There is a particular kind of exhaustion that comes from trying to treat depression and not getting better. You have filled the prescriptions. You have waited through the adjustment periods. You have reported back to your provider, tried a different dose, tried a different medication. And still, the weight of it remains. At some point, “I’ve tried everything” stops feeling like a statement and starts feeling like a verdict. We want to be direct with you about something: it is not.
What Treatment-Resistant Depression Actually Means
When multiple antidepressants have failed to bring meaningful relief — typically after two or more adequate trials — clinicians use the term treatment-resistant depression. This is not a character flaw. It is not evidence that you are beyond help. It is a clinical designation that tells us the standard tools have not been the right tools for your brain, and that it is time to look beyond them (Gaynes et al., 2020; McIntyre et al., 2023).
Treatment-resistant depression affects millions of Americans. The biology underlying it is complex, involving disrupted glutamate signaling, impaired neuroplasticity, and inflammatory processes that conventional antidepressants do not fully address. Understanding this matters because it reframes the conversation. You are not failing treatment. Treatment has not yet been tailored precisely enough to you (Duman et al., 2016; McIntyre et al., 2023; National Institute of Mental Health, 2024).
This is the space where ketamine therapy has emerged as one of the most significant developments in psychiatric medicine in decades. At Vigeo Wellness here in Fort Worth, we have seen what happens when someone who has spent years cycling through treatments finally finds something that works. That experience is why we offer ketamine therapy — and why we take it seriously.
How Ketamine Works Differently
Traditional antidepressants — SSRIs, SNRIs, TCAs — work primarily on the serotonin, norepinephrine, or dopamine systems. They require weeks to build therapeutic levels, and for a meaningful percentage of patients, they produce no relief at all. Ketamine operates on an entirely different pathway (Rush et al., 2006).
Ketamine is an NMDA receptor antagonist. It targets the glutamate system, which is the brain’s primary excitatory neurotransmitter. When administered at carefully controlled infusion doses, ketamine rapidly promotes the growth of new synaptic connections — a process called synaptogenesis — in brain regions associated with mood, motivation, and emotional regulation. This neuroplastic effect happens quickly, which is why many patients report meaningful improvements in mood within hours to days rather than weeks (Duman et al., 2016; Krystal et al., 2019). To understand the mechanism in greater depth, see our overview of how ketamine can boost mood quickly.
It is important to be precise about what ketamine is and is not. Ketamine infusion therapy for depression and other psychiatric conditions is an off-label use of the medication — meaning it is not FDA-approved for psychiatric indications, though the research base supporting its effectiveness continues to grow. SPRAVATO® (esketamine nasal spray) is a related compound that has received FDA approval specifically for treatment-resistant depression. We offer both at Vigeo Wellness, and our team will discuss with your provider which option may be appropriate for your situation (Rosenbaum et al., 2024; U.S. National Library of Medicine, n.d.).
What the Research Shows — and What It Doesn’t
The evidence base for ketamine in treatment-resistant depression is substantial and continuing to develop. Multiple controlled studies have demonstrated rapid and significant reductions in depressive symptoms, including in patients who have not responded to multiple prior treatments. Some research suggests particular effectiveness for suicidal ideation, with improvements sometimes observable within hours of infusion (Krystal et al., 2019; Walsh et al., 2022).
Results still vary by individual, and we will not promise outcomes we cannot guarantee. Some patients experience dramatic, sustained relief. Others find that a series of infusions brings meaningful but temporary improvement, requiring maintenance sessions over time. A smaller number do not respond as hoped. What we can tell you is that for people who have run out of conventional options, ketamine therapy represents a scientifically grounded, clinically monitored path that is worth an honest conversation.
We also want to name one of the most common barriers we hear: cost and insurance coverage. Ketamine infusions are not universally covered by insurance, and this is a real obstacle. We encourage you to call us directly at 817-634-5521 to discuss what financial options may be available. We believe that financial challenges should not be the reason someone cannot access care that might genuinely change their life.
What to Expect at Vigeo Wellness Fort Worth
Our ketamine infusions are administered in a private, calm clinical environment here at our Fort Worth location at 906 W Cannon St. A standard infusion session lasts approximately 45 minutes to an hour. Throughout your session, one of our nurses will continuously monitor your vitals to ensure your safety and comfort. Many patients find the experience deeply relaxing; you may feel a temporary dissociative or perceptual shift during the infusion, which resolves as the medication clears your system. For a first-person perspective on what the process is like, read our guide on what to expect in a ketamine session.
Before any infusion, we conduct a thorough intake process. We want to understand your full psychiatric history, your prior treatment experiences, and any current medications you are taking. Ketamine is not appropriate for everyone, and discussing this honestly with your provider is essential. Contraindications include certain cardiovascular conditions, active psychosis, and untreated substance use disorders, among others. Our team will review your history carefully and work with your existing psychiatric provider as needed to determine whether ketamine therapy is a safe and reasonable option for you.
A typical initial course of treatment involves a series of infusions — often six sessions administered over two to three weeks. Many patients also find value in continued psychiatric medication management alongside ketamine therapy to support long-term outcomes. Another barrier we frequently hear is the fear of judgment — that seeking a newer, less-conventional treatment will somehow mark you as desperate or unstable. We want to be clear: advocating for your own recovery is not desperation. It is exactly what we hope for every person who walks through our door.
After the Infusion: What Comes Next
Following your infusion, you will need someone to drive you home — you cannot safely drive or operate machinery for the remainder of the day. Most people feel a return to baseline within a few hours. Some notice improved mood beginning that same day or within the next 24 hours. We will follow up with you after each session and work closely with you to assess your response and adjust your treatment plan accordingly.
For patients who respond well to an initial series, maintenance infusions are often an option to help sustain benefits over time. We take a long-term view of your care. Your journey to recovery does not end after six sessions; it is an ongoing relationship, and we are here for it.
If you are interested in learning more, we also offer TMS therapy and SPRAVATO® treatment as additional options for treatment-resistant depression. Every path is different, and our goal is to find the one that works for you.
Frequently Asked Questions
Is ketamine therapy FDA-approved for depression? Ketamine infusion therapy for psychiatric conditions is an off-label use of the medication, meaning it has not received FDA approval specifically for depression or other mood disorders. However, SPRAVATO® (esketamine), a related compound, is FDA-approved for treatment-resistant depression and is also available at Vigeo Wellness. The research support for ketamine infusions is robust and growing, and many psychiatrists consider it a well-evidenced option for appropriate patients.
How many infusions will I need? An initial course typically involves six infusions over two to three weeks, though individual protocols may vary based on your clinical history and response to treatment. Some patients benefit from ongoing maintenance infusions after the initial series. Your provider will discuss a personalized plan with you.
Will my insurance cover ketamine therapy? Coverage varies widely. Some insurance plans provide partial or full coverage; many do not. We encourage you to call us at 817-634-5521 to talk through your specific situation and explore what options may be available to make treatment accessible.
Can I continue my current antidepressants during ketamine therapy? In many cases, yes — but this depends on your specific medications and clinical history. Some medications may affect how you respond to ketamine. This is a critical conversation to have with your prescribing provider and our clinical team during your intake process.
What does the infusion feel like? Many patients describe a sense of deep relaxation, sometimes accompanied by mild perceptual or sensory shifts. These effects are temporary and resolve as the medication clears. Our nursing staff will be present throughout to monitor your comfort and safety. For a more detailed look at the experience, see our post on what IV ketamine infusion therapy involves.
Key Takeaways
- Treatment-resistant depression is a clinical designation, not a personal failure — it means conventional treatments have not matched your brain’s specific needs
- Ketamine works on the glutamate system and promotes new synaptic connections, offering a fundamentally different mechanism than standard antidepressants
- Ketamine infusion for psychiatric use is off-label; SPRAVATO® is FDA-approved for treatment-resistant depression and is also available at Vigeo Wellness
- Results vary by individual — some patients experience significant sustained relief, and we will not promise outcomes we cannot guarantee
- At Vigeo Wellness Fort Worth, every ketamine infusion is conducted in a monitored, private clinical environment with nursing oversight throughout
Conclusion
If you have spent years trying to get better and have not, we want you to know that we hear you. The exhaustion of treatment-resistant depression is real, and so is your right to keep looking for something that works. At Vigeo Wellness in Fort Worth, we take your history seriously, we monitor your care carefully, and we believe that there is still a path forward for you — even when it has not felt that way. You do not have to do it alone. Call us at 817-634-5521 or contact Vigeo Wellness to schedule a consultation and take the next step on your journey to recovery. Our Weatherford office is also available at 817-672-9407. You are heard. You matter.
References
Duman, R. S., Aghajanian, G. K., Sanacora, G., & Krystal, J. H. (2016). Synaptic plasticity and depression: New insights from stress and rapid-acting antidepressants. Nature Medicine, 22(3), 238–249. https://doi.org/10.1038/nm.4050
Gaynes, B. N., Lux, L., Lloyd, S., Hansen, R. A., Gartlehner, G., Thieda, P., Brode, S., Evans, T. S., Viswanathan, M., Lohr, K. N., & Trivedi, M. H. (2020). Defining treatment-resistant depression. Depression and Anxiety, 37(2), 134–145. https://doi.org/10.1002/da.22968
Krystal, J. H., Abdallah, C. G., Sanacora, G., Charney, D. S., & Duman, R. S. (2019). Ketamine: A paradigm shift for depression research and treatment. Neuron, 101(5), 774–778. https://doi.org/10.1016/j.neuron.2019.02.005
McIntyre, R. S., Alsuwaidan, M., Baune, B. T., Berk, M., Demyttenaere, K., Goldberg, J. F., Gorwood, P., Ho, R., Kasper, S., Kennedy, S. H., Ly-Uson, J., Mansur, R. B., McAllister-Williams, R. H., Murrough, J. W., Nemeroff, C. B., Nierenberg, A. A., Rosenblat, J. D., Sanacora, G., Schatzberg, A. F., Shelton, R. C., Stahl, S. M., Trivedi, M. H., Vieta, E., Vinberg, M., Williams, N., Young, A. H., & Maj, M. (2023). Treatment-resistant depression: Definition, prevalence, detection, management, and investigational interventions. World Psychiatry, 22(3), 394–412. https://doi.org/10.1002/wps.21120
National Institute of Mental Health. (2024). Depression. https://www.nimh.nih.gov/health/topics/depression
Rosenbaum, S. B., Gupta, V., Patel, P., & Palacios, J. L. (2024). Ketamine. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470357/
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., Sackeim, H. A., Kupfer, D. J., Luther, J., & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905–1917. https://doi.org/10.1176/ajp.2006.163.11.1905
U.S. National Library of Medicine. (n.d.). DailyMed: SPRAVATO—esketamine hydrochloride solution. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d81a6a79-a74a-44b7-822c-0dfa3036eaed
Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D. J., & Morgan, C. J. A. (2022). Ketamine for the treatment of mental health and substance use disorders: Comprehensive systematic review. BJPsych Open, 8(1), e19. https://doi.org/10.1192/bjo.2021.1061
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. SPRAVATO® (esketamine) is a prescription medication approved for adults with treatment-resistant depression and 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.