Ketamine and Your Other Medications
How Spravato® and IV ketamine fit with your antidepressants, other medications, TMS, and therapy—including interactions, coordination, and tapering.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: February 2026
Key Takeaways
- Spravato® is used with an oral antidepressant; you typically stay on your antidepressant during treatment.
- Your doctor will review all medications for interactions (e.g., MAOIs, stimulants, blood pressure effects).
- Therapy and TMS can be coordinated with ketamine care; often they’re used in sequence rather than simultaneously.
- Do not change or stop medications without your prescriber’s guidance; tapering should be gradual and planned.
Continuing Antidepressants
Spravato® is FDA-approved for treatment-resistant depression when used with an oral antidepressant. So you’ll typically stay on your current antidepressant (or one your doctor chooses) while you receive Spravato®. IV ketamine is often used the same way—alongside your existing medications. Your prescriber will decide which antidepressant and dose are right for you.
Interactions and What to Avoid
Your doctor will review all your medications and supplements. Some drugs can interact with ketamine or esketamine—for example, MAOIs, certain stimulants, or medicines that raise blood pressure or sedation. Decongestants and alcohol may also be discussed. Don’t start, stop, or change doses without your prescriber’s approval.
Coordination with TMS and Therapy
Many people have tried TMS or therapy before ketamine, or do therapy while on ketamine. TMS and ketamine are usually used in sequence (e.g., TMS first, then ketamine if needed) rather than at the same time; your psychiatrist can explain the best order for you. Therapy (e.g., CBT) is often recommended alongside Spravato® or IV ketamine to build skills and maintain improvement. Your care team can coordinate all of this.
Tapering Considerations
If you and your doctor later decide to taper off an antidepressant or change your regimen, it should be done gradually and under supervision. Stopping suddenly can cause withdrawal or relapse. Your prescriber will create a plan that fits your response to ketamine and your long-term goals.
Frequently Asked Questions
Do I stay on my antidepressant with Spravato®?
Yes. Spravato® is approved for treatment-resistant depression when used with an oral antidepressant. Your doctor will keep you on an appropriate antidepressant while you receive Spravato®.
Can I do TMS and ketamine at the same time?
Sometimes both are used in sequence (e.g., TMS first, then ketamine if needed) rather than at the exact same time. Using them together is less common and would be a decision your psychiatrist makes based on your case. Coordination of care is important.
What about therapy?
Therapy (e.g., CBT) is often recommended alongside Spravato® or IV ketamine. It can help you build skills and maintain gains. Your team can coordinate therapy and medication/ketamine care.
Are there drug interactions?
Your doctor will review all your medications. Some drugs (e.g., certain MAOIs, stimulants) may need to be adjusted or avoided. Decongestants and other substances that affect blood pressure or sedation may also be considered. Don’t change doses or add new meds without asking your prescriber.
What if I want to taper off my antidepressant later?
Tapering should be done slowly and only with your prescriber’s guidance. If you’re doing well on Spravato® or IV ketamine and an antidepressant, the timing of any taper is something to discuss as part of your long-term plan.