Frequently Asked Questions for Providers:
What is Ketamine?
Although ketamine has been around for more than 50 years as an anesthetic agent, “off-label” ketamine therapy for the treatment of mental health disorders, suicidal ideation, psychological exploration and chronic pain is an exciting intervention that has shown potential benefits and is supported by a growing body of research. In March 2019, the FDA approved the esketamine nasal spray Spravato for treatmentresistant depression and in 2020 extended approval for treatment of adults with Major Depressive Disorder and acute suicidal ideation or behavior. Ketamine therapy is being touted as one of the biggest breakthroughs in mental health disorders in recent years.
Ketamine affects multiple neurotransmitters and works on different pathways in the brain compared to conventional antidepressants. Ketamine is believed to lead to neuroplasticity and affect new changes in the brain. Ketamine can produce rapid, temporary changes in mood and pain symptoms. Patients often need more than one medication session during the initial treatment phase to sustain benefit. Additional psychological support can help to prolong the effects of ketamine. Positive changes have been observed in areas of the brain involving memory, attention, cognitive flexibility, learning and executive functioning.
How is Ketamine used?
Medical professionals are finding more and more uses for ketamine. Although ketamine can be administered in many forms (pills, creams, sprays, sublingual tablets, suppositories, intramuscular/intravenous injections, and as infusions), IV ketamine infusion therapy is the most common and most researched route of administration for treatment-resistant depression and other chronic mental health and pain conditions.
Some of the other areas where ketamine has been shown to be effective include:
- Post-traumatic stress disorder (PTSD)
- Suicidal ideation
- Social anxiety disorder
- Palliative care
- Eating disorders
- Substance use disorders
- Bipolar disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder (OCD)
- Neuropathic pain
- Complex regional pain syndrome (CRPS)
How is ketamine administered?
At Ventura Center for Advanced Therapeutics, Dr. Wolfsohn offers several types of ketamine treatments. Except for the FDA-approved esketamine intranasal spray, all other ketamine treatments offered use generic, racemic ketamine and are considered “off-label” at this time. Slow, intravenous (IV) infusion is the most common route of administration for ketamine. IV ketamine therapy is often combined with IV hydration, supplements and other medicines which can extend the effects of ketamine and make your treatment experience more comfortable.
Dr. Wolfsohn is also able to offer intramuscular, sublingual/oral and intranasal ketamine therapy as an alternative for patients who may not be able to receive IV therapies. Patients may consider choosing intramuscular or sublingual ketamine treatments as a cost effective alternative to IV ketamine therapy. All routes of administration of ketamine therapy offered are discussed in detail with patients during the new patient consultation so that patients can make an informed decision about their care.
How soon after a ketamine infusion will I feel better? How long does it last?
Patients receiving IV ketamine infusions can report “feeling better” during the infusion experience and can often sustain that feeling well after the drug has been metabolized and eliminated from the body. “Feeling better” can be a subtle change and you may notice an improvement in your day-to-day function before you notice an improvement in your mood or pain. This effect has been reported to last from a few hours up to several weeks. When used in conjunction with other treatment modalities, the results can last up to several months or longer. Ketamine therapy is not a cure; however, it can be used to facilitate long-term change and transformation. Ketamine therapy is often paired with additional psychological support before, during and after the actual medicine session. Ketamine therapy used together with psychotherapy can help strengthen the benefits from ketamine therapy alone.
How safe is ketamine therapy if done in the outpatient/clinic setting?
Ketamine is considered a safe medication; however, how it is used and by whom determines how safely this medication can be used in the outpatient setting.
Dr. Stefany Wolfsohn is a board-certified anesthesiologist with additional mental health, trauma and psychedelic medicine training. She has maintained ACLS certification, equipment for monitoring as well as a crash cart with emergency airway equipment and medications for all services performed in the practice. There are different routes of administration of ketamine, different dosing protocols and therapy modalities that are utilized with this treatment in this practice. Dr. Stefany Wolfsohn is a licensed practitioner who can administer DEA schedule III medication and who can meet the American Society of Anesthesiologists requirements for the delivery of moderate sedation.
How does ketamine infusion therapy get incorporated into a comprehensive treatment plan?
Anyone can call to inquire about ketamine infusion therapy. Before initiating treatment, a plan must be set in place to optimize the possibility of successful treatment. At Ventura Center for Advanced Therapeutics, all patients start with a new patient consultation before treatment is offered. During this time, a medical and mental health assessment are done and previous medical records are reviewed. Patients are given baseline inventories to screen for the presence and severity of common symptoms treated with ketamine. Information about ketamine therapy, routes of administration, informed consent including risks / benefits / alternatives to ketamine therapy, treatment protocols, and adjunctive therapies are discussed. Communication with new and/or your existing mental health providers is established to coordinate care. In certain cases, a urine drug screen may be ordered in the initial consultation phase.
A supportive family member or advocate is also encouraged to participate in this process.
What is the success rate of IV ketamine infusion therapy?
Most research studies and ketamine infusion centers report that approximately 70 % of patients treated will respond positively and begin to feel better after their first ketamine infusion. Most ketamine infusions are initially scheduled as a series of 6 infusions within a 2- 3 week period of time to in order to provide relief anywhere from weeks to months. A high degree of importance is placed on the initial patient evaluation and candidate selection for this intervention. Some conditions, can be more challenging to treat and may require different infusion schedules, dosages and length of infusion times to maximize the patient’s benefit.
Are there side effects with ketamine infusion therapy?
Patients are monitored closely throughout the infusion process and additional psychological support is provided to help patients navigate challenging ketamine therapy experiences should they arise. The presence of medication side effects depends on the dose of ketamine given and the frequency of use. In general, the side effects of ketamine infusion therapy are mild and not every patient experiences them. Some side effects are anticipated and can be easily treated at the time of infusion such as anxiety, headache or nausea.
Other side effects that could occur during an infusion include increased heart rate and blood pressure, respiratory depression or a deeper level of dissociation than intended. Although all patients are pre-screened to assess the likelihood of these side effects from occurring, on the rare occasion they do occur, either stopping the infusion or treating them with IV medications, these side effects usually resolve within 5-15 minutes. The most common side effect following ketamine infusion is feeling tired for a few hours. Long-term side effects have not been reported by experienced ketamine infusion providers and it is important to choose a ketamine infusion provider who is maintaining a high standard of care.
Do insurance companies cover ketamine therapy?
Most providers do not contract with insurance companies. “Off-label” use of ketamine therapy is generally considered to be a “non-covered” service. The most common reasons insurance companies deny coverage to for these services are because they believe it is not medically necessary or it is viewed as an experimental treatment. As of September 1, 2022, Ventura Center for Advanced Therapeutics will no longer be contracted with any insurance companies and all services provided by Dr. Wolfsohn in this medical practice will be considered “out-of-network.” Superbills can be provided to patients upon request.
How much does ketamine therapy cost?
The range for ketamine infusion therapy across the United States averages between $400- $2000 per infusion (2022 data). Cost can depend on the provider, location, ketamine dose, duration of infusion and the condition being treated. Ketamine infusions at our facility for mood disorders and PTSD are typically 50 minutes long and cost $600 per infusion. Infusions for chronic pain can range between 2-4 hours and cost between $850-1350 per infusion. Patients are usually scheduled for an initial treatment series of 6 infusions to be done over a 4-6 week period of time. Treatment schedules may vary depending on the circumstances of each individual patient. Some patients will require less than 6 treatments and others may require more during the initial treatment phase.
Dr. Wolfsohn is able to offer intramuscular or low-dose/in-office sublingual ketamine treatments to patients as a cost-effective alternative and/or if a patient prefers to receive a route of administration other than IV ketamine. Intramuscular ketamine treatments (singleinjection or hybrid dosing) cost $400/treatment. In-office, low-dose sublingual ketamine treatments cost $250/treatment.
All ketamine treatments provided by Dr. Wolfsohn include the administration of medications, hemodynamic monitoring and psychological support within the scope of her medical, mental health, trauma and psychedelic medicine training. Additional psychological support with a licensed mental health provider is sometimes recommended during ketamine treatments. Fees for the second provider will depend on each individual practitioner and are in addition to the cost of the ketamine treatment and care provided by Dr. Wolfsohn.