Intravenous (IV) Ketamine Therapy in Canada

Intravenous ketamine therapy is the form of ketamine treatment with the largest peer-reviewed evidence base for psychiatric use. The standard psychiatric protocol — 0.5 mg/kg infused over 40 minutes — is what almost every landmark RCT used: Zarate 2006, Murrough 2013, Singh 2016, Phillips 2019, the ELEKT-D ketamine-vs-ECT 2023 trial. The Canadian Network for Mood and Anxiety Treatments places IV racemic ketamine as a third-line treatment for adults with treatment-resistant depression (Swainson et al., 2021). IV ketamine in non-hospital settings requires facility-level accreditation in most Canadian provinces — CPSA NSHF in Alberta, CPSO OHPIP Level II in Ontario, CPSBC NHMSFAP in BC, CPSS NHTF in Saskatchewan. This article is the clinical-technical companion to the broader Ketamine Infusion Therapy overview. ATMA CENA's corporate clinics deliver KAT (ketamine-assisted therapy) primarily through intramuscular and sublingual ketamine, not IV — the article also explains who runs IV-led clinics across Canada and how ATMA CENA fits in for patients whose indication points toward IV specifically.

Key takeaways

• Standard psychiatric IV ketamine: 0.5 mg/kg over 40 minutes in a recliner or bed, vitals continuously monitored, total in-clinic time ~90–120 minutes per session.
• IV is the route used in the largest psychiatric RCTs and meta-analyses (Berman 2000, Zarate 2006, Murrough 2013, Singh 2016, Phillips 2019, Marcantoni 2020, Anand 2023 ELEKT-D).
• IV bioavailability is ~100% versus IM ~93%, SL ~25–30%, intranasal Spravato ~48%. Higher bioavailability gives precise dose-effect control.
• Provincial accreditation — IV in non-hospital settings requires CPSA NSHF (AB) / CPSO OHPIP Level II (ON) / CPSBC NHMSFAP (BC) / CPSS NHTF (SK) in most jurisdictions. Lighter for IM, SL, intranasal.
• ATMA CENA's corporate clinics deliver KAT via IM and SL — not IV. Patients whose clinical picture points toward IV are routed via ATMA CENA intake call to appropriate IV-led providers or to Spravato.
• Major Canadian IV-led private providers include SABI Mind (Calgary, Saskatoon, Edmonton, Victoria), Toronto Ketamine Clinic, Ontario Ketamine and Infusion Centre (Mississauga), Braxia Health (Mississauga, Montreal), and the IV component of pain-medicine clinics. Edmonton's Misericordia/Grey Nuns is Canada's only publicly funded psychiatric IV ketamine program.

What "IV ketamine therapy" actually means

A peripheral IV catheter is placed in your forearm. Racemic ketamine — the standard pharmaceutical form — is mixed with sterile saline and infused via a controlled pump over 40 minutes at 0.5 mg/kg of patient body weight. Vitals (blood pressure, heart rate, oxygen saturation, ECG) are monitored continuously. A clinician (typically a nurse with anesthesiology backup, or directly an anesthesiologist or trained psychiatrist) stays with you throughout. Effects begin within 5–10 minutes, peak at 20–30 minutes, and resolve within 30–60 minutes after the infusion ends. You stay in clinic for an additional observation period. Total in-clinic time is ~90–120 minutes per session.

For the patient-friendly walkthrough of what a session feels like, see Ketamine Infusion Therapy and Does Ketamine Therapy Get You High?.

The IV evidence base — and why protocols converged on 0.5 mg/kg / 40 minutes

Berman et al. 2000 — Biological Psychiatry — was the first IV ketamine RCT in depression. Foundational proof of concept (PubMed).

Zarate et al. 2006 — Archives of General Psychiatry — pivotal NIMH IV ketamine RCT in treatment-resistant depression. Single 0.5 mg/kg infusion produced significant antidepressant effects within 110 minutes; ~71% response at 24 hours. The trial that established the modern field (PubMed).

Murrough et al. 2013 — American Journal of Psychiatry — two-site randomized active-controlled trial. Antidepressant response in 64% of ketamine vs 28% of midazolam at 24 hours (PubMed).

Singh et al. 2016 — American Journal of Psychiatry — RCT comparing twice-weekly versus thrice-weekly IV ketamine. Both schedules were efficacious; twice-weekly with somewhat better tolerability. Established that twice-weekly is sufficient for the acute course (PubMed).

Phillips et al. 2019 — American Journal of Psychiatry — Royal Ottawa Canadian study of single, repeated, and maintenance IV ketamine. Single-dose response ~28%; six-dose response ~60%; meaningful sustained remission in the maintenance phase (PubMed).

Marcantoni et al. 2020 — Journal of Affective Disorders — meta-analysis of IV ketamine for TRD. Pooled response rates at 24 hours of ~50–70%; remission ~30–35%.

Anand et al. 2023 — ELEKT-D — New England Journal of Medicine — IV ketamine non-inferior to ECT for non-psychotic TRD on the primary outcome. The largest randomized head-to-head comparison (PubMed).

The trials converged on the 0.5 mg/kg / 40-minute protocol because it produces robust antidepressant effects with manageable acute side effects. CANMAT 2021 adopted this as the standard psychiatric protocol.

How IV compares to other routes

Why IV remains the most-studied route: The IV route gave researchers precise pharmacokinetic control (constant infusion rate; predictable peak plasma levels), allowed mid-infusion titration if adverse effects emerged, and matched the anaesthesiology-led safety profile that early psychiatric ketamine work emerged from. Subsequent routes have grown evidence bases but remain smaller relative to IV.

Provincial accreditation for IV ketamine

IV ketamine in non-hospital settings is regulatorily distinct from IM, SL, and intranasal in most provinces. The accreditation requirement reflects the IV route's higher acuity and the depth of sedation that IV protocols can produce.

The practical effect for patients: a clinic offering IV ketamine in a non-hospital setting must be the appropriate accreditation tier in your province. Confirm this before booking; reputable clinics will provide it on request.

For IM, SL, and intranasal routes, the accreditation requirement is typically lighter — these can usually be delivered in standard medical office settings with appropriate physician/nurse practitioner credentialing.

Canada's IV-led private providers

Public sector: The Misericordia and Grey Nuns hospital ketamine program in Edmonton — the only Canadian publicly funded outpatient psychiatric IV ketamine program — is covered under AHCIP for ultra-resistant TRD patients with psychiatry referral.

For city-specific provider details, see Ketamine Therapy in Calgary, Ketamine Therapy in Edmonton, Ketamine Therapy in Toronto and the GTA, Ketamine Therapy in Mississauga, and Ketamine Therapy in Saskatoon.

Where ATMA CENA fits

ATMA CENA's corporate clinics in Edmonton and Calgary deliver KAT primarily via intramuscular and sublingual ketamine, not IV. This is a deliberate clinical model choice: bundled preparation, dosing, and integration psychotherapy in a non-IV format. The published rationale emphasizes the value of integrated KAP wraparound rather than infusion-only delivery.

For patients whose clinical picture points specifically to IV — for example, severe TRD where the largest published RCT base is in IV protocols, or complex pain with comorbid TRD — ATMA CENA intake call works through:

• Whether IV is genuinely the right next step versus IM, SL, or Spravato.
• If IV is the right call, coordinated care coordination with an IV-led provider, with ATMA CENA supporting the psychotherapy wraparound.
• Whether Spravato (Health Canada-approved, often privately covered) is a better access pathway than off-label IV.

The honest framing: the "best route" is the route that fits your indication, evidence base, access, and coverage — not a one-size answer.

Cost

A 6-session acute IV course in private settings typically lands in the CAD $2,250–$5,100 range depending on provider. For full Canadian pricing, see Ketamine Therapy Cost in Canada.

Frequently asked questions

Why is IV the most-studied route? Because IV gives precise pharmacokinetic control: a constant infusion rate, predictable peak plasma levels, and the ability to titrate or stop mid-session if adverse effects emerge. The early psychiatric ketamine work (Berman 2000, Zarate 2006) emerged from anaesthesiology and continued in IV format; subsequent landmark trials (Murrough 2013, Singh 2016, Phillips 2019, Anand 2023 ELEKT-D) all used IV.

Is IV better than IM, SL, or Spravato? Not necessarily. IV has the largest RCT evidence base for TRD specifically. IM is highly bioavailable (~93%) and operationally simpler. Spravato is the only Health Canada-approved psychiatric form and is the route most likely to be privately insurance-covered. The right route depends on indication, clinical fit, access, and coverage.

Does ATMA CENA offer IV ketamine? ATMA CENA's corporate clinics in Edmonton and Calgary deliver KAT primarily via IM and SL. For patients whose clinical picture points specifically to IV, the intake call will discuss coordinated care coordination with an IV-led provider or a Spravato pathway.

Does insurance cover IV ketamine? Generally no for off-label IV ketamine. Spravato is the form most likely to be privately covered with prior authorization for documented TRD. Workers' compensation pathways apply for compensable injuries; VAC covers ketamine drug forms case-by-case for service-related TRD or chronic pain. See Insurance Coverage for Ketamine Therapy.

Is IV ketamine safe? At sub-anaesthetic supervised doses with appropriate screening, IV ketamine has a well-characterized short-term safety profile (Murrough 2015 safety analysis pooled 205 IV infusions across 97 TRD patients). Common transient effects: brief blood pressure elevation, mild nausea, dizziness, headache. Pre-treatment screening rules out absolute contraindications. See Ketamine Therapy Side Effects.

Why does IV require facility accreditation? The IV route can produce deeper acute effects than IM, SL, or intranasal; provincial regulators apply non-hospital surgical or medical/surgical facility accreditation requirements to ensure clinical safety standards. Confirm your provider's accreditation tier before booking.

How is IV ketamine different from anaesthesia ketamine? Anaesthesia ketamine uses doses 4–10× higher than psychiatric IV doses to produce general anaesthesia for surgery. Psychiatric IV at 0.5 mg/kg over 40 minutes is sub-anaesthetic; patients remain conscious, communicative, and breathing spontaneously throughout.

Can I be on antidepressants while doing IV ketamine? Generally yes; many trials enrolled patients continuing oral antidepressants. Spravato's pivotal trials (Daly 2018, Popova 2019) explicitly tested esketamine + newly initiated oral antidepressant. MAOIs are typically excluded; high-dose benzodiazepines may attenuate effect. Discuss with your prescriber.

Sources

1. ATMA CENA — coordinated care: https://psychedelic.healthcare/find-care
2. Berman RM, et al. (2000). Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. https://pubmed.ncbi.nlm.nih.gov/10686270/
3. Zarate CA Jr, et al. (2006). Randomized trial of an N-methyl-D-aspartate antagonist in TRD. Arch Gen Psychiatry. https://pubmed.ncbi.nlm.nih.gov/16894061/
4. Murrough JW, et al. (2013). Antidepressant efficacy of ketamine in TRD: two-site RCT. Am J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/23982301/
5. Singh JB, et al. (2016). Twice-weekly vs thrice-weekly IV ketamine in TRD. Am J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/27056608/
6. Phillips JL, et al. (2019). Single, repeated, and maintenance IV ketamine for TRD. Am J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/30764648/
7. Marcantoni WS, et al. (2020). Systematic review and meta-analysis of IV ketamine for TRD. J Affect Disord.
8. Anand A, et al. (2023). Ketamine versus ECT for nonpsychotic TRD: ELEKT-D. N Engl J Med. https://pubmed.ncbi.nlm.nih.gov/37224135/
9. Swainson J, et al. (2021). CANMAT racemic ketamine task force recommendations. Can J Psychiatry. https://pubmed.ncbi.nlm.nih.gov/33174760/
10. CPSA — Ketamine Clinical Toolkit: https://cpsa.ca/resources/ketamine-toolkit/
11. CPSBC — NHMSFAP IV Ketamine for Mood Disorders: https://www.cpsbc.ca/files/pdf/NHMSFAP-AS-Intravenous-Use-of-Ketamine-for-the-Treatment-of-Mood-Disorders.pdf

Related articles in this cluster

• Ketamine Therapy in Canada
• Ketamine Infusion Therapy — patient-friendly companion
• Intranasal Ketamine and Spravato
• Group Ketamine Therapy
• Ketamine Therapy Side Effects
• Ketamine Therapy for Treatment-Resistant Depression (deep dive)
• Ketamine Therapy Cost in Canada
• Insurance Coverage for Ketamine Therapy
• Find care near you

Last updated: 2026-05-06