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If you've been researching ketamine therapy, you've probably encountered terms like "S-ketamine," "R-ketamine," "esketamine," and "arketamine." It's confusing, and the terminology matters more than it might seem at first.

These aren't interchangeable names for the same thing. S-ketamine and R-ketamine are chemically distinct mirror-image molecules with different uses, side effect profiles, and availability. Understanding the difference helps you make sense of your treatment options.

This guide breaks down what you actually need to know: what each form is, what's available to you, and how they compare for people exploring ketamine for depression and other mental health conditions.

Ketamine exists as two mirror-image molecules called enantiomers. Think of your left and right hands: both have the same components but are oriented differently in space. This seemingly small distinction creates meaningful differences in how each form works.

S-Ketamine (Esketamine) is the FDA-approved form, sold as a nasal spray called Spravato. It received approval in 2019 for treatment-resistant depression and must be administered at certified clinics with two-hour monitoring after each dose.

R-Ketamine (Arketamine) remains experimental. Early research suggested it might offer longer-lasting effects with fewer side effects, but a controlled clinical trial found it wasn't more effective than placebo for depression. It's not available outside clinical trials.

Racemic ketamine contains both forms in equal 50/50 proportions. This is what most IV clinics and at-home programs use. Originally FDA-approved as an anesthetic in the 1960s, it's now commonly prescribed off-label for depression via IV infusion or sublingual tablets.

Both S-ketamine and R-ketamine block NMDA receptors in your brain's glutamate system, a fundamentally different mechanism from traditional antidepressants that work through serotonin. This is why ketamine can produce effects within hours rather than the weeks required by SSRIs.

S-ketamine binds about four times tighter to these receptors. You might assume stronger binding means better results, but research suggests the opposite may be true: racemic ketamine (with both forms) often shows higher response rates than S-ketamine alone in comparative studies. Researchers call this the "potency paradox."

The stronger binding may also explain why S-ketamine causes more pronounced dissociative effects, and why Spravato requires mandatory clinic monitoring.

When ketamine blocks NMDA receptors, it triggers a cascade that can rapidly improve mood: increased glutamate release, activation of pathways that promote new neural connections, and stimulation of brain-derived neurotrophic factor (BDNF). Mental health conditions appear to physically affect brain structures, weakening connections in areas that regulate mood and stress. Ketamine helps rebuild these pathways by promoting synapse formation and enhancing neuroplasticity, your brain's ability to form new neural connections.

This is why many clinicians emphasize pairing ketamine with therapy. The medication opens a window of neuroplasticity; therapeutic support helps you make the most of it. Without that integration, the benefits may fade faster.

Both S-ketamine and R-ketamine activate these processes, but racemic ketamine engages them through both enantiomers working together. For a deeper dive into the mechanics of ketamine, explore our comprehensive guide on ketamine science.

Response rates of 27.7–31.6% for treatment-resistant depression

Long-term retention of 76% at 2 years for stable responders

These results come from large-scale studies involving thousands of people.

Despite promising laboratory research, R-ketamine has not produced comparable results in human clinical trials. The controlled study found that it wasn't superior to placebo, though it was extremely well-tolerated. This disconnect between lab findings and real-world outcomes has limited further development.

Comparative analyses suggest racemic ketamine may show higher response rates than esketamine in some meta-analyses. However, different delivery methods (IV vs. nasal spray) make direct comparisons complicated.

Common side effects include sedation (48–61% of people), dissociation, and blood pressure elevation. These safety concerns are why mandatory two-hour monitoring at certified facilities is required after each dose.

Early research suggests fewer dissociative effects, but since it wasn't more effective than placebo, this tolerability advantage may be moot.

Side effects involve both enantiomers' effects combined. Safety depends heavily on provider protocols. The American Society of Anesthesiologists issued guidance emphasizing that ketamine for mental health should meet the same safety standards as anesthetics, including trained healthcare professionals.

For all forms, long-term monitoring should include screening for bladder symptoms and cardiovascular effects.

Treatment follows a structured protocol: twice-weekly clinic visits for the first month (eight sessions minimum), then tapering to weekly or biweekly based on your response. Each visit requires treatment at a REMS-certified facility with mandatory two-hour monitoring, blood pressure checks, and stability assessment before you can leave.

Medication costs $761–$1,131 per session, with first-month totals reaching $6,088–$9,048 for medication alone; facility and monitoring fees are billed separately. Insurance coverage typically requires documented failure of at least two antidepressants at adequate doses.

Not available outside clinical trials. Given its failure to beat placebo in controlled studies, broader availability may not come.

More accessible and affordable. Compounded racemic ketamine costs approximately $100–150 per month through various providers. At-home ketamine therapy programs offer sublingual tablets without repeated clinic visits or IV infusions.

Insurance coverage varies significantly. Many plans don't cover off-label use, though some at-home providers have secured insurance partnerships.

Innerwell uses racemic ketamine with comprehensive clinical oversight. Unlike medication-delivery services with minimal support or clinic programs requiring repeated visits, Innerwell combines at-home convenience with the therapeutic integration that maximizes ketamine's benefits.

Ketamine opens a window of neuroplasticity, but what you do during that window matters. That's why every Innerwell plan includes licensed psychotherapist guidance, not unlicensed guides or minimal check-ins.

Evaluation: A comprehensive virtual psychiatric assessment by licensed providers (Master's or Doctoral level) determines whether ketamine is appropriate, reviews your medical history and current medications, and creates a personalized protocol.

Delivery: Once approved, sublingual tablets ship securely to your door with dosing instructions and direct clinician access. No clinic visits, no needle sticks, no IV infusions, just the convenience of treatment in your own space.

Preparation and integration: Before your first session, you'll work with a licensed psychotherapist who helps you prepare, set intentions, and understand what to expect. After each session, integration exercises help you process insights and apply them to lasting change.

Ongoing monitoring: Your care team tracks progress continuously, adjusting protocols based on your response. Regular check-ins and secure messaging keep you connected to clinical support.

Pricing: Innerwell's insurance partnerships make treatment accessible at a fraction of competitor costs:

Foundation Plan: $599 with insurance ($998 self-pay) for 8 treatments

Extended Plan: $1,299 with insurance ($1,999 self-pay) for 24 treatments

Per-session: As low as $54 with insurance

Available with insurance coverage in California and New York.

Ready to explore ketamine therapy with comprehensive clinical oversight? Take the free assessment to see if Innerwell's approach might work for you.

The short answer: R-ketamine isn't available outside trials. Your real choice is between S-ketamine (Spravato) and racemic ketamine.

You can commit to twice-weekly clinic visits with two-hour monitoring

At-home racemic ketamine may be better if:

You want therapeutic support built into your treatment

You find the emerging research on racemic formulations compelling

What to watch for: Skip providers that lack comprehensive screening, use unlicensed guides, or offer ketamine without mental health follow-up. The medication alone isn't enough; preparation and integration make the difference.

Find out if ketamine therapy is right for you and evaluate your options.

Which is more effective: S-ketamine or R-ketamine?

S-ketamine has demonstrated effectiveness in large-scale trials with response rates of 27.7–31.6%. R-ketamine failed to beat placebo in controlled trials despite promising preclinical research. Racemic ketamine (containing both) may show superior results in some comparative analyses, though different delivery methods make direct comparisons complicated.

No. R-ketamine is only available in registered clinical trials and has no legal prescribing pathway otherwise. Your practical options are FDA-approved S-ketamine (Spravato) or off-label racemic ketamine through IV clinics or at-home sublingual programs.

Safety depends on the provider and protocol. Spravato is legally prohibited from home use due to its REMS requirements. Racemic ketamine can be prescribed for at-home sublingual use when combined with proper clinical oversight: comprehensive screening, licensed clinicians, preparation and integration support, and ongoing monitoring.

Spravato costs $761–$1,131 per session for medication alone, with first-month totals reaching $6,088–$9,048 plus separate facility fees. At-home racemic ketamine through Innerwell costs as low as $54 per treatment with insurance, or $83–125 per treatment self-pay, including clinical oversight and therapeutic support.

You may experience dissociation (a floating sensation) along with perception changes during treatment. Effects typically peak around 40 minutes and resolve within two hours. Many people find the experience meaningful with proper preparation and intention setting. For details, read about what ketamine therapy feels like.

R-ketamine isn't available outside trials. Compare S-ketamine (Spravato) vs racemic ketamine: efficacy, cost, access, and why at-home may be better.

S-Ketamine vs R-Ketamine: Comparing Effects & Uses | Innerwell

Introduction

What Are S-Ketamine and R-Ketamine?

How Do They Work Differently?

What Does the Research Show?

Side Effects and Safety

Access and Cost

How Does Innerwell's Approach Work?

Which Option Is Right for You?

S-Ketamine vs R-Ketamine: Comparing Effects & Uses

You're supposed to be glowing. Instead, you're crying in the bathroom while your baby screams, wondering why you can't feel the joy everyone told you would come. Postpartum depression affects approximately 1 in 6 new mothers globally, and finding treatment while caring for a newborn can feel impossible.

Traditional antidepressants take eight to twelve weeks to work. But the reality is you don't have eight to twelve weeks. Your baby needs you now. Therapy requires regular appointments, but arranging childcare when you can barely get dressed feels like a nightmare. And underneath every treatment decision lurks the question: is this safe for my baby if I'm breastfeeding?

Ketamine therapy brings rapid relief, often within days, through Innerwell's at-home program designed for the realities of new motherhood.

Postpartum depression (PPD) is a major depressive disorder that emerges during pregnancy or in the months after childbirth. It's not the "baby blues," those mild mood swings that 80% of mothers experience which resolve within two weeks. PPD is persistent, heavy, and doesn't lift on its own.

PPD affects about 17% of mothers, and roughly half go undiagnosed. Many women suffer in silence because the symptoms feel shameful: you're supposed to be happy, but instead you feel disconnected from your baby, irritable with everyone, unable to sleep even when the baby sleeps, and haunted by thoughts that you're failing at the one thing you're supposed to know how to do.

Here's what makes PPD uniquely cruel: it strikes during the exact window when bonding matters most. The fog of depression creates distance between you and your baby during a developmental period you can't get back. PPD affects not just your mental health but your physical recovery, your relationships, your milk supply, and your child's emotional development.

Traditional Treatments for Postpartum Depression & Their Limitations

Standard treatment starts with SSRIs like Zoloft or Prozac, or therapy approaches like IPT (interpersonal therapy). But the numbers are discouraging: only 37% of women achieve remission with SSRIs within eight weeks. Most mothers don't get full relief from first-line treatments.

The postpartum period makes treatment especially difficult. SSRIs take months to work—months you spend white-knuckling through feeds and diaper changes while waiting to feel better. Many mothers won't take antidepressants at all because of breastfeeding fears, even when the evidence supports safety. And weekly therapy appointments? That requires childcare, transportation, pumping if you're nursing, and energy you simply don't have.

When standard approaches fail, options narrow quickly. This is why researchers have turned to ketamine, a treatment that works in days not months.

How Does Ketamine Therapy for Postpartum Depression Work?

Ketamine works differently than antidepressants. While SSRIs adjust serotonin levels over weeks, ketamine triggers an immediate cascade: it blocks NMDA receptors, floods the brain with glutamate, and releases BDNF, a protein that helps damaged neural connections repair themselves. The result is neuroplasticity, your brain's ability to form new, healthier pathways.

PPD has unique hormonal triggers, especially the dramatic drop in allopregnanolone after delivery, but these hormonal shifts ultimately damage the same brain circuits affected in other depression. Ketamine repairs those circuits regardless of what broke them.

A JAMA trial of 308 women found that esketamine reduced postpartum depression rates by 47%. The speed matters: when you're struggling to bond with your newborn, every day of depression costs something you can't recover.

What Are the Risks of Ketamine Therapy for Postpartum Depression?

Side effects are typically mild and short-lived: dissociation (a floaty, detached feeling), temporary blood pressure elevation, and dizziness. These resolve within about two hours.

The breastfeeding question: Research is reassuring. The NIH LactMed Database shows ketamine appears in breast milk at very low levels, less than 1% relative infant dose, well below the 10% threshold for concern. Waiting six to twelve hours after treatment before nursing reduces exposure even further. You can pump beforehand so someone else can feed the baby during your session and recovery window.

Ketamine isn't appropriate if you have uncontrolled hypertension, unstable heart disease, history of psychosis, or active substance-use disorder. Its use for PPD is off-label, but Innerwell provides legal treatment through comprehensive screening, licensed clinician oversight, and integration therapy.

Before starting treatment, you'll need to think through the practical realities of ketamine therapy while caring for a newborn.

During your session (about two hours): You cannot hold or care for your baby. You'll need a partner, family member, or trusted friend present, someone who can handle the baby entirely while you're in a treatment session and for a few hours afterward as the effects wear off. This isn't optional; it's a safety requirement.

After your session: You shouldn't drive for at least four to eight hours depending on your dose. If emergencies requiring you to drive are a concern, plan sessions when your support person can stay longer, or coordinate backup transportation.

Breastfeeding logistics: Plan to pump before your session so your baby has milk for the six- to twelve-hour window when you're avoiding nursing. Some mothers pump and dump during the waiting period; others simply time sessions for when they'd naturally have a longer stretch between feeds.

The guilt: Taking four to six hours for yourself when you have a newborn feels impossible, maybe even selfish. But untreated depression affects your baby too. The dissociation and bonding difficulties of PPD are far more damaging than a few hours of planned, supported treatment time. You're not abandoning your baby by getting well. You're fighting to be present for them.

How Innerwell's Ketamine Therapy Approach Works for Postpartum Depression

Innerwell's program is built around the reality that you're caring for a newborn while trying to heal. You don't have to find childcare for clinic visits or sit in a waiting room wondering if your baby is okay.

Comprehensive clinical evaluation: Your virtual psychiatric assessment covers your pregnancy history, current symptoms, breastfeeding status, and what support you have at home. We help you plan the logistics: when to schedule sessions, how to coordinate feeds, what your support person needs to know.

Secure at-home medication delivery: Sublingual ketamine tablets arrive at your door. No clinic trips. No pumping in a parking lot. No arranging childcare for appointments. You take treatment in your own space, with your baby nearby (in someone else's care) if that brings you comfort.

Guided preparation and integration therapy: Licensed therapists help you set intentions before sessions and process what comes up afterward. For new mothers, this often means working through the identity shift of becoming a parent, guilt about needing help, or fears about bonding. These sessions happen virtually, no travel required.

Ongoing monitoring and support: We track your symptoms and coordinate with your OB or midwife to ensure your depression care fits with your overall postpartum recovery. Your clinical team is available through secure messaging when questions arise between sessions.

Read our guide on how to prepare for ketamine therapy.

Is Ketamine Therapy for Postpartum Depression Right for Me?

You're likely a good candidate if SSRIs haven't worked, if you can't wait months for relief, or if breastfeeding concerns have kept you from trying traditional antidepressants. Some mothers choose ketamine specifically because the treatment window is short and predictable, easier to plan around than daily medication that affects every feed.

You'll need someone who can care for your baby during sessions and stay with you for a few hours afterward. If you're completely alone with no support, we'll need to problem-solve logistics together before treatment can begin safely.

Every patient starts with a thorough evaluation to ensure ketamine is safe and appropriate for your situation.

Try Ketamine Therapy for Postpartum Depression With Innerwell

You don't have to wait months to feel like yourself again. Ketamine offers rapid relief, and Innerwell brings that treatment to your home, designed around the reality of new motherhood.

Take our free assessment to see if ketamine therapy might help you reclaim joy in motherhood.

Frequently Asked Questions About Ketamine Therapy for Postpartum Depression

Is ketamine therapy for postpartum depression legal?

Yes. Ketamine is an FDA-approved Schedule III medication. Licensed clinicians can prescribe it off-label for postpartum depression. Innerwell operates under strict telemedicine regulations to ensure safe, legal care.

How long does it take for ketamine therapy to work?

Many women notice improvement within days, a dramatic difference from the months required for traditional antidepressants. This rapid onset is especially valuable when you're struggling to bond with and care for your baby.

How long do I need someone to watch the baby?

Plan for four to six hours total: about two hours for the session itself, plus two to four hours afterward while effects fully clear. Your support person should be able to handle all baby care during this window, including any feeding needs.

Research shows ketamine appears in breast milk at very low levels, less than 1% relative infant dose, well below safety thresholds. Waiting six to twelve hours before nursing and pumping beforehand gives you options to minimize any exposure.

You cannot drive for four to eight hours after treatment. Plan sessions when your support person can stay, or have backup transportation arranged. Many mothers schedule sessions when a partner is home for an extended period.

 Ketamine therapy for postpartum depression offers rapid relief when traditional treatments fall short. Learn about the research, safety, and Innerwell's approach.

Ketamine Therapy for Postpartum Depression: Complete Guide | Innerwell

What Is Postpartum Depression?

What New Mothers Need to Consider

Ketamine Therapy for Postpartum Depression: Complete Guide

If you've tried medication after medication for panic disorder and nothing has worked, you've probably started searching for alternatives. Ketamine therapy keeps coming up in mental health discussions, and for good reason: it's helped many people with treatment-resistant depression find relief when nothing else did.

But here's what you need to know upfront: Ketamine therapy is not recommended for panic disorder. No clinical trials have specifically studied ketamine for panic attacks, and ketamine's side effects can feel identical to panic symptoms, making it impossible to tell if you're having treatment effects or an actual panic episode.

This guide explains why ketamine poses specific risks for people with panic disorder, what the research actually shows (and doesn't show), and which evidence-based treatments can help when first-line options aren't enough.

Panic disorder is a condition where people experience sudden, intense panic attacks: surges of overwhelming fear with physical symptoms like racing heart, chest tightness, sweating, and shortness of breath. But the disorder goes beyond the attacks themselves. It includes persistent worry about when the next one will strike and avoiding situations that might trigger them.

The condition affects 2.7% of U.S. adults annually, approximately 7 million Americans. And it rarely occurs alone: about half of people with panic disorder experience major depression at some point, which complicates treatment and often leads people to search for options beyond standard care.

Why Is Ketamine NOT Recommended for Panic Disorder?

Here's the critical gap: no clinical studies have specifically tested ketamine for panic disorder. A 2023 comprehensive review examining ketamine for anxiety disorders found zero randomized controlled trials targeting panic disorder as a primary diagnosis. When panic disorder has appeared in ketamine research, it's only been seen as a comorbid condition in studies focused on other diagnoses. Researchers haven't measured panic attack frequency, severity, or panic-specific outcomes.

This means clinicians have no solid evidence about whether ketamine actually helps panic disorder or whether it might make symptoms worse.

Ketamine's Effects Can Mimic Panic Attacks

The documented side effects create particular problems for people with panic disorder because they overlap so directly with panic symptoms:

Cardiovascular changes: Research found that some patients experience elevated heart rate during treatment. For someone with panic disorder, a racing heart can trigger an actual panic episode. You wouldn't be able to distinguish between "this is the medication working" and "I'm having a panic attack."

Dissociation: Feeling disconnected from your body or reality is ketamine's most common side effect. If you're curious about what ketamine feels like, the dissociation and derealization it causes are also panic attack symptoms. Adding a treatment that induces dissociation to a condition that already causes it creates dangerous confusion.

Anxiety as a side effect: Anxiety itself is a documented adverse effect of ketamine. Using a treatment that can cause anxiety to treat an anxiety disorder presents an inherent contradiction.

No major psychiatric organization currently recommends ketamine for panic disorder or anxiety disorders in clinical practice guidelines. The 2014 Canadian guidelines comprehensively address panic disorder treatment without mentioning ketamine. The most authoritative consensus statement, published in JAMA Psychiatry, explicitly states that ketamine's strongest clinical benefit is for major depression, not anxiety disorders.

What Treatments Actually Work for Panic Disorder?

Evidence-based treatments with established safety profiles exist for panic disorder. Most people respond to first-line options, and effective alternatives exist for those who don't.

SSRIs (selective serotonin reuptake inhibitors) like sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil) are typically the starting point. A 2022 analysis showed 66% remission rates. They take 4-6 weeks for full effect but provide sustained improvement with well-established safety profiles.

Cognitive Behavioral Therapy (CBT) teaches practical skills for managing panic attacks and reducing avoidance. Studies from 2022-2025 demonstrate 53-57% response rates with lasting benefits, and the tools you learn stay with you without ongoing medication side effects.

SNRIs (serotonin-norepinephrine reuptake inhibitors) like venlafaxine (Effexor) serve as an alternative for patients who don't respond to SSRIs. A 2006 study showed 75% response rates.

30-60% of patients don't respond adequately to initial treatments. Evidence-based next steps include medication optimization (adjusting doses, trying different medications), intensive CBT programs, addressing comorbid conditions like depression, and combination therapy using both SSRIs and CBT together, which produces superior outcomes compared to either approach alone.

What Conditions Can Ketamine Therapy Help With?

While ketamine isn't appropriate for panic disorder, it has established efficacy for specific conditions where traditional treatments have failed.

Ketamine isn't recommended for panic disorder due to symptom overlap. Learn why, what the research shows, and which treatments actually work.

Reflections

S-Ketamine vs R-Ketamine: Comparing Effects & Uses

Ketamine Therapy for Postpartum Depression: Complete Guide

Ketamine Therapy for Panic Disorder: What You Need to Know

Ketamine Therapy Effects: Benefits, Risks & What to Expect

Ketamine Therapy for Psychosis: What You Need to Know

Ketamine vs Esketamine: Key Differences Explained

Racemic Ketamine: How It Works and When It's Used