What Are the Therapeutic Uses of Ketamine?

Ketamine occupies an unusual place in medicine. It is a genuine, long-established anaesthetic and, more recently, the basis of an evidence-backed treatment for depression that has not responded to anything else — yet it is also a drug that is increasingly misused, with serious consequences for the people who become dependent on it. Understanding the legitimate therapeutic uses of ketamine matters precisely because it helps explain why supervised medical use and recreational misuse are not the same thing.

Anaesthesia and Emergency Pain Relief

Ketamine’s original and still most widespread role is as a general anaesthetic. It induces a trance-like state that provides sedation, pain relief, and amnesia, which makes it valuable in surgery. One feature that sets it apart from many other anaesthetics is that, at anaesthetic doses, it tends to preserve breathing and airway reflexes, and it has bronchodilatory properties that can help patients with reactive airway conditions. Because of this safety profile, it is on the World Health Organization’s list of essential medicines.

In emergency medicine, ketamine is used for procedural sedation and rapid-sequence intubation, and its analgesic properties make it useful in trauma care. In the operating theatre it is sometimes given alongside opioids to improve pain control and reduce the opioid dose needed, which can lower opioid-related side effects. For chronic pain, low-dose ketamine infusions have been explored for conditions such as complex regional pain syndrome and neuropathic pain when other treatments have failed — always administered and monitored by specialists.

Treatment-Resistant Depression

The most significant recent development is ketamine’s use in treatment-resistant depression. Conventional antidepressants often take weeks to work, and a substantial number of people do not respond to them at all. Ketamine can produce antidepressant effects far more quickly — sometimes within hours — and is thought to work by modulating glutamate signalling and supporting synaptic plasticity, a different mechanism from standard antidepressants.

This is where the evidence is strongest. In 2019 the U.S. Food and Drug Administration approved esketamine (brand name Spravato), the S-enantiomer of ketamine, as a nasal spray for treatment-resistant depression, used alongside an oral antidepressant (Johnson & Johnson). In January 2025 the FDA went further and approved esketamine as the first standalone (monotherapy) treatment for adults with treatment-resistant depression (HCPLive). Crucially, Spravato is only administered in certified healthcare settings under direct supervision, because of side effects that include dissociation and raised blood pressure — patients cannot take it at home.

Post-Traumatic Stress Disorder

Not everyone with PTSD achieves remission through psychotherapy and standard medication, and ketamine has been studied as an additional option. A randomised controlled trial led by researchers at the Icahn School of Medicine at Mount Sinai and published in the American Journal of Psychiatry in 2021 found that repeated ketamine infusions reduced PTSD symptom severity significantly more than an active placebo, with 67% of the ketamine group classed as treatment responders compared with 20% of the comparison group (PubMed). The improvement was rapid but not permanent, so ketamine is viewed as one part of a broader treatment plan rather than a cure on its own.

Anxiety and OCD: Early, Promising Research

Evidence for other conditions is genuinely preliminary and should be described that way. Small studies have reported that ketamine infusions can produce rapid, short-lived reductions in symptoms of treatment-resistant anxiety disorders, and early controlled research has found a similar brief improvement in obsessive-compulsive disorder. These effects are thought to relate to ketamine’s action on glutamate pathways. Because the benefits tend to fade within days to a week, researchers see ketamine here as a possible catalyst that opens a window for other therapies, not a standalone treatment. Larger trials are needed before any firm conclusions can be drawn.

Substance Use Disorders: A Research Frontier

There is an apparent paradox worth explaining carefully: ketamine is being studied as a supervised, low-dose adjunct to therapy for some addictions, even though ketamine itself can be misused. In the Ketamine for Reduction of Alcoholic Relapse (KARE) trial, run by the University of Exeter and published in the American Journal of Psychiatry in 2022, people with alcohol use disorder who received low-dose ketamine combined with psychological therapy stayed abstinent for a greater proportion of the follow-up period and were more than 2.5 times as likely to remain fully abstinent as those given placebo (NIHR). Early work has also looked at opioid and stimulant use disorders.

These are experimental, tightly controlled research settings with carefully calibrated dosing and no take-home supply — a world away from unsupervised use. To be clear: this is a research field, not standard care, and it is not something Holina offers. Our approach to substance use is a whole-person addiction treatment programme, not ketamine-assisted therapy.

The Line That Matters: Supervised Therapy vs. Unsupervised Use

Every legitimate use above shares three things: a low, precisely measured dose; delivery by trained clinicians in a medical setting; and close monitoring throughout. That is exactly what separates therapeutic ketamine from recreational misuse. Taken without supervision, in escalating amounts and over time, ketamine carries real risks of psychological dependence and physical harm. Chronic recreational use is a well-documented cause of ketamine-induced uropathy — painful, sometimes irreversible bladder and urinary-tract damage that affects around a quarter of regular users (The Primary Care Companion for CNS Disorders).

This contrast is the whole point. Supervised, low-dose ketamine therapy carries a very different risk profile from unsupervised use precisely because of the controls around it. When those controls are absent, the same molecule becomes a genuine dependence and health risk.

What Holina Treats

Holina Rehab works at the misuse end of this spectrum. If ketamine use has become compulsive or is harming someone’s health, relationships, or bladder, that is a treatable condition. Our care begins with medically supervised ketamine detox to manage withdrawal safely, followed by structured ketamine addiction treatment that addresses the reasons behind the use.

Because ketamine misuse so often sits alongside depression, trauma, or anxiety — the very conditions supervised ketamine therapy is studied for — our Dual Treatment programme treats the addiction and the underlying mental-health condition together, since addressing only one rarely holds. For a quick primer on the most common questions people ask, see our short guide to ketamine’s top questions answered.

The Bottom Line

Ketamine’s therapeutic uses are real: it is a trusted anaesthetic, the basis of an FDA-approved depression treatment, and a promising subject of ongoing research in trauma and addiction. What makes those uses safe and legitimate is medical supervision, controlled dosing, and monitoring — the exact safeguards that unsupervised use lacks. If ketamine use has stopped being about medicine and started causing harm, help is available. Holina Rehab in Koh Phangan, Thailand offers medically supervised, compassionate, whole-person care. To find out how we can help, contact us on +66 82 113 0657 (main) or +66 61 936 8047 (Thai).