FAQs

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.

No, it is not.  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.

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. This does require an initial consultation 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 mood disorders that is considered treatment-resistant, or those with suicidal ideation.

Most patients we see do see substantial improvement.  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 (4 – 6 infusions).

It is possible.  These conditions take a much more selective process to determine if the patient will ultimately be an excellent candidate for ketamine therapy.

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 treatment, a total of six infusions is recommended within a 4 week period. Even if you feel better before the 6th infusion, it’s important to complete the 6 infusions for  the restoration of old and synapse growth of new dendrites (neurocellular connections).  This is critical to the durability of the treatment.

After the induction phase, patients are asked to return when they feel it necessary for single infusion boosters (maintenance phase). 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, the dissociation ends, and your perception returns to normal.  There are no delayed “flashbacks” or fear “that you don’t come back”.

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.

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.

You may feel somewhat tired for several hours and your thinking may feel cloudy.  We recommend you do not drive, make important decisions for at least 12 hours after, or until you have gotten a good night’s sleep.

Ketamine is an anesthetic and thus can compromise reflexes and coherence. We do not recommend driving, operating machinery, or signing documents for 12 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. Currently, ketamine infusion therapy is the most exciting and successful new treatment for severe depression, MDD, and suicidal ideation.

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. Some patients may want to try a taper reduction of their daily antidepressant after ketamine if their depression is in complete remission.

Rarely.  Pregnancy is a contraindication.  Cardiovascular disease, ie; uncontrolled high blood pressure and heart rate needs to be controlled. In addition, some neurovascular diseases; AVMs, aneurysms may require a medical clearance. Active substance use is also considered prior to starting. Regardless, all patients will be closely screened and monitored before and while undergoing treatment.

While it is sometimes abused recreationally in high doses as a “club drug,” there is no evidence that ketamine is addictive when used in a clinical setting.

Recent research published in the Journal of Affective Disorders supports this, indicating no concerning signs of addiction in individuals who participated in controlled ketamine clinical trials. The study followed up with participants over several years and found no significant association between initial ketamine administration and current symptoms of addiction or substance misuse. These findings reinforce the safety of ketamine therapy in a medical context, further alleviating concerns about its potential for addiction.

Our experience aligns with the extensive research showing it to be a safe and effective treatment option.

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, or those who have already established and are suffering from suicidal ideation that require prompt attention can be seen within a day. In general, we prefer to schedule patients 5 to 7 days in advance since our offices are by appointment only.

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 4 hours, and no fluids 1 hour prior to your appointment.  

Yes, WIFI is available throughout our entire office and in all treatment rooms. We recommend using our comfortable noise canceling headphones and playlist generated to encourage a proper mindset for ketamine therapy.  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.

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