Your Ultimate Guide to Ketamine Therapy:

Ketamine is a safe, effective anesthetic (medication used to reduce pain or cause sleepiness) that has been in use worldwide since 1970. It has been listed as one of the world’s most essential medicines by the World Health Organization (WHO) since 1985. Multiple studies since 1990 have shown that ketamine is exceptionally effective in treating depression, post-traumatic stress disorder (PTSD), anxiety, suicidal ideation, pain disorders, and other psychiatric disorders. Ketamine is fast-acting and can sometimes show immediate efficacy after a single dose. Because of its fast-acting nature, ketamine can be an extremely important tool in preventing suicide and immediately alleviating the suffering caused by depression, anxiety, pain, and stress.

Depression, anxiety, pain, and stress cause damage in areas of the brain responsible for memory, learning, and thinking.

Ketamine works by boosting the materials necessary to make repairs to this damage. One such material is called brain derived neurotrophic factor (BDNF). BDNF helps with the growth of synapses, which are the connectors between brain cells.

Ketamine also works on a chemical called glutamate. There are 3 types of glutamate receptors in the brain: NMDA, AMPA, and kainite. Ketamine can bind to these receptors, causing important activation and growth in the brain. More activation and more growth lead to flexibility of thinking and a reduction in mood/anxiety/pain symptoms.

Please call 512-985-9301 and ask for a Ketamine Consult.

Or visit our “Contact Us” page and request an appointment. We will call you back shortly to set up an appointment.

Your provider will spend approximately 30-60 minutes with you, getting to know you, answering your questions, and determining if Ketamine Assisted Psychotherapy is right for you.

Immediately after your consult, our office will schedule your ketamine assisted psychotherapy treatments.

Each ketamine appointment will take approximately 2 hours from beginning to end.

ARRIVAL (15 minutes): On arrival, your vital signs (heart rate and blood pressure) will be assessed. You will also be given tests to measure your mood. These will be repeated periodically during your treatment. Ketamine will then be given intranasally, orally, or sublingually. It will take a few minutes before the effects of Ketamine start working.

KETAMINE ASSISTED PSYCHOTHERAPY (60 minutes): During the treatment, you will notice you feel different. Your defenses/ego may be relaxed and you may see yourself in a different light, hopefully with more positivity and compassion. Your therapist will guide you through imagery that may appear and through thoughts/emotions that occur about your past, present, and future. You may feel “dissociated.” We will make sure you are safe and comfortable throughout the experience.

RECOVERY (up to 45 minutes): After the treatment, you will remain in the recovery room to make sure that you have recovered and are safe to leave with your pre-arranged transportation.

That is determined on a case-by-case basis.

With ketamine assisted psychotherapy treatment, patients usually undergo 1-2 treatments a week for 3-6 weeks. We recommend 6 treatments total.

After your treatment series is complete, you and your provider can discuss the risks and benefits of maintenance Ketamine treatments (i.e. Ketamine treatments at less frequency to maintain the benefits from the initial treatment series).

The initial consultation is $100. If you are an appropriate candidate, we will move forward with ordering Ketamine at your individualized dose and individualized route (i.e., Intranasal, Sublingual, or Oral). The one-time cost for the medication is $100.

Each treatment is $350. We offer a 7% discount for those who pay upfront for the 6 treatment series ($325 per treatment; $1950 for 6 treatments).

While we cannot predict with certainty who will respond to ketamine, clinicians across the country have reported that roughly 65%-75% of patients who have not been helped by any other treatment do show a dramatic improvement in their psychiatric symptoms with ketamine infusions, 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 ketamine infusions.

There are 5 different routes that ketamine can get into the body. Each route has a different bioavailability. What’s bioavailability, you ask? It’s the amount of medication that your body is actually able to use-- the portion that treats what’s bothering you (the rest is altered, digested, excreted, or otherwise discarded by your body).

The bioavailability of IV ketamine is 100%, so what you get is actually what the body uses. The downside of IV Ketamine is that it is logistically more complicated to get because it requires more monitoring and a needle being stuck in your blood vessels, and it is quite expensive (about $600-800 a treatment, which is not covered by insurance).

The bioavailability of IM ketamine about 93%. The downside of IM Ketamine is that it is a bit unpredictable. There’s no way to determine how much time it will take the ketamine to leach out of the muscle, or how much of it will leach out and into your bloodstream, so it can reach your brain. It also requires a needle stick and can be expensive.

The bioavailability of intranasal ketamine is about 25-50%. The downside of IN Ketamine is that it can irritate the nose. The bioavailability may be lessened by poor administration (it has to pass through your nose mucous membranes to reach your bloodstream).

The bioavailability of oral and sublingual ketamine is about 20-35%. The downside of O and SL ketamine is that it tastes bad and you will need a higher dose to achieve the same effects of the IV, IM, and IN routes.

Ketamine is a compound made of two molecules, esketamine (s-ketamine) and arketamine (r-ketamine). Esketamine and arketamine are enantiomers (i.e. mirror images) of each other. They are stuck together, like conjoint twins, to make the compound ketamine. Studies have shown that both the esketamine and arketamine molecules are active and have healing powers for mood, anxiety, and pain.

Some drug developers thought that the esketamine molecule was more potent, so they detached it from its conjoint twin arketamine. The esketamine molecule alone was then packaged, studied, and marketed. Esketamine is now being used as an intranasal spray (the only form that it is available in) called Spravato. Spravato comes in two doses—56 mg and 84 mg.

Currently cited costs of Spravato (esketamine) are $590 for the 56 mg dose and $885 for the 84 mg dose. Insurance companies may cover these costs.

In comparison, intranasal ketamine (i.e. the arketamine and esketamine stuck together) costs about $50 for a 60 mg or 80 mg dose. Ketamine is inexpensive as it has been off-patent (i.e. generic rather than a brand medication) for decades.

There have been no head-to-head trials between intranasal ketamine and intranasal esketamine to determine which compound is “better.” It is our belief that both work well.

Simply put, it’s easier to administer. Because of this, it is less expensive and therefore more accessible to a greater number of people.

We use oral, intranasal, and sublingual Ketamine. Because these routes have less “bioavailability” than IV or IM ketamine, we administer a higher dose to accomplish the same effect.

Ketamine has an extensive safety record and has been used at much higher doses for surgical anesthesia without complications.

The effects of ketamine on pregnancy have not been studied and it is therefore advisable to avoid this treatment during pregnancy.

Other effects may include dissociation, dizziness, nausea/vomiting, sedation, double vision, headache, high blood pressure, anxiety or lethargy. Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and bladder dysfunction.

Ketamine is not recommended for individuals with schizophrenia or those currently experiencing a manic episode.

Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Ketamine is classified as a hallucinogen.

There is no evidence for addiction or dependence if ketamine is taken as medically prescribed. Therefore, ketamine should never be used except under the direct supervision of a licensed physician.

Not at all.

Antidepressant medications do not interfere with ketamine’s mechanism of action.