Ketamine and Adolescent Depression
- Dr. Aubrey Verdun
- Nov 5
- 5 min read
In recent years, more adolescents and young people are being offered the drug Ketamine — originally developed as an anesthetic — to treat depression. A recent article in USA Today highlights this “controversial rise in youth” receiving ketamine therapy for mood-disorders. Although research is still limited, the driving force behind this trend is a growing mental-health crisis in youth populations and the frustration of standard treatments not working for everyone.
Depression in adolescents can be especially challenging. Many young people don’t respond fully to traditional treatments — psychotherapy, antidepressants, lifestyle interventions — creating a demand for newer-or-experimental approaches. Emerging evidence suggests ketamine might offer rapid relief in some cases of treatment-resistant depression. For example, a 2023 article in Front Psychiatry on ketamine-assisted psychotherapy in adolescents noted improved symptoms, reduced acute suicidality, and mood-lability in certain cases.
Yet, pairing that promise with the youth context brings extra layers of caution: brain development, long-term safety, ethical issues about off-label use, and the business aspects of therapy clinics.
How Ketamine Works (and What Makes It Different)
To understand why ketamine is getting attention, it helps to know how it’s different from standard antidepressants.
Traditional antidepressants (SSRIs, SNRIs, etc) typically act on serotonin or norepinephrine pathways and may take weeks to show full effect.
Ketamine operates via a different mechanism: it is a non-competitive antagonist of the NMDA (N-methyl-D-aspartate) glutamate receptor, which triggers downstream changes in glutamate signalling, synaptic plasticity and connectivity.
For adults with treatment-resistant depression, ketamine has shown relatively rapid improvement in mood and reduction in suicidal ideation. This speed is part of its appeal in severe cases.
Applying this to adolescents sounds promising — the idea of an intervention that can take effect faster in a population at elevated risk for worsening outcomes or self-harm. Indeed the 2023 adolescent study found that “ketamine was shown in adolescents to improve depressive symptoms, decrease acute suicidality, and reduce mood lability.”
What the Evidence Actually Says (and Doesn’t)
Here’s a breakdown of what we do know — and where the gaps remain.
What we know
Some small open-label trials, case reports and preliminary studies in adolescents show improvements in depression and suicidality with ketamine-assisted psychotherapy.
The treatment appears generally tolerated in those settings (though the number of subjects is low).
For adults, there is stronger data supporting ketamine’s rapid effect in treatment-resistant depression. That adult experience provides a backdrop for interest in younger people.
What we don’t know / major cautions
There is no large-scale randomized controlled trial in adolescents with long-term follow-up that firmly establishes safety and efficacy. The systematic review notes that research in youth is still nascent.
The long-term effects of repeated ketamine dosing in developing brains remain unclear. Some animal data raise concerns about neurotoxicity in early developmental periods.
Regulatory oversight is weaker when use is “off-label” (i.e., using ketamine for psychiatric disorders when it is not formally approved for that indication).
Business and marketing aspects — some clinics offering ketamine therapy may lack robust psychiatric oversight, especially for younger clients. The risk of misuse, inappropriate dosing, or lack of comprehensive support is a real concern.
Why Adolescents Are a Special Case
Adolescence is a period of rapid brain maturation, hormonal change, identity development, and social transitions. These features mean:
The adolescent brain may respond differently (both positively and negatively) to interventions like ketamine.
Risks of neurodevelopmental impact (though human data are lacking) are more salient.
Psychosocial context (family, schooling, peer relationships) plays a large role — meaning that medication or therapy alone may not suffice.
Ethical concerns escalate when we introduce newer treatments in minors: consent, assent, parent involvement, risk/benefit trade-offs.
Access, equity and cost issues may intersect with marketing of “ketamine clinics” to desperate families.
Thus while the idea of offering ketamine to an adolescent with severe depression may feel compelling, it must be weighed carefully with extra safeguards.
Practical Considerations for Stakeholders
If you’re a parent, caregiver, clinician or adolescent exploring this topic, here are some key questions and considerations:
Is depression treatment-resistant? Ketamine in adolescents is mostly considered when standard treatments (therapy, antidepressants) have failed or when there is high risk (e.g., suicidality).
What protocol is being used? Ask: Is there a standardized psychotherapeutic framework alongside ketamine (often described as ketamine-assisted psychotherapy)? Are doses carefully monitored? Is there a treatment plan for after the session (integration therapy)? The 2023 case series emphasizes that ketamine alone is not sufficient on its own — family involvement and psychotherapy matter.
What are safety measures and oversight?
Is the provider a psychiatrist or experience with adolescent mood disorders?
Are doses empirically supported and adjusted?
Are there safeguards for sedation, dissociation, blood-pressure changes, bladder health (ketamine has been linked to urinary issues in high-dose/chronic use) or potential abuse?
What is the follow-up plan?
What are the legal/regulatory status and cost? In the U.S., ketamine for psychiatric disorders is largely off-label; only Esketamine (a derivative) is FDA-approved for treatment-resistant depression in adults under strict supervision. Off-label use may not be covered by insurance and may carry higher out-of-pocket costs.
What is the fit for the individual adolescent’s case? Consider comorbidities (anxiety, trauma, substance use), developmental stage, family context, school/peer environment and whether alternative treatments have been adequately addressed.
What are the long-term plans? Ketamine may relieve acute symptoms, but depression often relapses or needs ongoing management. Is there a plan for maintenance, monitoring and combining with other strategies (therapy, lifestyle changes, social supports)?
The Big Picture: Promise vs. Caution
The emerging use of ketamine in adolescent depression represents both an opportunity and a challenge.
The opportunity: For adolescents who are suffering, not responding to standard treatments, or at high risk (e.g., suicidal ideation), ketamine could offer a rapid-acting option. Early research suggests meaningful improvement may be possible — something truly valuable given the stakes.
The caution: We simply do not yet have robust long-term data in youth. The developing brain, ethical issues around minors, off-label treatment contexts and variable clinic quality all raise red flags. Some critics liken aspects of the current wave of ketamine clinics to a “wild west” without enough regulation.
In short: This is not yet a mainstream, fully validated standard of care for adolescents with depression — but a promising frontier requiring careful navigation.
Takeaways
The decision to use ketamine in this age group should involve a highly qualified clinician, clear protocol, psychotherapy integration, and a full discussion of risks, benefits and alternatives.
Always ask about follow-up, long-term plan, cost and safety monitoring.
Don’t rely on ketamine alone. For adolescents, holistic treatment — therapy, family support, lifestyle interventions — remains essential.
If you are a parent or caregiver, ask for clear documentation of the provider’s adolescent psychiatry credentials and how treatment is being managed for a younger population.
The mental-health landscape for adolescents is unquestionably challenging, and innovations are needed. The rise of ketamine therapy for youth depression underscores that urgency. But with hope must come humility: humility about how much we still don’t know, how special adolescents are as a group, and how important it is to proceed with evidence, oversight and care.
For now, ketamine offers a cautiously hopeful option — not a guaranteed fix. If you or someone you care about is considering this route, it’s wise to consult trusted child/adolescent psychiatrists, ask hard questions, and ensure the treatment plan places the adolescent’s long-term wellbeing at its centre.
