlm.nih.gov/29532791/