Major depression is a disorder that is often successfully treated with antidepressants. These drugs are effective by changing the neurochemistry in the brain. While effective in most patients, unfortunately in a select few patients with severe or treatment resistant depression or those having thoughts of self harm- they may not work. For these patients, both Transmagnetic Stimulation and Electroconvulsive Therapy have been the only options. More recently researchers have found another neurotransmitter, glutamate, that might be effective in treating depression. In some cases, we now know that a subanesthetic dose of ketamine (a glutamate/NMDA receptor antagonist) can lead to clinically significant improvement.
Ketamine infusions in outpatient psychiatric practices are now available at Veritas Health, PLLC. The infusion takes about one hour (but clients should plan for up to 2 hours). We request that a friend or family member accompany the patient to take them home safely. Please note, that due to the anesthetic effects, you will experience some dissociation. Most patients find it pleasurable and non-threatening. If it does make you uncomfortable the infusion can be stopped, or medication given which will end the thoughts within a minute. It is rare that this is necessary. By the time you leave the office your mentation will be close to normal. Some patients are able to return to work and carry on an otherwise normal day. Other patients prefer to go home and take a short nap. The only restriction after leaving the office is no driving until the next day.
Your improvement in mood will not be immediate. The earliest that you might expect to feel better is several hours after leaving the office.
Our cost in providing ketamine infusions is not covered by insurance companies to the extent necessary to meet expenses. Therefore, we do not participate in any insurance plans and will not bill them on your behalf. We will provide you the necessary forms for you to submit to your insurance company after treatment for reimbursement to the extent that they will cover this service
The fee for the initial consult with our psychiatrists to make sure you have tried appropriate first and second line medications is $500. If the referral is made directly from a psychiatrist and is appropriate for ketamine– no initial consulation will be necessary. Ketamine infusions are $450 per infusion. The initial protocol is three infusions for the first week and six over the course of twelve-day period.
If you are physician or nurse calling from an emergency room, we will try to accommodate your patient within 24 hours.
Frequently Asked Questions
What is Ketamine?
Ketamine is a general anesthetic agent. It has been used in hospitals for decades and has a proven record of safety. The small doses and methods of administration used to treat psychiatric patients differ widely from those used in hospital operating rooms which allows us to use it in the outpatient setting.
Is this treatment FDA approved?
Not yet. Over the past two decades dozens of studies in prestigious medical centers and The National Institute of Mental Health have proven ketamine’s safety and efficacy in treating major depressive disorders, anxiety, obsessive compulsive disorders and suicide ideation. Yet, without very large controlled studies generally required by the FDA to get approval for any psychiatric drug, approval has been delayed. Ketamine is in phase 3 of clinical trials and we are hoping it gets to the FDA to make this drug more accessible to all who might benefit from it. We use “off label”, as is true with many other medications prescribed by physicians.
Will I be treated as an outpatient?
Yes, ketamine infusions for depression are outpatient procedures requiring no hospital admission.
Do I need a referral from a psychiatrist?
Ideally yes as we want to make sure oral antidepressants have been unsuccessfully tried. However, a consult with our psychiatrists will be required and if oral antidepressants are an option- they will most likely be tried first.
Is ketamine used to treat all patients with depression?
No, mild to moderate depression is successfully treated by mental health professionals with drugs and psychotherapy. The treatment of severe depression is more difficult and requires a higher level of care, such as ECT, TMS, and now ketamine. Ketamine infusion therapy is reserved for those patients with severe depression that is considered otherwise treatment resistant.
Is it likely that my severe depression will respond to ketamine infusion therapy?
The patients we see are all considered treatment resistant. That is, they have not responded to available antidepressant medications and in many cases have not responded to ECT or TMS. We cannot predict who will respond to ketamine, but statistically 2 out of 3 patients do show an improvement in their mood and 3 out of 4 will cease to have suicide ideation. We will know within two treatments if ketamine infusions will help you. If there is no benefit, we will let you know and help decide on an alternative treatment plan that might include referrals to ECT or TMS.
How many infusions will I need and how long will I feel better?
If you have a favorable response to the first two infusions, a total of six is recommended within a twelve-day period. That will maximize the ketamine effect. Thereafter, patients are placed on a maintenance program where they return when they feel it necessary for a single infusion booster. During the maintenance period, the duration of relief following the initial infusions and the first booster, and between subsequent single booster infusions varies between patients. The average duration of relief between booster infusions is 3 to 4 weeks. There is no way to predict what your needs will be.
If ketamine does work, will I be on it for the rest of my life?
No, right now ketamine infusion therapy is, perhaps, the most exciting and successful new treatment for severe depression. But, there are large pharmaceutical companies developing ketamine like drugs for more convenient nasal and oral administration. It may be a few years, but those drugs will become available.
Are there any medications that will interfere with ketamine treatment?
Yes. The benzodiazepines, such as Klonopin, Xanax, and Ativan do interfere with ketamine if used daily and at higher doses. Lamictal (lamotrigine) in doses above 100mg/day also can block ketamine efficacy. These medications will have to be stopped before Ketamine is administered.
Will I have to stop other antidepressant medications?
No, other antidepressant medications do not interfere with ketamine’s mechanism of action.
Are there any medical conditions that will exclude me from treatment?
Yes, uncontrolled high blood pressure or heart failure need to be corrected.
How quickly can I be seen?
True emergencies, with a psychiatric referral, can be seen within a day. But, in general, five to seven days are required to get you onto the schedule. Since we are here seven days a week we can meet most patient’s scheduling needs.
What is the cost?
The fee for each infusion is $450. We do not accept any private insurance or Medicare, but will provide you with the forms to submit for reimbursement. As of now about 35-40% of patients are receiving some reimbursement, but we cannot predict if your insurance plan will reimburse you.
In support of our Veterans of the United States military suffering with PTSD, we encourage you to call us for special fee consideration. Other fee considerations will be on a case-to-case basis.