Ketamine Therapy || Redemption PsychiatryRedemption Psychiatry

Ketamine Therapy

Discover relief and the transformative benefits of ketamine treatments at Redemption Psychiatry. Our treatments help alleviate depression, anxiety, OCD, PTSD, and chronic pain.

What is Ketamine?

Ketamine treatment refers to the use of the medication ketamine, originally developed as an anesthetic, to treat various mental health conditions such as depression, anxiety, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Given at lower doses, ketamine has shown promise in providing rapid relief from symptoms, especially when traditional therapies haven't been effective. It's administered under the care of a medical professional, typically through an IV, injections in the muscle, or a nasal spray.

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Benefits and Efficacy

Highlighting some of the benefits and efficacy of ketamine infusion therapy.

Relief from Treatment-resistant Conditions

Ketamine therapy has shown promising results in providing relief for individuals with treatment-resistant depression, anxiety disorders, and chronic pain. Treatment resistance refers to patients who have not responded to traditional treatments, such as medications and therapy. Many of these patients have experienced significant improvements in their symptoms after undergoing ketamine therapy.

Rapid Onset of Action

One of the key advantages of ketamine therapy is its rapid onset of action. Unlike traditional antidepressant medications that can take weeks or even months to show noticeable effects, ketamine therapy often produces significant improvements within hours or days. This can provide much-needed relief for individuals who are suffering from severe depression or other debilitating conditions.

Long-lasting Effects

In addition to its rapid onset of action, ketamine therapy has also been found to have long-lasting effects for some patients. This means that even after completing the initial treatment course, individuals may continue to experience relief from their symptoms for an extended period. However, it's important to note that the duration of effects can vary from person to person, and additional maintenance treatments may be necessary.

Potential for Personal Growth

Beyond symptom relief, ketamine therapy has shown potential for promoting personal growth and improving overall well-being. Some individuals have reported enhanced self-awareness, improved mood, increased motivation, and a greater sense of clarity and purpose after undergoing ketamine therapy. These positive effects can contribute to a more fulfilling and meaningful life.

Services

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IV Ketamine

Experience the transformative power of IV Ketamine therapy. This cutting-edge treatment offers new hope for individuals struggling with conditions such as depression, anxiety, OCD, and PTSD. With controlled and supervised medical administration in a relaxing environment, IV Ketamine has shown remarkable results in providing relief and promoting mental well-being. Please note that IV Ketamine therapy is not covered by most insurances (TriWestVA is the exception). We offer flexible payment options to make it accessible to those seeking this transformative treatment.

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IM Ketamine Injections

Our IM Ketamine injections provide a convenient and insurance-covered option for those seeking effective treatment for mental health conditions. Administered by our experienced medical professionals, these injections offer the benefits of ketamine therapy in a tailored and personalized approach. Discover the potential of IM Ketamine injections for enhancing your emotional well-being.

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Ketamine-assisted Therapy (KAT)

Combine the power of ketamine with therapeutic support through our Ketamine-assisted Therapy (KAT) program. This comprehensive approach integrates the therapeutic process with the benefits of ketamine treatment, facilitating a deeper healing experience. Please note that while ketamine infusion therapy itself may not be covered by insurance, the accompanying psychotherapy sessions in our KAT program may be eligible for coverage. Explore the insurance coverage options and find out how to maximize the benefits of this integrated treatment approach.

Patient Testimonials

Read what our patients have to say about their experience with ketamine infusion therapy.

"Ketamine changed my life. I've had success on and off with prescription medications but with the help of a series of ketamine treatments beginning last winter, I've been able to step back from suicidal thoughts and get treatment without checking into a behavioral health clinic. 2019 was the first winter in almost 10 years that I was able to enjoy and keep up with my everyday life. I'm genuinely grateful for Corinne and all of the Redemption team."

- Rebecca J.

Safety and Side Effects

Learn about the safety precautions and potential side effects of ketamine infusion therapy.

Safety Precautions

Ketamine therapy is generally considered safe when administered by trained healthcare professionals in a controlled environment. At Redemption Psychiatry, we prioritize your safety throughout the treatment process. Here are some safety precautions we follow:

  • Thorough evaluation: Before starting ketamine therapy, your psychiatric provider will conduct a comprehensive evaluation to ensure it is an appropriate treatment option for you.
  • Qualified professionals: Our specialized ketamine nurses and medical staff are experienced in administering and monitoring ketamine treatments, ensuring your safety and well-being.
  • Monitoring vital signs: During each treatment session, your vital signs, such as heart rate, blood pressure, and oxygen saturation, will be closely monitored to detect and manage any potential complications.
  • Emergency preparedness: We have protocols in place and direct access to medical professionals who can promptly address any unforeseen emergencies or complications that may arise during the treatment.

Potential Side Effects

While ketamine therapy is generally well-tolerated, it's important to be aware of potential side effects. These side effects are typically temporary and subside shortly after the session ends. Some commonly reported side effects include:

  • Mild dissociation: During the treatment, you may experience a sense of detachment or disconnection from your body or surroundings. This dissociation effect is usually temporary and resolves once the treatment is complete.
  • Perceptual changes: Ketamine can cause perceptual disturbances, such as changes in vision, hearing, or sensations. These effects are usually transient and fade as the medication clears your system.
  • Mood changes: Some individuals may experience fluctuations in mood during or after the treatment. This can include feelings of euphoria, tranquility, or temporary shifts in emotions. These effects are typically transient and should not be a cause for concern.
  • Physical sensations: Ketamine may cause temporary physical sensations, such as tingling, numbness, or changes in limb size or weight. These sensations are generally harmless and should diminish as the medication wears off.

It's important to note that the occurrence and intensity of side effects can vary from person to person. Your healthcare team will closely monitor your response during the treatment and make adjustments as necessary to ensure your safety and comfort.

If you have any concerns about the safety or potential side effects of ketamine therapy, we encourage you to discuss them with your psychiatric provider. They will provide personalized guidance and address any questions or apprehensions you may have.

Treatment Process

Explore the step-by-step process of ketamine infusion therapy.

Before starting treatment

Your psychiatric provider must determine that ketamine is an appropriate treatment for you. They will then order the ketamine nurse to administer the prescription. The first infusion appointment will take a little longer than subsequent treatments, but generally, you should plan for 90 min for the first treatment and 60 min for subsequent treatments. You will initially meet with the ketamine nurse and review the risks and benefits of the procedure to obtain your consent prior to starting the treatment. This gives you and your family the opportunity to ask any last-minute questions you may have before treatment begins.

Preparing for the infusion

You should wear comfortable clothing that allows easy access to your forearms for IV placement. Unless otherwise instructed, you should take your medications as you normally would but avoid taking any new medications or as needed medications for 8 hours prior to the procedure.

The procedure setting

You will be in a quiet, relaxing, private or semi-private space with a comfortable recliner and soft lighting. There may be space in the room for a friend or family member to stay with you for support. You can talk normally, but you shouldn't expect to have much meaningful conversation since you will find that you'll want a calm and quiet environment. We provide some optional items to help you stay relaxed and comfortable such as a soft blanket, fluffy pillows, water to sip, and noise canceling headphones to block ambient sound and listen to music during the treatment.

Starting the IV (for IV ketamine only)

Our specialized ketamine nurses are very experienced with IV placement and will place the IV catheter using a small-gauge needle as painlessly as possible to use for the infusion. Prior to starting the Ketamine drip, a medication such as atropine (or glycopyrrolate) is administered to safely and effectively prevent some of the possible side effects of Ketamine including excessive salivation and nausea.

During the treatment

A few minutes after the treatment begins, you will likely start to experience a peaceful and relaxing state that feels disconnected from your body and the world around you. This is a state of dissociation that may include perceptual disturbances, which most people have a difficult time describing. Some patients describe difficulty perceiving the passage of time, some see colors, some describe interesting feelings in their bodies like tingling, numbness, or increased size of limbs.

Getting the most out of treatment

The level of dissociation is not always the same from one treatment to another and the benefit of the treatment is not dependent on having an intense experience. Many factors play a role in the patient's subjective experience during the treatment, which depending on the patient, may include feeling anxious, being sleep deprived, being in pain, and the level of comfort with the procedure. We strongly advise patients to approach Ketamine treatments with the outcome in mind, especially if the temporary feeling of dissociation may make you feel anxious or uncomfortable.

Assuring safety

The nurse will monitor your vital signs during the treatment including heart rate, blood pressure, and oxygen saturation, and following the doctor's orders for your treatment, the nurse may adjust the Ketamine drip rate (for IV treatments) or administer comfort medications to optimize your response and prevent side effects. The doctor can be reached at a moment's notice if needed.

Dosing the treatment

We will start with a low-dose , typically at 0.5 mg/kg, consistent with accepted protocols that have been developed and researched since the early 2000’s. In order to find the most effective dose, we recommend always starting with IV treatments so we have the ability to speed up or slow down the infusion rate and/or raise or lower the dose. These adjustments can be made during an infusion (infusion rate) or adjusted for subsequent treatments (infusion rate and dose). You may experience different feelings and sensations from one treatment to the next regardless of whether any changes were made, and this is all very normal. There is no typical sensation a patient should experience in order to have a good effect. Although we may increase a patient's dose, unlike most medication treatments, a higher dose of Ketamine is not necessarily more effective, which is why the benefits of Ketamine for mood were not apparent over decades of using high doses for anesthesia.

Following treatment

The nurse will remove the IV catheter after the treatment and allow you to fully recover before you leave. You will need someone to drive you home because although you may feel fine, your reflexes will be slowed and equilibrium may be slightly off, so you will not be safe to drive, care for children, or make important decisions until you've had a full night's sleep to reset. We also have patients who choose to take a cab or an Uber; although this is not preferred, since we feel it would be best to travel with someone you know and trust. The medication will rapidly leave your system as soon as the treatment is completed, so you will quickly feel the effects of ketamine dissipate. However, lingering side effects such as slowed reflexes and poor equilibrium may persist until you have had a night of sleep, which is why you need a ride home.

Pricing Options

A typical course of treatment is usually approximately $2000 out of pocket, which includes the first probono and 5 follow up treatments. The treatment generally involves an initial round of six infusions and continued maintenance infusions as needed every one to three months until long-term remission is sustained. For this reason, we offer a steep one-time discount for those who know they want to complete a full series.

First Treatment

  • Price of consult varies based on patient insurance (covered by most private insurances)
  • Meet with our expert physicians
  • Determine if treatment is right for you
  • Pay for only the treatments you need!

Follow-up Treatment

$500(OR LESS!)
  • 40-60 minute low-dose infusion
  • Patients typically spend 1.5 hours in the office
  • Spa-like environment
  • The most appropriate course of treatments will be different for each patient
  • Healthcare Savings Accounts (HSA) can be used
  • Payment plans are available

Community Heroes

  • We show our appreciation to our community heros (first responder, medical professional, military, and others)
  • Call us for details regarding our discount program
  • **Tricare members: we offer 6 ketamine infusions for free with an approved course of TMS treatment as part of our commitment to the military






Frequently Asked Questions

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Ketamine is one of the most common general anesthetic agents in use today and is rapidly becoming an essential tool for the treatment of a variety of mental health disorders. It was developed in 1962 and FDA approved in 1970 as the first dissociative anesthetic agent in modern medicine, meaning that it can create a strong feeling of disconnection from one’s self and reality. Ketamine is given for anesthesia in operating rooms, emergency departments, and veterinary clinics for injuries and surgeries, it is administered at much higher doses than those used in psychiatric clinics.

Ketamine is a very safe and effective anesthetic, so it is often used for pediatric and elderly patients. Additionally, Ketamine’s high level of safety makes it indispensable for surgery in impoverished countries, disaster situations, and conflict zones where an anesthesiologist may not be available, and where running water, electricity, and oxygen needed for the administration of other general anesthetics may be unreliable. Ketamine has been on the World Health Organization’s “Essential Medicines” list since 1985 because of its safety and effectiveness.le.

Over the last couple of decades, Ketamine has been extensively studied for its beneficial effects in psychiatry with Major Depressive Disorder (MDD), Post Traumatic Stress Disorder (PTSD), Obsessive-compulsive Disorder (OCD), Postpartum Depression, and Suicidality.
The science behind Ketamine’s mechanism of action is not fully understood, but it is classified as an NMDA receptor antagonist. Ketamine blocks the N-methyl-D-aspartate receptors from being triggered by glutamate, the primary activating neurotransmitter used by 90% of neurons in the brain. This blockage has two effects. First, it increases the signal strength in an attempt to complete the transmission, resulting in a boost to the neural pathways. Second, it stimulates synaptic growth, which helps repair the brain's cell-to-cell connections. This repair mechanism and enhanced signal transmission can explain why ketamine works for a wide variety of symptoms and why it works quickly when other medications have failed.
Ketamine infusion therapy is a treatment used in psychiatry where ketamine is administered intravenously at sub-anesthetic doses. It is not high enough to induce general anesthesia, so patients stay conscious throughout the treatment. Ketamine infusions work by repairing the brain’s cell-to-cell connections and boosting signal transmission, resulting in new synaptic growth and restoring broken connections. It also activates key receptors. Ketamine infusion therapy is a highly effective treatment option for mental health disorders and chronic pain conditions. The dissociative effect of ketamine during the infusion is not what produces the benefit; it is the brain's response to ketamine after the infusion that makes it therapeutic.
The treatment generally involves an initial round of six infusions (typically administered over 3 to 6 weeks) and continued maintenance infusions as needed every one to three months until long-term remission is sustained. The ketamine dosage and the IV drip rate are determined based on factors such as the patient’s weight, medical conditions, and response to treatment. The infusion itself takes 40-60 minutes, and recovery usually takes another 20-30 minutes
Ketamine is considered one of the safest agents of its kind, but all medications have risks and benefits that must be weighed before initiating treatment. A clinical assessment helps determine whether or not ketamine is appropriate for a patient.
They may include disorientation, dizziness, fatigue, feelings of detachment, nausea, vomiting, increased heart rate, and elevated blood pressure. We are well equipped to handle changes in a patient’s vital signs and other side effects by adjusting the treatment parameters or administering treatments to prevent or reverse these effects. Ketamine has a very good “track record” having been used safely at high doses in millions of patients for many decades.
In study after study, patients with treatment-resistant disorders, those that haven’t responded to multiple trials of conventional treatments, are able to benefit greatly from Ketamine infusion therapy. Additionally, Ketamine’s fast acting effects are capable of providing relief that cannot otherwise be achieved using traditional psychiatric treatments for disorders that require a rapid response. This provides acute stabilization that allows time for other medications and therapies to take effect while preventing significant negative outcomes such as suicide, hospitalization, job loss, acute disability, school failure, and relationship disruption.
• Depression
• PTSD (Post Traumatic Stress Disorder)
• OCD (Obsessive Compulsive Disorder)
• Bipolar Depression
• Anxiety Disorders
• Chronic Pain

Ketamine has been shown to successfully treat many conditions, even when they are considered to be treatment-resistant. The effect that can be achieved in patients who respond to Ketamine treatment has astounded psychiatrists, neurologists, and pain management doctors due to the rapid and profound improvements. In general, psychiatric providers may recommend ketamine for patients who have moderate to severe disorders that are considered treatment-resistant meaning patients have not experienced significant progress with two or more first-line treatments. Ketamine has also been successfully used in tandem with psychotherapy and is safe to use with most antidepressant medications. Because of the rapid, effective, and safe characteristics of Ketamine treatment, we anticipate Ketamine will increasingly be used as a first-line option, especially when rapid stabilization is needed to prevent serious negative outcomes. The list of conditions that ketamine may be able to treat is surprisingly long and keeps getting longer. This is due to the unique reparative effects it has on the nervous system, which can be a benefit in many illnesses. The research into these uses is growing rapidly to find the best protocols for each indication and allow doctors to better predict response so patients can make an informed decision.
Unlike most psychiatric treatments that take 4-6 weeks to see improvement, some patients experience relief with Ketamine within an hour of their first treatment and most will see the results within two days.
The effects of one infusion can last for several days to a few weeks, providing relief during the acute phase of an illness and preventing negative outcomes. A series of six or more infusions delivered over 3-6 weeks will build on each other to promote more long-lasting effects over several months. Maintenance infusions every 1-3 months may be required to sustain the benefits for those who respond well to the treatment series.
For depression, including severe and treatment-resistant episodes, studies demonstrated that treatment is about 70% effective at significantly improving depression symptoms. It was important for these studies to exclude patients who were using other treatments including medication or psychotherapy in order to evaluate the effectiveness of Ketamine treatment by itself, but in practice, treatments are often given in combination to achieve the best outcomes. Most of our patients are using several different treatments in combination including antidepressant medication, therapy, and transcranial magnetic stimulation. This multifaceted treatment approach explains why we are able to achieve about 80-90% effectiveness for our patients.

About 50% of patients will know whether Ketamine is a good option for them after the first infusion, but another 20% respond following the second infusion and 10% after the third infusion. If a patient does not see improvements after the third infusion, we may not recommend continuing treatment unless it is possible to make a change in the treatment parameters since the likelihood of responding after four or more infusions is low. However, when patients have lived with depression for many years, it becomes very difficult to perceive positive changes and family and friends are often able to notice changes before the patient does.
It depends on several factors, but yes, the treatment we provide for mental health disorders may also simultaneously help with your pain. Please note that patients seeking Ketamine treatment primarily for pain may want to see a pain management specialist that uses Ketamine as part of their practice. Consider that a pain management doctor using Ketamine for pain will also see a benefit for mental health, but since they don’t specialize in psychiatric conditions, they will not have the same expertise or the same treatments at their disposal as the psychiatrist. Similarly, we have many treatments for mental health conditions, but we don’t specialize in pain and don’t have all the same treatments as a pain clinic would have.

That being said, Ketamine works best for neuropathic pain, where the nerve dysfunction is what causes the pain, but when pain results from an injury to tissue or bone, ketamine may not provide significant relief. Patients with neuropathic pain, conditions where the nerve is diseased, irritated, or damaged, will often see significant relief from ketamine infusions. This may include conditions like Complex Regional Pain Syndrome (CRPS) or peripheral neuropathies. If the exact reason for the pain is undiagnosed, it will be more difficult to determine if your pain would respond. Overall, research indicates that ketamine works at the level of neurons to restore proper function, so pain that comes from the neurons themselves is more likely to be responsive.
A series of six treatments followed by maintenance treatments every 1 to 3 months provides greater and longer-lasting results since each infusion builds on the last. Depending on your response and the duration of the Ketamine effect, we will gradually extend the time between treatments to taper treatments over time. The total number and frequency of treatments will vary from patient to patient.

IV is the most effective out of all the routes studied while IM is a very close second. Oral, intravenous, intramuscular, and intranasal Ketamine administration have all been studied for use in mental health conditions. All routes have shown some level of benefit for various disorders, but they are not all equal in efficacy and IV Ketamine has consistently had the best outcomes. Part of the advantage of IV and IM Ketamine is the ability to fine-tune the dose to each individual patient. IV Ketamine also allows for adjustment of delivery rate, which no other delivery method can do. Recently, there has been a lot of information disseminated about nasal ketamine spray and patients often ask why we recommend IV and IM Ketamine. The answer is complex, but it helps to understand how the route of administration affects absorption, regulation of dose, and breakdown of Ketamine.


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Beware of clinics preferring to use oral and nasal routes. Some clinics have decided to promote the use of these over IV and IM Ketamine delivery methods because they are much easier to administer and there is no need for specialty equipment, expert staff, or time-consuming monitoring. Consequently, these methods may be preferred by doctors wanting to offer the benefits of Ketamine for their patients despite having limited experience, resources, and expertise. Although this comes from a desire to help patients, it should not be considered equivalent to IV or IM Ketamine treatment.

Insurance companies generally take a very long time to recognize any new medical treatments. This is true for Ketamine infusion therapy, but unfortunately, there are even more barriers to insurance approval of Ketamine treatments.

• Generic medications aren’t very profitable.
Ketamine has been around for so long that it is generic, produced by several companies, and used very frequently. This means that pharmaceutical companies cannot charge thousands of dollars per use the way they do for most new procedural medications, so they are not willing to spend billions of dollars on the necessary research for FDA approval of a new indication for Ketamine.
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• New FDA indications require investment.
The other way to obtain FDA approval is when enough research is generated over several years to establish the new treatment. We are making progress, but Supplemental New Drug applications require sponsors to submit a safety profile for the new treatment as well as provide comparisons with previously approved indications. It seems simple, but the application sponsor is generally a pharmaceutical company willing to go through the effort and expense (estimated around $50M) because they have a financial interest that they plan to recuperate. Generic drugs can be manufactured by anyone, so no single manufacturer could profit from a new indication for Ketamine.
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• No insurance procedures exist.
Without FDA approval, insurances generally don’t create the necessary prior authorization procedures, billing codes, and fee schedules for doctors to get reimbursed for the procedure. Insurances can decide to move forward based on the generally accepted off-label use, but that only happens when they have a financial interest in the new treatment like when it saves them more money than it costs.
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• Ketamine use is new in psychiatry.
Insurance companies consider many treatments to be specialty-specific, and historically, Ketamine has most commonly been used by anesthesiologists. However, anesthesiologists obviously should not be treating depression any more than psychiatrists should be putting patients to sleep for surgery, but it is generally very difficult for a specialty-specific treatment to suddenly be approved under a new specialty.
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• Unique treatments require new approaches.
Ketamine infusion therapy is unique in many ways making it difficult for insurance companies to agree on how to implement it. There just has never been another treatment that is effective for so many mental health disorders, administered by IV under observation in an outpatient setting, and capable of producing safe and highly effective results. In contrast, when a new routine medication is approved, there is already a roadmap on how to implement its use.
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• Certification processes are needed.
Only psychiatrists with the proper training and experience should be contracted with insurance companies for administration of Ketamine treatment for mental health disorders, but there isn’t currently any certification recognized by insurance companies to assure doctors are qualified to administer the treatment. This means that unlike the doctors at Redemption Psychiatry who have a wealth of training and experience, insurance coverage may mean that other inexperienced psychiatrists could be financially encouraged to attempt to administer Ketamine infusions without the proper training and no regulation.
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Despite all these barriers, we are confident that insurance companies will eventually cover IV Ketamine infusion therapy. It may just take several more years before that happens. Fortunately, there is one insurance that is covering IV ketamine, TriWestVA, for our veterans who meet the qualifying criteria. This is a positive step forward and we hope that other insurances will eventually follow suit.
The answer to this question is more complex than just the simply the price of an infusion (which is currently $400 per treatment discounted from $500). However, qualified veterans may be able to get infusions covered through TriWestVA. Patients with an insurance plan that is contracted with Redemption Psychiatry will likely be able to get intramuscular injections or intranasal administration covered by their insurance for the same cost as an office visit, which can vary significantly depending on the type of coverage and amount of out-of-pocket expenses met at the time of treatment. We will do our best to help estimate the total cost of treatment prior to starting, but due to the complexity of insurance coverage, there may be some unforeseen variability in the final cost compared to the estimate. Redemption Psychiatry strives to have the most affordable, highest quality Ketamine treatment available in many ways:

• Low cost infusions.
Redemption Psychiatry keeps costs low by being one of the largest private psychiatric practices in Arizona, performing possibly the largest volume of Ketamine infusions in the valley. Being one of the largest providers also allows us to keep the costs per infusion low.
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• Discount programs
We offer significant discounts to first responders, medical professionals, and military through our Community Heroes program. We also offer discounts to patients undergoing additional treatments with us using transcranial magnetic stimulation. In addition, patients receiving maintenance ketamine will get a discount.
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• Low risk commitment
Unlike most Ketamine practices, commitment to the initial series of 6 infusions is not required at Redemption Psychiatry. Patients may qualify for the first infusion at no additional cost following their initial paid consultation, which may be covered by your insurance. Additional infusions are pay-as-you-go with no pressure to overextend your finances.
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• Payment plans are available
Patients may qualify for a payment plan that will allow no interest payments to be taken out at regular intervals to make it easier to afford treatment.
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Patients who have responded to Ketamine treatment will tell you that it is well worth the cost, but it can be hard to make the decision for yourself. It may be helpful to consider what your condition currently costs you. Below are a few examples of the cost of ineffective treatment:

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Ketamine is worth trying. At Redemption Psychiatry, you can try the first infusion for free and will likely know by the third infusion if you should continue treatment. Once you see how much you are personally saving, the cost of treatment is much easier to weigh out.
Spravato is a form of ketamine that was FDA approved in March 2019 for use in patients with treatment-resistant depression who have failed at least 2 trials of antidepressant medication and are currently taking an antidepressant. It has demonstrated efficacy and should be considered among your treatment options. Spravato is a chemical mirror image of arketamine. The medication we call “ketamine” contains half esketamine and half arketamine. Spravato must be administered under the supervision of a healthcare professional in a certified healthcare setting, such as a doctor's office or a clinic. The patient inhales the nasal spray under the healthcare professional's guidance and is required by the FDA to remain at the facility for monitoring for no less than two hours, to ensure safety. The dosage and treatment schedule are highly regimented and the prescribing healthcare provider has very few options for altering the treatment course enforced by the FDA under Spravato’s Risk Evaluation and Mitigation Strategies (REMS) program. It's important to note that Spravato may not be covered by insurance for various reasons.

There are several important things you should know about Spravato to make an informed decision:

1. Spravoto is repurposed ketamine
Pharmaceutical companies use a technique of “repurposing” in order to profit from existing FDA-approved medications as if they were new treatments even though they are already generic. In order to do this, they need to change something about the drug to make it “significantly” different, such as changing the route of administration, dosing, and/or chemical composition. In the case of Spravato, they did all three.

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2. Approved only for Treatment-Resistant Depression and acute suicidal ideation.
Despite all the research that shows the benefits of ketamine for so many different disorders, Spravato was only approved for treatment-resistant depression after 2 failed antidepressants and acute suicidal ideation. This is similar to the way Transcranial Magnetic Stimulation (TMS) was FDA approved in 2008 for treatment-resistant depression after only 1 failed antidepressant, and TMS has a greater response rate and long-term remission rate than Spravato. However, it took 8 years before TMS was covered by a majority of insurances, and not after 1 failed antidepressant as indicated by the FDA. Patients must fail 3-4 medications and a course of psychotherapy before insurance will cover TMS. We anticipate the same progression towards coverage to occur with Spravato. Most insurances will likely cover Spravato, but some may require 3-4 failed antidepressants and even a course of psychotherapy.
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3. Very expensive compared to Ketamine.
Because ketamine has been generic for so many years and is still used so frequently, it is only a fraction of the cost of Spravato. Depending on the dose and frequency of treatment, the cost of Spravato is approximately 100 times the cost of IV ketamine. Even if an insurance decides to cover Spravato, patients may have to pay an extremely high deductible or co-insurance and the cost of administration and observation will be similar. Janssen pharmaceuticals offers a discount coupon that can significantly reduce the cost of the medication but will not affect the cost of administration and observation.
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4. Not a routine prescription.
Unlike most “routine” medication approvals, Spravato is not routinely obtained at a retail pharmacy or administered at home and the FDA has imposed special requirements for its distribution and use. In order to even prescribe Spravato, a doctor must enroll in a Risk Evaluation and Mitigation Strategy (REMS) program. After the doctor prescribes Spravato and insurance approves (or the patient pays the cash price, about $600-$900 per use), Spravato has to be delivered to the doctor’s office from a specialty pharmacy, administered by the patient under supervision, and patients must be observed by qualified staff for 2 hours before they can be driven home. No other medication has ever been approved to be used in the same way, so it is understandable that insurance companies and doctors are having difficulty in implementing its use.
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5. Not normally given with supportive medications.
Spravato has all the same potential side effects as IV ketamine, but without IV access or payment for administration, IV medications cannot be provided to mitigate side effects. We provide oral antinausea medications free of charge because without treatment, about 30% of patients would vomit during the procedure. More importantly, the required 2-hour observation is primarily to prevent an unsafe rise in blood pressure. Since the medication administration is all at once, it cannot be slowed or stopped like IV ketamine, so an unsafe situation requires a call to emergency services and ambulance transport to an emergency room. Additional emergency services would incur additional costs under the patient’s insurance plan. We have additional oral medications to attempt to prevent such a situation, but without IV access, the treatment may take too long to be effective.
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6. It is only for adults.
Even though ketamine is safe to use in minors, the FDA approval was only for 18 and up. Many children and adolescents suffer from severe, treatment-resistant disorders just like adults do, and we have successfully treated minors who were in desperate need of help. Our success rate with IV and IM ketamine in minors is similar to what we see in adults.
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7. Must be used with an antidepressant at the same time.
The approval expressly indicates that a patient must be taking an antidepressant, so if a patient does not tolerate the medication, they cannot use Spravato. It is also important to note that the efficacy of Spravato was shown in combination, not as a stand-alone therapy.
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In short, no.

However, the question is more complex than a one-word answer. Because any abuse of ketamine outside of a legitimate therapeutic use can be addictive, it leads people to believe that it is dangerous in any form. There are several reasons for this perception.

1. Ketamine’s reputation has been tarnished due to illicit use.
This question often stems from recognizing “ketamine” as a street drug or “horse tranquilizer” that is referred to as “Special K,” “Vitamin K,” or simply “K.” When ketamine is abused recreationally as an illegal drug, individuals are self-administering the drug with no supervision and frequently taking high doses. In this drug abuse scenario, a person can become addicted to ketamine.
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2. Ketamine has low addictive potential compared to other substances.
If you have ever smoked a cigarette, had an alcoholic beverage, used prescription painkillers, or even experimented with an illegal drug, you were exposed to some risk for addiction. However, not everyone who tries a potentially addictive substance will become dependent on it. The potential for dependence on any substance is strongly related to the circumstances surrounding its use such as quantity, frequency, setting, reason for using, and monitoring.

drug addition levels chart
Ketamine has a much lower potential for dependence, which is why ketamine is more and more often used for pain in emergency situations, like setting a bone or reducing a dislocated joint, where we would alternatively use an addictive substance, like morphine.
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3. Ketamine given by infusion is not an abused route of administration.
Slowly infused, low-dose ketamine does not result in the sudden reaction that recreational users hope to experience when abusing ketamine. They take a high dose all at once, which can create a potentially addictive high. When a patient is given ketamine in a safe environment, strictly monitored by a healthcare provider, the addictive potential is not significant.
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No, it is used frequently in children and elderly. However, when using an IV treatment that requires monitoring, we are more cautious about patient selection. If a young patient is at high risk for suicide or has tried and failed numerous medications, the benefit may far outweigh the risk.
Possibly, there have been concerns that benzodiazepines and lamotrigine may reduce the efficacy of treatment. However, there isn’t a clear indication of how much of an impact they would have, especially since it would likely be dependent on the dose and duration of treatment. We have had success in holding these medications prior to the infusions to obtain the same benefit.



DISCLAIMER

It is important to fully educate yourself before pursuing any medical treatment. Deciding to undergo ketamine infusion therapy is no different, and we hope this information will be helpful in better understanding the treatment. Please note that the information contained on this webpage is not intended as an advertisement for treatment. You must be prescribed ketamine treatment by a mental health specialist. Like all medical treatments, we cannot guarantee results or promise there will not be any adverse effects. Although many patients experience total relief from their first infusion or after multiple infusions, it is possible for patients to have no response from treatment. Each individual’s response is unique and dependent on several factors, so you should know that your response may not be typical and should not be compared with the experiences of others or research outcomes.