Safe Ketamine Therapy for Older Adults
Age Is Not a Barrier to Better Mental Health
Late-Life Depression: An Undertreated Challenge
Age should not be a barrier to accessing emerging treatments. We have experience treating patients 65 and older, applying evidence-based protocols tailored to the unique considerations of late-life depression.
Depression in older adults is both common and frequently undertreated. Nearly 20% of adults 65 and older experience clinically significant depressive symptoms, and up to 30% of those have treatment-resistant depression — meaning depression that persists despite two or more adequate antidepressant trials. This is a higher rate of treatment resistance than observed in younger populations.
Late-life depression is associated with serious consequences: increased disability, cognitive decline, social isolation, and elevated risk of suicide — which is disproportionately higher in older men than in any other demographic group. Yet standard pharmacotherapy in older adults is complicated by age-related changes in drug metabolism, a higher burden of medical comorbidities, and polypharmacy concerns.
Electroconvulsive therapy (ECT) has historically been the gold standard for severe treatment-resistant late-life depression, but concerns about cognitive side effects, accessibility, and stigma limit its use. Ketamine represents an emerging and increasingly studied alternative in this population.
Evidence for Ketamine in Older Adults
The majority of ketamine research has focused on adults aged 18–65. However, a growing body of dedicated research in older adult populations provides meaningful data on safety and efficacy.
A 2025 systematic review in the American Journal of Geriatric Psychiatry synthesized data from 13 studies involving 757 adults aged 60 and older. Key findings: antidepressant effects were observed across multiple administration routes (IV, intranasal, subcutaneous); adverse effects were generally mild to moderate; and — critically — cognitive outcomes were mostly stable or improved. No studies found significant cognitive harm from therapeutic-dose ketamine in this population.
A pilot clinical trial at Columbia University (Oughli et al., 2023) treated 25 adults aged 65 and older (mean age 71.5) with IV ketamine twice weekly for four weeks. Response rates of 48% and remission rates of 24% were observed — promising figures for a population with limited options.
~30%
Of older adults with depression have treatment-resistant depression — higher than younger populations
48%
Response rate in pilot trial of IV ketamine in adults 65+ (Columbia University, 2023)
Stable
Cognitive outcomes in systematic review of 757 older adults treated with ketamine/esketamine
Important note from the literature: older adults may respond more slowly to esketamine than younger adults. Extended treatment protocols and individualized maintenance plans may be necessary. We factor this into our planning from the outset.
“Based on the limited current evidence, it is our opinion that ketamine shows some benefit in relieving depressive symptoms in older adults… Ketamine was well tolerated in both studies with adverse effects being mild and transient.”
— International Psychogeriatrics systematic review
Our Approach for Older Adults
We treat each older adult patient as an individual — accounting for their full medical history, current medications, cardiovascular status, cognitive baseline, and care goals. Our clinical team reviews all relevant factors before recommending a protocol and monitors closely throughout.
Special considerations we address
• Cardiovascular screening: ketamine can temporarily elevate blood pressure; we monitor and use prophylactic medication when appropriate
• Polypharmacy review: we evaluate all current medications for interactions
• Cognitive baseline: we assess memory and cognition before treatment to establish a reliable comparison point
• Dose calibration: older adults may require adjusted dosing protocols compared to standard adult regimens
• Caregiver coordination: we welcome family members or caregivers in the consultation process
Who we may be able to help: Older adults with major depressive disorder or bipolar depression that has not responded to at least two antidepressant trials, or for whom antidepressant side effects are intolerable, may be candidates for evaluation.