The Largest At-Home Ketamine Therapy Study To Date: What The Results Suggest, And Where They Fall Short
- Anahita Anais
- Jul 26, 2022
- 8 min read
By Anahita Anais, Nervous System and Microdosing Expert, founder of Microdose Guru.
Last reviewed: June 2026.
This article summarizes published research and is educational, not medical advice. Ketamine is a controlled substance and should only be used under qualified medical supervision.
A widely reported set of studies put a number on something the ketamine field had mostly talked about in anecdotes: what happens when people take ketamine for depression and anxiety at home, by telehealth, instead of in a clinic. The headline figures looked dramatic. The way these studies were built means those figures need to be read carefully, not at face value. Both of those things can be true at once, and the honest version of this story holds both.
What Ketamine-Assisted Therapy Is
Ketamine is a dissociative anesthetic that has been used in medicine for decades. At higher, clinically supervised doses, it can produce a sense of detachment from the body and ordinary thinking. Over the past several years, it has been studied as a fast-acting option for depression, including depression that has not responded to standard antidepressants.
There are different ways it reaches the body. Intravenous (IV) infusions are given in a clinic under direct monitoring. A nasal-spray form of esketamine (brand name Spravato) is FDA-approved for treatment-resistant depression and is administered in certified settings. In January 2025, the FDA approved Spravato as a standalone treatment, the first time a drug for treatment-resistant depression cleared as a monotherapy rather than only as an add-on to an oral antidepressant (J&J / FDA, 2025). The studies below looked at a third route: sublingual ketamine (dissolved under the tongue) taken at home and supported remotely by a telehealth provider. The appeal of the at-home model is access and cost. The trade-off is less direct medical oversight during each session, which matters for a drug with real risks.
This article does not give dosing instructions, and self-directing ketamine outside of medical care is not something this site endorses.
The Research
Early research on at-home ketamine looks promising but stays limited, and the two largest datasets so far both come with a built-in conflict of interest worth noting up front: both were run on clients of the same telehealth company that sells the treatment.
The first widely cited study was a prospective, open-label effectiveness trial of 1,247 people with moderate-to-severe anxiety and/or depression who used sublingual ketamine at home through a telehealth provider. After four weeks, about 89% reported some improvement in depression or anxiety symptoms, roughly 63% reported a 50% or greater reduction in symptoms, around 30% met criteria for remission, and most of those who had reported suicidal thoughts at intake no longer reported them. Side effects were described as generally mild (Hull et al., Journal of Affective Disorders, 2022).
That study has since been overtaken in size. In 2024, researchers from Johns Hopkins, NYU, and the same telehealth provider published an analysis of 11,441 clients, now the largest examination of at-home ketamine therapy to date. In that much larger sample, about 62% of clients reported clinically significant improvement in depression or anxiety, and roughly 28% reported remission after four sessions. Of clients who improved in a first round and went through a second, around 84% maintained or recovered. Fewer than 5% reported adverse effects (McInnes et al., Journal of Affective Disorders, 2024; PMC11284959).
Those numbers are encouraging. Here is why they are not the same as proof that at-home ketamine beats antidepressants, and why a bigger sample does not fix the problem:
They were open-label, with no placebo group. Everyone knew they were getting ketamine. In depression research, the placebo response is large, and without a control group, there is no way to separate the drug's effect from expectation, attention, and the simple fact that people often improve over four weeks. A sample of 11,441 has the same blind spot as a sample of 1,247. More people do not create a control group.
They were run on the provider's own clients. Both datasets came from the company that sells the treatment (McInnes et al., 2024). That does not make the results false, but provider-run effectiveness studies have a clear incentive to find a positive result, and they are weaker evidence than independent, blinded trials.
Outcomes were self-reported. Symptom change was measured by participants' own questionnaires, not by independent clinical assessment.
The samples selected themselves. People who sign up and pay for at-home ketamine are not a random slice of everyone with depression. They may be more motivated, more able to afford care, and more likely to expect benefits.
There was no head-to-head comparison. Neither study directly tested sublingual ketamine against antidepressants nor against IV ketamine. Any "outperforms antidepressants" framing comes from comparing these results to figures reported in other, separate studies, which is not a valid superiority claim. On the current evidence, no head-to-head winner can be declared.
They were short. Four weeks tells you little about whether benefits last, how often people relapse, or what repeated use does over months and years.
So the accurate read is: in two large groups of self-selected people, at-home sublingual ketamine was associated with reported short-term improvement and was reasonably tolerated. Calling it safer or more effective than standard antidepressants goes beyond what uncontrolled, provider-run, four-week studies can show, no matter how many people they enroll. Independent, placebo-controlled, longer-term trials are what would settle that, and they are not in yet.
A Note On Risk And Legal Status
Ketamine is a Schedule III controlled substance in the United States, placed there in 1999, with a recognized potential for psychological and physical dependence (DEA Ketamine Drug Fact Sheet). The risks are not just theoretical at the edges of use:
Dependence and misuse. Ketamine can be habit-forming, and demand for repeat sessions is something to watch, in any at-home or clinical model.
Bladder and urinary damage. Frequent, heavy ketamine use is linked to ulcerative cystitis, a painful and sometimes lasting bladder condition, mostly seen in near-daily users (Jhang et al., International Journal of Urology, 2015).
Cognitive effects. Heavy, frequent use has been associated with memory impairment that may improve after stopping.
Acute effects. Ketamine raises blood pressure and heart rate and causes dissociation during sessions, which is why supervision and medical screening matter, especially for people with cardiovascular conditions.
Regulators have grown more vocal as the at-home market has expanded. The FDA has warned patients and providers about the risks of compounded ketamine products used for psychiatric conditions, noting that without an on-site provider, there is no one to monitor for serious effects from sedation and dissociation (FDA, 2025). The largest at-home provider has also faced a wrongful-death lawsuit alleging a client overdosed on ketamine it supplied without adequate oversight (STAT News, 2026). At the same time, the regulatory door has stayed open: the DEA extended pandemic-era telemedicine flexibilities a fourth time, allowing controlled substances to be prescribed remotely without a prior in-person visit through December 31, 2026, while it works on a permanent rule (DEA, 2025).
This is the harm-reduction core of the at-home conversation. Easier access is genuinely valuable for people who cannot reach or afford clinic-based care. It also removes a layer of in-person monitoring during a session with a drug that has dependence potential and known physical risks. A model that expands access without taking screening, supervision, and follow-up seriously is not safer. It is a riskier one, wearing the language of convenience.
Where This Fits
Ketamine is one of the more credible fast-acting options in the depression toolkit, and the at-home telehealth model is a real attempt to widen access to it. The largest datasets so far suggest short-term benefit for many people who try it. They do not prove superiority over antidepressants, and the strongest version of this story is not the marketing headline. It is the more careful one: promising early signal, serious methodological limits, real medical risks, and a clear need for independent long-term research before anyone treats at-home ketamine as settled.
If you are weighing antidepressants alongside any of this, it is worth understanding how conventional medications interact with other approaches. Our guides below walk through what the interaction research says.
If you are considering ketamine for depression or anxiety, that decision belongs with a
qualified medical provider who can screen you, supervise treatment, and follow up over time, not with a press release or a chart.
How Microdosing Fits A Different Question
Ketamine therapy and psilocybin microdosing are often mentioned in the same breath, but they answer different questions. Ketamine is a clinically supervised, fast-acting intervention. Microdosing psilocybin is a low-dose, sub-perceptual practice many people use for steadier mood, focus, and creativity rather than acute crisis care. If you came here through the depression conversation and want to understand the gentler end of the spectrum, our overview of The Benefits Of Microdosing is a grounded place to start, and Whether Microdosing Can Be Dangerous covers the honest risk picture for psilocybin specifically.
Anyone exploring this for chronic pain or trauma should read Microdosing For Chronic Pain before drawing conclusions.
A standard microdose of dried psilocybin mushrooms sits in the 0.05 to 0.30 g range (roughly 5 to 20 µg for LSD), low enough that you stay fully functional. That is a different category of decision from ketamine, with a different risk profile and a different evidence base, and it is the work we focus on here.
Frequently Asked Questions
Is At-Home Ketamine Therapy FDA Approved?
No. The FDA-approved ketamine-derived product for depression is the esketamine nasal spray Spravato, which is given in certified medical settings, not at home. As of 2025 it is approved both as an add-on and as a standalone treatment for treatment-resistant depression (J&J / FDA, 2025). The sublingual ketamine used in at-home telehealth programs is typically compounded, which means it has not been reviewed by the FDA for safety or effectiveness, and the agency has issued a warning about those products (FDA, 2025).
Does The Research Prove Ketamine Works Better Than Antidepressants?
No. The largest at-home studies were open-label, self-reported, and run on the provider's own paying clients, with no placebo group and no direct comparison to antidepressants (McInnes et al., 2024). Any "outperforms antidepressants" claim compares these results to numbers from separate studies, which is not a valid head-to-head test. The honest answer is that no superiority has been established.
Can You Get Addicted To Ketamine?
Ketamine is a Schedule III controlled substance with recognized potential for psychological and physical dependence (DEA). Habitual or heavy use carries real risks, including the demand for ever more frequent sessions, which is one reason screening, supervision, and follow-up matter so much in any treatment model.
What Are The Physical Risks Of Frequent Ketamine Use?
The best-documented is bladder damage. Frequent, heavy use is linked to ulcerative cystitis, a painful and sometimes lasting condition mostly seen in near-daily users (Jhang et al., 2015). Ketamine also raises blood pressure and heart rate and causes dissociation during sessions, which is why people with cardiovascular conditions in particular need medical screening.
Is At-Home Ketamine Still Legal By Telehealth?
For now, yes. The DEA extended COVID-era telemedicine flexibilities a fourth time, letting practitioners prescribe controlled substances remotely without a prior in-person visit through December 31, 2026, while it finalizes a permanent rule (DEA, 2025). The longer-term rules are still being written, so the framework could tighten.
Is Microdosing The Same As Ketamine Therapy?
No. Ketamine is a clinically supervised dissociative used at meaningful doses for fast-acting effects. Microdosing means taking a sub-perceptual amount of a psychedelic such as psilocybin, in the 0.05 to 0.30 g range for dried mushrooms, low enough to stay fully functional through the day. They are different practices with different evidence bases and risk profiles. See The Benefits Of Microdosing for the basics.
Want A Clear, Grounded Starting Point?
If the research conversation has you trying to separate signal from marketing, our Microdosing Protocol Guide ($47) lays out a structured, harm-reduction-first approach to microdosing psilocybin, including dosing ranges, timing, and what the evidence does and does not support. Prefer to start free first? Grab the free mini-guide and get the fundamentals before you go further.
