About IV Ketamine

How many treatments does it take until I start feeling better / How quickly does ketamine work?

Patient responses to treatment can be highly variable. While some patients will notice immediate improvements after just one treatment, most patients will require a series of treatments before they start to feel better. Feeling better after one or two treatments is the exception, not the rule, so we recommend that you complete the full course of treatment before evaluating efficacy.By comparison, commonly used antidepressants such as selective serotonin reuptake inhibitors take weeks to produce symptom relief.

Does the IV infusion hurt?

Our nurses and providers have extensive experience starting IVs, making it as quick and painless as possible. After the initial prick, you should not feel any additional pain. 

What does an IV Ketamine Treatment feel like?

The dissociative sensations experienced during IV Ketamine (and Spravato (esketamine)) treatments is often described as alterations in perception, consciousness, and bodily awareness. These experiences can vary significantly among individuals, ranging from calming and insightful to disorienting or unsettling. Common descriptions are out-of-body experiences, altered time perception, sensory distortions, and emotional detachment. This sensation typically begins shortly after the medication is administered and can last anywhere from several minutes to hours, depending on the individual, type of treatment, and dosage. A trained medical professional is always monitoring you throughout the experience and assisting when needed. We make every effort to ensure you have a pleasant experience while the medicine takes effect.

Why do different clinics have different treatment protocols?

You may notice that treatment protocols vary depending on the clinic. Our specific protocol is based on evidence-based research and years of clinical experience, having delivered over 20,000 Ketamine/Spravato treatments. We may also adjust your specific protocol depending on your unique circumstances. 

If I showed no significant improvement with Spravato, why would IV Ketamine be an option? 

While IV ketamine and Spravato (esketamine nasal spray) are thought to have a similar mechanism of action and both are effective treatment options, they are technically different medications. As a result, we have seen that some patients respond better to Spravato and some patients respond better to IV Ketamine. A provider can work with you to determine the best treatment option given your specific situation. 

Can we go up beyond the "max" dose if I am not responding?

Your provider will determine your recommended dosage based on factors such as your weight, how you are responding to treatments, and how you are tolerating treatments. There are situations in which your provider may not recommend further increases in your dosage because of a lack of indication or potential safety concerns; similarly, there are times when a higher dose is medically necessary. It all depends on your clinical needs.

Can IV Ketamine be a treatment option for someone with a history of substance abuse?

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.

Where should I go to get my IV Ketamine treatment?

We believe strongly that a psychiatric clinic is the best treatment setting. IV Ketamine treatments are administered under the direct supervision of a medical doctor and the supporting medical staff. It is highly recommended to only receive ketamine treatments at a facility managed by a psychiatrist who is a trained expert in mental health and authorized to manage medications for mental health issues.

Some clinics that offer ketamine infusions are managed by other types of medical professionals who are not mental health experts. Palo Alto Mind Body is managed by Dr. M Rameen Ghorieshi, who holds dual board certifications in psychiatry. He is supported by a team of highly trained and experienced providers who specialize in ketamine infusion treatments.

Why is IV Ketamine so effective?

When you get an IV Ketamine infusion, 100% of the medication is introduced into your bloodstream. Unfortunately, other methods are unreliable and yield a much lower bioavailability or absorption into your blood.

For example, oral absorption can be as low as 16% and nasal spray as low as 8%, while sublingual and intramuscular administration can vary widely often have inconsistent and unsuccessful results. The slow, consistent, and controlled delivery of IV Ketamine has been shown to be far more beneficial and successful than all other methods.

Is IV ketamine treatment safe?

While there are potential risks with any medication, Ketamine is generally regarded as quite safe when it is used appropriately and under the direct supervision of a medical professional. It interacts with few medications and is a unique anesthetic in that it preserves a person's upper airway tone and protective airway reflexes. While we have extensive emergency equipment and training to manage any serious reaction, we have thankfully never needed to do in our over 20,000 Ketamine/Spravato treatments.

Are there medical or psychiatric conditions that would disqualify me for IV Ketamine treatments?

While Ketamine treatments are generally safe for most people, you may not be a good candidate in a few circumstances: for example, if you are pregnant or breastfeeding; engaging in active substance use; have uncontrolled hypertension or hyperthyroidism; or have a history of aneurysms, stroke/brain bleed, increased intracranial pressure, severe liver dysfunction, cardiovascular disease, or psychosis. That being said, we always take an individualized approach to your care, weighing the risks and benefits of treatment in your unique situation. If you have a condition that you are concerned about, please call our team to discuss.

Will my insurance cover IV Ketamine?

Because Ketamine is not FDA approved to treat depression or other mental health conditions, most insurance companies will not cover the cost of treatments. However, some insurance plans do. For example, PAMB has a specific contract with the Veterans Health Administration to provide coverage for these treatments if they are recommended by your VA provider. There are also some unique circumstances in which IV Ketamine treatments may be covered (eg, specific insurance plans or if you have tried and failed meds, TMS, and ECT in the past), and we are happy to further explore this with you. If Ketamine treatments are not a financially feasible option for you, Spravato (intranasal esketamine) is also an efficacious option that is covered by almost all insurance plans.