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Ketamine-Assisted Psychotherapy

The Craig Clinic offers ketamine-assisted psychotherapy (KAP) at 74 Harley Street for adults whose depression, post-traumatic stress disorder or anxiety disorder has not responded adequately to conventional treatment. The service is consultant psychiatrist led. Professor Craig undertakes every assessment, sets the treatment plan and retains medical oversight throughout.

Psychotherapeutic work is led by Annushka Shani, a Jungian analyst, who co-leads the clinic.

Approximately a third of patients with major depressive disorder do not achieve an adequate response to standard antidepressant and psychological treatment. Ketamine is currently one of the best evidenced pharmacological options for this group, and the clinic was established in response to that clinical gap.

The Development of the Service

Professor Craig previously developed and led the intravenous ketamine service for treatment-resistant depression at King Edward VII’s Hospital, and the present programme is built on that clinical experience. The service was established in 2026 with a senior Jungian analyst, and differs from a conventional infusion clinic in that the pharmacological and psychotherapeutic components are planned together from the outset, with psychotherapy integral to the treatment rather than an adjunct to it.

The clinic is developing a working relationship with Cambridge Biotherapies, a private treatment centre in the United States founded in 2016 by Dr Daniel A. Brenner, which provides ketamine infusion, ketamine-assisted psychotherapy and transcranial magnetic stimulation. The intention is that the two services will refer patients to one another where clinical need or geography makes that appropriate, and that Dr Brenner will contribute to discussion of complex cases, bringing substantial experience in this area of practice. This is a collegiate arrangement rather than a formal partnership, and clinical responsibility for patients treated at Harley Street rests with Professor Craig throughout.

More about Dr Brenner's clinic: cambridgebiotherapies.com

The Clinical Team

Professor Michael Craig undertakes all psychiatric assessment, prescribing and medical oversight for the clinic.

Psychotherapy is delivered by a senior Jungian analyst, a member of the Society of Analytical Psychology and registered with the British Psychoanalytic Council, who provides the preparation and integration work and co-leads the clinic.

Depression with mood-congruent psychotic symptomsWho May be Suitable?

The clinic treats depression. Referrals are accepted from GPs, consultant psychiatrists, clinical psychologists and other registered clinicians, and self-referrals are accepted. Presentations treated are:

Treatment-resistant unipolar depression, in a moderate or severe current episode
Depressive episodes in bipolar I and bipolar II disorder, but not mania or mixed states
Depression with mood-congruent psychotic symptoms
Depression in which suicidal ideation requires rapid stabilisation
Persistent suicidal ideation

Ketamine has been studied in post-traumatic stress disorder, obsessive compulsive disorder and other presentations, and there is a reasonable signal in that literature, but the number of randomised trials remains small and the clinic does not currently treat these conditions. Patients who are not suitable candidates are told so directly and alternatives are discussed, including rTMS where indicated.

Eligibility Criteria

In addition to diagnosis, the following criteria apply:

Aged 18 or over, with capacity to consent

Treatment resistance, defined as failure to respond, in the current or a previous episode, to at least two antidepressants at an adequate dose with good adherence, and to a course of psychological treatment in at least one modality

A HAM-D17 score of 17 or above at referral, consistent with moderate to severe depression

ECT considered, and either contraindicated, declined, poorly tolerated or previously ineffective

Not currently taking benzodiazepines, barbiturates, pregabalin, lamotrigine or St John’s wort, each of which attenuates the antidepressant response and must be tapered before referral

Able to attend follow-up, complete mood monitoring at home, and follow pre-infusion instructions including fasting

How Does Ketamine Work?

Ketamine is a non-competitive antagonist at the N-methyl-D-aspartate (NMDA) receptor, a glutamate receptor central to synaptic plasticity, learning and emotional regulation. Altered glutamatergic signalling in the prefrontal cortex, hippocampus and amygdala is implicated in the persistence of depressive cognition and of traumatic memory.

Blockade of tonic NMDA receptor activity produces a rapid rise in synaptic glutamate, activation of AMPA receptors and downstream mTOR signalling, which in turn increases synthesis and release of brain-derived neurotrophic factor (BDNF). The result is increased synaptogenesis in prefrontal and limbic circuits. A systematic review by Kang and colleagues, covering 139 preclinical and clinical publications, found consistent evidence that ketamine increases the molecules involved in neuroplasticity, including glutamate, AMPA receptors, mTOR and the BDNF and TrkB pathway, and that these changes accompany rapid improvement in mood. The mechanism is nonetheless not settled, and restoration of deficits in neuroplasticity is best understood as the most parsimonious account rather than a proven pathway. What is not in doubt is that it differs fundamentally from that of monoaminergic antidepressants, which accounts for the speed of response.

The Neuroplastic Window

The working premise of ketamine-assisted psychotherapy is that the period following administration is one of heightened capacity to form new associative pathways and to revise entrenched patterns of thought and affect, and that psychotherapy delivered inside it consolidates more readily than psychotherapy delivered at an arbitrary interval. Integration sessions are therefore timed to the 48 to 72 hours after dosing.

This is a clinical rationale rather than a measured biological interval. Animal and molecular work supports a time-limited increase in plasticity markers, but human data are less clear cut. A 2024 review by Pardossi and colleagues of BDNF in patients treated with ketamine and esketamine found that most studies report a rise in plasma BDNF after intravenous ketamine while others do not, and that studies remain small. The timing used here follows the observed course of the clinical response rather than a precisely defined window, and the page states the position on that basis rather than claiming more than the evidence supports.

What Does the Evidence Show?

Treatment-resistant depression

Ketamine is one of only a small number of interventions shown to outperform placebo or sham treatment for treatment-resistant depression in randomised controlled trials. A 2024 network meta-analysis by Saelens and colleagues in Neuropsychopharmacology examined 69 randomised trials and 10,285 participants across 25 treatments, and identified ketamine, electroconvulsive therapy, repetitive transcranial magnetic stimulation, theta burst stimulation, minocycline and aripiprazole as the treatments with a higher response rate than control. In the largest pooled safety and outcome analysis of intravenous ketamine in this population, reported by Wan, Murrough and colleagues, 205 infusions given at 0.5 mg/kg over 40 minutes to 97 patients produced a response rate of 67%, response being defined as a 50% or greater reduction in Montgomery Asberg Depression Rating Scale score. Response definitions and trial populations vary, most of the outcome data are short term, and these figures should not be read as a prediction of individual outcome.

The antidepressant effect emerges within 24 hours of a single infusion, which no conventional antidepressant approaches. Its main limitation is durability. The effect of a single administration is transient, and it is this that provides the rationale both for a course of treatment rather than an isolated infusion, and for integrating psychotherapy.

Post-traumatic stress disorder

Ketamine acts on the amygdala, hippocampus and prefrontal circuitry that subserves encoding and retrieval of traumatic memory. A 2024 systematic review and meta-analysis by Kwan and colleagues in CNS Spectrums, covering 44 studies of ketamine across psychiatric disorders other than mood disorders, found statistically significant reductions in PTSD symptom severity on both the PTSD Checklist for DSM-5 and the Clinician-Administered PTSD Scale, and in obsessive compulsive symptoms on the Yale-Brown Obsessive Compulsive Scale. The evidence base here is smaller and less mature than in depression and the studies are heterogeneous. Where ketamine is combined with trauma-focused psychotherapy during the integration phase, effects appear better sustained at follow up.

Suicidal ideation

Ketamine is distinctive among psychiatric medications in reducing suicidal ideation rapidly and to a degree that is at least partly independent of its effect on mood. Clinically meaningful reductions have been documented within hours of a single intravenous infusion. This makes it a useful option where rapid stabilisation is the priority, though it does not substitute for the usual measures required to manage acute risk.

Why is Psychotherapy Part of the Treatment?

The limited durability of ketamine given alone is the reason psychotherapy is built into the programme. A systematic review of ketamine combined with psychotherapy by Drozdz and colleagues, covering 17 studies and 603 participants, concluded that psychotherapy provided before, during and after ketamine administration can both amplify and prolong benefit, and that it was precisely the short-lived effect of ketamine as a drug that prompted this line of work. Protocols vary considerably in route, dose, frequency and psychotherapeutic modality, and larger randomised trials are still needed.

Ketamine reliably brings symbolic, imagistic and unconscious material to the surface, and psychotherapeutic traditions that already have a method for working with unfamiliar states of mind and with dream and symbolic content are well suited to this task. That is the reason for an analytic approach here.

As the ordinary organising sense of self loosens, patients often encounter aspects of themselves that are not usually accessible: a harshly self-critical voice, something that undermines change, grief or fear held from much earlier in life. Analytical psychology has described these as autonomous complexes, partly independent centres of feeling and memory that can behave as though they had a will of their own, and it understands the Self as the organising centre of the psyche towards which these fragments can be brought into relation. That is the framework used here. The aim in preparation is to help patients meet whatever arises with curiosity rather than resistance, and the aim in integration is to bring it into relation with the rest of their psychological life rather than to interpret it for them.

When a patient can meet a difficult aspect of themselves from a settled and compassionate position rather than being taken over by it, that meeting is usually where the useful movement happens. This is the individuation process as analytical psychology describes it, and it is why the psychotherapeutic work is not an adjunct to the infusion but the part of the treatment that determines what the infusion is worth.

Routes of Administration

Intravenous Infusion Ketamine

The clinic offers intravenous ketamine only. There is no fixed number of infusions. Dose, titration strategy, session frequency and the length of the course are determined individually at assessment and reviewed as treatment proceeds, within the three-phase framework described below. Response is judged on repeated symptom measurement rather than impression, and treatment does not continue where the measures show no benefit.

Why the Intravenous Route

Intravenous racemic ketamine gives the most predictable pharmacokinetics and allows real-time titration. Psychoactive effect begins at 5 to 10 minutes, peaks at 20 to 30 minutes and resolves within 60 to 90 minutes. It is the most extensively studied route in treatment-resistant depression and in acute suicidal ideation, and it is the route for which the clinic holds written clinical protocols.

Infusions are given in a dedicated clinical room with continuous cardiovascular monitoring. The first infusion is 0.5 mg/kg diluted in 0.9% sodium chloride and given by infusion pump over 40 minutes. At subsequent sessions the dose may be titrated according to response, to a maximum of 1.0 mg/kg, with doses above 0.75 mg/kg used only after discussion with the clinical lead. Response is defined as a 50% reduction in QIDS-SR16 score. Absence of any dissociation may indicate that the dose is too low, and dissociation is scored formally at the end of each infusion.

Unsupervised and at-home dosing is not offered, and no oral or sublingual ketamine is prescribed. All administration takes place on clinic premises under supervision.

Your Treatment: The Three Phases

No ketamine is administered without prior medical assessment and a confirmed clinical indication. Treatment is then delivered in three phases, each with a distinct purpose, and every clinician involved works to the same written protocol. Documentation passes between phases so that patients are met with continuity rather than having to repeat themselves at each stage.

1 Phase 1. Medical Assessment and Preparation

The medical assessment with Professor Craig confirms the referral information, diagnosis and treatment history, and covers current medication including over-the-counter preparations, illicit substance use and allergies. It includes mental state examination, HAM-D17, QIDS-SR16 and the Interstitial Cystitis Problem and Symptom Index, weight and blood pressure, bloods (full blood count, CRP, urea and electrolytes, liver function, TSH, magnesium and calcium), and an ECG. Urine toxicology is obtained where indicated. Capacity is assessed, contraindications reviewed, and written consent taken before any infusion is arranged.

Patients are given written instructions for the day of treatment. Clear fluids only from midnight, then nil by mouth from 07:00. Usual medication may be taken with a small sip of water, omitting short-acting hypoglycaemic agents and drugs not normally taken on an empty stomach such as aspirin and NSAIDs. Patients must be accompanied by a responsible adult for the first two infusions, and must not drive, drink alcohol, use recreational drugs, sign legal documents or take responsibility for dependents until the following morning after a night’s sleep.

Once medically cleared, the patient meets the psychotherapist for a preparation session. This covers what to expect physically and psychologically, the effect of ketamine on the default mode network and what that can open up, the possibility that unfamiliar or self-critical parts of the self may surface, and the distinction between a difficult experience and a genuinely adverse one. Patients are helped to set an intention if they wish to, though not everyone does and it is not a requirement. Consent is taken for any physical support during the session, such as hand holding, and may be withdrawn at any time. There is no sexual touch under any circumstances. Practical arrangements are settled here, including transport home and food and drink instructions.

2 Phase 2. Dosing

The infusion is given in a private clinical room. Blood pressure, heart rate, temperature and oxygen saturation are recorded before the infusion, every 10 minutes during it, and for at least 30 minutes afterwards, on a NEWS chart. A nurse remains with the patient throughout and does not leave the room at any point. Professor Craig is on site for the duration of every infusion. Intravenous lorazepam, ondansetron and labetalol are available for transient dissociation or anxiety, nausea, and transient hypertension respectively, and any serious adverse effect is escalated to Professor Craig immediately.

The room is arranged to support an inward experience, with dimmed lighting, music and an eye mask available. The nurse’s role is to provide a steady presence rather than to direct or interpret the experience, and any physical support is limited to what was agreed beforehand. The psychotherapist is not present during the infusion but remains contactable. Dissociation is scored on the CADSS-6 at the end of the infusion, and notable physical or emotional responses are documented for the integration session.

Patients then move to a recovery area. Discharge requires a CADSS-6 score of zero or no higher than the pre-treatment score, a settled mental state, and normalised observations. For the first two infusions patients remain for 90 minutes after the infusion before discharge. A journal is provided, and patients are asked to complete a QIDS-SR16 at home 24 hours after every infusion.

3 Phase 3. Integration

An integration session with the psychotherapist is held within 72 hours. Patients bring their journal and describe what surfaced, at their own pace. This includes bodily experience such as tension, release, warmth or heaviness, which carries as much material as any image or memory. Where an intention was set it is revisited. Mood, sleep and functioning since the infusion are reviewed and anything of concern is passed to Professor Craig. Next steps are discussed, whether a further infusion in the series, continued psychotherapy, or the patient’s own integration practices between sessions.

Review and Discharge Planning

Professor Craig conducts a formal psychiatric review once the acute course is complete, using the same symptom measures recorded throughout. Patients who have not responded are told so directly and treatment is stopped. Where there has been a response that is subsequently lost, maintenance by repeat infusion at intervals may be offered. Oral ketamine is not prescribed, either as maintenance or otherwise. Decisions on continuing psychotherapy or discharge back to the existing clinical team are made with the patient, and a clinical summary is sent to the referrer or GP as required.

Continuity of Care

Ketamine treatment is not a substitute for ongoing psychiatric care, and the clinic does not accept patients who would be left without it. Every patient must have an identified clinician responsible for their continuing care, whether their GP, an NHS team or a private psychiatrist. Where a patient self-refers, treatment is accepted on the condition that their GP is informed, and a summary is sent at assessment and again at the end of the course. Professor Craig will liaise with the treating team during treatment where clinically relevant.

Patients are given written aftercare information and a contact number for the clinic, together with instructions on what to do if their mood worsens between sessions. Deterioration between infusions is managed under a written pathway, which includes review by Professor Craig and, where risk requires it, escalation to NHS crisis services or emergency care. The clinic has no inpatient beds, and patients are told at assessment that admission, if it became necessary, would be arranged through those routes.

Side Effects and Risks

Ketamine is well tolerated by most patients at the doses used in psychiatric practice, and effects during a session are transient and resolve as the drug clears. Expected effects and side effects include:

Dissociation, perceptual change and altered sense of time during administration
Transient rise in blood pressure and heart rate
Nausea and vomiting
Dizziness, unsteadiness and blurred vision
Headache
Anxiety or distress during the session
Fatigue for the remainder of the day

Risks associated with repeated or prolonged use, principally urinary tract and bladder injury, hepatobiliary abnormalities, cognitive effects and dependence, are dose and frequency related. Programmes are therefore time limited, doses conservative, and cumulative exposure kept to the minimum needed for clinical benefit. Written aftercare guidance is provided and adverse event protocols are in place.

The rise in blood pressure is modest at the doses used in psychiatry. Pooled data from 2,252 ketamine or esketamine treatments across 15 studies give a mean increase of 12.6 mmHg systolic and 8.5 mmHg diastolic, transient in each case, which is why blood pressure is monitored throughout and why uncontrolled hypertension is a contraindication.

When is Ketamine not Suitable?

Treatment is not offered where any of the following are present:

History of psychotic symptoms that are not mood-congruent, and schizophrenia
Acute mania or a mixed affective state
Uncontrolled hypertension, or unstable cardiac disease including heart failure, valve disease, recent myocardial infarction or significant arrhythmia
Aneurysm or arterial dissection
Raised intracranial pressure, or recent head trauma or intracranial surgery
Raised intraocular pressure and glaucoma
Epilepsy
Acute porphyria
Untreated hyperthyroidism
Severe respiratory disease
Advanced liver disease
Interstital cystitis, or established ketamine-related urinary tract injury
Alcohol or illicit drug misuse within the past 2 years
Pregnancy, breastfeeding, or trying to conceive
Allergy or previous adverse reaction to ketanine or to benzethonium chloride
Concurrent barbiturates or opioids, which prolong recovery
Unable to attend follow-up, complete home mood monitoring, or follow-up pre-infusion instructions

Note that depression with mood-congruent psychotic symptoms is treated, whereas psychotic symptoms incongruent with mood are an exclusion. Renal impairment, personality disorder and dissociative disorders are assessed individually. Benzodiazepines, pregabalin, lamotrigine and St John’s wort attenuate the antidepressant response and are tapered before referral rather than treated as permanent exclusions. Caution applies with thyroid hormone replacement, which raises the risk of hypertension and tachycardia, with antihypertensives, which raise the risk of hypotension, with theophylline and aminophylline, which lower the seizure threshold, and with drugs affecting CYP3A4 activity, which alter ketamine clearance and may require dose adjustment. This list is not exhaustive. Patients are asked to confirm with their GP, and with their psychiatrist where they have one, that there is no contraindication to treatment.

Clinical Governance

Ketamine is administered only after written informed consent, medical screening and psychiatric assessment confirming indication. Consent covers the unlicensed status of the treatment, the possible side effects, and the restrictions on driving, alcohol, recreational drugs, signing legal documents and care of dependents. Physiological monitoring is maintained throughout every session. The premises at which intravenous ketamine is administered are registered with the Care Quality Commission. Ketamine is a controlled drug and is ordered, stored, recorded and destroyed in accordance with the relevant medicines code. Prescribing follows General Medical Council guidance on unlicensed and off-label prescribing.

Measurement and Ongoing Monitoring

Outcomes are measured rather than assumed. QIDS-SR16 is completed at every attendance and at home 24 hours after each infusion, and response is defined as a 50% reduction from baseline. HAM-D17 is recorded at referral. Dissociation is scored on the CADSS-6 at the end of each infusion. Medication changes, including over-the-counter preparations, are re

viewed at each visit. Anonymised outcome and adverse event data are collated for audit and quality assurance.

Safety monitoring is timed to cumulative exposure rather than left to clinical impression:

Interstitial Cystitis Problem and Symptom Index at every attendance, with treatment stopped if urinary symptoms emerge
Liver function at baseline and every 6 months during a course of treatment
Blood pressure and heart rate at every attendance, in addition to the observations recorded during each infusion
A brief cognitive screen for any patient passing 12 infusions, repeated if treatment continues
Formal review of urinary, hepatic and cognitive measures before exceeding 20 infusions in any rolling 12-month period

When Treatment is Stopped

Treatment stops as well as starts on the measures, and the thresholds are set in advance rather than decided as treatment proceeds. Treatment is discontinued where:

There is no response after three infusions, since response beyond that point is improbable and continuing would not be justified
Urinary symptoms emerge on the Interstitial Cystitis Problem and Symptom Index, or liver function becomes abnormal
Cognitive complaints emerge that do not resolve between sessions
Dissociation is poorly tolerated, or blood pressure rises are not adequately controlled
The patient no longer wishes to continue, at any point and without needing to give a reason

Cumulative exposure is limited. Maintenance infusions are given no more frequently than fortnightly, and no more than 20 infusions are given in any rolling 12-month period without an independent second opinion, a formal review of urinary, hepatic and cognitive measures, and a documented rationale for continuing. Any course extending beyond the usual length, or any dose above 0.75 mg/kg, is reviewed by a second consultant psychiatrist before continuing. Ketamine received elsewhere counts towards this total. The clinic has no financial interest in extending treatment: fees are charged per session as delivered, courses are not sold in advance, and sessions not delivered are not charged for.

Independent Oversight and Outcome Reporting

A private clinic has no medical advisory committee, and this service is deliberately structured so that clinical decisions are not made by one person unchallenged. A clinical governance group meets periodically to review cases, adverse events and outcome data, and includes at least one consultant psychiatrist independent of the clinic. Case review is minuted. Adverse events, incidents and complaints are logged and reviewed at each meeting, and the clinic operates under the duty of candour.

Outcomes are reported rather than asserted. The clinic undertakes an annual service evaluation using the anonymised data collected at every attendance, covering the number of patients treated, response and remission rates on QIDS-SR16, dropout, adverse events and cumulative exposure, and publishes the result. Patients and referrers are therefore able to see how this service performs rather than relying on figures from the published literature.

What this Treatment Does Not Do

Ketamine is not a cure for depression and is not presented as one here. A proportion of patients do not respond at all, and it is not currently possible to predict in advance who they will be. The effect of a single infusion is transient, which is why treatment is given as a course and why psychotherapy is built into it. Some patients who respond will relapse, and some will need maintenance treatment or a different approach altogether.

The treatment is unlicensed for this indication, the long-term effects of repeated administration in psychiatric use are not fully known, and the psychotherapeutic evidence base, while positive, rests on a modest number of trials. Patients are told all of this at assessment. Anyone offering ketamine as a straightforward or guaranteed solution to treatment-resistant depression is overstating what the evidence supports.

Referrals and Enquiries

A brief referral letter or clinical summary is helpful but is not required in order to make contact. All enquiries are treated confidentially. The clinic is private and does not hold NHS contracts. Fees are set out on the Fees and Terms page and are discussed at the point of assessment.

References

Sources are listed in the order in which the page draws on them. All were located on PubMed and DOIs are given so the citations can be held on file for substantiation purposes.

Kang MJY, Hawken E, Vazquez GH. The mechanisms behind rapid antidepressant effects of ketamine: a systematic review with a focus on molecular neuroplasticity. Frontiers in Psychiatry 2022;13:860882. doi:10.3389/fpsyt.2022.860882
Pardossi S, Fagiolini A, Cuomo A. Variations in BDNF and their role in the neurotrophic antidepressant mechanisms of ketamine and esketamine: a review. International Journal of Molecular Sciences 2024;25(23):13098. doi:10.3390/ijms252313098
Saelens J, Gramser A, Watzal V, Zarate CA, Lanzenberger R, Kraus C. Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology 2024;50(6):913-919. doi:10.1038/s41386-024-02044-5
Wan LB, Levitch CF, Perez AM, Brallier JW, Iosifescu DV, Chang LC, Foulkes A, Mathew SJ, Charney DS, Murrough JW. Ketamine safety and tolerability in clinical trials for treatment-resistant depression. Journal of Clinical Psychiatry 2015;76(3):247-252. doi:10.4088/JCP.13m08852
Kwan ATH, Lakhani M, Singh G, Le GH, Wong S, Teopiz KM, Dev DA, Manku AS, Sidhu G, McIntyre RS. Ketamine for the treatment of psychiatric disorders: a systematic review and meta-analysis. CNS Spectrums 2024:1-8. doi:10.1017/S1092852924000580Lamontagne SJ, Ballard ED, Zarate CA. Effects of stress on endophenotypes of suicide across species: a role for ketamine in risk mitigation. Neurobiology of Stress 2022;18:100450. doi:10.1016/j.ynstr.2022.100450
Drozdz SJ, Goel A, McGarr MW, Katz J, Ritvo P, Mattina GF, Bhat V, Diep C, Ladha KS. Ketamine assisted psychotherapy: a systematic narrative review of the literature. Journal of Pain Research 2022;15:1691-1706. doi:10.2147/JPR.S360733
Vankawala J, Naples G, Avila-Quintero VJ, Ramirez KL, Flores JM, Bloch MH, Dwyer JB. Meta-analysis: hemodynamic responses to sub-anesthetic doses of ketamine in patients with psychiatric disorders. Frontiers in Psychiatry 2021;12:549080. doi:10.3389/fpsyt.2021.549080
Sholevar R, Kromka W, Beaussant Y. Ketamine and ketamine-assisted psychotherapy for psychiatric and existential distress in patients with serious medical illness: a narrative review. Journal of Palliative Medicine 2025;28(7):967-981. doi:10.1089/jpm.2024.0346

Racemic ketamine given by infusion or by the oral and sublingual route is not licensed in the United Kingdom for the psychiatric indications described and is prescribed off-label. Intranasal esketamine is licensed for treatment-resistant depression. Information on this page is general and does not constitute medical advice. A formal psychiatric assessment is required before any treatment can be offered.