Ketamine for Depression in Australia: Treatment, Access, and Costs
Ketamine has emerged as a significant option for Australians living with treatment-resistant depression, offering rapid relief when conventional antidepressants have failed. Esketamine nasal spray was added to the Pharmaceutical Benefits Scheme in May 2025, reducing the medication cost to $31.60 per dose for general patients and $7.70 for concession card holders. However, the supervision fees remain a substantial barrier, with patients paying $300 to $400 per session. Consequently, while the medication has become more affordable, the full treatment cost continues to limit access for many Australians.
What Is Treatment-Resistant Depression?
Treatment-resistant depression (TRD) is defined as major depressive disorder that has not responded sufficiently to at least two different antidepressants, each administered at an adequate dose and duration. Approximately 30,000 Australians are estimated to be living with this condition. For these individuals, standard pharmacological treatments have failed to provide meaningful relief, creating a need for alternative approaches.
How Ketamine Works for Depression
Most conventional antidepressants act on serotonin, noradrenaline, and dopamine systems. Ketamine works differently. It primarily increases glutamate levels in the central nervous system, a mechanism that researchers consider novel in antidepressant treatment. This glutamatergic modulation produces rapid antidepressant effects that can begin within hours rather than weeks. Esketamine is the more pharmacologically active form of ketamine, and it can be administered through a nasal spray, offering a less invasive route than intravenous infusion.
The Clinical Evidence: What Australian Research Shows
Australian research has provided critical evidence for ketamine’s effectiveness. A world-first study published in 2025 analysed real-world clinical data from 65 patients treated with generic racemic ketamine between 2021 and 2024. The research, led by UNSW Sydney and the Black Dog Institute, found that depressive symptoms decreased during the first eight weeks of treatment, and the benefit was sustained over six months.
Three-quarters of participants showed improvement in suicidality at six months, and 44% responded to treatment, with nearly one-third achieving remission.
Dr Clara Massaneda-Tuneu, a psychiatrist and researcher at Black Dog Institute, noted that “to our knowledge, no other studies have evaluated the efficacy of generic racemic ketamine beyond four weeks.” The study filled a major gap in the literature and provided important supporting evidence for clinical generic ketamine use.
Professor Colleen Loo, a researcher with UNSW and the Black Dog Institute, described the findings as consistent with what had been observed in real-world clinical practice. The research represents a world first in terms of ongoing treatment for six months using generic, off-patent ketamine in Australian clinics.
Esketamine: The PBS-Subsidised Option
Esketamine nasal spray (Spravato) is the only TGA-approved ketamine-based product for treatment-resistant depression. It was added to the Pharmaceutical Benefits Scheme on 1 May 2025, making it significantly more affordable.
How It Is Administered
Spravato cannot be taken at home. Patients must self-administer the nasal spray at a registered treatment facility, such as a hospital, under the supervision of medical staff. This is because staff need to monitor for blood pressure changes and potential side effects.
The treatment schedule begins with twice-weekly administration in the first month, then once weekly in the second month, and then weekly or fortnightly after that. Once there are signs the medicine is working, treatment continues for at least six months. Spravato must also be taken alongside a new oral antidepressant that the patient has not tried before.
Effectiveness
Clinical trial data from more than 1,600 patients showed that a greater percentage of patients given Spravato had a meaningful response compared with those who received a placebo. Patients taking Spravato also relapsed at a lower rate, and for those who did relapse, it took longer. Professor Malcolm Hopwood noted that about 50% of patients who had not responded to two or three antidepressants did respond to esketamine.
The Cost Barrier: A Funding Loophole
Despite the PBS subsidy, a significant funding gap remains. The PBS only covers the medication itself. The administration and supervision fees are not covered by Medicare or typically by private health insurance.
Professor Hopwood estimates the cost at $300 to $350 per treatment session, representing nursing and pharmacy costs, including post-dose monitoring under the supervision of a nurse, exclusive of the drug cost. Professor Loo has stated that treatment sessions cost patients around $300 to $400 per session.
For generic ketamine, which can be prescribed off-label, the medication costs around $10. However, because there is no Medicare Benefits Schedule code covering the staffing costs, patients face the same clinic fees without any medication subsidy.
Professor Loo explained: “Because the drug is generic and off patent, there is no commercial sponsor. Without a commercial sponsor, no matter how much evidence you have that the drug works, it will never be listed by the TGA for the treatment of this condition.”
This means generic ketamine treatment costs patients approximately $10,000 for six months. Professor Loo described this as “a travesty,” noting that “Australian public patients with difficult-to-treat depression are not having the treatment that is optimal for them because of cost. It is cost that is determining what they have, not clinical judgment.”
Accessing Ketamine Treatment in Australia
Who Can Prescribe
Only AHPRA-registered psychiatrists can prescribe esketamine or ketamine for TRD. Other medical practitioners must refer patients to a psychiatrist. In New South Wales, psychiatrists must obtain approval from the NSW Ministry of Health under certain circumstances.
Where Treatment Is Available
Several clinics across Australia offer ketamine treatment. Epworth Camberwell in Victoria operates one of only two esketamine clinics in the state, led by Associate Professor Ashu Gandhi with a team of eight doctors and seven specially trained nurses. Fullarton Clinic in Epping, Victoria, offers esketamine therapy as part of its advanced mental health services.
Eligibility
To be eligible for a prescription, a patient must have been diagnosed with treatment-resistant depression, meaning they have unsuccessfully tried at least two other antidepressant drugs first. Esketamine is not indicated for bipolar depression, and caution is advised for patients with psychotic depression.
Comparing Ketamine to Other Treatments
Professor Loo has noted that all of her patients who have had both ketamine and electroconvulsive therapy (ECT) prefer ketamine. “Ketamine doesn’t cause any memory problems, so that they’re actually more able to function,” she said. Ketamine has fewer risks and side effects than ECT and does not require general anaesthetic.
Professor Hopwood noted that esketamine has reached a higher level of evidence compared with psychedelic therapy, which remains more at a research level. “So I would certainly see it as coming before psychedelic therapy in any hierarchy.”
Summary
Ketamine treatment for depression in Australia has advanced significantly, with esketamine now PBS-subsidised and generic ketamine shown to be effective over six months in real-world Australian clinics. The medication is affordable, but the supervision fees of $300 to $400 per session remain a major barrier. As Professor Loo states, “clinical treatment is being distorted by the funding framework, and the funding framework makes no sense whatsoever.” For Australians with treatment-resistant depression, ketamine offers genuine hope, but access remains shaped by financial capacity rather than clinical need alone.