Frequently Asked Questions About Ketamine Therapy

Is ketamine a legal medication?

Yes, ketamine is a legal medication that has been used for over 50 years as an anesthetic and analgesic. It was approved by the FDA as an anesthetic in 1970. Ketamine is now also being used off-label as a treatment for various mental health conditions that are treatment-resistant, such as depression, anxiety, PTSD, substance dependencies, and other psychiatric diagnoses.

How does ketamine work?

Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. While the exact mechanism of how ketamine works for patients with depression, anxiety, and other mental health conditions is not fully understood, scientific research suggests that it enhances excitatory (glutamatergic) neurotransmission and increases protein synthesis. The initial activation of the glutamate receptors leads to up-regulation of neurotrophic signaling and increased protein synthesis. Blocking the NMDA receptor produces an initial antidepressant reaction, and the synthesized protein is responsible for prolonging the duration of the effects.

Is ketamine addictive?

Ketamine is a Schedule III controlled substance under the Controlled Substance Act of 1970. Medical evidence suggests that ketamine has a low risk for addiction. While ketamine can have effects on mood, cognition, and perception that may make some people want to use it repeatedly, the problem with the abuse of ketamine is rarely seen in clinical practice given the limited access, psychoeducation of responsible use, and close monitoring. However, ketamine has been known to be a drug of abuse in recreational settings. Because of its potential for abuse or psychological addiction, ketamine should never be used except under the supervision of a licensed physician.

What is ketamine-assisted psychotherapy?

Ketamine-assisted psychotherapy (KAP) is a form of psychotherapy that incorporates the use of ketamine to facilitate treatment. At Isha Health, we believe that ketamine administration is most effective when combined with psychotherapy. The KAP protocol can vary depending on the specific mental health conditions being treated. During the initial intake, we evaluate your current problems and needs, go over your medical and psychiatric history, and address any questions or concerns you may have. Based on our evaluation, we will offer our clinical impressions and recommendations for your individualized treatment plan.

What can I expect from an at-home ketamine therapy session?

At Isha Ketamine Clinic, we prescribe a low dose of ketamine for at-home therapy sessions. This approach is often referred to as the psycholytic approach, which sees ketamine as a catalyst for unlocking deeper and more impactful therapy sessions. Unlike higher doses used for anesthesia, the low dose ketamine we prescribe will not cause dissociation but will provide relaxation and an open-minded state of mind.

What does it feel like when I take ketamine for depression?

Ketamine can produce different effects in different people, but generally, when taken in low doses under medical supervision, it can result in a rapid antidepressant effect. Some individuals may experience a sense of relief, improved mood, and mental clarity after ketamine therapy for depression. However, others may experience a temporary sense of detachment or dissociation during the treatment, which can be uncomfortable or distressing.

What should I do if I have never taken ketamine before?

If you are new to ketamine therapy, we recommend starting with a half of the troche, which is a small lozenge-like tablet that dissolves in your mouth. Keep the troche inside your mouth for 10 minutes, then spit it out. If you feel little effect after a few minutes, you may take the second half of the troche in the same manner. For your first two therapy sessions, we recommend that you have a support person present who can assist you with simple tasks such as going to the bathroom or getting a glass of water. As you go deeper into the experience, the support person can help you stay grounded.

How long do the effects of ketamine therapy last?

Ketamine therapy can lead to positive changes in mood and cognition during the treatment, as well as cumulatively over several weeks with repeated dosing. The optimal dosing for ketamine therapy varies for each individual, and some may require adjustments to find the optimal dose. The duration of the effects of ketamine therapy can also vary depending on the individual and the condition being treated.

What are the risks of ketamine therapy?

While ketamine therapy is generally considered safe and effective, there are potential risks associated with the treatment. These may include impaired balance and coordination, blurred vision, slurred speech, confusion, excitability, anxiety, nausea, and vomiting. Ketamine can also cause a significant increase in blood pressure and heart rate. In rare cases, ketamine can worsen certain psychotic symptoms in individuals with serious mental disorders. During the treatment itself, some people may experience frightening or unusual experiences, which is part of the therapeutic process. It is important to receive psychotherapeutic help and ongoing guidance from your therapist during ketamine therapy.

How much would the medication cost?

The cost of medication can vary depending on several factors such as the type of medication, dosage, and your location. In general, a 30-day supply of medication can cost anywhere from $50 to $100 or more, depending on where you live in the country.

Will I need to pick up my medication from the pharmacy?

No, you won't need to pick up your medication from the pharmacy. The compounding pharmacy will directly ship the medication to your home address for your convenience.

What is the significance of set and setting in ketamine treatment?

Set and setting are important considerations for ketamine treatment as they can significantly impact the patient's experience and treatment outcomes. "Set" refers to the patient's mindset and expectations prior to treatment, including their mental and emotional state and beliefs about the treatment. "Setting" refers to the physical and social environment in which the treatment takes place, such as the physical space, lighting, temperature, and the presence of others.

Patients who have a positive mindset and realistic expectations are more likely to have a successful outcome. Similarly, a comfortable, calming, and supportive environment can help to reduce anxiety and improve the patient's overall experience. At Isha Health, our clinicians provide support and guidance to help patients prepare mentally and emotionally for their ketamine treatment. This approach can help to enhance the therapeutic effects of the drug and reduce the likelihood of adverse effects.

Is ketamine therapy a suitable treatment for me?

If you are struggling with depression, anxiety, or PTSD and have not found relief from traditional treatments such as medication, psychotherapy, and self-care, ketamine therapy may be a suitable option for you. Many individuals who have not responded to these traditional treatments have found significant benefits from ketamine therapy. If you feel like your current treatments are not working, it may be worth exploring ketamine therapy as an alternative option.

How long is the medical evaluation appointment for ketamine therapy?

The initial medical evaluation appointment for ketamine therapy is scheduled for 40 minutes, while the follow-up appointment is for 30 minutes. Additionally, free 15-minute check-ins with a doctor can also be booked.

What is superbill?

A Superbill is a document used in the healthcare industry to provide a summary of services rendered by a healthcare provider to a patient. The document is typically created by the healthcare provider's office and contains a detailed breakdown of the services provided, along with the corresponding charges.

Superbills are commonly used by healthcare providers who do not bill insurance companies directly, such as naturopathic doctors, acupuncturists, or chiropractors. Patients can submit Superbills to their insurance companies for reimbursement of the services they received. Superbills may include information such as the date of service, the diagnosis, the CPT (Current Procedural Terminology) codes used to describe the services rendered, and the charges for each service.

Superbills can help healthcare providers to save time and money by streamlining the billing process, as they can eliminate the need for detailed invoices or explanations of benefits. They can also help patients to better understand the costs associated with their healthcare and enable them to submit claims for reimbursement more easily.

Can I eat or drink before my ketamine-assisted therapy (KAT) session?

To minimize the risk of nausea or vomiting during the session, we recommend that you do not eat for at least four hours and do not drink for at least two hours before your ketamine dosing session. However, it is important to stay hydrated, so we encourage you to drink plenty of water in the hours leading up to your session.

Do I need to receive ketamine therapy through injections?

No, at Isha Health we offer oral ketamine therapy. We partner with reputable compounding pharmacies that ship the medication directly to your home, making it a convenient and accessible treatment option.

Is ketamine therapy covered by insurance?

We issue superbills for ketamine therapy. While ketamine therapy is not typically covered by insurance, some insurance plans may cover certain aspects of the treatment. We encourage patients to check with their insurance provider to determine what is covered under their plan. However, we do issue superbills, which patients can submit to their insurance provider for possible reimbursement. A superbill is a detailed invoice that includes all the necessary codes and information that insurance companies require for reimbursement.

Can I continue taking my current medications during ketamine therapy?

It is important to inform your ketamine therapy provider about all the medications you are currently taking, including over-the-counter medications and supplements, as they may interact with ketamine. In general, it is recommended that you continue taking your current medications as prescribed by your primary care provider or psychiatrist. Your ketamine therapy provider may work with your current treatment team to coordinate your care and adjust your medications as necessary. However, any changes to your medications should be made under the guidance and supervision of your primary care provider or psychiatrist.

How long does it take to feel the effects of ketamine?

The onset of effects from a ketamine lozenge can vary, but typically it takes around 20-30 minutes to begin feeling the effects. However, the full effects may not be felt until up to 60-90 minutes after taking the lozenge. The effects can last for several hours after the peak effects are felt. It's important to note that the effects of ketamine can vary between individuals and the dosage administered.

Can I drive after a ketamine therapy session?

No, you should not drive or operate heavy machinery for at least 12 hours after a ketamine therapy session. Ketamine may impair your coordination, reaction time, and cognitive function, and it is important to allow time for the effects of the medication to wear off before driving or engaging in any activities that require alertness and focus. It is recommended to have a support person to accompany you home after the session.