For Health ProfessionalsMajor 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 are 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 might not be immediate. The earliest that you might expect to feel better is several hours after leaving the office.
We are now providing intranasal esketamine (SPRAVATO™) as well. Please call us to find out about possible insurance coverage.
Cost
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 be able to bill them on your behalf. We will however 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 line, second line medications, and to prescribe the ketamine) is complimentary. Ketamine infusions are $500 per infusion. The initial protocol is six infusions over the course of fourteen-day period ($3000 for the initial induction phase). Follow up ketamine infusions are dependent on the clients response to the medication but usually occurs every four weeks.
If you are physician or nurse calling from an emergency room, we will try to accommodate your patient within 24 hours.
Intranasal esketamine (SPRAVATO™) is newly approved and is now available at Veritas Health, PLLC for treatment resistant depression (TRD). We are an official designated provider of intranasal ketamine. As with ketamine infusions our psychiatrists must meet with you to determine if you do have treatment resistant depression and to prescribe the esketamine for you. The fee for this consultation is complimentary. We will try our best to get the medication approved through your insurance. At the moment co-pays vary greatly so please call us so we can help determine the out of pocket cost. The fee for administering the esketamine and monitoring for 2 hours is $200 per session. The drug itself must be administered at an approved facility, therefore one of our providers will need to meet with you to prescribe the medication. If your current psychiatrist is able to prescribe the medication, we can administer the medication in our facility and can then waive the initial consultation meeting. Please feel free to call us for more details on this process.
- Because of the possibility of delayed or prolonged sedation or dissociation in some cases, patients will be monitored by a healthcare professional for at least 2 hours following each treatment. Patients blood pressure will be monitored and if elevated can be controlled by medications.
- SPRAVATO™ may impair patients ability to drive, therefore patients will require transportation from our treatment center. Currently, we are not allowing patients to use lyft or uber and are requiring patients to be driven home by a friend or family member.
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?
Intravenous Ketamine is not, however nasal esketamine (SPRAVATO™) is FDA approved. They are the same drug (ketamine), absorption rates and the delivery process (intravenous vs intranasal) differs.
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 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. We will know within the induction phase of 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, TMS, or referral to NIH for possible enrollment in experimental medication trials.
How many infusions will I need and how long will I feel better?
A total of six is recommended within a fourteen 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. Unfortunately, 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?
We unfortunately do not know the answer to this as there are no term studies of ketamine or esketamine.
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. However medications such as lamotrigine and benzodiazepines might need to be tapered off.
Are there any medical conditions that will exclude me from treatment?
Yes, uncontrolled high blood pressure or heart failure need to be corrected before the use of ketamine.
How quickly can I be seen?
True emergencies, with a psychiatric referral, can be seen within a day. But, in general, three to seven days are required to get you onto the schedule. We will however try our best to accommodate any patient’s scheduling needs.
What is the cost?
The fee for a 30 minute consultation to see if ketamine or esketamine (Spravato) is an appropriate choice is complimentary. Each ketamine infusion is $500. We do not accept any private insurance, Medicaid 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.
We are working directly with patients, their insurance and speciality pharmacies to obtain SPRAVATO™ (esketamine) CIII Nasal Spray. Some patients have been able to obtain SPRAVATO™ (esketamine) for as low as $10 but unfortunately, others have received no coverage. The cost for the two hour sessions in which SPRAVATO™ (esketamine) CIII Nasal Spray is delivered is $200, also which may be reimbursed by insurance. Please call our offices at 202-525-5123 to speak with one of our patient care advocates. They will provide information on SPRAVATO™ (esketamine) insurance coverage and costs.
