By Dr. Lisa Parker, DNP, APRN, NP — Owner & Clinical Director, Parker Neuroscience, Omaha, Nebraska
Here is the direct answer: ketamine and Spravato® therapy for treatment-resistant depression is outpatient care. That is not a limitation of my practice, and it is not something I work around. It is how this treatment is built to work. My patients come in, are treated and monitored under my direct clinical supervision, and go home the same day. There is no version of this treatment that is designed around a multi-day hospital stay.
Inpatient and Outpatient Solve Different Problems
It helps to be precise about what each of these means, because they are not two versions of the same thing. They answer two different clinical questions.
Inpatient psychiatric care exists for one purpose: keeping someone safe around the clock when they are in acute crisis and need continuous supervision. That is a real and necessary level of care, and it has nothing to do with which depression treatment someone eventually receives. It is about immediate safety.
Ketamine and Spravato therapy exist for a different purpose entirely: treating depression, PTSD, anxiety, or OCD that has not responded adequately to standard treatment. It is a scheduled, monitored medical treatment, not a crisis intervention, and it is designed for patients who are medically and psychiatrically stable enough to be treated and discharged the same day.
If someone needs 24-hour safety monitoring right now, that need gets addressed first, and separately, from any conversation about ketamine or Spravato. The two are not sequential options on the same menu.
Why the Treatment Itself Requires This Model
This is not a policy I chose. For Spravato specifically, it is a federal requirement. Spravato (esketamine) is available only through the FDA’s REMS program, which requires every dose to be administered under the direct observation of a healthcare provider, with a minimum of two hours of monitoring afterward, in a certified setting. Spravato is never sent home with a patient. That requirement exists because the medication needs trained monitoring during its active effects. Once that window closes and you have met discharge criteria, there is no clinical reason to keep you longer. The monitored, same-day model is not a workaround. It is the safety mechanism that makes this medicine usable at all.
IV ketamine follows the same logic even without an identical federal mandate. It is a short-acting infusion, the effects resolve within the monitoring window, and once you are back to your baseline and meet discharge criteria, you go home. Extending that into an overnight stay would not make the treatment safer, because the period that requires supervision is a matter of hours, not days.
What Matters More Than the Setting
Once it is clear that ketamine therapy for depression is delivered outpatient almost everywhere, inpatient versus outpatient stops being the most useful question. The better question is who is actually providing the care, and what happens if something unexpected occurs during it.
Ketamine is a powerful medication. Serious complications are uncommon at the doses used for depression, but changes in heart rate, blood pressure, or level of consciousness can occur, so it matters that someone with the right training is monitoring you throughout. Any reputable provider will be glad to walk you through who prescribes and administers the medication, how you are monitored during the session, and what happens if something unexpected comes up. Those are reasonable questions to ask anywhere, and you should feel comfortable asking them.
I am Lisa Parker, DNP, APRN, NP. I bring more than two decades of advanced practice clinical experience to every session, including a background in emergency medicine and years of experience prescribing, administering, and monitoring ketamine. For me, treatment is about more than giving an infusion. It is about selecting the right patient, administering the medication appropriately, supporting psychological safety throughout, and continuously assessing how you are doing from the first vital signs to discharge.
There are several ketamine providers in the Omaha area, and it is worth exploring your options and finding the fit that feels right for you. Whichever clinic you choose, the experience of ketamine therapy is often therapeutic in itself, and the medical care behind it should give you confidence from start to finish.
I walk through this exact question in this short video.
What This Means If You Are in Crisis Right Now
If you are reading this because you or someone you love is in immediate danger, please do not wait on a scheduled consultation. Call or text 988, or go to your nearest emergency room. Once someone is safe and stable, that is when a conversation about whether ketamine or Spravato is an appropriate next step makes sense, and I am glad to have that conversation. You can reach my office at 402-915-1862.
What Outpatient Treatment Actually Looks Like
“Outpatient” can sound vague on its own, so it is worth spelling out what a visit involves. It starts with a thorough evaluation of your medical history, current medications, and safety considerations. That evaluation is what determines whether outpatient treatment is appropriate for you in the first place. On a treatment day, I take baseline vital signs before anything begins. That baseline becomes the reference point for monitoring throughout the session and for confirming readiness for discharge afterward. Treatment takes place in a private room, not a shared infusion suite, with continuous monitoring for the full session. My patients are never left unattended. Once the session ends, monitoring continues until you are back to that baseline and meet defined discharge criteria. Nothing about that step is rushed or assumed. Every patient leaves with a ride arranged in advance, because reaction time is temporarily affected after treatment.
That is the entire visit, start to finish, typically a few hours including preparation and monitoring. Not an overnight stay, and not a multi-day program. The full walk-through of what a session feels like is covered in what a first appointment looks like. Details on eligibility and the evaluation process are on the IV ketamine and Spravato pages, and a broader overview of what to know before starting treatment is on the ketamine treatment overview.
Questions Related to This One
Is there such a thing as inpatient ketamine therapy? Not as a distinct treatment path someone chooses. The federal REMS requirements that govern Spravato, meaning direct observation, a minimum two-hour monitoring window, and no take-home doses, apply the same way regardless of setting. When ketamine or Spravato is given to a hospitalized patient, it is incidental to that hospitalization, not a separate program built around an inpatient stay.
Why is ketamine therapy only offered same-day? Because that is what the treatment requires clinically, not a scheduling preference. Both IV ketamine and Spravato have effects that resolve within a monitored window of a few hours, and once you meet discharge criteria, there is no clinical reason to extend that further.
What if I need a higher level of care than outpatient treatment? If your evaluation shows you need a higher level of care first, I will tell you that and help you understand the appropriate next step, rather than starting a treatment that is not safe or appropriate yet.
Can I still get ketamine or Spravato therapy if I have been recently hospitalized? Possibly, depending on your current stability and clinical picture. That is exactly what a full evaluation is for: reviewing your history, your current status, and whether outpatient treatment is appropriate for you right now.
What should I ask before choosing a ketamine provider? Ask how the evaluation works, who prescribes and administers the medication, how you are monitored during the session, and what the discharge process looks like. Those answers tell you more about the care you will receive than whether a clinic calls itself inpatient or outpatient.