Frequently Asked Questions About Ketamine Infusion Therapy
Below are some of the questions patients often ask us about ketamine infusion therapy.
Are ketamine infusions safe?
Ketamine has been used for over 50 years in operating rooms, emergency departments, and the battlefield with an excellent safety profile at much higher doses than used for infusion therapy. It is notable that ketamine is on the World Health Organization’s list of “essential medications” due to its efficacy, utility, safety, and relatively low cost. Although there are reports of bladder problems with chronic use, this is rare and is associated with the abuse of high doses taken many times a day over weeks.
Unlike traditional analgesics and sedatives, ketamine is unique in that rather than depressing blood pressure, heart rate, and respiratory drive, it causes modest increases in heart rate and blood pressure, and only trivially affects breathing in the dosages used for infusion therapy. These effects are typically brief, minor, and resolve shortly after the infusion is completed. You will be placed on a cardiac monitor with frequent blood pressure checks and continuous monitoring of your oxygen levels during your infusion. In addition, you will be under the care of a licensed emergency nurse and emergency physicians throughout your treatment.
Is the ketamine experience scary?
The effects of ketamine infusion start rapidly but gently. They begin with a sensation of lightheadedness or dreaminess that most patients find pleasant and enjoyable. As you get deeper into the experience, you may start to feel as if you are floating on a calm ocean and may even feel somewhat out of your body. However, you will find that your mind is alert and easily able to think about and analyze your inner feelings and conflicts without undo emotion and pain.
Many people find that they are able to deal with many thoughts with a calm and clarity that they have never experienced before. Although some thoughts can be briefly disturbing or anxiety-provoking, these feelings are typically fleeting, and you can easily change the focus of your thoughts. Rarely does a patient require anti-anxiety medications or cessation of their infusion.
Are there contraindications to ketamine use?
Yes, there are a few conditions where ketamine treatment might be unsafe. Patients with uncontrolled blood pressure or active coronary artery disease are not good candidates for ketamine, nor are patients with untreated hyperthyroidism due to its ability to raise blood pressure. Likewise, patients who have a history of schizophrenia, other psychotic disorders, or bipolar disorder who are currently experiencing a manic phase should not receive ketamine as it may exacerbate these conditions
Will my sessions be private?
Yes, all of your infusions are performed in comfortable, darkened, and tranquil private rooms. You will be under the care of a nurse and physician, each of whom will be checking on how you are feeling and how your experience is progressing. Unlike many “infusion centers” that have several people receiving their treatment together in a common room, we feel that privacy brings a sense of comfort and security to the patient, optimizing the ketamine experience and minimizing unnecessary distractions that could frighten you or hinder the depth of your experience.
How should I prepare for my ketamine infusion?
You should refrain from consuming alcohol or using recreational drugs for 24 hours before and after your infusion. You should attempt to get a good night’s sleep the night before your infusion. If you regularly take benzodiazepine medications such as Valium, Ativan, Xanax or Klonopin, or opioid pain medications, we ask that you not take these medications for eight hours before your treatment. This is because sedative medications have been found to decrease the depth and effectiveness of the ketamine experience. Do take your blood pressure medication if you suffer from hypertension.
We recommend wearing an eye mask. If you do not have an eye mask, they are available through our clinic for a nominal cost. The ketamine experience is greatly enhanced by music. If you plan on listening to music, please bring headphones or earbuds. We recommend relaxing, meditative types of music, though any type of music you enjoy and puts your mind at ease can be used. Some people enjoy reading during their infusion. We ask that you mute your cell phone, ignore your texts, and only use your phone as a music player. This is a special and private experience for you, which would only be diminished by having to attend to the demands of social media. Most importantly, come relaxed and prepared to enjoy the flow of your ketamine experience.
Will I be able to drive myself to and from your clinic for my infusions?
No. Ketamine is a dissociative anesthetic with sedative effects that last beyond your infusion. Your balance and coordination will be impaired for hours after your treatment, and although you may be able to walk with little difficulty, your reaction time and judgment will be impaired. We require you demonstrate to us that you have a driver at the time of your infusion and we will not discharge you from our clinic without your driver present when you are ready to leave. We recommend you not drive a motor vehicle or use power machinery until the day after your infusion. If you do not arrive with a driver before your infusion, we cannot authorize and begin your treatment. Should you leave the clinic without a driver present, we reserve the right to cancel any future infusions. You will forfeit any monies paid for future treatments in this scenario.
What does it mean that ketamine infusions are “off-label”?
Ketamine is a dissociative anesthetic that was developed in the 1960s and rapidly approved by the U.S. Food & Drug Administration for use in humans for surgical anesthesia and sedation. It afterward became approved for use in procedural sedation in emergency departments due to its effectiveness and favorable safety profile in patients of all ages, from children to seniors. Once a medication is FDA approved, it can be used by clinicians for other indications, though this is referred to as an “off-label” usage. It is estimated that up to 25% of medications are safely used “off-label” to treat a myriad of conditions.
It is important to understand that when a medication becomes “FDA approved,” that its use has been determined to be safe. The FDA approval process involves studying the medication for specific indications over a long period of time. However, as time goes on, and the medication has been used many times, other conditions may be found that respond well to it. Although the medication is being used “off-label,” its safety profile has not changed. It became apparent to anesthesiologists and surgeons that ketamine given to their depressed patients rapidly improved their depressive symptoms. Since that time, multiple research studies have verified ketamine’s effectiveness for depression and other conditions at much lower dosages than used in surgery.
Unfortunately, the anti-depressant effect of ketamine was not recognized until the medication went off patent, and the drug companies are not interested in seeking FDA approval for this usage due to the high cost of the multiphase approval process and limited profit margin inherent with generic drugs. However, myriad studies continue to prove the safety and efficacy of low dose ketamine infusions, particularly when administered and monitored by medical professionals who adhere to published indications and dosage guidelines. If the FDA felt a medication was unsafe for use, a “black box” warning would be issued for the medication. No “black box” warning is attributed to ketamine.
Is ketamine addictive?
In medically supervised usage, no. Unlike typical drugs of abuse, ketamine does not trigger the dopamine reward circuitry of the brain that is associated with addiction. However, psychological and physical dependence and addiction have been reported in unsupervised, high-dosage, long-term recreational use of ketamine. We do not prescribe ketamine for home usage, and our infusions consist of infrequent, brief, low-dose administration of ketamine. This type of usage has not been associated with increased desire for ketamine, need for increasing doses, or problems with addiction or dependence.
Is ketamine safe for use in children?
Ketamine has been used safely to sedate children for decades in the emergency department. It is thought of as first-line therapy for children for the performance of painful procedures such as laceration repair, abscess drainage, or the setting of broken bones. It has proven to have an excellent safety profile, and is used in much higher doses in the ED than that given during ketamine infusions. Children also suffer from mental health issues such as depression, anxiety, OCD, and PTSD, as well as chronic pain syndromes which can all respond favorably to ketamine infusions. However, in patients younger than 18, we ask that the child is referred by and treatments approved and closely followed by their primary care provider and/or mental health specialist.
Do I need a doctor’s referral to receive ketamine infusions?
No, we use widely accepted screening tools, our medical expertise, and a screening interview to determine if ketamine infusion therapy is right for you. However, we do have a referral form for your provider on this website to make it easier for you to obtain treatment. The screening interview is free, should you decide to have your first infusion the day of your initial evaluation. Otherwise, the screening appointment costs $125. Of course, although a referral is not needed, we strongly recommend that your primary care provider and/or mental health specialist are aware you are seeking ketamine infusion treatments, and that your mental health concerns continued to be monitored and managed by your providers.
What are the costs of ketamine treatment?
An 45-minute initial consultation with our one of our physicians is required before your first infusion to determine if ketamine therapy is right for you. The cost of the consultation is $125. The fee will be waived if you elect to receive your first treatment immediately following your consultation. A single 90-minute infusion costs $450. Six infusions over two weeks is the recommendation for the treatment of depression, PTSD, OCD, chronic anxiety, and stress-related conditions. The cost of six infusions is $2,700 if infusions are purchased individually. However, the package rate is $2,400 if you opt to pay for all six infusions at the start of your therapy. Infusions for Chronic Pain and Substance Use Disorders are four hours long and cost $1,250 each. We recommend three four-hour infusions over one week for the treatment of chronic pain. A package rate of $3,500 is available. Periodic booster treatments will be billed at the single infusion rates. Infusions are all given in comfortable, private rooms.
Both a nurse and a physician are always on site during treatments. We request credit card information be given at the time of scheduling to hold your appointment. There is no refund if you do not arrive for your scheduled treatment or if you cancel less than 24 hours before your appointment. We do not accept payment with cash or check. Payment is by credit card, HSA card, Apple or Google Pay, or through our 0% financing partners.
Will you bill my insurance for my treatments?
No, unfortunately insurers typically pay for treatments with assigned CPT codes, and as we use ketamine “off-label” for mental health and chronic pain conditions, there is no assigned CPT code that allows insurers to determine their level of reimbursement. Hopefully, with the recent FDA approval of ketamine-related medications and with the increasing body of evidence supporting the efficacy of ketamine for multiple psychiatric and pain conditions, insurance providers will begin reimbursement in the future. However, you may use your HSA (health savings account) to cover the cost of your treatments.
Certain insurers have provided some coverage for ketamine infusions as an out-of-network expense, but this would require you to contact your insurer to determine if it is worthwhile for you to submit the bill directly to them for reimbursement. In addition, we have partnered with companies that offer 0% financing with very reasonable repayment plans. Please refer to the links on this website to apply for or to obtain further information regarding these financing options.
I’ve read about Spravato nasal spray, a ketamine derivative. Do you provide Spravato treatment?
No. Although Spravato (esketamine) has been FDA approved for the treatment of treatment-resistant depressive disorder (TDD), esketamine is administered through a nasal spray and this method of administration has been found to have 25 to 35% bioavailability (the amount of drug available relative to total dose given) compared to nearly 100% bioavailability for IV ketamine. Due to the problem of variable absorption with nasal ketamine, the patient may experience inconsistent treatment response day-to-day. Spravato is also very expensive (up to $900 per session and $7,000 per month) and still requires you to be monitored in a clinic for two hours at a time.
In addition, although esketamine was designed to have fewer psychic “side effects” than ketamine, we at Tranquility Ketamine Clinic agree with many other ketamine providers that these “side effects” are crucial in creating a transpersonal and transformational experience for the patient, which we feel is critical in obtaining a good therapeutic response. Given that IV ketamine is 70% effective in treating TDD, brings about a desirable mental state for healing, and has a similar cost to the patient as esketamine, we do not believe that Spravato is the best course of therapy for our patients. In addition, if difficult IV access is a concern, ketamine may be given to patients intramuscularly.