FAQ's

Ketamine is an anesthetic medication and pain reliever that has been used during surgery for many decades. In this role, it’s so common and safe that it’s often recommended for pediatric surgeries. When used as an anesthetic in this way, ketamine is administered in high doses.

In recent years, however, ketamine has been clinically shown to be effective in treating certain mental health and chronic pain disorders. To treat these issues, ketamine is administered in low doses using an intravenous process in a medical office setting.

These low-dose treatments effectively relieve pain and help to balance brain chemicals associated with mental health disorders. Research has shown ketamine administered in this way to be exceptionally effective for depression, and now emerging studies show it may be just as beneficial for quick relief of anxiety even in patients whose anxiety didn’t respond to other medications.

There is extensive research showing that Ketamine can be quite effective at treating depression and suicidal ideation. While the data are less robust, there is also growing research that it is helpful for treating other mental health disorders such anxiety, PTSD, and OCD. In our clinical experience, we have also seen success in treating a variety of mental health conditions with IV Ketamine infusions.

Mental health providers, like a psychiatrist, are specifically trained to diagnose and treat mental health disorders, often using a combination of medication, therapy, and behavioral interventions. Other providers who offer Ketamine treatments (such as anesthesiologists or emergency medicine physicians) have no formal training on the diagnosis or management of these disorders and may miss important features of your condition. While some non-psychiatrist ketamine providers may take a weekend or even multi-month mental health course, this is no substitute for years of training and experience working with conditions of the brain and mind. Just as you wouldn't see a psychiatrist for sedation during surgery, it doesn't make sense to see an anesthesiologist to treat your depression. Getting treatment from a trained mental health provider allows for a more thorough and thoughtful approach.

This extensive experience has allowed us to develop an expertise in the field with effective treatment protocols that maximize a patient's response while ensuring their safety. We have treated a diverse range of patients and observed firsthand that each patient is unique. This clinical experience allows us to expertly adjust treatment plans based on each patient’s specific needs. There is no substitute for evidence-based practice coupled with extensive experience.

When seeking a clinic for Ketamine or Spravato treatments, you should look for a board-certified mental health provider--ideally, a psychiatrist--with extensive experience administering these medications.

Other characteristics of a reputable clinic include strong protocols and procedures for both patient safety and appropriate treatment candidate selection. The rapid increase in the number of ketamine clinics in recent years has unfortunately led to the rise of some clinics that employ practices that are questionable at best. Similarly, the increase in online startups that deliver ketamine with little to no examination or supervision can expose patients to scary or even unsafe experiences. Ketamine and Spravato can be powerful treatment options for those struggling with depression, CRPS, or other conditions that have not responded to traditional treatments, but they should only be done in a clinical setting with a specialized and experienced team of medical and mental health professionals.

Lastly, you'll want to choose a clinic that is comfortable and calming with a team that is caring and compassionate. At PAMB, all of our staff are carefully selected and highly trained by Dr. Ghorieshi, a Stanford-trained, double board-certified psychiatrist and addiction medicine specialist who was a pioneer in the use of ketamine in the treatment of mental health conditions. We have administered over 20,000 Ketamine/Spravato treatments and strive to make these advanced treatments accessible and affordable to all who need them while maintaining the extremely high level of care and service of our concierge roots.

Ketamine treatments may be the right choice when traditional psychiatric medications, talk therapy, or pain management treatments have been ineffective or provided inadequate relief. For example, if you have tried at least two antidepressants but are still experiencing depressive symptoms, Ketamine/Spravato could help you feel better or even reach complete remission of your symptoms.

A trained medical professional will monitor you for the duration of your treatment and up until you are ready to be escorted to your ride home. We follow specific safety protocols that include monitoring of vital signs. All medical professionals are trained to recognize and address any adverse reactions to treatment.

Fasting before Spravato or Ketamine treatment is recommended to reduce the risk of nausea and vomiting. Patients are advised not to eat for at least two hours before and not to drink liquids for at least 30 minutes before taking Spravato. Regarding IV Ketamine treatments, patients are advised not to eat for at least six hours before and not to drink liquids for at least two hours before treatment. We also have medications that may be administered with your treatment to help minimize any nausea/vomiting.

The number of treatments delivered with IV Ketamine or Spravato is determined by several factors, including evidence-based science, clinical experience, and each patient's unique circumstances. That being said, we believe a full course of Spravato or IV Ketamine is essential to bring robust, long-lasting results. Many people have read online that they "should" feel better after a single treatment; while that is possible, it is the exception not the rule, and most patients need a full initiation to reach the best outcome.

Spravato has a structured, FDA-approved protocol that starts with two treatments a week for at least four weeks. Protocols for IV ketamine can vary greatly, as the studies around IV ketamine for depression were conducted with anywhere between 6 to 12 infusions for initiation. Through our experience of delivering thousands of treatments, we have found an initiation phase of 8 infusions in about two weeks to be most effective in rapidly and effectively improving symptoms. After the initiation phase, both Spravato and IV ketamine require maintenance to continue the progress you've made.

Some conditions have specific protocols. For example, for the treatment of Complex Regional Pain Syndrome (CRPS), we use the Cleveland Clinic protocol of up to 10 high-dose, extended-duration IV ketamine infusions to bring relief from CRPS's often-debilitating symptoms.

All this being said, we never require patients to commit to a specific protocol or number of treatments up front. Rather, we will make treatment recommendations based on clinical data and then work with you collaboratively to help you decide what is best for you.

While the exact mechanism is still unknown, it is hypothesized that Ketamine works by modulating the activity of glutamate, a key neurotransmitter involved in learning and memory. Unlike traditional antidepressants that target serotonin, norepinephrine, or dopamine; glutamate acts more quickly to promote the reactivation of existing neural pathways and the formation of new ones.

This increase in neural connectivity supports improved mood, reduced negative symptoms, and the ability to engage in more positive thoughts and behaviors—often within a shorter timeframe than conventional antidepressants.

You can find out more about this subject by reviewing blogs and articles or to speak with a member of our clinical team. Here are some links to more information. https://medium.com/@DrGhorieshi/depression-as-disease-the-case-for-ketamine-d9feb1a7a5be.

Traditional antidepressants target neurotransmitters such as serotonin, norepinephrine, or dopamine. However, it is hypothesized that Ketamine works by modulating the activity of glutamate, a key neurotransmitter involved in learning and memory. Glutamate acts more quickly to promote the reactivation of existing neural pathways and the formation of new ones. This increase in neural connectivity supports improved mood, reduced negative symptoms, and the ability to engage in more positive thoughts and behaviors—often within a shorter timeframe than conventional antidepressants.

While research comparing the two medications is limited, we do know that both can effectively treat depression. There are some studies showing similar efficacies and others showing a more rapid or slightly better response with IV Ketamine. However, according to a recent meta-analysis of real world outcomes, Spravato has been shown to have a similar effectiveness and is significantly less costly for patients compared to IV Ketamine, making this type of treatment more affordable and accessible to those with treatment-resistant depression.

For the remainder of the day of your treatment, you should not drive, operate machinery, or make any important decisions. You should also limit or abstain from other non-prescribed substances that may impact your thinking or the Ketamine/Spravato treatment process.

While Ketamine and Spravato are controlled substances that carry and addictive potential, when they are used in clinic under direct medical supervision, the risk of addiction is quite low. However, individuals who have a history of a substance use disorder may be at a greater risk of developing problematic use of these medications and/or reinstatement of a prior addiction. Depending on your specific situation, you may still be a candidate for Ketamine/Spravato treatments even if you have a history of a substance use disorder. A provider can meet with you to thoughtfully weigh the potential risks and benefits of treatment. Interestingly, there is some growing research that Ketamine may actually be helpful for the treatment of addictive disorders such as alcohol use disorder, but more research is needed in this area.

Yes. Ketamine and Spravato can be very effective treatment options for patients who are struggling with suicidal ideation. In fact, Spravato is specifically FDA approved to treat depressive symptoms in patients with major depressive disorder (MDD) with suicidal thoughts or actions. Suicidal thoughts can sometimes reduce or resolve completely after just one or two Ketamine or Spravato treatments.

Since we provide treatments on an outpatient basis, patients must be able to keep themselves safe at home. If you are experiencing any active plan or intent to harm yourself, please seek emergent care now by calling 911 or going to the nearest hospital emergency department. After inpatient care, we can continue your interventional treatments as an outpatient.

While most patients tolerate treatments quite well, some of the most common short-term side effects include dissociation, disorientation, dizziness, blurred vision, drowsiness, nausea, and increased blood pressure.

Studies on the long-term effects of Ketamine have mostly been done in patients who abuse ketamine (that is, use high doses very frequently for non-medical reasons); this research shows the potential for the development of bladder problems, liver/kidney problems, and cognitive impairment. We do not frequently see these complications when Ketamine or Spravato are being used appropriately (ie, lower doses and frequency) in a clinical setting under the direct supervision of a mental health provider. However, we are mindful of these possible complications, and our team is continuously monitoring your response to treatment.

During your intake appointment, a provider will go over a detailed list of all the possible side effects.

In addition to being safe, ketamine is fast-acting. It quickly balances the activity of a neurotransmitter called glutamate, which in turn lessens the symptoms of mental health disorders such as depression. Our holistic approach combines the ketamine treatment with other treatments to ensure a comprehensive and personalized approach to mental health and well-being.

Ketamine often creates a temporary distortion in perception (many call it an out-of-body feeling) for a few hours after treatment, so it is only administered in a clinical setting by practitioners trained in how to deliver the medication, monitor for side effects, and guide you through the process. You’ll relax in the clinic while the medication takes effect and you are cared for by our trained staff.

After treatment, you may resume your usual activities with the exception of driving, operating machinery, or making any major decisions for the remainder of the day.

Yes, you will need time to recover both in-clinic and later at home. You will be monitored for about 1.5 to 2 hours after you begin an IV Ketamine or Spravato treatment, and then a provider will clear you for discharge before you are escorted to your ride home. Once at home, try to rest and relax and focus on your health. While most people feel back to their regular selves once they are back home, you may not drive, operate machinery, or make important decisions for the remainder of the day.

You really don't need to bring anything specific with you, as we can provide most everything you need. However, some patients like to bring personal items such as headphones and music they find soothing or anything else that may bring them calm and comfort.

While we won't stop anyone from working or playing a game during treatment, we encourage you to think of your treatment as time for you and your health and to be present with your experience.

Both Spravato and IV Ketamine can effectively treat depression. Spravato is FDA approved for the treatment of treatment-resistant depression as well as depressive symptoms in adults with MDD and acute suicidal ideation or behavior. For this reason, Spravato can be a great option that is often covered by insurance. If you are interested in using Ketamine to treat another mental health disorder such as bipolar depression, OCD, PTSD, or anxiety; IV Ketamine may be the way to go, as Spravato is not approved for these uses. A provider will discuss these options with you in more detail to find the best fit given your specific needs.

No. We strongly believe that Ketamine treatments are safest and most effective when used under the direct supervision of a trained mental health provider in a clinical setting. Using a strong dissociative medication like Ketamine without a medical professional present may lead to an unpleasant, dysphoric, or even dangerous experience. Additionally, the FDA requires that S-Ketamine (Spravato) treatments take place in a pre-approved healthcare setting.

The interval where a patient continues to feel good is highly variable but at some point, most patients will start to notice a gradual return in symptoms, requiring a maintenance or "booster" treatment.

Maintenance treatments are often an essential part of ongoing care. The interval where a patient continues to feel good is highly variable but at some point, most patients will start to notice a gradual return in symptoms, requiring a maintenance or "booster" treatment.

Our clinical team works closely with each patient to determine the most appropriate long-term approach to help sustain their progress and symptom relief over time.

Over time, physicians who administered ketamine to patients began to notice that the drug appeared to help lift severe depression and even gave patients a reprieve from suicidal thoughts. After extensive research, ketamine and its derivative S-ketamine (phoneticized as "esketamine" and marketed under the brand name Spravato™) are now recognized as an evidence-based treatment in patients for whom other depression therapies have proven ineffective or insufficient. To simplify things, the majority of this page will refer to both ketamine and S-ketamine as just "ketamine."

These are names for the documents that define your insurance plan--effectively the contract that your insurance has with you for your benefits. While other providers like your PCP or primary psychiatrist may not need this detailed document, the intricacies of getting coverage for interventional treatments like Spravato and ketamine often require us to be aware of the minutiae of your plan to make sure you get the insurance benefits to which you are entitled (and have already paid for). You can often find your plan documents through your online insurance portal, by contacting your HR, or by calling your insurance provider.

Low-dose ketamine may be administered in several ways: oral, sublingual (under your tongue), intranasal, rectal, intramuscular injection, and intravenous (aka IV) infusion. However, not all methods achieve the same success. Dr. Ghorieshi offers intravenous infusions which have been shown to deliver the highest, most optimal results.

Ketamine is a medication that was initially developed for use as an anesthetic. In the 1960s, the drug was used to sedate animals during surgery and other procedures. Ketamine received FDA approval for use in humans in 1970 and was instrumental in treating battlefield injuries during the Vietnam War.

Our ketamine clinic provides a safe, calm, and welcoming environment where healing can truly begin. With a focus on comfort and professionalism, our setting is designed to promote relaxation and peace of mind which allows our patients to fully engage in their treatment. We avoid the exam- and surgical-tables you may see in other offices or an anesthesia suite and instead opt for comfortable, homey furnishings.