If you have been receiving ketamine for depression, whether through IV infusions, Spravato (esketamine) nasal spray, or an at-home program, you may be wondering what happens when you stop. For most people in supervised treatment, the bigger concern is not withdrawal but the chance that depression symptoms return. That is why stopping is best planned with your prescriber, not done suddenly on your own.

This guide explains what the research and FDA labeling say about stopping, how relapse differs from withdrawal, how the three common ways of receiving ketamine compare, and the signs that therapeutic use may be drifting into misuse. It is written for patients and for families who want to understand the options.

Why People Stop Ketamine Therapy

There are many reasons someone might want to stop, and all of them are worth discussing openly with a provider:

You feel better and want to see how you do without it
Side effects, such as dissociation, nausea, or blood pressure changes
Cost, travel, or time, especially with frequent sessions
Insurance changes or coverage limits
You are worried about how you feel about the medication, such as looking forward to sessions more than you expected

None of these reasons is wrong. What matters is having a plan for what comes next.

Relapse vs. Withdrawal: Two Different Things

Searches for “what happens if you stop ketamine therapy” often mix two separate issues. Keeping them apart makes the decision clearer.

Relapse: Depression Symptoms Returning

Ketamine’s antidepressant effect can be fast, but it often does not last on its own. Cleveland Clinic notes that effects can fade within days or weeks. In one study of people who responded to a series of IV infusions, the median time to relapse after the last infusion was about 18 days.

For Spravato, the SUSTAIN-1 trial (published in JAMA Psychiatry in 2019) followed people who were doing well and then either continued esketamine or switched to placebo. Among those in stable remission, 26.7% of people who continued relapsed, compared with 45.3% of those switched to placebo. Among stable responders, the figures were 25.8% and 57.6%. In plain terms, continuing lowered relapse risk, and stopping raised it.

This does not mean you can never stop. It means stopping works best with a plan for monitoring mood and for other supports.

Withdrawal: Rare at Therapeutic Doses

The Spravato prescribing information states that no withdrawal symptoms were captured up to four weeks after stopping esketamine in clinical trials. It also notes that withdrawal has been reported after people stopped frequently used, large doses of ketamine taken over long periods.

When withdrawal does happen, usually after heavy non-medical use, it tends to be mainly psychological: cravings, anxiety, irritability, low mood, fatigue, and sleep changes. Our article on ketamine withdrawal symptoms and timeline covers that pattern in detail.

How the Three Types of Ketamine Treatment Compare

	Spravato (esketamine)	IV ketamine infusions	At-home ketamine
FDA status for depression	FDA-approved for treatment-resistant depression in adults (alone or with an oral antidepressant)	Off-label use	Off-label; FDA warned about compounded at-home products in 2023
Where it is given	Only in certified healthcare settings under a safety program (REMS)	Clinic or hospital setting	At home, often via telehealth
Monitoring	At least 2 hours of observation after each dose	Varies by clinic	Often limited or none
What to plan for when stopping	Relapse risk; talk with prescriber	Effects may fade within days to weeks	Relapse risk plus safety of unsupervised use

Why Stopping Should Be a Shared Decision

Whatever type of ketamine treatment you receive, the safest approach is to plan the change with the person who prescribes it. A good conversation usually covers:

How you are doing right now, including mood, sleep, and any thoughts of self-harm.
What else is supporting you, such as an oral antidepressant, therapy, or other care.
A monitoring plan, such as check-ins or symptom tracking after your last session.
What to do if symptoms return, including whether and how treatment could restart.
Other treatment options, such as medication changes, psychotherapy, or TMS therapy.

If you have ever had thoughts of suicide, it is especially important not to stop any treatment without a plan. If you are in crisis, call or text 988 at any time.

Concerned About How Ketamine Fits Into Your Life?

If ketamine use has started to feel harder to control, or you are not sure whether what you are experiencing is relapse or something else, you do not have to sort it out alone. Call Virginia Recovery Centers at (804) 269-8075 or contact us for a confidential conversation.

Signs Therapeutic Use May Be Shifting Into Misuse

Ketamine has real potential for misuse. That is why Spravato carries a boxed warning about abuse and misuse and can only be given under observation. The National Institute on Drug Abuse notes that signs of a problem include continuing to use despite knowing it is causing harm. Other signs to watch for:

Wanting extra sessions or higher doses than your provider recommends
Using ketamine between prescribed sessions
Getting ketamine from non-prescribed or online sources
Needing more to feel the same effect
Using ketamine with alcohol or other substances
Urinary symptoms such as frequent, urgent, or painful urination, which can signal ketamine-related bladder problems with heavier use

Research on ketamine-related bladder problems shows much higher rates among people who use ketamine recreationally than among people in therapeutic studies, and risk rises with higher and more frequent doses. Any urinary symptoms are worth raising with a doctor.

Noticing these signs does not make you a bad patient. It means it is time for an honest conversation. For some people, that leads to ketamine addiction treatment that addresses both the substance use and the depression underneath it. Our article on breaking psychological dependence on ketamine explains how that works.

When Depression and Substance Use Overlap

Many people who start ketamine for depression are also managing anxiety, trauma, or other substance use. Treating only one piece often is not enough. Dual diagnosis treatment addresses mental health and substance use together, with therapies such as cognitive behavioral therapy and trauma-informed therapy. If alcohol is part of the picture, it is worth knowing the risks of combining ketamine and alcohol.

Depending on what you need, care may happen in an intensive outpatient program, a partial hospitalization program, or residential treatment.

Final Thoughts

Stopping ketamine therapy is usually less about withdrawal and more about protecting the progress you have made. Plan the change with your prescriber, keep other supports in place, and watch for signs that symptoms are returning. If you have noticed your relationship with ketamine changing, that is worth talking about too, and it is never too early to ask for help.

Frequently Asked Questions

Will my depression come back if I stop ketamine?

It might, and that is the main thing to plan for. In a large Spravato trial, people who stopped esketamine after doing well relapsed more often than those who continued. Effects of individual IV ketamine infusions also tend to fade over days to weeks. Your prescriber can help you plan monitoring and other treatments so you are not left without support.

Can you get withdrawal from ketamine therapy?

Withdrawal appears to be uncommon at the doses and schedules used in supervised therapy. The Spravato label reports no withdrawal symptoms captured up to four weeks after stopping in trials. Withdrawal has been reported mainly with frequent, large, long-term ketamine use, and tends to involve cravings, anxiety, irritability, and low mood.

Do you have to taper off Spravato?

Decisions about how to stop Spravato should be made with the prescriber who oversees your treatment. They will consider how you are doing, your other medications, and your risk of relapse. Do not change your schedule on your own.

Is at-home ketamine safe?

In October 2023, the FDA warned about compounded ketamine products, including oral forms, used at home for psychiatric conditions without monitoring, citing risks such as abuse and misuse, psychiatric events, increased blood pressure, slowed breathing, and bladder symptoms. If you use at-home ketamine, talk with your prescriber about safety and monitoring.

Can prescribed ketamine become addictive?

Ketamine carries a risk of misuse, which is why Spravato is only given in certified healthcare settings. Signs that use may be shifting include wanting extra doses, using between sessions, or getting ketamine from non-prescribed sources. Noticing this early is a reason to talk with your provider, not a reason for shame.

This article is for general educational purposes only and is not medical advice. Do not start, stop, or change any medication or treatment without talking to your prescriber. If you are in crisis or thinking about harming yourself, call or text 988 or call 911.

Ready to Talk It Through?

Virginia Recovery Centers provides licensed addiction and dual diagnosis treatment serving Richmond, Mechanicsville, and communities across Virginia. Call (804) 269-8075, verify your insurance, or contact us. All calls are 100% confidential.