IM ketamine session
$349
per session, cash pay
Starting price for each supervised injection visit. Most patients do a short induction series, then space maintenance sessions as needed.
Rockville & Frederick, MD · Accepting new patients
Intramuscular ketamine for treatment-resistant depression
When antidepressants have already failed and you need a faster, more flexible option than a fixed nasal-spray protocol, intramuscular ketamine is one of the treatments we offer under medical supervision at our Rockville and Frederick clinics.
IM ketamine is given as an injection in the office. It reaches the bloodstream more directly than a nasal spray, and the dosing schedule can be adjusted in ways Spravato's protocol does not allow. Sessions are cash pay at $349. We publish that price here so you know before you book.
What intramuscular ketamine is
Ketamine has been used safely as an anesthetic for decades. At much lower doses, psychiatrists use it off-label for depression that has not responded to standard care. Intramuscular means the medication is injected into a muscle rather than infused through an IV or sprayed into the nose.
That route matters because absorption is more direct than nasal spray, and the clinician can adjust dose and timing based on how you respond. Spravato (esketamine) is the FDA-approved nasal option we also offer. IM ketamine is the flexible, cash-pay alternative when that fixed protocol or coverage path is not the right fit.
- Off-label Used for depression under psychiatric supervision, not as an FDA-approved depression indication
- In clinic Every dose is given on site with monitoring afterward — never taken home
- Cash pay $349 per session — published upfront, no prior auth wait
How it is different, at a glance
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Injection, not a spray
Given intramuscularly in clinic so dosing can be tailored to your response
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A different brain target
Works on glutamate and NMDA receptors, not the serotonin pathways older antidepressants use
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Often faster
Some people feel a shift within hours to days, not weeks of waiting on a new pill
Is IM ketamine right for you
It may be a fit if
- You have tried two or more antidepressants without adequate relief
- You need more dosing flexibility than Spravato's fixed schedule allows
- You are comfortable with cash-pay sessions at $349 and want that price stated upfront
- You can arrange a ride home after each session
It may not be the right fit if
- You have untreated psychosis, certain substance use disorders, or other contraindications we identify at evaluation
- You need an option your insurance will cover first — Spravato or Deep TMS may be a better starting point
- You are under 18
- You cannot stay for post-dose monitoring or arrange transportation home
Not sure where you land? A consultation sorts it out. We would rather tell you honestly that IM ketamine is the wrong fit than start you on something that will not help — or that your insurance would cover another way.
Why it can help when other treatments have not
Conventional antidepressants
Work mainly on serotonin, norepinephrine, and dopamine. They often take four to six weeks, and for many people with treatment-resistant depression they never deliver enough relief.
Ketamine
Acts on glutamate and NMDA receptors. That different pathway is why it can help people whose depression has not responded to multiple medications — and why effects can appear much sooner than with a new oral antidepressant.
What to expect on the day
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Check in
We review how you have been, confirm vitals are in a safe range, and answer questions before dosing
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Injection
A clinician administers the intramuscular dose in the office. The injection itself is brief
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Monitoring
You stay on site while we watch for dissociation, blood pressure changes, and sedation until you are clinically stable
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Ride home
You cannot drive afterward. Plan a ride and leave the rest of the day open
How treatment is structured
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Evaluation
Before treatment
We review your history, prior medications, and whether IM ketamine, Spravato, Deep TMS, or another path fits better. Cost and logistics are part of that conversation.
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Induction
Early sessions
An initial series of supervised sessions builds response. Exact spacing depends on your plan — that flexibility is one reason people choose IM over a fixed nasal protocol.
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Maintenance
As needed
If you respond, booster sessions can be spaced further apart. We adjust based on how you are doing, not a one-size schedule.
Unlike Spravato's REMS-mandated twice-weekly start, IM ketamine timing is set with your clinician. That is useful when you need a different pace — and it is also why coverage usually does not apply.
IM ketamine
Injection route, adjustable dosing, usually cash pay. Chosen when flexibility matters more than insurance coverage, or when nasal spray is not preferred.
Spravato (esketamine)
FDA-approved nasal spray for treatment-resistant depression, usually covered by insurance after prior authorization. Fixed protocol with two-hour REMS monitoring.
How IM ketamine compares
| Feature | IM ketamine | Spravato | Deep TMS |
|---|---|---|---|
| What it is | Intramuscular racemic ketamine injection | Esketamine nasal spray (FDA-approved) | Magnetic pulses to the brain (Deep TMS) |
| FDA status for depression | Off-label use | FDA-approved for TRD & suicidal ideation | FDA-cleared for depression & OCD |
| How it is given | Injection in office | Self-administered nasal spray in office | Helmet coil, ~20 minutes |
| Insurance | Cash pay — $349 per session | Usually covered after prior auth | Usually covered after prior auth |
| Can you drive home | No | No | Yes |
| Schedule flexibility | Clinician-adjusted | Fixed induction then taper | Daily course, or accelerated options |
Which option fits depends on your insurance, history, and how you responded to anything ketamine-based you have already tried. That is a consultation conversation, not a website decision. Learn about Spravato or Deep TMS .
Side effects to know about
- Dissociation
- Dizziness
- Nausea
- Sedation
- Short-term rise in blood pressure
- Injection-site discomfort
Most effects happen during or right after the session, which is why we monitor you on site. Risks, alternatives, and whether you are a candidate are covered in informed consent before treatment starts. Read important safety information .
How much IM ketamine costs
Because IM ketamine is used off-label for depression, sessions are cash pay rather than insurance. That also means no prior authorization wait. Pricing is published here so you are not guessing.
We still accept major plans for the initial consultation and other covered services. See the plans we accept .
- We confirm the $349 rate during your consultation
- If coverage matters more, we review Spravato or TMS instead
- You decide with full information, not after the first bill
Initial consultation
Insurance
billed to your plan when covered
Your evaluation is billed to insurance when your plan covers it. That visit is where we confirm fit, review alternatives, and confirm the cash-pay session rate before you start.
Where we provide IM ketamine
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Rockville
Serves Montgomery County and the DC suburbs. Also has Spravato and BrainsWay Deep TMS on site — so if another advanced option fits better, you do not have to start over elsewhere.
Book at Rockville -
Frederick
Serves Frederick County and the I-70 corridor. IM Ketamine and Spravato on site, with Deep TMS available at Rockville when you need it.
Book at Frederick
Both clinics are led by Dr. Amir Etesam, a Johns Hopkins-affiliated psychiatrist. Deep TMS is Rockville only. Same practice, shared chart, one care team.
Common questions
What is the difference between Spravato and IM ketamine?
Spravato is an FDA-approved esketamine nasal spray for treatment-resistant depression and is usually covered by insurance. IM ketamine is an injection used off-label, which allows more dosing flexibility but is usually cash pay.
Is IM ketamine FDA-approved for depression?
No. Ketamine is FDA-approved as an anesthetic. Using it for psychiatric conditions is an off-label use under medical supervision after evaluation and informed consent.
Does insurance cover intramuscular ketamine?
Usually not. Sessions are cash pay at $349 each. Your initial consultation is still billed to insurance when your plan covers it. If you need a covered treatment option, Spravato or Deep TMS may be a better fit.
Can I drive myself home after a session?
No. You need a ride home and should not drive or operate machinery until the next day after a restful sleep.
Where is IM ketamine available?
At our Rockville and Frederick clinics. Deep TMS remains Rockville only. Same practice, shared chart, one care team.
How do I know if I should choose IM ketamine or Spravato?
It depends on insurance, your history, and how you responded to anything ketamine-based you have already tried. That decision belongs in your evaluation, not on a webpage.