Frequently Asked Questions

 About ketamine

  • Ketamine is a dissociative anesthetic. Developed out of the desire for an ideal anesthetic with analgesic (pain-relieving) properties, ketamine was first synthesized in 1962, patented in 1966 and approved for human use by the FDA in 1970. It is widely used in operating rooms for general anesthesia and in emergency departments for procedural sedation.

  • While ketamine is FDA approved for anesthesia, ketamine therapy for mood disorders or chronic pain is not FDA approved. Ketamine can be used “off-label” by providers skilled in its administration.

  • We do not. Most insurance companies do not cover ketamine therapy for mood disorders or chronic pain. We are hopeful that this will change in the near future. See our Pricing page for further details.

  • The good news is that ketamine is a very safe drug, particularly when used at low doses. That does not mean that it is without risks. Before beginning your treatments, we will review your medical and psychiatric history, current medications, and allergies to ensure that there are no contraindications to pursuing ketamine therapy. If we have any concerns regarding safety, we will ask for input from your primary care physician or appropriate specialist. We will not proceed with an infusion if we feel it is dangerous for you in any way. Every patient is monitored closely throughout their infusion via in-room cameras (not recorded) and vital sign machines, regardless of age or health conditions.

  • It is common to feel sleepy or “out of it”, dizzy or nauseous after ketamine therapy. If you suffer from anxiety, you may feel a little more anxious after the first couple of treatments. We can provide medications to combat nausea should you experience it. We will ask you to relax in our tranquility room before leaving the clinic. Most side effects of ketamine will resolve within minutes to a couple hours and should not persist beyond the day of treatment. Some people can experience mild headaches, more vivid dreams, and rarely nightmares, which we have seen persist for a few days after receiving ketamine.

  • Memory issues and bladder problems have been seen in individuals who abuse ketamine. In other words, these issues are seen when using high doses of ketamine frequently. If you have any urinary symptoms following your ketamine therapy please notify us immediately.

  • Low-dose ketamine, when given by skilled providers, has not been shown to be addictive.

  • Once you have had your initial consultation and are found to be a good candidate for ketamine therapy, you should be able to receive your first treatment within a week. In cases  where we request additional testing because of underlying medical conditions, then this may postpone things a bit. Our goal is to start your ketamine treatments as soon as it is safe to do so and get you on a path to feeling better!

  • It is rare that we have to turn clients away for ketamine therapy due to underlying medical conditions but If you have uncontrolled/untreated high blood pressure, glaucoma, liver disease or thyroid disease, have certain heart issues (e.g. congestive heart failure, abnormal heart rhythm, active chest pain), have an active substance abuse disorder, history of psychosis, active manic symptoms, delusions or hallucinations it is likely unsafe to give you ketamine.

  • Benzodiazepines (e.g. Xanax, Ativan, Klonopin) and possibly lamotrigine (A.K.A. Lamictal) can decrease the effectiveness of ketamine. This does not mean you should stop these medications! Doing so can have serious consequences. We will review your medications during the consultation and we may ask you to make some adjustments to your dosing schedule if you are taking any medications that could interfere with ketamine.

  • Not exactly, but there are a number of factors that go into providing ketamine treatments to minors. We are able to offer treatments to those 13 years of age and older.

Ketamine for mood disorders

  • There are likely numerous ways that ketamine therapy works in the brain to help mood disorders and researchers continue to investigate its mechanisms of action. The most commonly accepted theory is that ketamine acts on the NMDA receptors to increase glutamate levels. Glutamate is the most prevalent neurotransmitter in the human brain and nervous system, and it plays a key role in neuroplasticity. To put it simply, the increase of glutamate in the brain following a ketamine treatment is thought to be what accounts for the rapid positive effect on mood disorders while it also helps to repair, strengthen and even regrow connections that provide long term benefit in helping to change the way we process information and emotions.

  • Most of the research surrounding the use of ketamine therapy and mood disorders has specifically looked at treatment-resistant unipolar depression. That being said, we have seen that ketamine can be effective for bipolar depression, seasonal affective disorder, and other types of depression.

  • Many people have reported changes in mood within minutes to hours after a single treatment of ketamine. However, these effects are often mild and short-lived, lasting hours to days. This is the reason why it is recommended to have a series of ketamine treatments as opposed to just one and studies have validated this model. Most people who benefit from ketamine therapy will notice more profound and lasting changes starting 1-2 weeks after they start treatment. 

  • We would love to tell you that ketamine therapy is 100% effective for all mood disorders but, unfortunately, nothing is that good! It has been our experience, and we know from colleagues around the country, that the majority of people who undergo ketamine treatments note improvement in their symptoms. Some clinics report that as many as 85% of their patients have had success with ketamine. We believe that there are a number of factors that can enhance the success rate including the mode of administration, the environment in which the treatments are given, integration of psychotherapy, mindfulness techniques, and the person’s openness to the possibility of healing.

  • This is not an easy question to answer and one that we encourage you to discuss further at your initial consultation and  with your therapist/psychiatrist. In general, most people who undergo ketamine treatments have already tried multiple medications without lasting results or have had significant side effects from conventional therapies and are looking for a different type of treatment. 

  • While we do not require you to be under the care of a psychiatrist in order to receive ketamine treatments for mood disorders, we do believe it is in your best interest. We feel that in order to optimize your success, it is important that we collaborate with your psychiatrist, therapist and/or primary care physician. If you do not have a psychiatrist, we can set up an appointment for you with Dr. Steinbrenner.

  • No, a referral is not required.

  • This is unlikely. However, it is extremely important to notify your care team at Imagine if you are ever experiencing any symptoms of mania. Your safety is always our greatest priority. 

Ketamine for chronic pain

  • Ketamine acts at the receptor level to reduce or eliminate what is known as “central sensitization”. Pain itself changes the way your central nervous system works. When you have been in pain for a long time, you can actually become more sensitive and get more pain with less provocation. By a number of different mechanisms, ketamine treatments reduce or eliminate this effect. Similar to mood disorders, it is likely that there are numerous other ways that ketamine works for chronic pain and studies are ongoing.

  • Ketamine’s effectiveness in chronic pain has been most widely studied in patients suffering from CRPS (chronic regional pain syndrome). However, ketamine can be effective for a variety of conditions including fibromyalgia, phantom limb pain, migraines, trigeminal neuralgia, and some malignant pain conditions. In general, neuropathic pain responds well to ketamine treatment. 

  • This really depends on the diagnosis. For some conditions such as CRPS, we will recommend a series of at least five, four-hour ketamine infusions on consecutive days. For other conditions such as fibromyalgia, you may benefit from much shorter infusions and lower dosing, like we use for mood disorders.

About Spravato

  • Ketamine is a racemic compound made up of equal parts of its two enantiomers, (S)-ketamine and (R)-ketamine. What on earth does that mean?  Think of it this way, the ketamine we normally use for general anesthesia and in low-doses to treat mental health disorders and chronic pain is made up of a pair of molecules. These two molecules are mirror images of one another, much like our hands. While they are mirror images, the molecules are not identical. The esketamine molecule is actually more potent at the NMDA receptor which is believed to be the main site of action of ketamine. Johnson and Johnson isolated the “left hand” of ketamine or, eskatemine, and created the nasal spray, Spravato. 

  • Spravato is FDA approved for adults with treatment resistant depression (TRD)  OR with major depressive disorder with acute suicidal ideation or behavior (MDSI). Spravato is only approved for use in adults who are also on an oral antidepressant. It is not approved for those under the age of 18. 

  • Yes. We currently offer Spravato for those covered by Medicare and most major insurance carriers.

  • No, the induction protocol is different than ketamine therapy. You will need to come twice a week for four weeks then once a week for four weeks. Maintenance is either once a week or once every two weeks initially.

  • According to Johnson & Johnson, Spravato can cause sedation and dissociation, abuse and misuse, increased risk of suicidal thoughts and actions. Please refer to their website for further details https://www.spravato.com/

  • Spravato is contraindicated for anyone with aneurysmal vascular disease or arteriovenous malformation, those with history of intracerebral hemorrhage or anyone with hypersensitivity to esketamine, ketamine or any of the excipients (i.e. preservatives, additives, etc). Like with ketamine, if you have other conditions (e.g. uncontrolled high blood pressure, liver disease, etc) it may be unsafe to receive Spravato. This will be discussed during the screening process. 

  • Please visit https://www.spravato.com/

Preparing for ketamine/Spravato

  • If you would like to bring your own blanket, pillow, or eye mask with you then please feel free to do so. Otherwise we can provide you with any of the above for use during your ketamine or Spravato treatment. We also provide noise canceling headphones, but if you have a favorite pair bring them along. If you have any other comfort items you’d like to bring, we encourage you to do so. 

  • We ask that you don’t eat for 4 hours prior to your first ketamine or Spravato treatment so we can see how you respond. Also, we ask that you not drink for 2 hours before coming in as getting up to go to the bathroom in the middle of your session is no fun! Avoid caffeine or any other stimulants. Avoid alcohol the night before receiving ketamine or Spravato.

  • You are welcome to bring a family member or friend to the clinic. However, we discourage having anyone in the treatment room with you while you are receiving ketamine or Spravato as it could be distracting and make it difficult for you to have a full dissociative experience. Exceptions can certainly be made.

  • We will review your current medications at your initial consultation. We ask that you do NOT make any medication changes during your induction series as this can complicate treatment. If you are on medications that have been known to lessen the effectiveness of ketamine therapy (e.g. benzodiazepines, lamotrigine) we may ask you to make some adjustments to your dosing schedule. 

  • Get comfortable! Wear loose fitting clothes and layers are advisable. Avoid heels. Keep in mind that we will need access to your arm if receiving IV ketamine or an intramuscular ketamine injection and you will have a couple stickers placed on your chest and upper abdomen for the heart monitor. We provide slides for you to change into for your comfort.

  • As mentioned previously, ketamine is a dissociative anesthetic. What in the world does that mean? In broad terms, to dissociate is to disconnect – disconnect from earthly surroundings, thoughts, emotions, memories and even your sense of self. Perception of time and space is often warped. Each person’s experience is unique and each session can differ for each individual. Lay back, uncross your legs and relax. Get centered, breathe, let go of thoughts the best you can and know you are safe. Allow the music to help guide you through the experience. If there are visuals, watch and enjoy. If there are thoughts or ideas you want to explore, do so. If there is emptiness, enjoy the peace. For most people receiving low-dose ketamine or Spravato the experience is peaceful.  For some, however, the feeling of disconnection can provoke anxiety or fear resulting in an unpleasant experience. It is not always easy to predict who will have the latter. There are things that we can do to make each session as pleasant as possible. There are also things that you can do to help set the stage for a positive and beneficial experience. We will help to guide you on your individual journey.

  • Ketamine and Spravato can cause nystagmus - involuntary movement of the eyes. While this is generally very mild at low doses, trying to focus your eyes on anything may prove difficult and can lead to feeling dizzy or nauseous. We encourage you to wear an eye mask for this reason. Also, we encourage you to let go of any outside stimulus and focus on what your own mind is experiencing. Allow yourself to explore. Music, on the other hand, can play an important role and act as a guide. Music is very personal and everyone responds differently to different types of music. We recommend you listen to something that relaxes and comforts you in some way. It is not advisable to listen to music with lyrics as they can become distorted and distracting. We can provide music playlist recommendations and a listening device for use during your treatment. We highly discourage listening to music on your phone as all too often a call, text or email notification will manage to sneak through and ruin your session. In fact, we will ask that you turn off your phone and put it away until after your treatment is complete. 

  • Ketamine treatments for mood last about 40-60 minutes but you should plan on being at the clinic for at least 90 minutes to account for the preparation time needed prior to your session and the time needed to recover afterwards. Some clients won’t need this much time but some may need even a bit longer. Pain infusions can be as long as 4 hours so plan on being at the clinic for a good portion of your day. For Spravato, you must be in the clinic for at least 2 hours for monitoring per protocol. 

  • Your health and safety is our highest priority. If for any reason we do not feel it is safe for you to receive ketamine or Spravato, then we will not give it. Hopefully we can help to resolve any issues and you will be able to reschedule for another day.

  • Absolutely not. You will be asked to sign a form stating that you understand this. You cannot drive for at least 12 hours after either ketamine or Spravato. Doing so will put you and others in danger. Please arrange for a trusted friend or family member to pick you up. Public transportation is NOT recommended! It is simply too much stimulus after treatment. Taxis and rideshares are an option but not ideal. Please discuss any transportation concerns with us.

  • We recommend that you go home and relax the rest of the day, particularly following your initial session. Some people recover very quickly from any side effects of ketamine or Spravato while others need time. Until you know how your body reacts, plan on just taking it easy. When the effects wear off, pay attention to your mood. Has it shifted and, if so, how? Take some time to reflect on your experience. Take notes and consider journaling.  Engage in activities that have a positive effect on your mood and avoid negative input. You should definitely not operate heavy machinery, make any big life decisions or plan on taking care of young children following your ketamine or Spravato treatment.

Life after ketamine/Spravato treatment

  • It is our hope that you are feeling significantly better and your quality of life has greatly improved! We will work with you to gradually transition you into a maintenance schedule depending on the types of treatments you are receiving (i.e. Spravato, keamine pain infusions, etc).

  • Keep in mind that ketamine or Spravato is actually only a small part of your journey. So much of what you do outside of the clinic will determine the outcome. If you rely solely on the ketamine or Spravato, then you will not experience the best results. Similarly, if you are not truly open to the fact that there is potential to change your life then, again, you will not have the best results. However, if you have an open mind, do the treatments, continue your medications, work with your therapist or pain management team, learn how to integrate what you’ve experienced throughout your ketamine or Spravato sessions with us then you have an excellent chance for lasting results. 

  • This does depend on your underlying condition but most people do require maintenance ketamine therapy or Spravato indefinitely. Keep in mind that ketamine is a tool, not a cure. Generally speaking, if you have suffered from major depression for as long as you can remember, you’ll likely need ongoing support. If you experienced a single traumatic event and suffer from acute PTSD, you may not need months or years of regular treatments. Every condition responds differently as does every person.