Q: What is ketamine?

A: Ketamine was originally developed as an anesthetic over 50 years ago (and is still commonly used for that purpose today). When research showed that subanesthetic (smaller) doses are extremely effective in treating depression, anxiety, PTSD, and OCD, it was developed for use as a mental health medication. 

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Q: I hear there are "different forms" of ketamine. Can you explain?

A: Generally speaking, there are three forms of ketamine used for mental health treatment: 1) ketamine given in a simple shot (called IM ketamine); 2) a specific form of ketamine called eskatamine (brand name Spravato) that is administered via a nose spray, and 3) oral ketamine given via a lozenge or "troche." A shot of ketamine is the most effective and oral ketamine is the least effective. 

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Q: Is ketamine similar to traditional mental health medications?

A: Ketamine works in a completely different way, so it is ideal for people who failed to get full symptom relief from other medications (or who had significant side effects from them). Cleveland Clinic calls ketamine a “top ten medical innovation" for treatment-resistant depression and Johns Hopkins says it is the first (truly) new medication we have had in 60 years. Unlike other medications, it works quickly—many people feel significantly better after one treatment.

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Q: How does ketamine work?

A: In plain English, ketamine sparks new brain growth and helps balance naturally-occurring components in your brain, thus easing depression, anxiety, OCD, and PTSD. Research shows that ketamine sparks neural growth in the brain within hours of taking it, which starts a repair process in the brain. As those neurons regrow, the brain gets healthier and mental health symptoms improve. (Technically speaking, what ketamine does is block glutamate at the NMDA receptor, thus increasing your levels of BDNF and GDNF, resulting in better brain health.)

 

Q: Is ketamine safe?

A: The use of ketamine as an anesthetic has provided over 50 years of data showing it is safe. Ketamine is still commonly used as an anesthetic for medical procedures at thousands of medical centers every day.

Q: What is esketamine and do you offer it as well?

A: Esketamine (brand name Spravato) is a specific form of ketamine (administered as a nasal spray), and we offer it as well. We will talk with you about the difference between ketamine and esketamine and determine which one is right for you. 

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Q: I've heard the cost of the nose spray esketamine (Spravato) can be quite high and that many places won't bill insurance for it--is that true?

A: Esketamine (brand name Spravato) is quite expensive. However, our hard working staff are willing to put in the work to get your insurance company to cover the cost of it. We find we are almost always able to get the cost of esketamine covered (there are a few exceptions to this--Kaiser, for instance).

Q: Is ketamine (or esketamine) a pill?  Do I take it at home?

A: No. Ketamine is administered via a simple shot (using an even smaller needle than the one used for the flu shot) and esketamine (Spravato) is administered as a nose spray. Only a licensed medical practitioner (e.g., a physician, nurse practitioner, etc.) can evaluate your symptoms and prescribe ketamine, and all treatments are completed in our REMS-certified office. We have comfortable recliners in private rooms for you to relax in during your treatment. You will be the only patient in the room and you are welcome to have a friend, family member, or therapist stay in the room with you.

Q: Does ketamine (or esketamine) take long to work? 

A: Both are fast and highly effective! People often report feeling significantly better after just one treatment. 

Q: Do I need to come in daily for treatment? How long is the course of treatment?

A: People come in two or three times a week. Many people feel completely better after six treatments; your course of treatment will depend upon how quickly your symptoms respond.

Q: What are the side effects and how long do they last?

A: The ketamine takes effect a few minutes after you take it in the office. People tend to describe the feeling as “weird, but not in a bad way." That feeling lasts for 45 minutes or so and you can choose to nap, listen to music, or just relax during the experience. Brief nausea is possible if you have eaten recently. Your blood pressure may temporarily go up (similar to how it does during exercise). You will be medically monitored in one of our comfortable and private single rooms. Most people report no side effects once the treatment is over. 

 

Q: Why do people say oral ketamine is not as effective as other forms of ketamine?

A: First of all, oral ketamine has very low bioavailability (only 10-20%), so less of the medication is available for your body to make use of when it is taken orally. Second, ketamine tastes bad--really bad--so most people swallow it sooner than they should (rather than holding it in their mouth as instructed). When the ketamine is swallowed, it is converted into norketamine, which isn't very effective for treating mental health conditions. Numerous published studies have shown that oral ketamine is far less effective than IM ketamine or esketamine. Accordingly, we rarely use oral ketamine since there are more effective forms of ketamine available.

 

Q: What if I am taking other mental health medication(s)? 

A: Most medications are fine in conjunction with ketamine and esketamine. Our licensed medical providers will talk with you about the few exceptions and determine a medically-appropriate course of treatment.

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Q: Do you offer ketamine-assisted psychotherapy (KAP)?

A: We do have therapists who are trained in ketamine-assisted psychotherapy (KAP), so this is an option for those who request it. If you have an established therapist already, our providers will work collaboratively with them to help you integrate the ketamine experience.

 

Q: How many patients do you have per room?

A: Just one! All our rooms are private and comfortable, with recliners for the patient plus a comfortable chair if the patient would like a friend, family member, or therapist to stay with them during the treatment. Yes, we know other places have six people per room--we would never want to personally experience that, so we will never offer that. 

 

Q: Can I get some ketamine from you to take at home?

A. No. We follow the recommended medical guidelines for ketamine, which clearly state that ketamine should only be administered in a medical setting with medical oversight. In the past, some medical practices were allowing people to take oral ketamine at home, but this is no longer considered to be an ethical or appropriate use of ketamine (most malpractice companies no longer allow it for that reason). Both IM ketamine (the shot) and esketamine (the nose spray called Spravato) can only be legally administered by a licensed medical professional. 

 

Q: Who is a candidate for ketamine or esketamine treatment? 

A: Adults (ages 18+) with PTSD, OCD, anxiety, or depression. Our licensed medical providers will do an evaluation to make sure our treatment options are right for you.

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Q: Do you bill insurance? 

A: We are happy to do the prior authorization paperwork and give you a superbill you can submit to your insurance company to get coverage for the treatments (we do not bill insurance directly). We are usually able to get the cost of esketamine (Spravato) covered by insurance.