Ketamine for Treatment-Resistant Depression in Menlo Park, CA

When Standard Depression Care Has Not Brought Enough Relief

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.