Ketamine therapy has gained significant attention as a potential treatment for mental health distress, including treatment-resistant depression, anxiety, post-traumatic stress disorder (PTSD), acute suicidality, and more. However, before embarking on this journey, it's crucial to clearly understand if ketamine is the best treatment for you and where to go for treatment. Here are seven essential questions you should ask your psychiatrist before starting ketamine therapy. 

Ketamine therapy can be administered through intravenous (IV) infusions or nasal spray. Multiple treatment options are vital, especially if you're considering insurance coverage. While insurance typically covers nasal spray treatments like Spravato (esketamine), IV infusions are out-of-pocket and can be cost-prohibitive. Please review our Spravato costs and IV Ketamine infusions cost articles to understand how much these treatments cost and the advantages and disadvantages for each option. Contrary to the wisdom of strangers on the internet, we have found that both nasal sprays and infusions have been nearly equivalent in effectiveness in helping patients recover from depression.  

For many, the choice to begin ketamine therapy will be dictated by insurance coverage. Navigating insurance can be challenging, but a mental health clinic that strives to make treatment accessible to a broader population will employ the clinical staff necessary to work with insurance providers and provide you with complete transparency regarding out-of-pocket costs. Well-run clinics can look at your insurance plans and explain what your benefits will cover, and what other options to consider if ketamine therapy isn’t appropriate for you at the moment. This includes managing the prior authorization process to ensure that you are covered for SPRAVATO® or other options like TMS before starting treatment. If your clinic does not accept insurance, you should research options before committing to treatment. For instance, Spravato has a treatment center locator that can help you find a clinic who offers the treatment in your zip code, and they oftentimes also offer treatment options like TMS.

Treatment schedules can vary depending on your condition and the type of ketamine therapy you are getting. For SPRAVATO, you will need to plan 2-hour visits, twice a week for the first month and once weekly for the second month. IV Ketamine infusions can range between 4 days and 3 weeks with 2-4 hour durations depending on the condition. In either scenario, you will also need to plan to take time off of work or caregiver duties, and a transportation plan as driving is prohibited immediately after treatment.  

Be sure to check with your provider about their hours of operation. Ideally, your provider will have late appointments and weekend hours to minimize the time you need to leave work. Also, consider if you have other responsibilities that may need to be delegated to other family members after you come home for treatment. For instance, childcare may need to be managed by someone else after treatment to give yourself time to rest and recover. 

Ketamine therapy is just one approach within integrative psychiatry practices. It's essential to understand that there are alternative treatments to consider if ketamine doesn't yield the desired results. Ask your psychiatrist about additional therapies. For instance, at Axis Integrated Mental Health, we offer transcranial magnetic stimulation (TMS) nutritional supplementation, or cognitive-behavioral therapy, mindfulness-based approaches, or holistic practices. Understanding the range of options ensures you have a comprehensive treatment plan tailored to your needs and that can help you get well, not just dependent on another substance. 

Ketamine therapy, like any medical treatment, has potential side effects. Your psychiatrist should discuss these with you, including common ones like dissociation, dizziness, nausea or elevated blood pressure. If you have a history of nausea, antiemetics like Zofran or Promethazine may be prescribed ahead of treatment to minimize this side effect.  

It’s also important to know what rescue measures your provider will take in the case of severe nausea. Do they provide IV fluids or are you on your own if you have a poor outcome? If your blood pressure is too high, what is their protocol for addressing it? Additionally, inquire about the implications of missing a scheduled dose and how it may impact your overall treatment plan.   

Ketamine is a powerful substance that can open doors to profound introspection and emotional experiences. Collaborating with a therapist during your ketamine sessions can enhance the integration of these experiences and lead to better outcomes. Ask your psychiatrist if they offer ketamine assisted psychotherapy with ketamine trained therapists, or if they can work closely with your therapist while you are undergoing treatment. Also ask if the therapists they work with are specifically trained for ketamine assisted psychotherapy and what additional training they did to prepare. 

Understanding the financial structure of the clinic is essential as it can shed light on its priorities. Many clinics rely heavily on venture capital funding, which may prioritize investor interests over patient well-being. In some cases, patients have been left scrambling for a new provider when clinics have closed overnight. Other clinics prescribe doses higher than what the National Institutes of Health (NIH) recommends and are doing so without clinical data or safety protocols guarding against psychological addiction. Look for a clinic where the providers have a stake in the practice, ensuring patient care remains the top priority and offer integrative treatments that help patients get well beyond just medication. 

 As you embark on ketamine therapy, arming yourself with knowledge and asking the right questions can empower you to make informed decisions about your mental health treatment. By inquiring about clinic funding, treatment options, insurance coverage, alternative therapies, side effects, and collaboration with therapists, you'll better understand the available options and increase the likelihood of a successful therapeutic journey. Open communication with your psychiatrist ensures a comprehensive and personalized approach to your mental well-being.