InTRavenous kEtAmine and immerSive virtUal Reality to Treat dEpression

Inclusion Criteria: * Age ≥ 18, able to provide informed consent * Patient diagnosed with treatment-resistant depression * Outpatient recommended and approved by psychiatrist for ketamine treatment * Patients who are on IV ketamine and requiring at least 4 treatments of IV ketamine per course (prescribed by their physiatrist) * Cognitively alert, oriented, and able to watch immersive content and respond to questions * Negative human chorionic gonadotropin test before treatment, for female participants of childbearing potential who are not practicing medically appropriate methods of birth control (e.g., hormonal contraceptives, implants, injectables, intrauterine devices, intrauterine systems, etc.) Exclusion Criteria: * History of psychosis/comorbid psychiatric disorders/psychotic depression/dissociative syndromes, significant personality disorder, as clinically assessed by psychiatrist * Using non-prescribed substance (e.g., cannabis) or alcohol use within the preceding 48 hours of treatment * Current or recent (within past twelve months) documented diagnosis of moderate or severe substance use disorder including uncontrolled/active alcohol abuse excepting nicotine or caffeine * Previous ketamine use * Acute dementia/delirium * Acute risk of suicide at baseline, as determined by the study psychiatrist * Pregnancy/breastfeeding * Previous sensitivity to ketamine or related compounds * Unstable medical condition which may require anesthesia consult * History of elevated intracranial pressure or cerebrovascular accident * Recent (within 6 weeks) major cardiovascular event (such as myocardial infarction) * Significant motion sickness (i.e. occur during exposure to physical/visual and virtual motion, cybersickness, etc.) self-identified by patient * Inability to communicate with the study team