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Yes. There are only a few medical studies that address this question, but they consistently report that more favorable results are obtained when higher doses of ketamine are administered.
The very low doses that nasal ketamine (also called Spravato) delivers to patients provide relief of symptoms for only a short period of time, requiring long-term administration at least every two weeks, and often every week. Also, very low IV doses are less effective than the modest doses most clinics administer.
Anesthesiologists understand that the higher doses of ketamine they can safely administer to patients provide greater relief of symptoms in a shorter period of time and also allow a longer time period between infusions once the initial treatment regime is completed. Lengthening the time between maintenance infusions saves patients money and is far more convenient for them.
Treatments are given by intravenous infusion. That is, a health care professional will start an IV, and then ketamine is given continuously into the vein over 1 to 4 hours depending on your treatment protocol. Patients are given other medications such as propofol along with ketamine to make the experience pleasant and to prevent nausea.
Patients are given the treatments in a room with low lighting while sitting in a comfortable reclining chair listening to soft music. Patients are lightly sedated and usually experience very pleasant thoughts or dreams. Patients may or may remember much after the infusions but typically recall the experience as very positive and often spiritual.
Common experiences at our clinic include some of these insightful comments from our patients:
Yes. A comprehensive medical evaluation, including medical history, physical exam, assessment, plan, discussion of risks, benefits, alternatives, and medical treatment with the administration of ketamine and propofol anesthesia along with the management of potential complications and side effects, is considered the practice of medicine. By law, only medical doctors are licensed to practice medicine in the State of Tennessee.
Patients should understand that there are practitioners in Tennessee who are not medical doctors, yet they may advertise themselves as “Doctor”; similarly, some clinics may not have a doctor on-site at all times. We suggest you ask your primary physician whether ketamine should be administered in the setting of a medical doctor or not.
A board-certified anesthesiologist is on-site and always immediately available should any difficulties, which are rare, arise.
Once the initial course of treatment is completed, many patients need “booster” or maintenance infusions to continue receiving the beneficial effects of ketamine. It is unusual for a patient to only need the initial course of therapy. The time period between maintenance infusions varies widely from approximately every 4 weeks to many months between infusions.
You know yourself better than anyone. When you feel your symptoms of depression returning, that is generally when a maintenance infusion is needed.
Ketamine is a drug that sometimes causes vivid dreams or mental images. These can be unpleasant for some patients. We generally give an infusion of a drug called propofol along with the ketamine to lessen the chance of this occurring. Propofol is also an anesthetic drug, and we are specifically trained to administer it safely.
Occasionally, we give other medications such as a sedative to further decrease the chance of unpleasant side effects. Ketamine typically increases the amount of urine a patient produces, so you are likely to need to use the bathroom prior to discharge.
Finally, we administer an anti-nausea drug to decrease the chance of nausea, which can occur in some patients. Propofol also has a beneficial side-effect of nausea prevention.
Ketamine infusions do not meet the strict criteria set by the FDA to be “approved” for treating depression and other conditions. When drugs are approved for use by the FDA, they are generally done so for only the narrow range of conditions studied when they are undergoing development.
For ketamine, that dates back almost 50 years, decades before it was known to help many patients with depression and other conditions; thus, the approval for ketamine by the FDA has always been an anesthetic agent. Esketamine, the nasal form of ketamine (also called Spravato), which was developed and studied for the express purpose of treating depression, has been given FDA approval for the treatment of depression, thereby demonstrating that the FDA recognizes the ability of ketamine to benefit patients with that condition.
Many of the drugs doctors commonly prescribe for their patients are not “FDA approved,” but like ketamine, there is a wealth of medical literature demonstrating their safety and effectiveness.
There are a number of ketamine clinics that are staffed by nurses and not medical doctors. We believe that ketamine treatments constitute the practice of medicine, which is why we always have an anesthesiologist on-site while a patient is receiving treatment in the center and always work in close conjunction with the patient’s personal physician.
Some clinics give only 45-minute infusions while others give intramuscular injections of ketamine, all of which reduce their costs but may also decrease effectiveness. Our charges are in line with other clinics where an anesthesiologist is present, and we are on the low end for ketamine clinics nationwide. We suggest you consult your primary physician as to whether you should have your treatments in a clinic staffed with an anesthesiologist, a non-anesthesiologist doctor, or only nurses.
Since all patients do not receive a beneficial result from ketamine infusions, we assess every patient during the course of their treatment and together make a determination as to whether additional treatments are advisable. This assessment is ongoing with each treatment, and for most patients, no further infusions are given if there has been no relief after the third infusion (though there may be a few exceptions to this policy).
Also, we believe it is inappropriate to charge in advance for the anticipated six infusions prior to your first infusion as is the standard practice for many other ketamine clinics.
A small number of patients, such as those with dangerously high blood pressure that is not under control, should not be treated with ketamine.
Pregnant patients should NOT receive ketamine. Also, females of child-bearing age should take precautions to prevent pregnancy while under treatment.
You can refer yourself to our center for evaluation, or your provider can refer you to us. Either way, we will coordinate your care with your healthcare team.
Your doctor will still be your primary physician. We are here to help him or her by giving you ketamine treatments. You will continue taking the medications that your regular doctor has prescribed.
While we do not accept insurance, some insurance companies will cover all or a portion of the treatment as an “out of network” service. If so, we will gladly provide you the necessary forms to submit to your insurance company for potential reimbursement. Please call us at 615-813-5006 to discuss this topic further.
Yes. We offer CareCredit. The CareCredit health, wellness, and personal care credit card gives you a convenient, flexible way to pay for care for the whole family—including pets! With everyday promotional financing for purchases of $200 or more, you can pay over time with convenient monthly payments.* Ask to speak with our Patient Care Team member who can answer any questions you have.
*Subject to credit approval. Minimum monthly payments required.
No. Unfortunately, none of the major treatment modalities listed above are effective in all patients. Each has a success rate of approximately 60 – 70%.
As with the other major treatment options, there is no way of predicting which patients will respond favorably to ketamine infusions. It is simply a matter of giving several infusions and then assessing whether or not relief is being obtained.