Frequently Asked Questions
About Depression

Ketamine is a safe, effective anesthetic that has been in use worldwide since 1970 and has been listed on the World Health Organization’s Essential Medicines list since 1985. Multiple studies and trials run at Mt. Sinai in New York, Yale and other prestigious universities and hospitals since 1990 have shown that ketamine is exceptionally effective in treating treatment-resistant depression, PTSD, anxiety, suicidal ideation, neuropathic pain and other related mood disorders. Unlike standard antidepressants like SSRIs and SNRIs which generally take 4 to 8 weeks to work (if they work at all), ketamine is fast-acting and can sometimes show immediate efficacy after a single intravenous dose. Because of its fast-acting nature, ketamine can be an extremely important tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder (MDD). More recently it has also been used to treat neuropathic pain and the symptoms of PTSD. The small doses and method of administration (intravenous infusion) used to treat depression patients differ greatly from those used in hospitals for anesthesia.

While ketamine can be legally prescribed and administered “off label” by licensed physicians, the drug has only been officially approved by the FDA as an anesthetic and not as a treatment for depression. By way of comparison, an estimated 30% of all medications are prescribed “off-label,” including many cancer drugs, and are frequently used by physicians even though they are not FDA approved for that particular purpose. Although ketamine has shown the potential to help millions of people find relief from the crushing effects of depression and neuropathic pain, pharmaceutical companies have been hesitant to invest the tens of millions of dollars required to fund the extensive and expensive clinical trial process necessary to get official FDA approval. Since the drug is and will remain off-patent, no company can own the revenue stream. Ketamine’s use for depression and neuropathic pain treatment follows all required rules and regulations, and has safely and effectively been prescribed as a fast-acting depression and pain treatment for almost a decade in private medical practices and some hospitals and HMOs.

Yes. All infusions are administered in our offices in comfortable, private treatment rooms.

A direct referral from a psychiatrist is not required. While a referral from any mental health care provider is encouraged, an initial phone or office consultation with one of our doctors can determine if you are a good candidate for ketamine therapy. We provide this initial consultation free of charge.

Not necessarily. Mild to moderate depression is often successfully treated by mental health professionals with antidepressant drugs and/or psychotherapy, which we encourage. The treatment of severe depression, major depressive disorder (MDD) treatment-resistant depression and other mood disorders is more difficult and requires a higher level of care, such as ECT, TMS or ketamine therapy. Ketamine infusion therapy is reserved for those patients with severe depression and anxiety that is considered treatment-resistant, or those with suicidal ideation.

The patients we see are all considered treatment-resistant. That is, they have not responded to any available antidepressant medications and in many cases have not responded to ECT or TMS. While we cannot predict with certainty who will respond to ketamine, clinicians across the country have reported that roughly 70%-75% of patients who have not been helped by any other treatment do show a dramatic improvement in their mood with ketamine, and 3 out of 4 patients who present with suicidal ideation cease to have such thoughts. A meta-analysis by the American Psychiatric Association using data from multiple ketamine trials reported similar results, with 70% of treatment-resistant patients responding positively after receiving the initial round of low-dose infusions. 

We’ve shown very good results for patients suffering from all of these conditions, though we cannot predict with certainly which patients will respond.

About an hour, with an additional half hour of quiet time before discharge.

Once we begin infusion therapy, the number of infusions you will need before feeling mood improvement will vary. A small percentage of patients will begin to feel better the day after the first infusion. Most young adults will need 3 or 4 infusions before noticing significant improvement. Adults over 50 years old may need 4 or 5 infusions before improvement becomes apparent. Although the above are typical response times, your experience will be individual.

Assuming you begin to feel better during the initial treatments, a total of six infusions is recommended within a twelve-day period, which will maximize the ketamine effect on new dendrite and synapse growth. Thereafter, patients are placed on a maintenance program and are asked to return when they feel it necessary for single infusion boosters. During the maintenance period, the duration of relief varies by patient. The average duration of relief between booster infusions is 4-6 weeks. There is no way to predict what your needs will be. Some patients find that as they go through this process, the time between boosters lengthens, prompting them to come in every other month, every 3 months, or even less frequently. In our experience, patients find ketamine boosters effective for as long as needed with no long-term side effects. 

Most patients experience a mild dissociation or inner reflective experience that is generally well tolerated and often quite enjoyable. If you find it unpleasant in any way, we can make adjustments to minimize or eliminate any unpleasant sensations. Within 15 minutes of ending the infusion, your thinking will be clear. There are no delayed “flashbacks.”

No. The low dose of ketamine you will receive does not cause any loss of consciousness.

The treatment is essentially pain-free. Other than a small prick while starting the infusion line, you will feel no pain and may even enjoy the experience.

Your thinking may be a bit cloudy and your walk a bit unsteady for an hour or so after treatment. You may also find that you will be somewhat tired for several hours. Hopefully, there will be a noticeable improvement in your mood shortly after one or two infusions.

Ketamine is an anesthetic and thus can compromise reflexes and coherence. We do not recommend driving, operating machinery, or signing documents for 24 hours. We recommend that a friend, relative or caretaker accompany you home, if possible.

We don’t believe so. After the first year or so, many patients find the need for booster infusions decreases over time. In the meantime, several large pharmaceutical companies are sponsoring clinical trials with ketamine-like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will likely become available. But for now, patients with debilitating severe depression with constant thoughts of self-harm often cannot afford to wait. Currently, ketamine infusion therapy is the most exciting and successful new treatment for severe depression, MDD, and suicidal ideation and is the subject of many ongoing trials.

Yes. Benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 150mg/day also can block ketamine efficacy. Please speak with the doctor to discuss if and how to modify your existing medication regimen in order to maximize ketamine’s effectiveness.

Not at all. SSRIs and other antidepressant medications do not interfere with ketamine’s mechanism of action.

Almost none. Uncontrolled high blood pressure or heart failure need to be corrected in advance. Regardless, all patients will be closely monitored while undergoing treatment.

We’ve treated over 2,400 patients and have seen no instances of ketamine addiction. Ketamine has been used safely for surgical anesthesia and trauma management in hospitals and elsewhere for over five decades, has been included on the World Health Organization’s Essential Medicines list since 1985, and has few side effects. Although it is sometimes abused recreationally in high doses as a “club drug,” there is no evidence that ketamine is addictive.

Depression treatments require a very low dose, so hallucinations and any uncomfortable side effects that may come with much higher doses are extremely rare. Ketamine has few other side effects.

True emergencies, with a psychiatric referral, and those suffering from suicidal ideation that require prompt attention can usually be seen within a day. In general, we prefer to schedule patients 5 to 7 days in advance. Since our offices are open seven days a week and we open early and close late, we can meet most patients’ scheduling needs.

The fee for our consultation and initial treatment for depression and mood disorder patients is $525. Additional treatments, if necessary, will also be billed at $525. This fee is all-inclusive with no additional charges. We accept all payment methods. While we do not accept insurance, some insurance companies will cover all or a portion of the treatment as an “out of network” service. If so, we will gladly provide you the necessary forms to submit to your insurance company for potential reimbursement. Our experience shows that about 30-35% of patients are receiving some reimbursement.

We also offer affordable financing options to our patients, available through CareCredit. The CareCredit health, wellness, and personal care credit card gives you a convenient, flexible way to pay for care for the whole family—including pets!

Veterans of the United States military suffering with depression, MDD or PTSD are encouraged to call us for special fee consideration.

You do not need anyone to accompany you, though they are certainly welcome. You may also leave on your own following our evaluation, but we recommend that a friend, relative or caretaker accompany you home, if possible. We also recommend not driving until the following day.

You can eat, but you should not have any food within one hour of your appointment.  

Yes, WIFI is available throughout our entire office and in all treatment rooms. Most of our patients bring their own devices and earbuds or headphones to listen to music while undergoing treatment. We strongly discourage using your devices to make phone calls, texting or emailing during the treatment. Those accompanying you are welcome to bring laptops, iPads, iPods and cellphones as well.

Yes. Our offices are all handicap accessible and ADA compliant.

We follow all HIPAA rules and regulations. Our privacy policy can be viewed here: privacy policy

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