Ketamine is a dissociative anesthetic. Developed out of the desire for an ideal anesthetic with analgesic (pain-relieving) properties, it was first synthesized in 1962, patented in 1966 and approved for human use by the FDA in 1970. It is widely used in operating rooms for general anesthesia and in emergency departments for procedural sedation.
While ketamine is FDA approved for anesthesia, it is not FDA approved for treating mood disorders or chronic pain. It can be used “off-label” by providers skilled in its administration.
The good news is that ketamine is a very safe drug, particularly when used at low doses. That does not mean that it is without risks. Before beginning your infusions, we will review your medical and psychiatric history, current medications, allergies, and recent bloodwork to ensure that there are no contraindications to pursuing ketamine therapy. If we have any concerns regarding safety, we will ask for input from your primary care physician or appropriate specialist. We will not proceed with an infusion if we feel it is dangerous for you in any way. Every patient is monitored closely throughout their infusion via in-room cameras (not recorded) and vital sign machines, regardless of age or health conditions.
It is common to feel sleepy or “out of it” after an infusion. You may feel a bit dizzy or nauseous. We can provide medications to combat nausea should you experience it. We will ask you to relax in our recovery room before leaving the clinic. Most side effects will resolve within minutes to a couple hours and should not persist beyond the day of infusion. Some people can experience more vivid dreams, and rarely nightmares, which we have seen persist for a few days following the infusion.
Memory issues and bladder problems have been seen in individuals who abuse ketamine. In other words, these issues are seen when using high doses frequently.
Low-dose ketamine infusions, when given by skilled providers, have not been shown to be addictive.
Once you have had your initial consultation and are found to be a good candidate for ketamine, you should be able to receive your first infusion within a week. In cases where we request additional testing because of underlying medical conditions, then this may postpone things a bit. Our goal is to start your infusions as soon as it is safe to do so and get you on a path to feeling better!
It is rare that we have to turn clients away due to underlying medical conditions but If you have uncontrolled/untreated high blood pressure, glaucoma, liver disease or thyroid disease, have certain heart issues (e.g. congestive heart failure, abnormal heart rhythm, active chest pain), have an active substance abuse disorder, history of psychosis, any symptoms of mania, delusions or hallucinations it is likely unsafe to give you ketamine. If you have been diagnosed with a personality disorder (e.g. schizotypal, borderline) then ketamine may not be the ideal medication for you.
Benzodiazepines (e.g. Xanax, Ativan, Klonopin) and lamotrigine (A.K.A. Lamictal) have been known to decrease the effectiveness of ketamine. This does not mean you should stop them! Doing so can have serious consequences. We will review your medications during your consultation and we may ask you to make some adjustments to your dosing schedule if you are taking any medications that could interfere with ketamine.
Not exactly, but there are a number of factors that go into providing infusions to minors. We are able to offer treatments to those 13 years of age and older.
Ketamine is made up of two mirror image molecules – R-ketamine and S-ketamine. Spravato is a S-ketamine (aka “esketamine”) intranasal spray that was approved by the FDA in 2019 for treatment-resistant depression when used in conjunction with an oral-antidepressant. Originally, it was only offered in two different dose strengths and we found it to not be as effective as IV ketamine infusions. However, it is currently offered in three different strengths and outcomes have significantly improved. It is now also FDA approved for adults with major depressive disorder with suicidal thoughts or actions.
We currently offer Spravato for those covered by Medicare and BCBS. We will be adding more insurance carriers in the coming months.
We do not. Most insurance companies do not cover ketamine infusions for mood disorders or chronic pain. We are hopeful that this will change in the near future. See our Pricing Policy for further details.
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There are likely numerous ways that ketamine works in the brain to help mood disorders and researchers continue to investigate its mechanisms of action. The most commonly accepted theory is that ketamine acts on the NMDA receptors to increase glutamate levels. Glutamate is the most prevalent neurotransmitter in the human brain and nervous system, and it plays a key role in neural plasticity. To put it simply, the increase of glutamate in the brain is thought to be what accounts for the rapid positive effect on mood disorders while it also helps to repair, strengthen and even regrow connections that provide long term benefit in helping to change the way we process information and emotions.
Most of the research surrounding the use of ketamine and mood disorders has specifically looked at treatment-resistant unipolar depression. That being said, we have seen that it can be effective for bipolar depression, seasonal affective disorder, and other types of depression.
Many people have reported changes in mood within minutes to hours after a single treatment of ketamine. However, these effects are often mild and short-lived, lasting hours to days. This is the reason why it is recommended to have a series of infusions as opposed to just one and studies have validated this model. Most people who benefit from ketamine infusions will notice more profound and lasting changes starting 1-2 weeks after they start treatment.
We would love to tell you that ketamine is 100% effective for all mood disorders but, unfortunately, nothing is that good! It has been our experience, and we know from colleagues around the country, that the majority of people who undergo these treatments note improvement in their symptoms. Some clinics report that as many as 85% of their patients have had success with ketamine. We believe that there are a number of factors that can enhance the success rate including the mode of administration, the environment in which the treatments are given, integration of psychotherapy, mindfulness techniques, and the person’s openness to the possibility of healing.
This is not an easy question to answer and one that we encourage you to discuss further at your initial consultation and with your therapist/psychiatrist. In general, most people who undergo ketamine treatments have already tried multiple medications without lasting results or have had significant side effects from conventional therapies and are looking for a different type of treatment.
While we do not require you to be under the care of a psychiatrist in order to receive ketamine infusions for mood disorders, we do believe it is in your best interest. We feel that in order to optimize your success, it is important that we collaborate with your psychiatrist, therapist and/or primary care physician.
No, a referral is not required. However, we will need to confirm your diagnosis with your psychiatrist, therapist, or primary care physician prior to your first infusion.
This is unlikely. However, it is extremely important to notify your care team at Imagine if you are having any symptoms of mania when you are due for your infusion. Your safety is always our greatest priority.
Ketamine acts at the receptor level to reduce or eliminate what is known as “central sensitization”. Pain itself changes the way your central nervous system works. When you have been in pain for a long time, you can actually become more sensitive and get more pain with less provocation. By a number of different mechanisms, ketamine reduces or eliminates this effect. Similar to mood disorders, it is likely that there are numerous other ways that ketamine works for chronic pain and studies are ongoing.
Ketamine’s effectiveness in chronic pain has been most widely studied in patients suffering from CRPS (chronic regional pain syndrome). However, ketamine can be effective for a variety of conditions including fibromyalgia, phantom limb pain, migraines, trigeminal neuralgia, and some malignant pain conditions. In general, neuropathic pain responds well to ketamine.
If you would like to bring your own blanket, pillow, or eye mask with you then please feel free to do so. Otherwise we can provide you with any of the above for use during your infusion. We also provide noise cancelling headphones, but if you have a favorite pair bring them along.
We ask that you don’t eat or drink anything for 4 hours prior to your first infusion so we can see how you respond. Also, we don’t want you to drink just before coming in as getting up to go to the bathroom in the middle of your infusion is no fun! Avoid caffeine or any other stimulants. Avoid alcohol the night before your infusion.
At this time, due to COVID-19, we ask that you call us to ensure we can accommodate guests in the clinic.
We will review your current medications at your initial consultation. We ask that you do NOT make any medication changes during your induction series as this can complicate treatment. If you are on medications that have been known to lessen the effectiveness of ketamine (e.g. benzodiazepines, lamotrigine) we may ask you to make some adjustments to your dosing schedule.
Get comfortable! Wear loose fitting clothes and layers are advisable. Avoid heels. Keep in mind that we will need access to put an IV in your arm and you will have a couple stickers placed on your chest and upper abdomen for the heart monitor.
Great question! You may hear us talk about “set and setting” when it comes to preparing for an infusion. We are mostly in charge of the setting - providing a comfortable, low stimulus, and safe environment. On the other hand, you are the master or your own mindset. Try to clear your mind and prepare yourself for the experience. For some, this may mean doing yoga, breathwork, listening to music, or meditation. Others may want to take a nature walk or sit by the lakeside and listen to the lapping of the waves. Setting the stage for yourself can lead to a more profound and peaceful infusion.
As mentioned previously, ketamine is a dissociative anesthetic. What in the world does that mean? In broad terms, to dissociate is to disconnect – disconnect from earthly surroundings, thoughts, emotions, memories and even your sense of self. Perception of time and space is often warped. Each person’s experience is unique and each session can differ for each individual. Lay back, uncross your legs and relax. Get centered, breathe, let go of thoughts the best you can and know you are safe. Allow the music to help guide you through the experience. If there are visuals, watch and enjoy. If there are thoughts or ideas you want to explore, do so. If there is emptiness, enjoy the peace. For most people receiving low dose ketamine infusions the experience is peaceful. For some, however, the feeling of disconnection can provoke anxiety or fear resulting in an unpleasant experience. It is not always easy to predict who will have the latter. There are things that we can do to make each session as pleasant as possible. There are also things that you can do to help set the stage for a positive and beneficial experience. We will help to guide you on your individual journey.
Ketamine can cause nystagmus - involuntary movement of the eyes. While this is generally very mild at low doses, trying to focus your eyes on anything may prove difficult and can lead to feeling dizzy or nauseous. We encourage you to wear an eye mask for this reason. Also, we encourage you to let go of any outside stimulus and focus on what your own mind is experiencing. Allow yourself to explore. Music, on the other hand, can play an important role and act as a guide through your infusion. Music is very personal and everyone responds differently to different types of music. We recommend you listen to something that relaxes and comforts you in some way. It is not advisable to listen to music with lyrics as they can become distorted and distracting. We can provide music playlist recommendations and a listening device for use during your infusion. We highly discourage listening to music on your phone as all too often a call, text or email notification will manage to sneak through and ruin your session. In fact, we will ask that you turn off your phone and put it away until after your infusion is complete.
Mood infusions last about 45 minutes but you should plan on being at the clinic for at least 90 minutes to account for the preparation time needed prior to your infusion and the time needed to recover afterwards. Some clients won’t need this much time but some may need even a bit longer. Pain infusions can be as long as 4 hours so plan on being at the clinic for a good portion of your day.
Your health and safety is our highest priority. If for any reason we do not feel it is safe for you to undergo an infusion, then we will not give it. Hopefully we can help to resolve any issues and you will be able to reschedule for another day.
Absolutely not. You will be asked to sign a form stating that you understand this. You cannot drive for at least 12 hours after an infusion. Doing so will put you and others in danger. Please arrange for a trusted friend or family member to pick you up. Public transportation is NOT recommended! It is simply too much stimulus after an infusion. Taxis and rideshares are an option but not ideal. Please discuss any transportation concerns with us.
We recommend that you go home and relax the rest of the day, particularly following your initial infusion. Some people recover very quickly from any side effects while others need time. Until you know how your body reacts, plan on just taking it easy. When the effects wear off, pay attention to your mood. Has it shifted and, if so, how? Take some time to reflect on your experience. Take notes and consider journaling. You should definitely not operate heavy machinery, make any big life decisions or plan on taking care of young children following your treatment.
It is our hope that you are feeling significantly better and your quality of life has greatly improved! You will receive a check-in call from one of our team members after your induction series to see how you are doing and if there is anything we can do to support you before we see you again for your first maintenance appointment. There may be challenges that come with integrating back into daily life once you have experienced a brain reboot from ketamine. We want to help!
Keep in mind that ketamine is actually only a small part of your journey. So much of what you do outside of the clinic will determine the outcome. If you rely solely on the ketamine, then you will not experience the best results. Similarly, if you are not truly open to the fact that there is potential to change your life then, again, you will not have the best results. However, if you have an open mind, do the infusions, continue your medications, work with your therapist, learn how to integrate what you’ve experienced throughout your sessions with us then you have an excellent chance for lasting results.
This does depend on your underlying condition but most people do require maintenance ketamine infusions indefinitely. Keep in mind that ketamine is a tool, not a cure. Generally speaking, if you have suffered from major depression for as long as you can remember, you’ll likely need ongoing support. If you experienced a single traumatic event and suffer from acute PTSD, you may not need months or years of regular infusions. Every condition responds differently as does every person.
We do and encourage clients to take advantage of this service. Ketamine is a unique drug and you may find it challenging for those unfamiliar with it to understand the changes you have experienced. Talking to others who have undergone ketamine infusions can be extremely helpful and provide additional support that may be critical for your journey of healing.