Frequently Asked Questions
What is ketamine?
Ketamine is a dissociative anesthetic, originally developed in 1962 for use as a sedative in the operating room. Since then, it has been used widely in emergency medicine, veterinary medicine, and wound care around the world. Ketamine is often used for the most vulnerable patients, including children and the elderly, due to its safe profile and minimal side effects. The World Health Organization has designated ketamine as one of the 100 most essential drugs in the world WHO.
Research since 2000 has found that when administered in low doses, Ketamine addresses symptoms of mood spectrum disorders, including depression, anxiety, PTSD, and bipolar disorder. It is also used to address symptoms of severe pain.
Is ketamine right for me?
For appropriate patients, ketamine can be an exceptionally effective option to relieve symptoms of depression. It can help people even when other treatments have not worked.
Studies have shown that ketamine relieves depressive symptoms for 75% of patients with depression, including Major Depressive Disorder and Treatment-Resistant Major Depressive Disorder. CANMAT This is compared to antidepressant prescription medications, which have shown to be effective in as few as 30% of people with depression, and often include extensive side effects. JAMA STARD*D
Some patients experience relief after one infusion, some experience relief after multiple infusions, and some patients receive infusions without obtaining any relief. Each individual is unique, and the outcome of their infusion treatment plan may not match the results found in studies or experienced by other patients. Nature
What happens after my consultation call?
If this treatment option is a good fit for you, you will be sent a series of intake and consent forms via email along with a link to book your orientation and four foundational visits. Once your intake and consent forms are complete and your visits are booked, we will reach out to your other mental healthcare providers to confirm your care with us. There should be a period of three to five business days from the time of your booking to the day of your first in-office visit.
How is IV ketamine different from intranasal, oral, or intramuscular?
At Ember Health, we administer ketamine intravenously (IV). This is for two reasons: First, 87% of all studies on ketamine to date have been conducted using IV ketamine source. Second, those studies have shown that IV ketamine has the highest efficacy rate among all routes of administration for addressing depression.
Data supports that IV ketamine helps 75% people with treatment resistant depression (TRD)source whereas intranasal helps around 40% source, oral helps 30% source, and intramuscular helps around 50% source.
Perhaps most importantly, only IV ketamine has long term outcome data supporting its use over time source.
Why IV ketamine works best remains unclear. The current theory is that IV ketamine provides the most consistent blood/brain plasma ketamine levels during administration, and by delivering it this way, clinicians can prevent the body from breaking ketamine down before it gets to where it is needed source. This is also why Ember Health employs a team of clinicians with the background and skillset to safely and knowledgeably administer IV ketamine.
Is ketamine safe?
Yes. Ketamine is used extensively in hospitals and clinics every day, and has been administered safely to millions of patients for decades.
To ensure safety, ketamine infusions should be administered by medical professionals trained in anesthesia or emergency medicine.
Does ketamine have side effects?
During infusion, the most common side effect of ketamine is mild nausea. In rare cases, patients may experience allergic reactions, elevated blood pressures, elevated heart rate, or cardiac arrhythmia. A monitoring physician will intervene in the case of any of these effects FDA .
There are no known negative long-term effects of ketamine when used at the appropriate doses for depression and anesthesia. Select cases of long-term, daily use of ketamine by those who abuse the drug have shown some negative effects on the bladder and on cognition Yale .
How does ketamine for depression compare to SSRIs?
Over the past 30 years, selective serotonin reuptake inhibitors (SSRIs) have been widely prescribed to address depression. SSRIs are based on the chemical imbalance theory of depression - that adding more serotonin to one’s system will lead to an improvement of mood. Literature supports that SSRIs have a 30 - 50% effectiveness rate for people with depression source . They require a steady state of medication in one’s system over time to have an effect. SSRIs often result in significant side effects and can take 6 to 12 weeks in the system before working. People often experience additional side effects when they stop taking SSRIs.
Ketamine benefits occur via the neural network theory of depression. Treatment leads to a structural reset of the emotional reward system in the brain. Patients who have a generally low baseline mood achieve a new neutral from which they can appropriately feel good when good things happen and appropriately feel bad when bad things happen. These new neural connections triggered by ketamine often happen within the first 72 hours. Literature supports that ketamine has a 75% efficacy rate for people with Treatment Resistant Depression. These positive results do not depend on the chemical staying in the body over time. Treatment results in very few-to-no side effects, and stopping treatment at the dosage and frequency we administer does not result in any unwanted side effects.
Patients have told us that while SSRIs may help stabilize their mood, they result in a “flatness”, “emotional numbness”, or a “mental fog.” Medication makes them feel less like themselves by dampening their emotions and therefore their depressive symptoms. These same patients have described how ketamine has helped them feel more like themselves by creating an emotional baseline to appropriately feel emotions and reframe core issues that have contributed to their depressive state.
How does ketamine compare to psilocybin and MDMA for treating depression?
“Psychedelic medicine” has received a lot of attention in recent years for its potential as a powerful tool in mental health. Like psilocybin and MDMA, ketamine can lead to a powerful experience through an altered state of consciousness. Each of these substances affects neural pathway connections which help people literally “think differently”, whereas traditional antidepressants regulate people’s chemical “balance.”
That said, there are significant differences between substances that are considered “psychedelic”.
Ketamine is currently the only "psychedelic" in widespread clinical use. MDMA for the treatment of PTSD is expected to be approved for medical use in 2023. Psilocybin for depression remains in the research realm.
Each of these substances has different effects for different mental health issues. To date, MDMA is thought to be the most helpful for Post Traumatic Stress Disorder (PTSD). Ketamine and psilocybin are thought to help most with Major Depressive Disorder (depression), and only ketamine is currently understood to help with the depressive state of Bipolar Disorder.
To date there is far more literature and clinical evidence supporting ketamine’s use for depression. At the time that we wrote this Q&A: 3,546 clinical papers have been published on ketamine for depression source , 233 papers have explored psilocybin for depression source and only 300 papers have explored MDMA for depression source .
Of the research trials that are currently underway, most focus on ketamine link .
Beyond the clinical trials and research differences, the administration and experience of each of these substances is very different. Sessions with psilocybin and MDMA often last for multiple hours (6-8+). Those substances are taken orally and cannot be stopped once administered. IV ketamine administration lasts for 40 minutes, and can be stopped at any time. Patients have described psilocybin and MDMA as altering how one sees and engages with their immediate surroundings, whereas ketamine experiences tend to be far more inward and introspective.
Finally, legal classifications under the Controlled Substance Act enforced by the DEA differ from substance to substance. Psilocybin and MDMA are currently Schedule 1 substances, and will need federal reclassification in conjunction with the DEA and FDA in order to be used legally outside of the research world. IV ketamine for depression is a schedule III non-narcotic substance that can be legally and safely administred today in clinical settings in the state of New York.
Is ketamine for depression experimental?
Ketamine for depression is not experimental. There is an overwhelming body of literature supporting the safe, effective use of ketamine for depression. Since 1968, there have been over 4,000 scientific, peer reviewed papers exploring ketamine for depression source . As a comparison, there have been 6,700 papers exploring Prozac (fluoxetine) for depression source , and 230 papers exploring psilocybin for depression source . The American Psychiatric Association as well as the Canadian Agency for Drugs and Technologies in Health have both published consensus guidelines for how to treat patients. Ketamine is considered part of the Standard of Care in helping people deal with their depression.
Is ketamine addictive?
No. Ketamine is well documented to be a non-addictive medication. There is no physical dependency established with the use of ketamine, and patients who stop using the drug do not experience symptoms of withdrawal WHO .
That said, there are cases of abuse of ketamine among some people seeking an altered mental state who have access to the drug in a non-medical environment, without supervision of trained medical professionals.
How much do infusions cost?
We charge $550 per treatment visit and $275 per orientation visit. Otherwise we do not charge for intake, care coordination, or any additional services outside of the office visit fees.
Read more about cost of care here.
Will insurance pay for infusions?
Patients who have out-of-network insurance benefits should expect to receive reimbursement for their care with us. Our services are not currently covered in-network by any insurance plans.
Read more about insurance coverage here.
How long do infusions take?
Each infusion includes 40 minutes of medication administration, with an additional 20 minutes of resting time before discharge.
How many infusions will I need?
The American Psychiatric Association suggests an Foundation (an initiation series) of four infusions within a two-week period as a foundational course of treatment JAMA.
Ongoing care will depend on how durable this treatment is for you as an individual and will be discussed extensively as part of our care.
For how long will I feel better?
For most patients, ketamine relieves depressive symptoms for an average of six weeks after each infusion. Patients may receive booster infusions as depressive symptoms recur JAMA.
We work with each patient to identify a suitable maintenance program. Sometimes, this consists of a regular cadence of infusions according to a patient’s needs and schedule. Some patients find that their need for boosters becomes less frequent over time, prompting them to come in every 2 - 3 months. In some cases, patients experience full remission of their depressive symptoms and do not feel the need to seek continued treatment Yale.
Ketamine boosters may be given for as long as needed with no known long-term side effects.
What if I don’t have a referral?
At Ember Health, we only provide ketamine treatment to people who are working with an accredited and trusted healthcare provider, including psychiatrists, psychologists, therapists, or primary care providers.
This is important to us for several reasons: For one, we never want to be the ones to diagnose people directly with depression or encourage our therapy if there are other options that might be of greater help. Second, data shows that ketamine treatment is most effective when accompanied by continuous therapy.
For those not yet connected to a provider, we’re happy to help. We’ve built a strong and trusted network of mental health professionals who can assess symptoms of depression and discuss whether ketamine is an appropriate option.
Will any medications interfere with this treatment?
Yes. Ketamine will not be as effective in addressing depressive symptoms for patients taking Benzodiazepines (trade names: Valium, Klonopin, Xanax, or Ativan). A handful of other medications may also decrease the effectiveness of ketamine.
We discuss medication history with each patient before treatment, and work with healthcare partners to suggest modifications of existing medication as appropriate.
What if I'm on other antidepressant medication?
While starting ketamine infusion therapy, the concurrent use of other antidepressant medications will not interfere with ketamine's effectiveness of addressing depressive symptoms, nor will it cause negative medication interactions.
Many patients who experience relief from ketamine have found that over time, they can reduce or eliminate other antidepressent medications. We advise each patient to tailor their unique medical treatment plan in partnership with their prescribing physician.
Will other medical conditions exclude me from treatment?
There are no medical conditions that preclude the use of ketamine treatment. That said, ketamine is not advised for patients with schizophrenia or uncontrolled heart or blood pressure issues.
Our physicians review the medical history of each patient prior to treatment. All patients are closely monitored during treatments by a extensively trained clinical team to ensure the safety of the treatment (see above).
What if I don't live in New York?
While the majority of people we treat live in or around New York City, we make every effort to accommodate the needs of those who come to us from farther away.
Consistent with the American Psychiatric Association’s guidelines, we administer four foundational ketamine treatments to all new patients over a 14 day period. For those coming in from out of town, this often entails a week-long stay in New York or two, three-day visits over the course of two weeks. That said, we tailor treatment plans based on individual medical needs and travel restrictions.
After the foundational treatment, we provide infusions as depressive symptoms may recur, and will continue to work with individual calendars and travel plans as needed. For those new to the area, we’re happy to recommend nearby accommodations and services.