Ketamine Therapy

Table of Contents

1. What Is Ketamine Therapy?
2. How Ketamine Therapy Works
3. Conditions Treated
4. Who Is a Candidate for Ketamine Therapy?
5. IV Ketamine vs. Intranasal Esketamine (Spravato)
6. Effectiveness & Clinical Evidence
7. What to Expect During Treatment
8. Side Effects & Safety Profile
9. Insurance & Cost
10. How It Works at KwikPsych
11. Frequently Asked Questions
12. Disclaimer
13. References

Key Takeaways

• Rapid onset: 40–120 minutes after first infusion; 50% of patients respond within hours
• For treatment-resistant depression: Effective when 2+ antidepressants have failed
• Two delivery methods: IV ketamine (full-dose infusions) or intranasal esketamine/Spravato (requires REMS monitoring)
• Response rate: 25–65% depending on patient population; large clinical effect size vs. placebo
• Safe, monitored setting: Blood pressure, heart rate, oxygen, and mental status monitored during and 1+ hour post-infusion
• Board-certified psychiatrist: Dr. Monika Thangada, M.D., specializes in ketamine-assisted therapy
• Most insurances accepted: Aetna, BCBS, Cigna, UnitedHealthcare, Superior/Ambetter, Medicare; or self-pay from $299 initial eval

What Is Ketamine Therapy?

Ketamine therapy is a rapidly emerging, evidence-based treatment for severe depression, particularly treatment-resistant depression (TRD) where patients have not responded to two or more standard antidepressants. Unlike traditional antidepressants that take weeks to work, ketamine acts within 40 to 120 minutes after a single infusion.

Ketamine is a dissociative anesthetic that has been safely used for decades in anesthesia and pain management. In recent years, psychiatrists have harnessed its unique neurochemical properties to treat depression, anxiety, PTSD, and suicidal ideation with remarkable speed and efficacy.

At KwikPsych in Austin, Texas, we offer two forms of ketamine therapy:

1. IV Ketamine Infusions – Full-dose intravenous administration (0.5 mg/kg over 40 minutes)
2. Intranasal Esketamine (Spravato) – FDA-approved nasal spray requiring REMS-regulated monitoring

Both modalities deliver rapid relief when other treatments have failed.

How Ketamine Therapy Works

The Neuroscience Behind Ketamine

Ketamine works through a fundamentally different mechanism than traditional antidepressants (SSRIs, SNRIs, tricyclics). While those drugs inhibit serotonin reuptake (increasing serotonin availability in the synapse), ketamine targets the glutamatergic system.

Mechanism of Action:

• NMDA Receptor Antagonism: Ketamine blocks N-methyl-D-aspartate (NMDA) receptors on glutamate neurons
• Increased Glutamatergic Transmission: This blockade paradoxically increases glutamate release in the prefrontal cortex, a brain region critical for mood regulation and executive function
• Synaptic Plasticity: Enhanced glutamate promotes the growth of new synaptic connections (neuroplasticity), helping rewire depressive neural circuits
• Rapid Antidepressant Effect: These changes occur within hours, not weeks, unlike serotonergic drugs

Esketamine (S-Enantiomer) Advantage

Esketamine is the active S-enantiomer of ketamine, which has greater NMDA receptor affinity than racemic ketamine. This means:

• Stronger therapeutic effect at lower doses
• Reduced dissociative side effects (in some cases)
• Longer duration of action, allowing for less-frequent dosing (weekly or biweekly)

Conditions Treated

Primary: Treatment-Resistant Depression (TRD)

IV ketamine is used off-label for adults with major depressive disorder who have failed at least two antidepressant trials at adequate doses and duration. (Note: IV ketamine is not FDA-approved for depression; only intranasal esketamine/Spravato is FDA-approved for treatment-resistant depression.)

• Symptoms: Persistent sadness, anhedonia (loss of pleasure), fatigue, hopelessness, concentration problems
• Timeline: Rapid improvement within hours to days

Secondary Indications

Suicidal Ideation / Acute Suicidality

• Ketamine provides rapid symptom relief in patients with active suicidal thoughts
• Widely used in psychiatric emergency settings
• Bridges the gap until longer-acting treatments take effect

PTSD (Post-Traumatic Stress Disorder)

• Growing evidence supports ketamine for PTSD-related depression and trauma memory processing
• Dissociative properties may reduce emotional intensity of traumatic memories

Anxiety & Panic Disorder

• Off-label use; results promising in early studies
• Often improves alongside depression relief

Major Depressive Disorder with Catatonic Features

• For non-psychotic catatonia, ketamine is preferred over ECT initially

Who Is a Candidate for Ketamine Therapy?

Ideal Candidates

✓ Adults (18+) with major depressive disorder

✓ Failed 2+ antidepressants at adequate dose/duration

✓ Non-psychotic depression (psychosis is a relative contraindication)

✓ No uncontrolled hypertension (BP screening required)

✓ No history of substance use disorder or ketamine abuse

✓ Medically stable; able to tolerate brief dissociative effects

✓ Willing to attend multiple infusions over 2–4 weeks

Relative Contraindications

⚠ Active psychosis – Ketamine may exacerbate psychotic symptoms

⚠ Uncontrolled hypertension – Ketamine elevates BP; must be baseline-controlled

⚠ History of ketamine abuse – Risk of relapse; careful monitoring needed

⚠ Benzodiazepine dependence – May reduce ketamine efficacy; gradual taper recommended

⚠ Recent cardiac events – Medical clearance required

Medical Screening

All candidates undergo:

• Psychiatric evaluation with board-certified MD psychiatrist
• Medical history & vital signs
• Blood pressure monitoring (baseline and throughout treatment)
• Cardiac assessment if indicated
• Substance use history
• Current medication review

IV Ketamine vs. Intranasal Esketamine (Spravato)

KwikPsych Recommendation: Esketamine/Spravato is preferred for most patients due to FDA approval, better insurance coverage, and superior long-term safety. IV ketamine is offered for rapid-response cases or when esketamine is contraindicated.

Effectiveness & Clinical Evidence

Response Rates

• 25–65% of patients achieve significant response (≥50% symptom reduction on depression scales)
• Meta-analysis of 8 RCTs (n=577 patients): Large clinical effect size vs. placebo
• First-dose response: At least 50% of responders achieve improvement within hours of the first infusion
• Continued response: Approximately 65% of responders maintain improvements with maintenance dosing

Why Ketamine Works When Other Treatments Fail

1. Different mechanism: Targets glutamate, not serotonin—effective in "serotonin-resistant" depression
2. Rapid neuroplasticity: Promotes growth of new synaptic connections within days (vs. weeks for SSRIs)
3. Prefrontal cortex engagement: Directly activates mood-regulating brain regions
4. Combined therapy: Works synergistically with other antidepressants; not mutually exclusive

Clinical Significance

For patients with TRD, ketamine therapy can be life-changing: rapid relief from suicidal ideation, restoration of function, and hope after years of medication failures.

What to Expect During Treatment

Phase 1: Initial Psychiatric Evaluation

• Duration: 60–90 minutes
• Cost: $299 (self-pay); often covered by insurance
• Assessment: Detailed depression history, medical review, vital signs, risk assessment
• Screening: Substance use, cardiac history, baseline blood pressure
• Outcome: Determination of candidacy; discussion of risks/benefits

Phase 2: Pre-Treatment Preparation

• Fasting: No food for 4 hours before infusion (light breakfast acceptable)
• Medications: Continue antidepressants unless directed otherwise
• Transportation: Must arrange a driver or rideshare; cannot drive for 8–12 hours post-session
• Comfort items: Bring headphones, a comfort blanket, or journal for post-session reflection

Phase 3: During the Infusion

Duration: 40 minutes for IV ketamine; 2–3 hours total for esketamine (including monitoring)

1. Setup (5–10 min): IV line placed (ketamine) or nasal spray applied (esketamine) in comfortable reclining chair
2. Infusion (40 min): Saline + ketamine or esketamine administered; patient relaxes/may rest
3. Dissociation (common, expected):

• Mild "floating" or dreamlike sensation
• Detachment from body (not frightening; monitored staff present)
• Time distortion
• Peak effect within 2 hours; resolves completely within 4 hours

1. Monitoring: Continuous pulse oximetry, blood pressure, heart rate; staff at bedside

Phase 4: Post-Infusion Recovery

• In-clinic monitoring: 1–2 hours post-infusion
• Vital signs stable: BP, heart rate, oxygen return to baseline
• Discharge: Patient alert, oriented, with confirmed driver or rideshare
• Post-treatment effects: Mild grogginess, residual dreaminess (resolves within 4–8 hours)

Phase 5: Acute Treatment Phase (Weeks 1–4)

• Schedule: 2 infusions per week (Monday & Thursday, for example)
• Expected trajectory: Most notice mood lift by session 2–3
• Maintenance: If responding, continue sessions; if not responding by week 3, reassess

Phase 6: Maintenance & Follow-Up

• Responders: Transition to weekly, then biweekly sessions
• Duration: Typically 6–12 months of maintenance; some patients require 2+ years
• Long-term plan: Discuss with psychiatrist; esketamine safer for long-term use than racemic ketamine

Side Effects & Safety Profile

Common Side Effects (Transient)

Frequency & Timeline: Peak within 2 hours; resolve completely within 4 hours post-infusion

Serious but Rare Side Effects

⚠ Hypertensive Crisis – Uncontrolled BP elevation; prevented by baseline screening and monitoring

⚠ Respiratory Depression – Rare with proper dosing; pulse ox monitoring prevents complications

⚠ Psychotic Reaction – In susceptible individuals; avoided via psychiatric screening

Long-Term Safety Considerations

Racemic Ketamine:

• Chronic use (5+ years) associated with neurotoxicity risk: cognitive impairment, bladder toxicity
• Not recommended for indefinite maintenance

Esketamine/Spravato:

• Years of clinical use show maintained or improved cognitive function
• No evidence of neurotoxicity with long-term esketamine
• Safer for patients requiring extended maintenance

Monitoring During Treatment

✓ Continuous pulse oximetry, BP, heart rate

✓ Mental status assessment every 15 minutes

✓ Staff at bedside throughout infusion

✓ 1–2 hour post-infusion observation period

✓ Vital signs must normalize before discharge

Insurance & Cost

Insurance Coverage at KwikPsych

Accepted Plans:

• Aetna
• Blue Cross Blue Shield (BCBS)
• Cigna
• UnitedHealthcare
• Superior Health Plan / Ambetter
• Baylor Scott & White Health
• Oscar Health
• First Health
• Optum
• Medicare
• Self-Pay

Cost Breakdown

With Insurance (typical):

• Initial psychiatric evaluation: $0–150 copay (covers candidacy assessment)
• Each ketamine infusion: $100–350 copay per session
• Maintenance infusions: Similar copay structure

Esketamine (Spravato) Note: FDA-approved with REMS program; more insurers cover esketamine than IV ketamine. Expect higher approval rates.

Self-Pay Pricing:

• Initial psychiatric evaluation: $299
• Each ketamine/esketamine infusion: $179–249
• Maintenance (biweekly): ~$180 per session

Insurance Pre-Authorization

• KwikPsych will handle pre-authorization on your behalf
• Most insurers require documentation of ≥2 failed antidepressant trials (we provide this)
• Esketamine (Spravato) pre-authorization typically faster due to FDA approval
• Timeline: 1–3 weeks for approval; some insurers expedite for high acuity (suicidal ideation)

Financial Assistance

• Payment plans available; discuss at intake
• Some pharmaceutical manufacturers offer copay assistance for esketamine
• Medicare may cover sessions; verification at scheduling

How It Works at KwikPsych

Our Approach

Dr. Monika Thangada, M.D., Board-Certified MD Psychiatrist (ABPN), leads ketamine therapy at KwikPsych with a patient-centered, evidence-based protocol:

1. Thorough Psychiatric Evaluation – Comprehensive assessment of treatment history, contraindications, and candidacy
2. Medical Clearance – Baseline vitals, cardiac review, substance use screening
3. Informed Consent – Detailed discussion of risks, benefits, alternatives
4. Personalized Protocol – IV ketamine, esketamine, or combined approach; adjusted for individual response
5. Intensive Monitoring – Continuous vital signs, mental status checks, staff presence throughout
6. Rapid Symptom Assessment – After each session, we track mood, ideation, functionality
7. Flexible Maintenance – Transition to weekly or biweekly sessions based on response; long-term monitoring
8. Integrated Care – Ketamine therapy combined with ongoing psychotherapy, antidepressants, or other modalities as needed

Our Facility

Address: 12335 Hymeadow Dr, Ste 450, Austin, TX 78750

Phone: 737-367-1230

Hours: Monday–Friday, 7 AM–7 PM | Saturday, 8 AM–5 PM | Sunday, 9 AM–12 PM

Specialties: Treatment-resistant depression, esketamine/Spravato, IV ketamine, psychiatric evaluation, medication management

Important: Ketamine and esketamine therapy require in-person visits. While KwikPsych offers telehealth in Texas for some services, ketamine infusions are office-based only.

Frequently Asked Questions

1. Is Ketamine Therapy Addictive?

Ketamine is a Schedule III controlled substance, and yes, it has abuse potential (street name: "Special K"). However:

• Therapeutic doses are safe: Medical-grade ketamine administered in a controlled clinic setting has low addiction risk
• Monitoring prevents misuse: Supervised infusions eliminate unsupervised use
• Short-term protocol: Most acute phases last 4–6 weeks; not chronic, daily use
• Screening: We screen for substance use history and avoid treatment in those with active SUD
• Esketamine (Spravato) has REMS oversight, making diversion extremely difficult

Thousands of patients have safely received ketamine therapy without addiction.

2. How Quickly Does Ketamine Therapy Work?

Faster than any other antidepressant:

• First infusion: 40–120 minutes after administration
• Within 24 hours: Many patients notice a shift in mood, motivation, or suicidal ideation
• By session 2–3: Clear improvement in depressive symptoms
• Sustained response: With maintenance dosing, improvements continue

This rapid onset is why ketamine is life-saving for suicidal patients.

3. Can I Take Other Antidepressants With Ketamine?

Yes, ketamine can be combined with most antidepressants:

• SSRIs, SNRIs, tricyclics: All compatible
• Bupropion: Safe to combine
• Benzodiazepines: May reduce ketamine efficacy; gradual taper before treatment recommended
• Lithium: Generally compatible; monitor kidney function
• Stimulants: Discuss with psychiatrist; usually acceptable

Dr. Thangada will review your current medications and adjust as needed.

4. How Long Do Results Last?

Variable by individual:

• Some patients: Benefits last weeks to months after stopping infusions
• Most patients: Require ongoing maintenance (weekly to biweekly) to sustain improvements
• Long-term plan: Dr. Thangada will discuss maintenance duration; some patients continue for 1–2 years or longer
• Relapse risk: If maintenance stops, symptoms may gradually return (similar to other antidepressants)

Maintenance esketamine (Spravato) is safe long-term; racemic ketamine is less ideal for multi-year use.

5. What If Ketamine Therapy Doesn't Work for Me?

Not all patients respond (response rate: 25–65%):

• Early non-response: By session 3–4, we can usually detect a trend
• Reassessment: We'll review dosage, protocol, and underlying psychiatric factors
• Alternative treatments: TMS (transcranial magnetic stimulation), ECT (if severe and psychotic), or augmentation strategies
• No harm in trying: If ketamine doesn't work, you're back where you started; no permanent risk

6. Can I Drive After a Ketamine Infusion?

No. Patients may not drive for 8–12 hours post-infusion:

• Dissociative effects: Impair judgment and reaction time
• Drowsiness: Common for several hours
• Legal liability: Operating a vehicle while dissociated is unsafe and illegal
• Requirement: You must arrange a driver, rideshare, or stay at clinic until safe

Plan ahead and confirm transportation before your appointment.

7. How Often Will I Need Infusions?

Acute Phase (initial response):

• 2 infusions per week × 4 weeks = 8 infusions typical

Maintenance Phase (sustaining response):

• Weekly × 4–8 weeks, then
• Biweekly × 6–12 months (or longer, depending on stability)

Total commitment: 3–4 months minimum; often 6–18 months depending on response and goals.

8. Are There Any Drug Interactions I Should Know About?

Generally safe with most medications, but:

• Benzodiazepines may reduce efficacy; discuss tapering
• Tramadol & other opioids: May increase seizure risk; use cautiously
• Amphetamines & stimulants: Usually compatible; monitor for anxiety
• MAOI inhibitors: Relative contraindication; inform your psychiatrist

Bring a complete medication list to your evaluation. Dr. Thangada will screen for interactions.

Disclaimer

This page provides educational information about ketamine therapy and is not medical advice. Ketamine is a Schedule III controlled substance with potential risks. It is not appropriate for all patients. This information does not replace a consultation with a qualified psychiatrist.

Important Safety Information:

• Ketamine therapy is not FDA-approved for depression as a standalone medication; esketamine (Spravato) is FDA-approved
• Ketamine has abuse potential and requires careful patient selection and monitoring
• Serious adverse effects include hypertensive crisis, respiratory depression, and psychotic reactions (rare with proper screening)
• Ketamine is contraindicated in psychotic depression, uncontrolled hypertension, and active substance use disorders
• Long-term racemic ketamine is associated with neurotoxicity risk; esketamine is safer long-term
• Dissociation and transient cognitive effects are expected but reversible

Before pursuing ketamine therapy:

1. Schedule a psychiatric evaluation with a board-certified MD psychiatrist
2. Disclose all medical conditions, medications, and substance use history
3. Discuss risks, benefits, and realistic expectations
4. Ask questions about your specific clinical situation

KwikPsych assumes no liability for outcomes arising from ketamine therapy. All treatment decisions are made collaboratively between patient and provider.

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