Depression can be persistent in a quiet, exhausting way. You may have tried medication, therapy, lifestyle changes, or a combination of approaches. You may have done everything asked of you and still feel that relief remains out of reach.

This is often when people encounter the phrase treatment-resistant depression. It can sound definitive. It is not. It is a clinical term used to describe depression that has not improved adequately after appropriate treatment attempts, often including more than one antidepressant medication taken at a therapeutic dose for a sufficient period.

The phrase does not mean you have failed treatment. It does not mean nothing can help. It means your care deserves a closer, more thoughtful review.

At Soft Reboot Wellness, we provide IV ketamine therapy in Menlo Park and serve patients across the Bay Area. We begin with the larger picture, not simply a label.

What “Treatment-Resistant” Actually Means

There is no single blood test or scan that establishes treatment-resistant depression. Clinicians consider your diagnosis, the severity and pattern of symptoms, prior medications, dose and duration, therapy history, medical conditions, substance use, sleep, and current supports.

Two people may both be described as having treatment-resistant depression while having very different histories. One may have had partial benefit from several medications but difficult side effects. Another may not have found meaningful change despite consistent psychiatric care. These details matter.

A careful evaluation also asks whether prior treatments were truly adequate trials. Medication changes sometimes happen quickly because of side effects, access barriers, or life circumstances. Those experiences still count. They simply need to be understood in context.

Depression can also coexist with anxiety, trauma symptoms, chronic pain, sleep disruption, or other health concerns. We do not reduce your experience to a checklist. We want to understand what has been difficult, what has helped even slightly, and what has felt unsustainable.

What the Evidence Can Tell Us About Ketamine

Ketamine is an anesthetic medication that has been used in medical settings for decades. Its psychiatric use, including ketamine for depression, is off-label. That means it is not FDA-approved for depression, even though clinicians may use it when they determine it is medically appropriate.

Interest in ketamine comes partly from its different mechanism of action. Traditional antidepressants often focus on serotonin, norepinephrine, or related systems. Ketamine acts primarily through glutamate-related pathways. Researchers continue to study how its effects unfold over time, including multistage effects on depressive symptoms (Walter et al., 2014).

Research on ketamine and related medications has focused heavily on adults with treatment-resistant depression. Trials of intranasal esketamine given alongside a newly initiated oral antidepressant found improvement in depressive symptoms for some participants compared with an active-control approach, while also underscoring the importance of structured monitoring (clinical trial findings in treatment-resistant depression (Popova et al., 2019)).

Studies of IV ketamine have also examined patient experiences beyond mood scores. A 2024 observational study reported changes in sleep quality and circadian rhythm measures during treatment, though this kind of research cannot establish that ketamine caused every reported change (patient-reported sleep outcomes (Yan et al., 2024)).

These findings are meaningful. They are not a promise. Research results describe groups, while treatment decisions are made for one person at a time.

What the Evidence Cannot Promise

It is understandable to want a clear answer. Will this work for me? How long will any improvement last? Will it replace my current care?

No responsible clinician can answer those questions with certainty before an evaluation. The evidence does not establish that IV ketamine is superior for every person with depression. Comparative research across medication and somatic treatments points to a varied landscape of benefits, tolerability concerns, study designs, and unanswered questions (a network analysis of treatment options (Papadimitropoulou et al., 2017)).

Even comparisons between IV ketamine and esketamine require care. A recent systematic review and meta-analysis noted differences in available studies and the need for more high-quality direct evidence (comparative ketamine research (Elmosalamy et al., 2025)).

That is why we encourage a grounded conversation rather than a search for certainty. You can also read our discussion comparing ketamine with SSRIs as part of considering the broader treatment landscape.

Off-Label Care and Individual Candidacy

An evaluation is not a formality. It is where we consider whether ketamine may be appropriate, and whether another approach may make more sense.

We review your medical and psychiatric history, current medications, prior treatment experiences, cardiovascular considerations, substance-use history, and the practical support you will have around treatment. Ketamine can temporarily affect blood pressure and heart rate, which is one reason supervised care matters. A review of treatment-resistant depression studies emphasized the need for cardiovascular assessment and monitoring during administration (cardiovascular safety considerations (Szarmach et al., 2019)).

We also discuss possible acute effects, which can include dissociation, nausea, dizziness, fatigue, or changes in perception. The experience can be unfamiliar. It should not be treated casually.

Our role is not to persuade you. Our role is to help you make an informed decision with full information about potential benefits, limitations, risks, and alternatives.

Why Physician-Led Care Matters

Ketamine treatment requires attention before, during, and after each infusion. We provide physician-led ketamine care with monitoring and individualized clinical oversight.

We also believe treatment should fit within the reality of your life. That may include ongoing psychiatric care, therapy, family support, rest, and a plan for getting home safely afterward. For some people, reflective therapeutic support is part of the larger work. Our introduction to ketamine-assisted psychotherapy explores that distinction.

We do not assume ketamine should replace existing treatment. Do not stop or change prescribed psychiatric medications without speaking with the clinician who manages them.

What an IV Ketamine Treatment Course May Involve

If ketamine is appropriate, we will explain the proposed treatment plan, the infusion setting, monitoring, recovery time, and follow-up. The exact schedule is individualized. It depends on your clinical history, response, safety considerations, and the care plan you develop with your providers.

Before an infusion, practical preparation helps. Arrange transportation, wear comfortable clothing, and give yourself room afterward rather than scheduling demanding obligations. Our guidance on preparing for your infusion can help you think through the day.

During the infusion, you remain monitored by our clinical team. You may be awake, relaxed, or experience temporary changes in perception. Afterward, you will need time to recover before leaving with your arranged ride.

Questions Worth Bringing to a Consultation

You do not need to arrive with perfect language. But it can help to ask direct questions:

Does my treatment history meet the clinical meaning of treatment-resistant depression?

What risks or medical factors should we consider in my case?

What are the alternatives to ketamine at this point?

How would this fit with my current psychiatrist, therapist, or medications?

What monitoring happens during and after an infusion?

What costs should I expect, and what follow-up is recommended?

We welcome these questions. They are part of careful care.

Key Takeaways

Treatment-resistant depression is a description of an incomplete response to prior care, not a verdict on your future. Ketamine for depression is an off-label clinical option that requires individualized medical assessment. Research offers reasons for continued study and cautious clinical interest, but it cannot predict your personal response or guarantee lasting benefit.

If depression has become overwhelming, or you are thinking about harming yourself, call or text the 988 Suicide and Crisis Lifeline for immediate support. For a non-urgent conversation about whether our approach may fit your situation, we invite you to contact Soft Reboot Wellness and schedule a consultation.

Works Cited

1. Popova V, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. https://pubmed.ncbi.nlm.nih.gov/31109201/

2. Szarmach J, et al. Short-term ketamine administration in treatment-resistant depression: focus on cardiovascular safety. https://pubmed.ncbi.nlm.nih.gov/31488795/

3. Yan R, et al. Patient-reported outcomes on sleep quality and circadian rhythm during treatment with intravenous ketamine for treatment-resistant depression. https://pubmed.ncbi.nlm.nih.gov/38440104/

4. Walter M, et al. Multistage drug effects of ketamine in the treatment of major depression. https://pubmed.ncbi.nlm.nih.gov/25217177/

5. Papadimitropoulou K, et al. Comparative efficacy and tolerability of pharmacological and somatic interventions in adult patients with treatment-resistant depression: a systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/28035869/

6. Elmosalamy A, et al. Intravenous ketamine versus esketamine for depression: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/41244961/

7. 988 Suicide and Crisis Lifeline. https://988lifeline.org/

Disclaimer

This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.

The post Ketamine for Treatment-Resistant Depression in Menlo Park, CA appeared first on Soft Reboot Wellness.

Roughly one in three people with major depressive disorder experience treatment-resistant depression, commonly defined as an inadequate response to at least two adequate antidepressant trials (McIntyre et al., 2023). For people who have spent years cycling through antidepressants without meaningful relief, learning that a different biological approach exists can be an important part of the conversation.

At Soft Reboot Wellness in Menlo Park, California, we offer physician-supervised IV ketamine therapy for treatment-resistant depression. Dr. Sara Herman, MD, a Harvard-trained anesthesiologist, has guided more than 10,000 patients through anesthesia, pain management, and ketamine therapy. We want patients across the Bay Area to understand what this treatment actually involves.

A Different Biological Approach to Depression

Treatment-resistant depression is not a diagnosis of hopelessness. It is a clinical category that describes inadequate relief from prior treatment, not a prediction of what is possible next.

Unlike antidepressants that primarily target monoamine neurotransmitter systems, ketamine works through a distinct biological mechanism. Its proposed antidepressant effects involve NMDA receptor antagonism in the glutamate system, along with downstream changes in BDNF signaling and synaptic plasticity (Abdallah et al., 2016). Landmark research and later randomized trials found that antidepressant effects may emerge within hours to days for some patients, rather than over the weeks often associated with conventional antidepressants (Berman et al., 2000; Murrough et al., 2013). To understand this mechanism in greater depth, our educational ketamine science resource offers a thorough overview of how ketamine interacts with the brain.

Off-Label Use and Individual Candidacy

It is essential to be precise: IV ketamine is used off-label for psychiatric indications. It is not FDA-approved for the treatment of depression. Published evidence has supported its use in some treatment-resistant mood disorders, while expert consensus also emphasizes careful screening, informed consent, monitoring, and attention to the limitations of the available evidence (Sanacora et al., 2017).

The clinical question for any individual patient is not whether ketamine works in general, but whether it is appropriate, safe, and likely to be beneficial for their specific situation. Our blog post on comparing ketamine versus SSRI treatment provides further context on how these approaches differ and when each may be considered.

Why Physician-Led Care Matters

This is where the physician you work with matters enormously. Dr. Sara Herman founded Soft Reboot Wellness after guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy. Her anesthesiology training and experience with ketamine administration inform the individualized dosing, physiological monitoring, and supportive care provided during each infusion.

Precision dosing, physiological monitoring, and proactive management of the infusion experience are central to a physician-led practice.

What an IV Ketamine Treatment Course May Involve

At Soft Reboot Wellness, an initial treatment course is individualized. Current protocols commonly involve four to six infusions scheduled weekly over four to six weeks, with treatment planning tailored to each patient’s symptoms, goals, and clinical response.

Sessions may run from approximately 45 minutes to two hours depending on the treatment protocol. During an infusion, patients may experience mild dissociation, visual or perceptual changes, and a dreamlike state. At subanesthetic doses, patients generally remain conscious, and the acute effects are expected to resolve before discharge (Sanacora et al., 2017).

Many patients find the experience more manageable when they are prepared and in a calm, supportive clinical environment. Our team helps patients understand what to expect during ketamine therapy and remains present throughout treatment to address discomfort if it arises.

Cost, Insurance, and the Infusion Experience

We hear two concerns consistently from patients considering IV ketamine in the Menlo Park and Peninsula area.

The first is cost. Insurance coverage for IV ketamine for psychiatric indications is inconsistent, and the out-of-pocket investment is real. We are transparent about our fees and discuss them fully during consultation. We also recognize that for patients who have spent years and significant resources pursuing mental health treatment without lasting relief, the cost-benefit calculation looks different. We respect each patient’s need to make that decision with full information.

The second concern is what the experience will feel like. Many people are unfamiliar with ketamine outside of its anesthetic or recreational contexts, and the prospect of an altered state can understandably feel anxiety-provoking. We address this directly in every consultation: the experience is time-limited, closely monitored, and discussed in advance.

Individualized Ongoing Treatment Planning

After the initial treatment course, some patients may benefit from periodic maintenance infusions to help sustain an antidepressant response over time. The frequency and duration of maintenance are individualized.

Results vary by individual, and we never guarantee specific outcomes. Our commitment is to provide an evidence-informed, carefully supervised experience and to partner with you in evaluating and adjusting your treatment plan. Please discuss all aspects of treatment planning with your provider, including how ketamine therapy may integrate with ongoing psychiatric care.

Whether you are in Menlo Park, Palo Alto, Redwood City, Mountain View, or elsewhere on the Peninsula, Soft Reboot Wellness is here to provide physician-level care for one of the most difficult mental health challenges patients face. We encourage you to schedule a consultation with our team.

FAQ

How quickly can I expect to feel a difference with IV ketamine?

Clinical studies have observed antidepressant effects as early as 24 hours after an infusion, though the timing and degree of response vary significantly between individuals (Murrough et al., 2013). Some patients respond gradually over the course of an initial treatment series.

Results vary by individual, and treatment is evaluated as a whole rather than based on the response to any single session.

Will I be awake during the infusion?

Yes. IV ketamine for depression is administered at subanesthetic doses, meaning patients generally remain conscious throughout treatment. You may experience dissociation or perceptual changes, but you are not expected to be asleep. Dr. Herman and the clinical team are present throughout each session.

Do I need to stop my current antidepressants to try ketamine?

Do not stop or change prescribed antidepressants on your own. Whether any medication adjustment is appropriate depends on your current regimen, medical history, and psychiatric history. Dr. Herman will review your medications carefully during intake and advise on any adjustments needed before treatment.

How do I know if I am a candidate for IV ketamine therapy?

A consultation with Dr. Herman is the appropriate starting point. In general, treatment-resistant depression commonly refers to depression that has not responded adequately to at least two antidepressant trials (McIntyre et al., 2023). Your complete medical and psychiatric history, current medications, and health status are evaluated during the intake process.

Key Takeaways

• IV ketamine engages the glutamate/NMDA receptor system through a mechanism distinct from conventional antidepressants and may produce rapid antidepressant effects for some patients with treatment-resistant depression.
• IV ketamine is used off-label for psychiatric indications and is not FDA-approved for depression.
• Soft Reboot Wellness in Menlo Park is led by Dr. Sara Herman, MD, a Harvard-trained anesthesiologist with experience guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy.
• A typical initial Soft Reboot Wellness protocol involves four to six infusions over four to six weeks, followed by individualized maintenance planning when appropriate.
• Results vary by individual; cost and the infusion experience are common concerns that Dr. Herman’s team addresses transparently during consultation.

Conclusion

For patients across the Bay Area who have not found adequate relief from standard depression treatments, IV ketamine therapy represents a biologically distinct, evidence-informed option that deserves serious consideration.

At Soft Reboot Wellness in Menlo Park, the focus is physician-led care that combines anesthesiology experience with individualized dosing and monitoring. If you are ready to explore whether IV ketamine therapy might be the right next step for your mental health, discuss your options with your provider and contact our team to schedule a consultation.

References

Abdallah, C. G., Adams, T. G., Kelmendi, B., Esterlis, I., Sanacora, G., & Krystal, J. H. (2016). Ketamine’s mechanism of action: A path to rapid-acting antidepressants. Depression and Anxiety, 33(8), 689–697.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351–354. https://doi.org/10.1016/S0006-3223(99)00230-9

McIntyre, R. S., Alsuwaidan, M., Baune, B. T., et al. (2023). Treatment-resistant depression: Definition, prevalence, detection, management, and investigational interventions. World Psychiatry, 22(3), 394–412. https://doi.org/10.1002/wps.21120

Murrough, J. W., Iosifescu, D. V., Chang, L. C., 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://doi.org/10.1176/appi.ajp.2013.13030392

Sanacora, G., Frye, M. A., McDonald, W., et al. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405.

About Dr. Sara Herman

Dr. Sara Herman, MD, is a Harvard-trained anesthesiologist who founded Soft Reboot Wellness after guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy. Her clinical experience in ketamine administration, pharmacology, and safety shapes every aspect of her practice, from the precision of each infusion to the monitoring protocols that support patients throughout treatment.

At Soft Reboot Wellness, Dr. Herman applies this combination of academic training and hands-on experience to the care of patients with treatment-resistant depression, offering a physician-led approach grounded in individualized assessment and evidence-informed care.

Medical Disclaimer

The content provided on this page is for educational purposes only and does not constitute medical advice. IV ketamine therapy is used off-label for psychiatric indications and is not FDA-approved for the treatment of depression. Individual results vary, and not every patient will experience the same outcomes. This information should not replace a consultation with a qualified medical provider. Please discuss with your provider whether any treatment described here is appropriate for your specific health situation. Soft Reboot Wellness serves patients in Menlo Park, CA and the greater Bay Area.

The post IV Ketamine Therapy for Treatment-Resistant Depression in Menlo Park: A Physician’s Perspective appeared first on Soft Reboot Wellness.