Ketamine Therapy Availability — the article + the world, ranked

A fuller editorial guide to ketamine therapy availability is coming soon. For now, the ranking below compares every country we have assessed on it — open a country's report for the cited detail behind its score.

The country comparison

Which countries are best for ketamine therapy availability

The destinations ranked high→low under this lens — each with the reasoning behind its score, the cited evidence one click down, and its full report. The verdict is free; the report is the depth.

19 / 19 Countries ranked

Researched and assessed by the Epidaurus editorial pipeline against our published scale. A country below the rule is not yet assessed enough — never ranked last.

1 United States US 4.0/5 Good The United States demonstrates strong ketamine therapy infrastructure with full FDA approval of esketamine (Spravato) since 2019 and expansion to monotherapy status in January 2025, over 1,500 clinics nationwide, mult... Full report
The evidence behind this score 6 cited points
- FDA approved esketamine (Spravato) in 2019 with expansion to monotherapy status in January 2025 for treatment-resistant depression
- Over 1,500 ketamine therapy clinics nationwide by 2024, growing from fewer than 100 in 2015; market valued at approximately $3.4 billion in 2023
- American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3) established 2016 with 400+ multidisciplinary members and Standards of Practice issued July 2020
- Multiple treatment modalities available including IV infusions, intramuscular, sublingual, and intranasal (Spravato) administration
- Ketamine Research Institute Mini-Fellowship meets American Psychiatric Association and American Society of Anesthesiology training standards; over 800 practitioners trained since 2018
- Lack of established ketamine-specific international patient programs with dedicated coordinators, with most clinics focusing on domestic patients and no evidence of widespread coordinated international programs
Read the full United States report →
2 Germany DE 4.0/5 Good Germany demonstrates solid Good-level ketamine therapy infrastructure with regulatory approval (EMA-authorized esketamine, legal off-label IV ketamine), 15+ facilities including world-class specialist centers like OVI... Full report
The evidence behind this score 5 cited points
- Esketamine (Spravato) received EMA authorization December 2019, entered German market March 2021 with two approved indications (treatment-resistant depression and acute depressive emergencies)
- 15+ facilities offering psychiatric ketamine therapy including OVID Clinics Berlin, Dr. Scheib network (Berlin/Munich/Frankfurt), 24-location Oberberg Kliniken hospital network, and multiple university hospitals
- Established treatment protocols with multiple modalities: IV ketamine (0.5 mg/kg over 40 minutes, 6 sessions over 2-3 weeks) and esketamine nasal spray, with mandatory anesthesiologist supervision and comprehensive safety monitoring
- Multiple international-friendly clinics offering services in English and other languages (OVID: English/Spanish/Arabic; Dr. Scheib: 7 languages), virtual consultations available, typically no waiting list at leading centers
- Strong research infrastructure: DZPG 28-institution network, University Hospital Jena leading multicentre trial (60 patients across multiple DZPG centers), real-world effectiveness studies published from Münster and Freiburg
Read the full Germany report →
3 Spain ES 4.0/5 Good Spain meets or exceeds most Score 4 criteria with clear regulatory approval of esketamine through EMA (2019) and AEMPS (Q4 2022), approximately 14-15 facilities offering ketamine therapy (4-5 private clinics plus 10+ ... Full report
The evidence behind this score 5 cited points
- Esketamine (Spravato) EMA-authorised December 2019 and AEMPS-confirmed Q4 2022; publicly financed under SNS. Racemic ketamine authorized for anaesthesia only, off-label psychiatric use permitted under physician responsibility.
- 4-5 dedicated private ketamine clinics (Clínica Synaptica Barcelona, NYKET Madrid, Instituto Dr. Scheib Mallorca/Sotogrande, Samu Wellness Seville) plus 10+ public hospitals including Hospital de Bellvitge (~100 patients by 2024), Hospital del Mar, Hospital Basurto, and Hospital Clínic Barcelona.
- Multiple treatment modalities established: IV ketamine (0.5 mg/kg/40 min × 6 sessions), IM ketamine-assisted psychotherapy, and esketamine nasal spray with structured induction and maintenance protocols published in 2025 Spanish clinical consensus.
- International patient access operationalized at Dr. Scheib clinics (Mallorca, Sotogrande) and Clínica Synaptica with multilingual staff (German, English, Turkish, Spanish), accommodation coordination, and bilingual websites; no formal government-coordinated international referral network.
- Active research involvement: 24 clinical trials involving ketamine/esketamine in Spain, 4 currently active; ESCAPE-TRD trial at Hospital Clínic; two peer-reviewed Spanish national consensus documents on esketamine published 2025 (theoretical and practical aspects).
Read the full Spain report →
4 Hungary HU 3.5/5 Moderate Hungary demonstrates full EMA regulatory approval for esketamine with documented clinical adoption (4x sales growth to >280 million HUF/year), established treatment protocols across two modalities (IV infusion and nas... Full report
The evidence behind this score 5 cited points
- Spravato (esketamine) holds full EMA approval EU/1/19/1410/001 with 100% NEAK reimbursement for Hungarian residents; sales quadrupled to >280 million HUF annually by 2024, confirming real clinical adoption
- Three confirmed ketamine/esketamine providers identified: Fájdalomklinika (Budapest, 2 sites offering IV ketamine-assisted therapy with 14-18 week protocol), Panoráma Poliklinika TRD Clinic (Budapest, esketamine), and University of Debrecen Clinical Centre Psychiatric Unit
- Multidisciplinary treatment teams documented (psychiatrists, anesthesiologists, psychologists, nursing staff); Fájdalomklinika follows internationally aligned protocol with ECG screening, psychiatric evaluation, preparatory psychology sessions, and post-infusion integration
- Critical gap: No unified national ketamine-assisted psychotherapy (KAP) protocol exists; research literature explicitly confirms most Hungarian facilities do not integrate formal psychotherapy with ketamine administration
- International patient access feasible through English-language services but without dedicated coordination programs; NEAK reimbursement excludes foreign visitors (cost ~€190-€560 per esketamine session); geographic concentration limits accessibility outside Budapest
Read the full Hungary report →
5 Israel IL 3.5/5 Moderate Israel demonstrates moderate-to-good ketamine therapy infrastructure with formal esketamine (Spravato) approval since 2020 and regulated access to racemic ketamine via per-patient Ministry authorization. Six clinics a... Full report
The evidence behind this score 6 cited points
- Esketamine registered by Ministry of Health since 2020 for treatment-resistant depression with real-world efficacy data published from Lev-Hasharon showing 100% acute treatment completion and 60% maintenance at one year
- Six identified facilities (KetaMind, Keter Health, Mindful Pathways, Lev-Hasharon, Shaarei Nefesh/Shaare Zedek, Be'er Sheva) providing IV infusion, IM injection, and intranasal esketamine across Jerusalem and Tel Aviv metropolitan areas
- Established treatment protocols with psychotherapy integration in KAP-model clinics and hospital programs; 0.5 mg/kg IV protocol over 6-week standard; 12-15 session KAP protocols with preparation and integration
- At least 5-6 identified qualified psychiatrists and physicians with US board certification and ketamine-specific training; Keter Health offers structured KAP facilitator certification program
- No dedicated international patient programs; KetaMind requires Israeli residency; Keter Health and Mindful Pathways accept English-speaking patients informally without concierge services or treatment coordination
- Strong research involvement including published peer-reviewed efficacy studies from Lev-Hasharon, 23 tracked clinical trials (5 active), and research partnerships with Sheba Medical Center, Hadassah, and Bar-Ilan University
Read the full Israel report →
6 United Arab Emirates AE 3.5/5 Moderate The UAE has established a functioning infrastructure for esketamine therapy with clear regulatory approval from MoHAP (2020) and a dual public–private delivery model. Eight to ten facilities across Dubai and Abu Dhabi... Full report
The evidence behind this score 5 cited points
- Esketamine (Spravato) formally endorsed by UAE Ministry of Health and Prevention in January 2020; registered in UAE pharmaceutical database as controlled drug under regulatory framework
- Eight to ten confirmed facilities offering esketamine or IV ketamine therapy in Dubai and Abu Dhabi, including three SEHA public hospitals (SKMC, Ambulatory Healthcare Services, Al Ain Hospital) and private clinics with JCI accreditation (Al Amal Psychiatric Hospital)
- Standard FDA/EMA Spravato protocol established: induction (twice-weekly ×4 weeks), consolidation (weekly ×4 weeks), maintenance (weekly/biweekly); two-hour post-dose monitoring mandatory; co-administration with oral antidepressant required
- At least 6–8 DHA/DOH-licensed psychiatrists identified as esketamine specialists (Dr. Joseph El Khoury, Dr. Bassam Dheyaa, Dr. Danilo Arnone at The Valens Clinic; Dr. Samer Makhol at Reem Hospital); all trained through general psychiatry and Janssen product training
- International patients eligible under medical visa framework (90-day or 180-day multiple-entry options); no legal prohibition on foreign nationals; multilingual private clinics and international patient coordinators available; estimated consultation-to-treatment timeline 1–3 weeks
Read the full United Arab Emirates report →
7 Brazil BR 3.5/5 Moderate Brazil exceeds Score 3 baseline with 10+ clinics across 5 major cities, superior wait times (days to 4 weeks vs. 1-2 months), published research, and robust anesthesiologist-supervised protocols. However, the complete... Full report
The evidence behind this score 5 cited points
- ANVISA approved Spravato (esketamine) in November 2020; CFM Parecer 20/2024 explicitly sanctions IV ketamine off-label with defined safety requirements
- At least 10 clinics identified across São Paulo, Rio de Janeiro, Belo Horizonte, Curitiba, and Salvador, including ONA-accredited IPq-HCFMUSP Ketamine Unit
- Wait times as short as 4 days at leading centers (Dr. Tiago Gil); standard 6-8 infusion courses over 3-4 weeks with mandatory psychiatric-anesthesiologic supervision
- No formal international patient programs, multilingual services, or dedicated coordinators found; international patients must self-coordinate in Portuguese-language environment
- Active research involvement including SciELO-indexed USP publication (2019), ECNP 2025 presentations, IPq-FMUSP clinical textbook (June 2025), and formal fellowship in interventional psychiatry
Read the full Brazil report →
8 United Kingdom GB 3.5/5 Moderate The UK has established ketamine therapy infrastructure with ~10 facilities, multiple treatment modalities, CQC regulation, and active research participation, placing it above the Moderate range. However, the absence o... Full report
The evidence behind this score 7 cited points
- At least 10 clinical facilities identified across multiple regions (3 NHS/academic, 7+ private), within the Score 4 range of 8-14
- Esketamine has UK marketing authorisation but NICE rejected NHS funding in December 2022; racemic ketamine prescribed off-label under medical supervision
- Multiple treatment modalities available: IV infusion (gold standard), intramuscular injection, oral/sublingual, and esketamine nasal spray
- CQC regulation mandatory for all facilities; multidisciplinary teams standard with consultant psychiatrist prescribing
- UK described as 'one of the most active countries globally in ketamine psychiatry research' with MORE-KARE phase III trial across 8 NHS sites and NIHR-funded pilots
- Lack of formal national clinical guidelines explicitly acknowledged; 2024 BJPsych Open editorial called for national guidelines and mandatory national registers
- No dedicated international patient coordinator programmes or medical tourism packages; providers do not facilitate visa support or travel logistics
Read the full United Kingdom report →
9 Poland PL 3.5/5 Moderate Poland demonstrates strong regulatory approval for both esketamine and racemic ketamine, with a formalized national reimbursement program (B.147) and published clinical standards, complemented by 8+ facilities across ... Full report
The evidence behind this score 7 cited points
- Esketamine approved via EMA centralized procedure (Dec 2019) with NFZ Program B.147 reimbursement launched July 2023—Poland's first psychiatric drug program
- At least 8 facilities across multiple regions: 3 private clinics in Warsaw/Kraków (Key Clinic, PHOENIX, TMS Clinic) and 5+ public hospitals participating in NFZ program across Warsaw, Opole, Pruszków, Międzyrzecz, and western Pomerania
- Multiple treatment modalities available: IV infusion, intranasal esketamine, and ketamine-assisted psychotherapy with psychotherapy integration at Key Clinic and PHOENIX
- Standardized protocols established: esketamine follows 3-phase protocol (induction/maintenance I-II, 34-week max); IV ketamine protocol validated through Medical University of Gdańsk research
- Active research involvement: Medical University of Gdańsk published peer-reviewed studies on ketamine efficacy and CNS safety; 2024 clinical standard published in Psychiatr Pol
- NO formal medical tourism infrastructure: absence of dedicated international patient coordinators, medical tourism packages, established referral networks, or multilingual support
- NFZ program underperformance: enrolled ~250 patients vs. 1,000 projected in first year, signaling access and awareness barriers
Read the full Poland report →
10 Singapore SG 3.5/5 Moderate Singapore has formal HSA regulatory approval for esketamine (October 2020) with clear prescribing guidelines and robust clinical safety protocols, exceeding merely limited approval. However, the small provider pool (5... Full report
The evidence behind this score 5 cited points
- HSA approved esketamine nasal spray (Spravato) on 27 October 2020 for treatment-resistant major depressive disorder with formal prescribing guidelines and ministerial oversight.
- Approximately 5 private psychiatrists across 3 private clinics and 1 public institution (IMH) offer ketamine therapy; IV ketamine is restricted to public sector only and not available in private clinics.
- Clear treatment protocols with supervised clinic-based administration, 90-minute post-dose observation, resuscitation equipment on-site, and nursing staff throughout session; cardiovascular monitoring and regular specialist review mandated.
- No dedicated international ketamine therapy programme exists; foreign patients must self-navigate directly with private psychiatrists, with no packaged treatment-plus-accommodation services.
- Institutional research involvement through NUH, IMH, and SGH in oral ketamine clinical trials; IMH introduced IV ketamine service in 2024, signalling expanding institutional commitment.
Read the full Singapore report →
11 Turkey TR 3.0/5 Moderate Turkey demonstrates moderate ketamine therapy availability with 2-3 psychiatric hospitals in Istanbul offering established IV ketamine infusion protocols under multidisciplinary supervision. However, critical gaps inc... Full report
The evidence behind this score 5 cited points
- Only 2-3 facilities identified offering ketamine therapy, both concentrated in Istanbul; psychiatry workforce distributed with two-thirds in Istanbul, Ankara, and Izmir only
- No confirmed Turkish regulatory approval for esketamine (Spravato) nasal spray despite 77-country global approval; ketamine available as controlled substance for off-label psychiatric use
- IV ketamine infusion only confirmed treatment modality; esketamine nasal spray, IM, and sublingual options not confirmed available
- Established protocols include 45-minute IV infusions (2-3 sessions weekly, average 6 sessions) with multidisciplinary team (psychiatrist, anesthesiologist, nurse) and vital sign monitoring
- Comprehensive international patient services including visa support, 8-language translation, accommodation, and coordination, though treatment remains experimental with limited outcome data
Read the full Turkey report →
12 India IN 3.0/5 Moderate India demonstrates moderate ketamine therapy availability with 10-15 facilities across major cities offering off-label racemic ketamine treatment. While qualified providers with international training exist and wait t... Full report
The evidence behind this score 6 cited points
- Approximately 10-15 specialized facilities offering ketamine therapy across major cities including Mumbai, Delhi, Bangalore, Chennai, Hyderabad, and Surat
- Esketamine (Spravato) is currently not available in India; treatment relies on off-label racemic ketamine only
- No formal ketamine therapy certification programs exist in India; treatment administered by psychiatrists and trained nurses without mandatory specialized training requirements
- Multiple treatment modalities available (IV infusion, intramuscular injection, oral) with established protocols and multiple qualified providers with international training
- Initial consultations typically scheduled within 1-2 weeks with no dedicated international patient coordinators, language services, or medical tourism packages specifically for ketamine therapy
- Ketamine classified as Schedule X and NDPS-controlled substance (1985, 2013) with complex regulatory requirements; India lacks centralized registry or standardized treatment guidelines
Read the full India report →
13 Mexico MX 3.0/5 Moderate Mexico qualifies as Moderate based on 5-6 identified ketamine therapy facilities concentrated in major cities and tourist destinations, off-label use permitted under medical supervision rather than formal psychiatric ... Full report
The evidence behind this score 7 cited points
- Approximately 5-6 dedicated ketamine therapy facilities identified nationally (Ketamine Health Centers, Ker Clinic, Holistic Bio Spa, Baja Ibogaine Center, Inward Travel), concentrated in major cities and tourist destinations
- Off-label psychiatric use permitted under medical supervision by licensed professionals; COFEPRIS regulates but specific psychiatric indication approval undefined
- Three treatment modalities available: IV infusion, intramuscular injection, and esketamine (Spravato) nasal spray through COFEPRIS-regulated pharmacies
- Estimated 5-9 qualified providers including psychiatrists, anesthesiologists, and Advanced Practice Nurse Anesthetists; formal certification requirements and training standards not clearly documented
- International patient access available with no referral requirement and videoconference evaluations, but barriers include prescription requirement from Mexican provider and unclear wait times
- Comprehensive treatment protocols with medical evaluation, 45-minute supervised infusions, continuous monitoring, and 30-minute post-treatment observation
- Variable psychotherapy integration and minimal documented current research involvement; historical expertise in ketamine-assisted psychotherapy from 1970s
Read the full Mexico report →
14 Colombia CO 2.0/5 Poor Colombia's ketamine therapy infrastructure is underdeveloped and operates in an ambiguous regulatory environment. While off-label prescribing is legally permissible, ketamine is registered only as an anesthetic with p... Full report
The evidence behind this score 5 cited points
- Ketamine registered in Colombia only as anesthetic (INVIMA 2018M-0013924-R1) with psychiatric diseases listed as contraindication; esketamine has no INVIMA registration
- Only Kaapi Center (Bogotá) and Clínica Pinares (Antioquia) publicly identifiable as offering psychiatric ketamine therapy; no dedicated esketamine clinics
- No national certification program for ketamine therapy providers; practitioners operate under general psychiatric licenses with uncertain training standards
- International patient access possible but limited: Clínica Pinares has US representative and PlaneTree affiliation; Kaapi works in English; no specialized ketamine medical tourism packages identified
- Facilities follow international guidelines informally; no standardized national protocol, dosing mandate, or adverse-event reporting framework; general psychiatric wait times reach 3 months with no indication ketamine appointments are faster
Read the full Colombia report →
15 Thailand TH 2.0/5 Poor Thailand's ketamine therapy infrastructure scores poorly due to lack of regulatory approval for psychiatric use (approved only as anesthetic), severely limited clinical availability with only one unconfirmed ketamine ... Full report
The evidence behind this score 6 cited points
- Ketamine classified as Category 2 psychotropic/Type 2 narcotic drug with possession penalties up to 7 years imprisonment and 700,000 baht fines
- Only one unspecified ketamine clinic mentioned with no location or accessibility details; Siriraj Hospital conducting first randomized controlled trial (research, not clinical service)
- No regulatory approval or availability of esketamine (Spravato) nasal spray for psychiatric use
- No international patient infrastructure: report explicitly states 'no clear pathways for international patients,' 'no advertised treatment packages,' 'no dedicated coordinators for this specific service'
- Only IV ketamine available from research protocols; no evidence of IM, sublingual, or other modalities
- Expertise concentrated in academic research; no evidence of 5+ qualified providers, no formal training standards or certification programs for ketamine therapy
Read the full Thailand report →
16 Japan JP 2.0/5 Poor Japan's ketamine therapy infrastructure remains minimal and nascent. Ketamine is classified as a Schedule I narcotic with no PMDA approval for psychiatric use—all clinical applications are strictly off-label. Only two... Full report
The evidence behind this score 5 cited points
- Ketamine classified as Schedule I narcotic since 2007 with no PMDA psychiatric approval; all use is off-label [Narcotics and Psychotropics Control Act]
- Only 2 specialized ketamine clinics in Japan, both in Nagoya and Tokyo, operated by same physician group [Nagoya/Tokyo Anesthesiology Clinic sources]
- Single effective provider (anesthesiologist with 15+ years experience and 2,000+ ketamine cases); no national certification or training program exists [Clinic sources and clinical reports]
- Only IV infusion modality available; esketamine (Spravato) unavailable after Phase 2b trial failed to meet efficacy endpoint [BMC Psychiatry - October 2021]
- 2024 Keio University double-blind RCT confirmed IV ketamine efficacy in Japanese TRD patients (MADRS reduction p=0.034 per-protocol), published in journal of Japanese Society of Psychiatry and Neurology [Psychiatry and Clinical Neurosciences - December 2024]
Read the full Japan report →
17 Jordan JO 2.0/5 Poor Jordan has unclear regulatory status with no formal JFDA approval for psychiatric ketamine or esketamine use, leaving practice in a gray zone. Only one identified provider (Dr. Khaled Bani Hani in Amman) explicitly of... Full report
The evidence behind this score 5 cited points
- Only one publicly identified provider (Dr. Khaled Bani Hani, Amman) explicitly advertising ketamine treatment for depression
- No JFDA-specific approval found for esketamine (Spravato) or psychiatric ketamine indications; off-label use in regulatory gray zone
- Approximately 87 total psychiatrists in Jordan (<1 per 100,000 population); no ketamine-specific training certifications or professional organizations identified
- No standardized ketamine therapy protocols, monitoring mandates, or emergency management guidelines at national or institutional level
- Jordan receives 224,740 international patients annually but mental health/ketamine programs are not part of medical tourism offerings; no JCI-accredited ketamine facility or international patient coordination services
Read the full Jordan report →
18 South Korea KR 2.0/5 Poor South Korea has esketamine regulatory approval but faces substantial constraints limiting ketamine therapy availability for international patients. Regulatory uncertainty from failed clinical trials in neighboring Eas... Full report
The evidence behind this score 5 cited points
- Esketamine approved by MFDS in June 2020 but regulatory uncertainty persists: manufacturer required to submit additional phase 3 clinical data after failed trials in Japan and China, raising questions about continued approval
- Safety concerns: total ketamine doses used in South Korea significantly higher than general recommendations and may compromise patient safety; no consensus on treatment protocols with dosages ranging from 3.5 to 140 mg/70 kg
- Limited psychiatric ketamine infrastructure: approximately 5 tertiary hospitals plus only 1 private practice; no dedicated ketamine clinics for psychiatric conditions; only 'few experts' had esketamine experience as of 2021
- No documented international patient pathways for ketamine therapy despite strong general medical tourism infrastructure; specific multilingual ketamine providers not identified; insurance limitations with >3 sessions uninsured for patients
- Active research participation in SUSTAIN-2 phase 3 study at Samsung Medical Center with Asian subgroup analysis demonstrating some clinical expertise
Read the full South Korea report →
19 Malaysia MY 2.0/5 Poor Malaysia receives a score of 2 (Poor) due to severe limitations in practical ketamine therapy access despite regulatory approval for esketamine. Only two documented facilities (HKL and HCTM/UKM) offer treatment, both ... Full report
The evidence behind this score 5 cited points
- Only 2 facilities with documented ketamine/esketamine psychiatric use (both academic hospital settings in Kuala Lumpur)
- Fewer than 5 clinicians with documented ketamine/esketamine psychiatric experience; no formal certification or training program
- Esketamine (Spravato) officially registered by NPRA on 2 March 2021, but clinical access remains limited to compassionate access and academic protocols rather than routine prescription
- No dedicated ketamine clinics; private hospitals do not market or openly offer ketamine therapy to domestic or international patients
- No international patient infrastructure: Malaysia Healthcare Travel Council does not list psychiatric ketamine therapy; no referral networks or coordinators specializing in ketamine treatment
Read the full Malaysia report →

See the full ranking, the 1–5 rubric and the reports →