Route comparison
Different dose, different setting, different economics. Neither is universally better. This page lays out the real tradeoffs so you can pick the route that fits your severity, your budget, and your life - not the one the ads push hardest.
IV or IM, at a licensed clinic
Sublingual lozenges, via telehealth
A pragmatic decision tree. This is not medical advice - your prescriber has the final call - but it mirrors how most experienced psychiatrists in the field actually triage patients.
Failed 2+ SSRIs, severe or suicidal symptoms, or documented TRD
Start in-clinic
Higher dose, controlled environment, strongest remission data. Tapering and maintenance can move to sublingual later.
Moderate depression or anxiety, stable home, no cardiac history
At-home is reasonable
Lower cost, lower friction, good real-world outcomes when therapy is bundled.
Insurance coverage is non-negotiable
Neither - consider Spravato
Spravato (esketamine) is the only covered ketamine-family option. Different drug, different experience, same mechanism family.
You have cardiac disease, uncontrolled hypertension, or recent cardiac event
Only in-clinic, with medical clearance
Ketamine raises BP and heart rate transiently. At-home monitoring is not sufficient.
You have untreated substance use disorder (not in recovery)
Stabilize first, neither route
Most programs will not admit you. Address the SUD with a qualified clinician first.
Family or personal history of psychosis, schizophrenia, bipolar I
Not a good fit for either
Ketamine can trigger acute dissociative or psychotic symptoms in predisposed individuals. Different pharmacology applies.
Veteran or active duty with TRD
Start with Spravato via VA or Tricare
Covered path with strongest administrative support. If Spravato fails, step to in-clinic IV; at-home last.
In-clinic route
Verified IV ketamine clinics, filterable by state
Every clinic in the directory is cross-checked against the state medical board before listing. Filter by state, insurance, and modality.
Browse clinicsAt-home route
5 telehealth programs compared side-by-side
Mindbloom, Joyous, Innerwell, Better U, Peak. Cost, protocol, state coverage, and who each program is a real fit for.
See the comparisonWhich works better - in-clinic IV ketamine or at-home sublingual?
On the strongest published data (remission rates in treatment-resistant depression), in-clinic IV has a modest edge, largely because the dose is higher and absorption is near-100 percent. At-home sublingual has lower bioavailability (20 to 30 percent) but is delivered more frequently over a longer course, which for many users stacks into a similar clinical result. The real gap is in trial controls, not everyday outcomes - most patients who do either protocol honestly get real benefit. Severity and your life situation matter more than the route.
Is at-home ketamine safe?
Yes, within its constraints. The safety profile is good when you follow the rules: sober sitter present, no alcohol or other CNS depressants in your system, truthful medical history disclosure, stable private environment, and a responsive clinician. The risk profile is not zero, and you should decline at-home if you have untreated cardiac conditions, active substance use disorder, or a personal or family history of psychosis.
What about cost over 6 months?
A typical 6-month at-home course runs $1,200 to $2,400 all-in (Mindbloom, Innerwell, Better U). A typical 6-month in-clinic maintenance course runs $3,000 to $9,000 depending on whether it is IV or IM and how aggressive your booster schedule is. Insurance closes almost none of that gap on either side unless you qualify for Spravato, which is a different drug.
If I want insurance to pay, what should I actually do?
Neither at-home ketamine nor off-label clinic ketamine is reliably covered. The only covered option is Spravato (esketamine nasal spray) at a REMS-certified clinic, with documented treatment-resistant depression. If insurance is a must-have, stop shopping ketamine and go look at Spravato-only providers. We have a directory filter for that.
Can I start with at-home and switch to in-clinic if it is not working?
Yes, and this is a legitimate pathway. Many patients do a 3-month at-home course, do not hit remission, and then step up to a 6-infusion in-clinic IV series. The clinic will want records from your at-home program. Some at-home providers (Innerwell) will even coordinate the handoff. Do not try to run both simultaneously.
What about therapy - does the ketamine alone do the work?
The consensus in the field is that ketamine alone opens a neuroplasticity window, and the therapy done during that window is where durable change happens. In-clinic IV without integration is not much more effective than ketamine alone. At-home with a real therapist (Innerwell model) usually outperforms at-home with just a coach or nothing. If you are spending money on ketamine at all, budget therapy into the plan.
We maintain editorial independence from every clinic and telehealth program listed on this site. Some outbound at-home telehealth links are affiliate links, which we disclose on every page where they appear. In-clinic provider listings are not paid placements - they are added after verification against the issuing medical board.
Nothing on this page is medical advice. The clinician who prescribes, supervises, and maintains your treatment is the one making clinical decisions. Call 988 in a mental health crisis, or your provider or emergency services in an immediate danger.