Ketamine Treatments
Time to Think Outside of the
Pharmaceutical Box
What is Ketamine?
Ketamine was approved by the FDA in 1970 for procedural sedation and anesthesia. It is routinely used at hospitals and in emergency rooms all over the world. It is even on the World Health Organizations “List of Essential Medicines”. It has an excellent safety profile when used properly. More recently ketamine has been used “off-label” to treat many conditions at doses much lower than what is normally used for sedation. It can be effective for PTSD, Depression, Anxiety, OCD, Addiction, Eating Disorders as well as some Chronic Pain Syndromes, Fibromyalgia, Migraines and Neuropathic Pain.
Since ketamine is now generic, pharmaceutical companies have little incentive to get FDA approval since this is an expensive endeavor and no one company would have a monopoly on the product. Because of the issue with FDA approval, insurance companies often refuse to pay for ketamine treatments despite the evidence supporting its use.
For this reason, one company developed a slightly different medication called Spravato or esketamine which has gained FDA approval for Treatment Resistant Depression. Regular ketamine contains “S” ketamine and “R” ketamine which are the 2 different ketamine enantiomers (chemicals that are a mirror image of each other). Spravato/esketamine only contains the “S” enantiomer making it just different enough that a pharmaceutical company could get approval and now has the exclusive rights to market this medication with a hefty price tag. Regular ketamine is readily available and costs a lot less. Because Spravato is more often covered by insurance we offer both options at our clinic.
How Does Ketamine Work?
Ketamine is completely different than any of the traditional antidepressant or anti-anxiety medications. While we don’t fully understand how it works, it seems to have a “reset” or “reboot” type of effect on the brain.
We do know that it quickly increase the activity of glutamate in brain and this may stimulate the growth of new synapses. It seems to open up neural pathways that are blocked or not working correctly and improves the signaling of neurotransmitters. It may also work in other ways such as reducing inflammation.
Because ketamine directly activates glutamate instead of going through the serotonin pathway like traditional medications it can start working very quickly making it increasingly popular for patients in the hospital for suicidal ideation.
Ketamine seems to increase neuroplasticity in the brain which is the ability to think in different ways and adapt, change or “re-wire”. This may happen because ketamine increases BDNF (Brain-Derived Neurotrophic Factor) which protects and helps neurons heal and form new connections which improves mood, learning and memory. This in turn makes other modalities such as psychotherapy and neurofeedback more productive.
How is Ketamine Given?
Ketamine is usually given for 6 sessions over 3-4 weeks, followed by booster sessions as needed. Boosters are usually given every 2 weeks to 3 months depending on how well the patient is doing. In some cases, patients are able to achieve remission and don’t need boosters or only need boosters every once in a while. We usually recommend having the first booster session about 2-3 weeks after the initial protocol and then gradually spacing them out from there if possible.
Ketamine is not absorbed well through the stomach so it is best administered through an IV, an injection, or a nasal spray. An IV is a good way to deliver the medication but it is not necessary. We choose to primarily administer through injections for the following reasons;
- Injections are well absorbed and with a proper technique much more comfortable than an IV. Ketamine often gives people the urge to use the restroom making having an IV in place an inconvenience.
- IV placement adds extra unnecessary cost and increases the risk of infection.
- Ketamine is not absorbed as well through the nose and the absorption can vary more from treatment to treatment based on how clear or stuffy the nose is and how well it is delivered into the nasal passage.
Depending on treatment goals and insurance coverage we may administer the ketamine through an IM (intramuscular), SQ (subcutaneous) injection, or in the case of Spravato an intranasal spray.
The body will naturally infuse injected ketamine into the bloodstream in a predictable manner. We start with a low dose based on weight and patient preference and adjust from there, but usually, increase the dose over the first several sessions until settling on a “sweet spot”. More is not merrier with ketamine.
IM injections are quickly absorbed in a pattern where ketamine will build up and peak at about 15 minutes. Many patients will receive a 2nd injection about 30 to 60 minutes after the first injection. Most of our sessions are done this way and last about 2 ½ hours.
SQ injections also have a rapid onset but are absorbed more slowly with more of a flat curve and are usually given at an even lower dose making them ideal for KAP (Ketamine Assisted Psychotherapy) where a therapist sits in the room with you and provides therapy with the aid of ketamine.
Intranasal ketamine takes longer to have its effect. The effects start at 5-15 minutes and peak at about 40 minutes.
Ketamine Pricing Options
Consultation and Initial Intakes:
$140 – $230 for Initial Psychiatric Evaluation which is required before starting treatment with ketamine or Spravato. Price listed is discounted cash price. Price is based on time spent and complexity. This intake can be billed to insurance regardless of whether insurance pays for ketamine treatment. This visit is designed to determine whether you are a good candidate, review other treatment options, and create a treatment plan which may or may not include ketamine treatment.
Free 15 minute consultation:
via phone or in office with one of our medical providers.
Ketamine Sessions:
$200 Single injection/infusion session (about 1.5 hours). Given to patients participating in KAP (Ketamine Assisted Psychotherapy) and for those who struggle to tolerate multiple injections or just prefer an easier recovery.
$250 Regular session consisting of 2 injections (about 2.5 hrs).
Spravato:
Cost for Spravato varies based on insurance plan. Contact us with your info and we will estimate your cost.
KAP Sessions:
KAP sessions cost around $320 total per session depending on insurance coverage. The costs are broken down as follows:
Psychotherapy – $120
Ketamine and medical monitoring – $200
Individual therapy “Integration Sessions” without ketamine – $120