Ketamine Is at Risk of Becoming the Next Zoloft

Ketamine may be one of the most important advances in mental health care in decades. But if we reduce it to a 45-minute infusion and a credit card swipe, we will have learned remarkably little from everything that came before it.

A few weeks ago, our founder returned from the FDA’s public hearing on psychedelic medicine in Washington with an uncomfortable impression. The hearing was about the larger future of psychedelics, but ketamine offers a useful glimpse of what that future could look like. It is already being used widely in mental health care, and many of the questions the psychedelic field is now confronting are already playing out in ketamine clinics.

Right now, ketamine is standing at a crossroads. It can become part of a genuinely different model of mental health care, one that uses a powerful biological intervention to create an opportunity for deeper and more durable recovery.

Or it can become the next Zoloft.

The comparison is not pharmacological; Ketamine works very differently from SSRIs such as Zoloft. It is about what medicine does when it discovers a treatment that works, then gradually builds a system around delivering more of the treatment rather than understanding why the patient remains sick.

The danger is not ketamine. It is turning ketamine into another medication-delivery business while calling it a transformation in mental-health care.

And if we make that mistake with ketamine, there is every reason to worry that we will repeat it as psilocybin, LSD, MDMA and other emerging treatments move closer to mainstream clinical care.

We have seen this movie before. A patient is depressed. A medication is prescribed. Symptoms improve or they don't. The dose changes. Another medication is added. Another one replaces it. Five years later, the patient may still be taking medication, still be sleeping badly, still have metabolic dysfunction, still be isolated, still be under extraordinary stressThe body's response to external demands. Chronic stress disrupts hormones, sleep, and immune function., still have unresolved traumaA deeply distressing experience that leaves lasting psychological impact., still be sedentary, still have nutritional deficiencies, and still identify as someone who has depressionA prolonged low mood that interferes with life..

We call this treatment. But too often, we have simply gotten very good at managing the treatment.

Now ketamine has arrived, and we have the opportunity to do something different. The question is whether we will.

Ketamine Is Not Just a Faster Antidepressant

Ketamine deserves the attention it is getting. Unlike conventional antidepressantsA medication that alters brain chemistry to relieve depression., which generally work through monoamine systems and often take weeks to produce meaningful improvement, ketamine acts primarily through glutamatergic signaling, including NMDA-receptor antagonism, and can produce antidepressant effects remarkably quickly in some patients.

That is an extraordinary clinical development. For people suffering from treatment-resistant depressionDepression that persists despite adequate trials of antidepressant treatment., severe symptoms or suicidal thinking, rapid improvement can be profoundly important. Research accumulated over more than two decades supports ketamine's short-term antidepressantA medication that alters brain chemistry to relieve depression. efficacy, even as important questions remain around long-term treatment, maintenance and real-world implementation. Recent interdisciplinary consensus guidance describes the acute antidepressant effect of IV ketamine as well established while noting that evidence around repeated maintenance treatment remains more limited.

But the interesting thing about ketamine isn't simply that it can make a depressionA prolonged low mood that interferes with life. score fall faster. It is what may become possible during and after that change.

For some patients, ketamine appears to create a period in which rigid patterns loosen. The emotional landscape changes. Thoughts that felt immovable become less fixed. Behavior may become easier to change. We have written in more detail about the neuroplastic window and how Fountain structures care around it in The Fountain Health 4-Phase Ketamine Therapy Framework™.

We see versions of this clinically. A patient who has spent months or years feeling that nothing is going to change may suddenly begin talking about going back to work, repairing a relationship, exercising again or doing something else that only days earlier felt impossibly far away.

Those moments are precisely why the period around ketamine treatment matters so much.

Treating ketamine like an ordinary recurring prescription therefore feels like a profound missed opportunity. The infusion may be the beginning of treatment. It should not automatically become the treatment.

The same principle will matter even more as psychedelic medicines enter clinical practice. A powerful experience, however novel the molecule, does not by itself create durable recovery.

Welcome to the Ketamine Turnstile

Walk through the emerging ketamine marketplace and you can already see where this is heading.

The model is becoming familiar: standardized protocols, a brief medical clearance, a series of treatments and, increasingly, maintenance infusions when the effect begins to wear off.

Some clinics provide sophisticated psychiatric care around ketamine. Others provide considerably less. Economically, the temptation is easy to understand. An infusion is simple to count, schedule and bill. Another infusion can be scheduled after it.

What is much harder to operationalize is everything surrounding that infusion.

Why is this particular patient depressed? What happened after treatment? Did sleep improve? Did functioning improve? Did suicidal thinking change? Is the patient exercising, eating differently or re-engaging socially? Is therapy progressing differently? Are metabolic or hormonal problems contributing? Is the patient actually getting better, or simply feeling temporarily better after each treatment?

Those questions are harder. They require clinicians, follow-up, measurement and different disciplines talking to one another. Occasionally, they also lead to the least attractive answer for a treatment business: the patient may not need another infusion.

That is where incentives become important. When a business makes money primarily each time a drug is administered, there is an unavoidable temptation to confuse continued treatment with successful treatment. The clinicians involved may be excellent. The tension is built into the model itself, and the model deserves scrutiny.

We explored the clinical version of the same problem in Why Ketamine Therapy Sometimes Fails, which looks at what happens when the drug is separated from preparation, biological timing and the larger treatment architecture around it.

Ketamine matters here partly because it is already showing us what can happen when a novel psychiatric treatment becomes a service category. The psychedelic field should pay attention before the same delivery model is built around the next generation of therapies.

The Psychedelic Medicine Says It Wants to Change Mental Health Care

This is what made the recent FDA hearing so interesting. The discussion points toward a coming generation of treatments including psilocybin, LSD, MDMA and other compounds now moving through research and development. On September 14, 2026, the FDA convened clinicians, researchers, companies, patients and other stakeholders to discuss the potential future therapeutic use of psychedelic drugs in “supervised and supportive settings.”

Those last three words "supervised and supportive settings" may turn out to be among the most important. What exactly is a supportive setting? Is it someone sitting nearby while a drug is administered? Is it a questionnaire before treatment and an integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy. appointment afterward?

Or does supportive care mean understanding the patient before treatment, preparing them appropriately, measuring what changes afterward and helping translate a temporary period of increased psychological flexibility into different behavior?

Does it mean addressing sleep, stressThe body's response to external demands. Chronic stress disrupts hormones, sleep, and immune function., nutrition, physiology, relationships and environment when those factors are contributing to illness, following function rather than merely symptoms, and knowing when treatment should continue — and when it should not?

Interestingly, the clinical field itself is moving in this direction. New interdisciplinary consensus guidance for IV ketamine recommends comprehensive psychiatric and medical evaluation, preparation before treatment, measurement of response, psychological aftercare following dosing, ongoing reassessment and placing maintenance ketamine inside a larger mental-health treatment plan. The same guidance recommends trying to lengthen the interval between maintenance infusions as tolerated while sustaining clinical benefit.

That last point deserves more attention than it receives. A successful ketamine program should not be trying to create the world's best lifelong ketamine customer. It should be trying to produce a tangible clinical outcome, and its success should be measured by the outcomes it delivers rather than the number of infusions it performs.

Recovery Is a Terrible Recurring-Revenue Model

There is an uncomfortable tension running through much of modern medicine.

At the MAHA Summit, as at almost every health conference now, people repeatedly described America as a “sick-care system.” The phrases that follow are equally familiar: prevention, root causes, outcomes, personalized medicine.

We all seem to agree on the words.The harder question is whether our business models actually behave any differently.

Somebody develops a powerful new drug and suddenly the model looks remarkably familiar: acquire patients, administer treatment, retain patients and repeat. The molecule may change. The machinery often does not.

Psychedelic medicine was supposed to challenge that machine. Instead, there is a real risk that the machine simply absorbs psychedelic medicine and the latter inherits the same recurring-treatment logic that came to define much of the SSRI era.

The language changes. The rooms become prettier. The branding becomes warmer. We talk about transformation, neuroplasticityThe formation of synapses between neurons. and journeys. But underneath it all, the economic unit can still become exactly what it was before: one patient, one drug, one recurring treatment.

If that is where this goes, we haven't reinvented mental health care. We've reinvented the infusion suite.

We made a related argument earlier in Psychedelic Medicine After the Executive Order: Why Systems Matter More Than Molecules: the session itself is only one piece of care; preparation, physiology, integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy. and follow-through determine what happens around it.

Integration Cannot Be a Checkbox

“IntegrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy.” has become one of the favorite words in psychedelic medicine. We also worry that it is becoming one of the emptiest.

Give ketamine. Schedule an integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy. session. Discuss the experience. Treatment complete.

Real integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy. is considerably less convenient. It asks what the patient is going to do with whatever changed. If a person emerges from treatment with less depressive rumination but returns immediately to four hours of sleep, chronic stressThe body's response to external demands. Chronic stress disrupts hormones, sleep, and immune function., social isolation and no behavioral support, what exactly have we integrated?

If anxietyA state of worry or tension that disrupts focus and sleep. drops for several days but nothing changes in the environment producing that anxiety, what did the treatment accomplish?

If a patient describes profound insights during an infusion but six weeks later their relationships, functioning, routines and symptoms are unchanged, should we call the experience successful?

These questions take ketamine seriously. A powerful intervention deserves a care model sophisticated enough to use it properly.

Psychological aftercare is also not merely a Fountain Health philosophy. Recent ketamine consensus recommendations support psychological aftercare after dosing, including structured check-ins, psychoeducation, supportive psychotherapy or integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy.-focused care, alongside continued assessment of clinical response and functional improvement.

The evidence for exactly which form of psychotherapy or integrationThe process of making sense of and applying insights after a therapeutic experience such as ketamine therapy. produces the best results is still developing. We shouldn't pretend otherwise. But uncertainty about the perfect integration protocol is hardly an argument for treating the rest of the patient's care as someone else's problem.

There is another version of this issue that larger medical and mental health practices should think about carefully.

A ketamine provider can reasonably say that its job is to administer treatment safely while the patient's psychiatrist, therapist or primary clinician remains responsible for the broader course of care. That arrangement can work very well when the two sides are actually connected. Too often, however, the referral creates a gap large enough for the patient to fall through.

Who is measuring whether ketamine is actually changing the course of the illness? Who decides whether another infusion is appropriate? Who connects what happened during treatment with therapy, medication management, sleep, behavior and the rest of the patient's care? Who notices when the patient is improving transiently but not actually recovering?

The issue is not whether every infusion clinic should become a full-service mental health practice. The issue is whether anyone clearly owns the whole picture.

Ketamine may be delivered by one team while the patient's broader care remains with another. The medicine becomes far more meaningful when those teams operate as one care pathway, working from the same clinical picture rather than handing the patient back and forth as two unrelated services separated by a referral.

That broader view of mental health is also why Fountain has argued that mental health is biological: sleep, metabolic healthHow efficiently your body manages blood sugar, cholesterol, and energy balance. A strong predictor of long-term wellness., hormones, inflammation, stressThe body's response to external demands. Chronic stress disrupts hormones, sleep, and immune function. physiology and other systems can matter alongside psychiatric symptoms and treatment.

The Goal Should Be Less Ketamine, Not More

This is perhaps the simplest way to explain how we think about ketamine at Fountain Health.

The goal of ketamine treatment should not be more ketamine treatment. The goal is recovery.

Sometimes that may require additional infusions. Sometimes maintenance treatment is entirely appropriate. Expert consensus guidance recognizes maintenance ketamine as a reasonable option for selected patients who responded clearly to induction and remain at risk of relapseA return to substance use after a period of improvement., while recommending that maintenance occur within a larger mental-health treatment plan and that treatment intervals be lengthened when clinically possible.

But maintenance should be a clinical decision, not a business strategy.

The question shouldn't automatically be, “When is your next infusion?” It should be: What changed? What's still wrong? What are we missing? What is happening to sleep, anxietyA state of worry or tension that disrupts focus and sleep., relationships, metabolic healthHow efficiently your body manages blood sugar, cholesterol, and energy balance. A strong predictor of long-term wellness., work, exercise, medications, therapy and daily behavior, and what do we need to do now to make the gains last?

That is a much less scalable conversation than booking another chair.

It is also medicine.

We Have a Chance Not to Repeat Ourselves

There is something genuinely exciting happening in mental health care right now.

Ketamine has already challenged assumptions about how quickly severe depressionA prolonged low mood that interferes with life. can change. Psilocybin, LSD, MDMA and other emerging treatments may eventually challenge many more. The question is whether the care models developing around them will be as innovative as the drugs themselves.

The federal government is actively considering how these treatments should enter clinical practice. The National Institute of Mental Health is simultaneously calling for better real-world effectiveness evidence on rapid-acting interventions including ketamine and esketamineAn FDA-approved esketamine nasal spray with specific labeled indications and safety requirements., specifically to understand how they perform in heterogeneous patient populations and to generate evidence health systems can use in broader clinical implementation.

This is exactly the moment when the care model matters. Before thousands of clinics become tens of thousands. Before protocols become habits. Before reimbursement structures harden. Before investors decide what the unit economics of psychedelic medicine are supposed to look like. Before patients begin believing that psychedelic medicine means replacing the pill they take every morning with the infusion they receive every month.

We should decide what success actually means.

At Fountain, we use ketamine because we believe it can be an extraordinary intervention. And extraordinary interventions place an equally extraordinary responsibility on the medicine surrounding them.

A treatment capable of producing rapid psychological change deserves rigorous screening beforehand, thoughtful medical supervision during treatment, measurement afterward and a serious plan for turning improvement into something durable.

We can build beautiful clinics, replace fluorescent lights with soft lighting, call appointments journeys, and talk about transformation, neuroplasticityThe formation of synapses between neurons. and whole-person medicine. Underneath all of it, we can still build a business whose primary activity is getting people back into the chair for another dose.

That would be a terrible waste of what ketamine has given us. Its great promise is not that we found a better drug to administer indefinitely. And the promise of psychedelic medicine will not be fulfilled simply because the next molecule is newer, more powerful or more profound.

That means screening and diagnosing carefully, understanding the patient, preparing them well, treating them safely and measuring what actually changes. It means using the period after treatment thoughtfully, looking at the parts of health that psychiatry has historically ignored, and following patients long enough to know whether improvement lasted.

And when a patient no longer needs ketamine, that should be something to celebrate.

We don't need a better drug-delivery system. We need more people to actually get better.

And those are not the same business.

References

Mathai DS, Cluck M, Aslam AM, et al. Interdisciplinary, Delphi-driven consensus guidelines on the use of intravenous ketamine infusions for depressive disorders from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3). Journal of Affective Disorders. 2026;411:121970. View on PubMed

U.S. Food and Drug Administration. Considerations for Potential Future Therapeutic Use of Psychedelic Drugs Public Hearing. September 14, 2026. FDA hearing materials

National Institute of Mental Health. Advancing Real-World Effectiveness Evidence for Rapid-Acting Psychotropic Interventional Drugs. September 15, 2026. NIMH concept clearance

Piazza MK, Kavalali ET, Monteggia LM. Ketamine-induced synaptic plasticity operates independently of long-term potentiation. Neuropsychopharmacology. 2024;49:1758–1766.

Miller CB, Lopes B, McCurdy A. The collective lie in ketamine therapy: A call to realign clinical practice with neurobiology. Frontiers in Psychiatry. 2025;16.

Medically reviewed by Doreen Zarfati, MD

Medical Disclosure

This article is for educational and informational purposes only and does not constitute medical advice, diagnosis or treatment. Ketamine treatment should be considered only after an individualized medical and psychiatric evaluation by a qualified clinician. IV ketamine for psychiatric indications is generally used off-label in the United States; treatment appropriateness, dosing, monitoring and follow-up should be determined individually based on a patient's clinical history, current condition and potential risks and benefits.

September 2026

Fountain Health is a multidisciplinary medical practice in New York City providing care across mental health, metabolic health, longevity, sleep, nutrition, fitness, and related areas of advanced medicine. This article is for educational purposes and does not replace individualized medical evaluation.