Ketamine in Children and Adolescents: Where Are We Now?

Depression in young people is one of the most challenging conditions I encounter in practice. While many adolescents respond to standard treatments—psychotherapy, SSRIs, healthy lifestyle changes—there remains a subgroup for whom symptoms are severe, persistent, and even life-threatening. Understandably, families search for new options, and in recent years one medication has received growing attention: ketamine.

What is Ketamine?

Ketamine is an anesthetic developed in the 1960s and widely used in medicine because of its safety profile. Over the past two decades, research in adults has revealed that ketamine—at much lower doses than used in anesthesia—can have rapid antidepressant effects, sometimes within hours. This is particularly striking compared to the weeks it often takes traditional antidepressants to work.

What Do We Know About Ketamine in Youth?

Here’s the honest answer: not much yet.

• Research is very limited. Most studies of ketamine for depression have been in adults.

• Pediatric data are sparse. A handful of small pilot studies and case reports suggest that ketamine may reduce depressive symptoms in some adolescents, including those with suicidal thinking.

• Esketamine (a ketamine derivative) has been FDA-approved for treatment-resistant depression in adults, but it has not been approved for children or adolescents.

Potential Benefits

• Rapid relief of symptoms: For a teenager in crisis, the possibility of quickly reducing suicidal thoughts is compelling.

• Treatment-resistant depression: For youth who have not responded to multiple antidepressants and psychotherapy, ketamine could offer hope when other options have failed.

Potential Risks

This is where caution is essential.

• Unknown long-term effects: We do not yet know how repeated exposure to ketamine might affect the developing brain.

• Side effects: These can include dissociation, increased blood pressure, nausea, dizziness, and perceptual changes.

• Addiction potential: Ketamine is sometimes misused recreationally. Although the doses and settings in medical treatment are very different, the concern about dependence is real.

Ethical Considerations

Because children and adolescents are still developing—both neurologically and psychologically—we must balance urgency (helping youth who are suffering now) with prudence (avoiding harm we don’t yet understand).

Where Does That Leave Families?

• Ketamine is not a first-line treatment. Therapy and standard antidepressants remain the evidence-based starting point.

• Specialized settings only. If ketamine is considered, it should be within a research protocol or a highly supervised clinical program, ideally linked to academic medical centers.

• More research is needed. Several clinical trials are underway exploring ketamine and esketamine in adolescents, and these will help clarify safety, dosing, and effectiveness.

My Perspective as a Child Psychiatrist

I share families’ frustration when standard treatments don’t work. I’ve seen the suffering that comes with severe depression in youth, and I understand the hope ketamine generates. But my role is to help families navigate that hope responsibly. At present, ketamine remains experimental in children and adolescents. Until we have stronger evidence, I recommend considering it only in the most severe, treatment-resistant cases, within research or specialized clinical contexts.

In the meantime, I remain optimistic. Ketamine research has already transformed our understanding of depression and may ultimately lead to safer, more effective treatments for young people. Our task now is to let science catch up to the urgency of the need.