New ASKP3 Ketamine Guidelines: Key Takeaways for IV Ketamine Treatment
New ASKP3 Ketamine Guidelines: Key Takeaways for IV Ketamine Treatment
Over the past few years, many of you (patients, therapists, and medical colleagues) have asked how often IV (and/or IM) ketamine should be given, what doses are truly necessary, and how long treatment should continue. To help answer these questions, I am reviewing a new (May 2026) expert consensus guideline paper that brings together interdisciplinary recommendations on the safe and effective use of intravenous ketamine infusions for depressive disorders.
This publication is not a single clinical trial, but a Delphi‑driven consensus statement from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3). In other words, a large group of experienced clinicians and researchers systematically reviewed the existing data and their real‑world experience to agree on practical guidelines for how IV ketamine should be used in depression.
In this post, I want to translate those guidelines into clear, real‑world takeaways for my community (professionals and patients) focusing on three core questions:
How many IV ketamine sessions should most people receive in the initial “induction” phase?
What does ongoing “maintenance” typically look like after that?
Are higher doses (above 1 mg/kg) actually better, or simply more intense?
What This ASKP3 Guideline Is & Why It Matters
This paper lays out expert‑driven, practical recommendations for using IV ketamine to treat depressive disorders, including major depression and treatment‑resistant depression. Rather than being a single doctor’s opinion, it combines input from a multidisciplinary panel (psychiatrists, anesthesiologists, therapists, and ketamine clinicians) using a structured Delphi process to reach consensus.
Why is this relevant? In the absence of FDA-approved racemic IV ketamine protocols for depression, clinicians have often had to rely on a combination of small clinical studies, published research on FDA-approved esketamine, evolving real-world experience, and careful clinical judgment. These guidelines help bring more structure to the field by giving practitioners a more standardized, safety-conscious foundation to build from while still allowing room for individualized care.
This is important for patients, but it is also important for the medical community. The more clearly we define safe screening, dosing, monitoring, and follow-up, the easier it becomes for responsible clinicians to feel confident referring to, collaborating with, and practicing within this field.
Induction Phase: Why 4–6 IV Ketamine Sessions Are Recommended
The induction phase is the first few sessions when we are trying to achieve a meaningful antidepressant response.
One of the clearest messages from the guideline is the recommendation of a series of 4–6 IV ketamine infusions as a typical induction course for depressive disorders.
Here is what that means in practice in my clinic:
We are not evaluating ketamine based on a single infusion.
We are expecting a treatment course, not a one‑time “magic bullet.”
Clinical improvement is usually monitored across several sessions, with ongoing assessment of mood, suicidality, anxiety, sleep, and functioning.
This aligns with what has been seen in research: antidepressant effects often build across multiple sessions and may not fully emerge after just one or two infusions. For patients, this is important to understand up front so expectations are realistic. For clinicians, it provides a minimum “dose of exposure” before judging response or making major changes.
Maintenance: Why Ongoing Support Is Usually Needed
The second key point is that maintenance treatment is often necessary after the induction phase. Ketamine can create rapid shifts in mood, neuroplasticity, and psychological flexibility, but depression is typically a chronic or recurrent condition driven by biology, trauma, lifestyle, and environment.
In the guideline, experts emphasize that many patients require:
Less frequent maintenance infusions after the initial 4–6 treatments.
Ongoing psychotherapy, ideally integrative or trauma‑informed, to help consolidate gains.
Attention to sleep, movement, nutrition, relationships, and meaning, which is very much aligned with the holistic, biopsychosocial model I use.
Maintenance does not mean staying on the same schedule forever. Many patients can gradually space out sessions as their mood stabilizes and they build skills and support systems. Others may need intermittent “booster” infusions during stressful periods. The guideline’s message is that ketamine is best thought of as a course of care with follow‑through, not a quick fix. In our practice, this often looks like once or twice a month for a few months after the induction period.
Dosing: Why Going Above 1 mg/kg Is Usually Not Necessary
The expert panel concluded that IV ketamine doses above 1 mg/kg are generally not necessary for treating depression in most patients.
In practice, doses for depressive disorders tend to fall in a moderate range, often below this threshold, especially when treatment is combined with psychotherapy and proper preparation and integration. Higher doses may increase dissociation and side effects without reliably improving antidepressant benefit. The guideline highlights that:
More is not automatically better.
The goal is the minimum effective dose that supports therapeutic benefit.
Safety—cardiovascular, psychological, and neurocognitive—needs to remain central.
This matches what we see clinically: when we pair ketamine with intention, preparation, breathwork, somatic awareness, and integration, patients often do very well without escalating to very high doses.
Safety, Screening, and Setting: More Than the Ketamine Infusion
Another important part of this guideline is that ketamine treatment should not be reduced to the infusion itself. The medicine is powerful, but the safety of the experience depends heavily on who is being treated, how they are screened, how they are monitored, and what kind of support surrounds the treatment.
The consensus process and prior ASKP3 communications emphasize:
Careful screening for medical and psychiatric risks (cardiovascular disease, psychosis, substance use concerns, uncontrolled hypertension, etc.).
Appropriate monitoring during infusions (vital signs, mental status, emergence).
A trained team present (ideally including both a medical professional familiar with ketamine and a mental health professional) rather than a purely “spa‑like” experience.
Informed consent that clearly explains not just potential benefits, but risks, alternatives, and unknowns.
In our practice, ketamine is never just a drug drip; it is a therapeutic container that includes preparation, support during the experience, and integration afterward. The guideline supports moving the field toward this more responsible standard.
How This Fits with NeuroPain Health’s Integrative Approach
Our work at NeuroPain Health focuses on chronic pain, trauma, and mood disorders through an integrative, whole-person lens. Depending on the patient, this may include plant (cannabis) medicine, ketamine-assisted therapy, pain reprocessing, movement, nervous-system regulation, and collaboration with other members of the patient’s care team.
These consensus guidelines support many of the principles we already use:
Preparation: Includes physical screening as well as mental, emotional, and practical support before treatment begins.
Time‑limited induction: A defined series of infusions (4–6) rather than open‑ended, frequent dosing.
Thoughtful maintenance: Gradually spacing or tapering infusions when appropriate, while leaning heavily on therapy, lifestyle, and nervous‑system regulation tools.
Moderate dosing: Staying generally under 1 mg/kg for depression and focusing on depth and quality of the experience, not intensity for its own sake.
Team‑based care: Collaboration among physicians, therapists, and other practitioners so ketamine is integrated into a broader healing plan, rather than isolated from psychotherapy or medical care.
For patients, this means ketamine is one part of a larger healing process, not the entire plan.
What This Means if You Are a Patient
If you are considering or already receiving IV ketamine for depression, these guidelines and our own clinical approach suggest a few key points:
Expect an initial series of 4–6 infusions as a reasonable window to assess response, not just one session.
Know that maintenance is common and not a sign of failure; it is simply how we support brain and behavior change over time.
Trust that we will not chase unnecessarily high doses. Doses above 1 mg/kg are usually not needed for depression, and the goal is to keep treatment effective and safe.
Understand that the most powerful changes often come from combining ketamine with therapy, lifestyle shifts, and learning to regulate your nervous system, not from the medicine alone.
Ask your provider about how they screen, monitor, and integrate care so you know you are in a setting that respects both the power and the risks of this medicine.
What This Means if You Are a Clinician
For clinicians—whether you are in psychiatry, pain medicine, primary care, or mental health—these guidelines offer a framework you can apply even if you are not a ketamine specialist:
When referring patients, ask whether the receiving clinic follows a structured induction and maintenance plan or just does “one‑off” infusions.
Coordinate care so that your patient’s ketamine treatment is embedded within ongoing psychotherapy, lifestyle interventions, and medical management, not in a silo.
Be aware that higher doses are not required for antidepressant effect in most patients, and that keeping doses at or below 1 mg/kg is reasonable unless there is a specific indication.
Monitor for longer‑term trajectories—does your patient need ongoing maintenance, or can they gradually increase spacing as they stabilize?
This kind of shared framework helps move the field away from fragmented, highly variable care and toward a more evidence‑informed, humane standard.
A Note on IV vs IM Ketamine
This specific guideline paper focuses on intravenous ketamine infusions for depression. At NeuroPain Health, we work with both IV and IM ketamine (as well as lozenge), but these recommendations are written specifically for IV protocols.
There is certainly overlap in the clinical thinking: careful screening, thoughtful dosing, monitoring, integration, and maintenance planning all apply across routes of administration. However, readers should not assume that every IV dosing or scheduling recommendation automatically transfers to IM ketamine. IM ketamine is also used in clinical practice for mood disorders, but the data and consensus recommendations discussed in this post are IV-specific.
For patients, this simply means your route of administration should be discussed with your provider as part of an individualized treatment plan.
The TLDR on the ASKP3 Consensus Guidelines
In summary, the new ASKP3 consensus guidelines on IV ketamine for depressive disorders support several key clinical practices:
Use an induction series of about 4–6 IV ketamine infusions to properly evaluate and initiate response.
Plan for maintenance. Usually less frequent, individualized follow‑up infusions, integrated with psychotherapy and lifestyle work.
Recognize that doses above 1 mg/kg are generally not necessary for depression in most patients, and that safety and therapeutic context matter as much as the milligram number.
For my patients and colleagues, this means we can feel more confident that the structured, integrative way we are using ketamine is increasingly aligned with national expert consensus, not just personal philosophy.
Curious about how ketamine treatment could help you? Contact our office today.