Treatment-resistant depression affects approximately one-third of people treated for major depressive disorder. It generally refers to depression that has not improved adequately after two or more appropriate treatment trials (McIntyre et al., 2023). If that describes your experience, you already know what it feels like to do everything right and still not feel better. You’ve taken the medications, followed the recommendations, waited through the weeks of titration, and found yourself back at the same place. That persistent gap between effort and relief is one of the most demoralizing realities in mental health care.
At Mindful Infusions, our Salt Lake City clinic serves patients across the Wasatch Front who have reached that point and are looking for a path forward that is both evidence-based and honestly presented. IV ketamine therapy, used off-label for psychiatric conditions including treatment-resistant depression, has become an important area of clinical research and care. We want you to understand what the evidence says, what treatment involves, and whether it may be appropriate for you.
What Makes Depression “Treatment-Resistant”?
Treatment-resistant depression, or TRD, is generally defined as a major depressive episode that has not responded adequately to at least two antidepressant trials of appropriate dose and duration (McIntyre et al., 2023). In practice, this often means years of medication adjustments, augmentation strategies, therapy combinations, and still-unresolved suffering. The personal and economic burden can be substantial, with TRD associated with greater disability and health care use than depression that responds to treatment (McIntyre et al., 2023).
Here in Utah, depression rates and access to behavioral health care have long been public health concerns. Utah has mental health provider shortages in every county and fewer mental health providers per 100,000 people than the national average (Kem C. Gardner Policy Institute, 2024). At Mindful Infusions, we’ve observed that a meaningful portion of the patients who come to us have already spent years trying to find relief through conventional channels and arrive at our clinic not as a first resort, but after exhausting other options. We take that history seriously, and it shapes how we approach every evaluation. To learn more about the broader landscape of alternative depression treatment in Utah, our blog offers a helpful overview.
How IV Ketamine Works for Depression
Ketamine is an NMDA, or N-methyl-D-aspartate, receptor antagonist. Most conventional antidepressants target the monoamine system, affecting serotonin, norepinephrine, or dopamine. Ketamine works differently: it blocks NMDA receptors in the brain, triggering downstream effects that may support synaptic plasticity and signaling involving brain-derived neurotrophic factor, or BDNF (Abdallah et al., 2015).
This process, sometimes described as synaptic remodeling, may help explain why ketamine can affect depressive symptoms differently from conventional antidepressants. For a closer look at this mechanism, read our guide to how ketamine therapy works in the brain for depression relief.
The clinical result that most distinguishes ketamine from other antidepressants is its speed. While SSRIs and SNRIs often require several weeks to produce a meaningful response, IV ketamine can produce measurable antidepressant effects within hours to days for some patients. A landmark 2006 randomized controlled trial by Zarate and colleagues at the National Institute of Mental Health found significant antidepressant effects within hours after a single IV ketamine infusion in patients with treatment-resistant major depressive disorder (Zarate et al., 2006). Later randomized research also found rapid antidepressant effects compared with an active placebo (Murrough et al., 2013).
What the Evidence Shows
The evidence base for IV ketamine in treatment-resistant depression continues to grow. Systematic reviews and meta-analyses support short-term antidepressant effects in people with major depression, including those with treatment resistance, while also emphasizing that response, duration of benefit, and long-term outcomes vary by individual and study design (Nikolin et al., 2023).
We’ve observed in our clinic that patients who respond to ketamine often describe the early effects in a distinctive way — not as sedation or artificial mood elevation, but as a lifting of the cognitive and emotional heaviness that depression creates. Many describe renewed capacity for engagement: being able to participate in therapy more productively, reconnect with relationships, and return to activities they had withdrawn from. Results vary by individual, and we communicate that honestly from the first conversation. Our post on ketamine for depression when antidepressants fail explores this experience in greater depth.
Who Is a Candidate for IV Ketamine at Mindful Infusions?
Ketamine may be considered for patients who have not achieved adequate relief through conventional antidepressant trials. Before beginning treatment, our team conducts a thorough clinical evaluation that reviews your full medical and psychiatric history, current medications, and factors that may affect safety or appropriateness. Conditions such as uncontrolled hypertension, active psychosis, and certain cardiovascular histories require careful assessment before ketamine can be considered (Swainson et al., 2021).
For patients living along the Wasatch Front, proximity and access matter. Ketamine infusions require you to be driven home afterward and to rest for the remainder of the day. Having a clinic nearby on Salt Lake City’s east side can make the logistical side of an infusion series more manageable. We’ve structured our scheduling and intake process with that practicality in mind. Discuss your eligibility and full treatment history with your provider before moving forward.
What to Expect at Mindful Infusions
Each IV ketamine infusion at our Salt Lake City clinic takes approximately 40 to 60 minutes. You’ll be seated in a calm, private setting with continuous monitoring throughout. Many patients experience a dissociative or perceptual shift during the infusion. This can be an expected, temporary part of the ketamine experience, and our team prepares you for it thoroughly. You will need a driver for the remainder of the day.
Our initial protocol commonly includes six infusions administered over two to three weeks. Response is evaluated throughout the course, and any discussion of additional infusions is individualized for patients who respond. Published guidance does not establish one maintenance schedule that is appropriate for every patient (Swainson et al., 2021). Our providers integrate ketamine treatment with your existing mental health care rather than positioning it as a standalone intervention. For a detailed walkthrough of the process, see navigating your first visit to a ketamine clinic: what to expect.
Key Takeaways
- Treatment-resistant depression affects approximately one-third of people treated for major depressive disorder and generally involves inadequate response to two or more appropriate treatment trials (McIntyre et al., 2023).
- IV ketamine works through the NMDA receptor pathway, producing effects that differ fundamentally from conventional monoamine-targeting antidepressants (Abdallah et al., 2015).
- Research supports rapid antidepressant effects from IV ketamine for some patients with treatment-resistant depression, sometimes within hours (Murrough et al., 2013; Zarate et al., 2006).
- IV ketamine for psychiatric conditions is used off-label. It is not FDA-approved for depression, and we disclose that clearly at Mindful Infusions.
- Infusion schedules and duration of benefit vary. We evaluate treatment response and next steps individually.
If you’ve been living with depression that hasn’t responded to medications you’ve already tried, our team at Mindful Infusions in Salt Lake City is equipped to have that conversation with you honestly. We review your full history, set realistic expectations, and help you understand whether IV ketamine therapy is a reasonable next step for your situation. To schedule a consultation, call us at (385) 299-0473 or visit Mindful Infusions.
References
Abdallah, C. G., Sanacora, G., Duman, R. S., & Krystal, J. H. (2015). Ketamine and rapid-acting antidepressants: A window into a new neurobiology for mood disorder therapeutics. Annual Review of Medicine, 66, 509–523. https://pubmed.ncbi.nlm.nih.gov/25341010/
Kem C. Gardner Policy Institute. (2024, March 18). Utah Behavioral Health Assessment & Master Plan. University of Utah. https://gardner.utah.edu/public-policy/health-care-and-life-sciences/utah-behavioral-health-assessment-master-plan/
McIntyre, R. S., et al. (2023). Treatment-resistant depression: Definition, prevalence, risk factors, and treatment challenges. The Canadian Journal of Psychiatry. https://pubmed.ncbi.nlm.nih.gov/37713549/
Murrough, J. W., et al. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: A two-site randomized controlled trial. American Journal of Psychiatry, 170(10), 1134–1142. https://pubmed.ncbi.nlm.nih.gov/23982301/
Nikolin, S., Rodgers, A., Schwaab, A., Bahji, A., & Zarate, C. A., Jr. (2023). Ketamine for the treatment of major depression: A systematic review and meta-analysis. eClinicalMedicine, 63, 102127. https://doi.org/10.1016/j.eclinm.2023.102127
Swainson, J., et al. (2021). The Canadian Network for Mood and Anxiety Treatments Task Force recommendations for the use of racemic ketamine in adults with major depressive disorder. The Canadian Journal of Psychiatry, 66(2), 113–125. https://pubmed.ncbi.nlm.nih.gov/33174760/
Zarate, C. A., Jr., Singh, J. B., Carlson, P. J., et al. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856–864. https://pubmed.ncbi.nlm.nih.gov/16894061/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine infusion therapy and SPRAVATO® should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. SPRAVATO® is FDA-approved for specific indications; IV ketamine for psychiatric conditions is used off-label. 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.