Can I get ketamine therapy if I'm pregnant?

Not from us electively. We do not offer ketamine therapy as a default during pregnancy. ACOG has not endorsed ketamine or esketamine as a standard perinatal mental-health treatment, and the FDA Spravato label classifies use in pregnancy as not recommended. If you are pregnant and struggling, please talk to your OB and ask for a referral to a perinatal psychiatrist who can weigh the risks of treatment against the risks of untreated illness.

What if I'm trying to conceive?

Talk to your OB first. We typically do not start a new ketamine series during active conception attempts without coordinated care between your OB, a perinatal psychiatrist, and our clinic. If you are already in a maintenance protocol with us and you begin trying to conceive, tell us right away so we can pause and re-plan with your OB.

What if my depression is severe and I'm pregnant?

Severe untreated depression in pregnancy is itself dangerous, both for you and for the baby. The right step is almost never to do nothing. We would refer you to a perinatal psychiatrist and your OB, and let them lead the decision-making. Ketamine is rarely the right tool here, and any treatment plan during pregnancy belongs with maternal-fetal medicine and perinatal psychiatry, not with us alone.

Ketamine During Pregnancy and Breastfeeding: What to Know

Q: Is breastfeeding a hard 'no' for ketamine therapy?

No, but it is not a routine yes either. The NIH LactMed database reports limited published data on ketamine in human breast milk; ketamine's short half-life suggests low infant exposure with single doses, but routine use during breastfeeding is not well characterized. Any decision must be coordinated with your OB and your pediatrician, including timing of dosing relative to feeds and a pump-and-discard plan if appropriate.

Q: What about postpartum depression?

Postpartum is a different conversation, with a growing evidence base of its own. Ketamine and esketamine for postpartum depression are studied and discussed separately from elective use during active pregnancy. We have a dedicated article on ketamine and postpartum depression, and we always coordinate with your OB and pediatrician before starting.

Why this question deserves caution, not a quick answer

Pregnancy and breastfeeding are the two situations where we are most conservative about ketamine therapy. We say this plainly because patients deserve a clear answer, not a hedge dressed up as an offer. If you are currently pregnant, we do not provide elective ketamine therapy as a default. If you are breastfeeding, the conversation is more nuanced, but it is not one we have alone — it must include your OB and your pediatrician.

The reason is straightforward. Perinatal pharmacology is a specialty of its own. Decisions about any psychiatric medication during pregnancy or lactation belong to the people who know you best in that context: your obstetrician, a perinatal psychiatrist, and your pediatrician once the baby arrives. An outpatient ketamine clinic is not the right starting point for those decisions. Please talk to your OB before you make any choice in this category.

Ketamine is FDA-approved as an anesthetic; its use for depression, anxiety, and chronic pain is off-label. That off-label status matters in every context, but it matters more here, because the safety data we lean on for non-pregnant adults does not translate cleanly to a developing fetus or a nursing infant.

What ACOG and the FDA actually say

The American College of Obstetricians and Gynecologists (ACOG) published a 2023 Clinical Practice Guideline (No. 5) on the treatment and management of mental health conditions during pregnancy and postpartum. The guideline recommends an individualized risk-benefit assessment for any psychiatric medication in pregnancy, with care coordinated between OB-GYN and behavioral health. Ketamine and esketamine are not endorsed as standard perinatal treatments in that guideline. That is a meaningful absence. ACOG does not say “never,” but it also does not say “use it.”

The FDA prescribing information for Spravato (esketamine), first approved in 2019 for treatment-resistant depression, classifies use during pregnancy as not recommended. The label notes that animal data show developmental toxicity. Spravato is not the same molecule as racemic ketamine, but it is the closest regulated cousin we have, and its label is the most direct regulatory signal available on this question.

Read together, these two sources point in the same direction: caution, individualization, and OB leadership. They do not point toward a routine perinatal protocol at an outpatient ketamine clinic. We take those signals seriously. You can read more about how the FDA frames ketamine and esketamine in our overview of the FDA and ketamine.

What's known about ketamine pharmacokinetics in pregnancy

Ketamine crosses the placenta. That is well established from its long history as an obstetric anesthetic, where it has been used in carefully selected emergency situations. Single anesthetic doses in labor are a different scenario from repeated subanesthetic infusions for depression or pain over weeks or months, and the safety data from one does not automatically apply to the other.

What we do not have is robust, prospective human data on the developmental effects of repeated subanesthetic ketamine exposure across the trimesters. Animal studies cited in the Spravato label show developmental toxicity at certain exposures. Translating animal data to human pregnancy is always imperfect, but in the absence of strong human studies, regulators and OB-GYN bodies err on the side of caution. So do we.

If you are reading this and looking for a clear safety signal that says “ketamine is fine in pregnancy,” that signal does not exist. Anyone who tells you otherwise is reaching beyond the evidence. Please bring this question to your OB.

Untreated perinatal depression has its own risks

Saying “no ketamine in pregnancy” does not mean “no treatment.” That is a critical distinction. Untreated severe depression in pregnancy is itself dangerous. A landmark 2013 study by Wisner and colleagues in JAMA Psychiatry screened more than 10,000 postpartum women and found that untreated perinatal depression is associated with adverse maternal and infant outcomes, including suicidality, impaired bonding, and worse pediatric outcomes. The risk of doing nothing is real and it should not be minimized to make a patient feel better about declining all care.

What this means in practice: the right comparison is never “ketamine versus no treatment.” The right comparison is between the risks of untreated illness and the risks of the treatment options that are appropriate during pregnancy — therapy, certain SSRIs with established perinatal data, perinatal psychiatry consultation, intensive outpatient programs, and in severe cases, hospitalization. Those decisions belong to your OB and a perinatal psychiatrist. Please talk to your OB if you are pregnant and struggling. There are paths forward that are not ketamine.

If you would like background on how ketamine works in non-pregnant adults, our explainer on how ketamine works walks through the NMDA-glutamate-neuroplasticity mechanism. None of that mechanism story changes the perinatal calculus. The decision still belongs to your OB.

Breastfeeding: limited evidence, individualized decisions

Breastfeeding is where the conversation gets more nuanced, but it is not a routine yes. The NIH LactMed (Drugs and Lactation Database) reports limited published data on ketamine in human breast milk. Ketamine has a short half-life, which suggests low infant exposure with single doses, but routine use during breastfeeding is not well characterized in the published literature.

What that means in plain English: there is not a deep evidence base on what repeated outpatient ketamine infusions do to a nursing infant over time. There is enough pharmacology to suggest that single-dose exposure is likely low, especially if dosing is timed away from feeds. There is not enough to say “routine ketamine during breastfeeding is safe.”

Any decision in this space has to be made with your OB and your pediatrician, not around them. If a treatment plan ever moves forward, it would involve careful timing of dosing relative to feeds, possible pump-and-discard intervals, and pediatric input on the infant. That is not something we decide unilaterally at our Nashville clinic. Please talk to your OB and your pediatrician first.

Postpartum is a different conversation

Once you are no longer pregnant, the calculus shifts. Postpartum depression is a recognized indication area with a growing evidence base, and ketamine and esketamine for postpartum mood disorders are studied and discussed separately from elective use during active pregnancy. Some of that evidence supports a role for ketamine-class treatments in well-selected postpartum patients, again with OB and pediatric coordination if breastfeeding is ongoing.

We have written about this in more depth in our articles on ketamine for postpartum depression and ketamine therapy for postpartum depression. Those are the right places to read if you are postpartum and weighing options. They are not the right reading if you are currently pregnant and looking for a workaround. The honest answer for active pregnancy remains: talk to your OB, and do not start ketamine therapy electively.

What we will and won't do at our Nashville clinic

We want to be specific so there is no ambiguity. Here is how we handle this category at Music City Ketamine in Franklin.

Active pregnancy. We do not start an elective ketamine series during pregnancy. If you are already in a maintenance protocol with us and you become pregnant, please tell us right away so we can pause and coordinate with your OB. Talk to your OB before any further dosing decisions are made.
Trying to conceive. We typically do not start a new series during active conception attempts without coordinated care. If you are in this window, please bring your OB into the conversation before booking.
Breastfeeding. Not a hard no, not a routine yes. Any decision involves your OB and your pediatrician, dosing timing relative to feeds, and a clear-eyed read of the limited LactMed data. We will not move forward without that coordination.
Severe depression in pregnancy. We will refer you to a perinatal psychiatrist and your OB. Ketamine is rarely the right tool here. Doing nothing is also not the right answer — please get care, just not from us alone.
Postpartum, not breastfeeding. This is a different conversation, and one we are equipped to have, alongside your OB and primary care.

For monitoring and safety standards in the patients we do treat, our overview of whether ketamine therapy is safe describes the clinical setup. Marla Peterson, CRNA, oversees every infusion and is on-site throughout. None of that monitoring infrastructure replaces the role your OB plays during pregnancy or lactation. The right specialist for that period of your life is your OB, full stop.

If you are dealing with a perinatal or postpartum mood disorder and want to understand the broader treatment landscape, our depression treatment overview is a useful starting point — with the same caveat that pregnancy-specific decisions belong with your OB.

Honest expectations and the bottom line

This article exists to give you accurate context, not a treatment plan. We are not going to tell you ketamine is safe in pregnancy, because the evidence does not support that statement. We are also not going to tell you to suffer through severe untreated depression, because that is dangerous in its own right. The path forward is almost always a conversation with your OB and, where appropriate, a perinatal psychiatrist.

If you are currently a patient of ours and you become pregnant, tell us early. We will pause, talk with you about what you are feeling, and help you find the right next step with your OB. If you are considering ketamine for the first time and you are pregnant, trying to conceive, or breastfeeding, please talk to your OB before you talk to us. That is the right order of operations. We are not in a hurry, and you should not be either.