DR. MANDEL ANSWERS THE MOST FREQUENTLY ASKED QUESTIONS ABOUT KETAMINE TREATMENT
Ketamine Infusion Therapy is the use of ketamine for the treatment of mood disorders and pain conditions, most commonly depression, suicidal ideation, posttraumatic stress disorder (PTSD), and complex regional pain syndrome (CRPS). For the treatment of mood disorders, ketamine therapy involves a series of six infusions at a ketamine infusion center spaced out over 2-3 weeks, with each infusion lasting about one hour. The dissociative effects of ketamine subside quite quickly, with most patients feeling comfortable enough to go home 20-30 minutes after the infusion is complete. For pain conditions, ketamine treatment involves a series of five, higher dose infusions at a ketamine infusion clinic over five days, with each infusion lasting about four hours.
Mood disorder patients often get rapid results from ketamine infusion. When given through an intravenous infusion in a slow, controlled, and constant rate, ketamine has many highly therapeutic effects on the brain. Among them is the ability to cause a physical growth in the brain’s prefrontal cortex, establishing new connections between neurons while repairing damaged cells. Ketamine causes an increase in neurotransmitters like glutamate that help to build new pathways in the brain, improving function in areas of mood, sleep, and more.
Pain patients often suffer from a process known as “central sensitization,” where pain signals increase in frequency and intensity over time. Ketamine acts to reset pain receptors and block signals of pain, restoring a healthier balance.
Yes, ketamine is an FDA-approved medicine that has been widely used in the medical field for over 50 years. Ketamine for depression is a newer, off-label use. Esketamine in nasal spray form, AKA Spravato, was approved for depression by the FDA in 2019. While it is legal to operate a clinic, there are many local, state, and federal laws and regulations that clinics must abide by and there are common best practices and standards of care that ethical ketamine clinics follow.
Ketamine, the medicine, was approved by the FDA as an anesthetic in 1970. Ketamine Infusion Therapy for the treatment of mood disorders and pain conditions is an off-label treatment. When evidence shows medicines to be helpful in treating conditions other than what they were originally approved for that use is considered off-label. This is a very common practice throughout the world. Almost one in four medications in the United States are used off-label and one in three psychiatric medications are. In early 2019, esketamine AKA Spravato, a nasal spray version of ketamine, was approved by the FDA for the treatment of depression.
The exact cost of ketamine therapy varies depending upon the condition being treated, whether the patient is local or traveling from out of town, if insurance coverage is likely to help offset the cost, and several other factors. Please contact us to learn about our pricing and interest-free financing options.
It is our goal for you to begin treatment within a few days of your first phone consultation. Most patients are seen within one week of their initial inquiry.
No. As one of the leading ketamine clinics LA has to offer, we’ve provided ketamine therapy to many patients and not a single one has reported any symptoms of addiction.
Patients commonly feel tired or groggy after an infusion. This usually subsides completely after a full night of sleep. Some patients experience mild nausea after an infusion, especially those prone to motion sickness. If you are prone to nausea, we can administer anti nausea medicine before the infusion to help prevent it. Additionally, patients who experience nausea after an infusion usually feel much better after we provide additional anti nausea medicine. Side effects usually dissipate within a few hours and are usually completely gone by the following day. There are no known long-term side effects of IV Ketamine Infusion Therapy when administered by a responsible clinician in a medical setting.
We do not require a referral or prescription from a psychiatrist or other physician. We do require speaking with another clinician who has managed the condition for which you are seeking treatment. This is to confirm your diagnosis, learn more about you, and personalize your treatment plan. The clinician can be a psychiatrist, psychologist, therapist, general practitioner, or pain specialist. All patients are encouraged to engage in talk therapy and implement positive lifestyle changes.
No. There is zero link between therapeutic ketamine use and bladder damage, also known as cystitis. The only known reports of bladder damage caused by ketamine are based on the abuse of street ketamine at doses 10-20 times the amount we administer, taken daily, over the course of years. There is only one study we are aware of on this topic, but bladder cells were exposed to ketamine for 72 hours at concentrations several thousand times greater than the peak serum levels achieved in patients undergoing low-dose infusions of ketamine.
Although hypomania is possible, we have not seen this occur in our patients. Patients on the verge of hypomania or in the midst of an episode may be directed to postpone treatment.
For mood disorder patients, some will begin to feel better within 1 hour of their first infusion. Patients with thoughts of self-harm or suicidal ideation often notice those thoughts and feelings dissipate first, and almost completely. There is often dramatic relief of dread and hopelessness. Other patients may not notice any improvement in mood until after completing a full course of treatment, which is a series of 6 infusions. Most patients see some improvement the day after their 3rd infusion. Some patients require more infusions and more time following their infusions before feeling significant relief. It is important to note that the results of ketamine can be sudden and dramatic, but they are often not. It is more common for patients to see gradual, subtle improvement that increases over time. Sometimes function improves before mood does.
For pain patients, it is uncommon to see substantial relief before completing a full course of treatment, which is a series of five infusions.
We have administered thousands of IV Ketamine Infusions since opening in 2014 and 83% of our patients have received significant relief. Although we cannot guarantee any particular outcome, our past experience has been very encouraging. Many clinical trials have shown that Ketamine Infusions produce results for about 70% of those involved. Our treatment is personalized for each individual, in terms of frequency and dosage, and we believe it offers you the best possible chance of success at 83%.
Mood disorder patients receive a series of 6 infusions over 2-3 weeks. Afterwards, booster infusions may be provided on an as-needed basis for maintenance. Typically, booster infusions are two infusions, provided one to two days apart. On average, patients enjoy around three months of relief before needing boosters. Sometimes, the results of the initial series do not last as long and in other cases, they last much longer. It is not unusual for patients to enjoy six months of relief, or longer.
Pain patients receive a series of five, 4-hour long infusions, over five consecutive days. Afterwards, booster infusions may be provided on an as-needed basis for maintenance. Typically, booster infusions are 2 infusions, provided on consecutive days or sometimes one to two days apart. On average, patients enjoy around three months of relief before needing boosters. Sometimes, the results of the initial series do not last as long and in other cases, they last much longer. It is not unusual for patients to enjoy six months of relief, or longer.
Some patients achieve long-term relief after one series of infusions. Others find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle changes. If ketamine therapy is the only solution for a patient, they may be able to increase the amount of time between booster infusions. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance and are typically two infusions, provided one to two days apart. Patients who make positive lifestyle changes and engage with their provider can remain depression-free long term.
For mood disorder patients, low-dose ketamine is administered for 50-55 minutes and patients are awake the entire time. During the infusion, most patients have a mild dissociative experience, with an increased sensitivity to light and sound and an altered perception of time. Most patients tolerate this without discomfort and many find the experience to be pleasant or interesting. In the rare case these side effects are considered unpleasant, other rapid-acting medications can be used to relieve or eliminate this discomfort. Once the infusion is complete, the dissociative effects rapidly dissipate and are often mostly gone within 20-30 minutes. There are no delayed “flashbacks” and patients generally leave the clinic within 20-30 minutes following an infusion.
For pain patients, ketamine is administered over a period of four hours. The amount given is higher than what mood disorder patients receive and can increase side effects such as dissociation. We use a number of adjuvants to decrease or eliminate the side effects that are associated with higher doses of ketamine. Patients generally take 60-90 minutes of rest following the infusion before they leave the clinic. There are no delayed “flashbacks” and aside from being tired or fatigued, most feel much like themselves. We require pain patients to be picked up inside our clinic by a responsible adult.
We ask that you not eat or drink anything four hours before your scheduled appointment; some water is okay. This decreases the chance of nausea and other complications.
You do not need to have someone bring you or remain with you during the infusion, but someone must bring you home. We advise you to not drive a car, operate heavy/dangerous machinery, sign any contracts, or partake in other potentially risky activities until the following morning.
All ketamine infusions administered by Ketamine Clinics of Los Angeles are outpatient procedures and are provided in our state-of-the-art facility in Culver City, California. Our address is: 6801 Park Terrace, Suite 525, Los Angeles, CA 90045
Our commitment to you and your recovery remains long after your last infusion. We know how vital it is that ketamine therapy be part of a bigger treatment plan for our patients, and that’s why we combine our program with an extensive aftercare plan including: regular availability to you for any resources or referrals you may need, quick replies to your questions and concerns, daily text message check-ins, bi-weekly depression assessments sent straight to your phone through an encrypted and HIPAA compliant server, a detailed list of lifestyle changes to support your recovery, regular follow up from our medical team, and more. Some patients are more receptive to conventional oral antidepressants after treatment and most are encouraged to be involved in talk therapy with a trusted, licensed, mental health professional. We also work with patients on modifying their lifestyle choices to help maintain their good results. For pain patients, the aforementioned treatment plan applies as well. Physical therapy, exercise, and stretching are also beneficial in some cases, depending on what the cause of the pain is and the condition.
Some patients achieve long-term relief after one series of infusions. Others find that infusions enhance the impact of antidepressants or provide initial relief that is then sustained by oral medicines, other therapies, and lifestyle changes. After the initial series of infusions restores the brain to a healthy balance, it is generally easier to maintain that balance than it was to attain it in the first place. Follow-up or “booster” infusions are provided on an as-needed basis for maintenance and are typically two infusions, provided one to two days apart.
There are very few. Call now to discuss your other medical conditions or fill out a contact form.
There are very few medications that have any known interaction with ketamine. Please inform us of any and all medications you are taking. We are particularly interested in learning if you are taking:
- Lamotrigine, AKA Lamictal. Patients should allow 6 hours between taking Lamictal and the start of their infusion. They should wait 6 hours after their infusion before resuming Lamictal.
- Benzodiazepines. Patients taking large doses may have a reduced response to ketamine. This does not mean you can’t receive ketamine treatment while taking benzodiazepines or that you won’t benefit. It is perfectly safe to combine these medications. We want to ensure the best possible chances for your success though, so we may ask you to skip a dose six hours before the start of your infusion and wait six hours post-infusion before resuming your benzodiazepine. Some common brand names are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
- SSRIs and tricyclics do not interfere with ketamine. There is no need to adjust dosing.
- If you are taking opiates, muscle relaxants, or anti-inflammatories, there is no need to adjust dosing.
In some cases, patients may benefit from reducing the dose or completely eliminating medications that don’t work and/or produce negative side effects. Ketamine can be helpful in this process, but you should not adjust your dose or frequency of use of any prescription medication without first consulting with your prescribing physician.
There are no formal age limitations. We have treated patients as young as nine and as old as 88.
We accept all major credit and debit cards, cash, and select interest-free financing options. We do not accept checks.
Reimbursement varies widely among insurance companies and policies within companies. Some insurers offer policies with reimbursement for ketamine therapy. We can provide you with a sample billing statement with the correct CPT codes so you can contact your insurance provider ahead of time and check whether they’ll reimburse you. Many PPO plans reimburse a portion of the cost after you’ve met your deductible. We require payment at the time of treatment. We also offer interest-free financing through Advance Care.
We infuse ketamine intravenously and esketamine AKA Spravato is taken intranasally. We provide ketamine intravenously because the IV route of administration (ROA) offers a number of safety and efficacy advantages. Please call us to discuss the pros and cons of both treatment options.
The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF or “quad ASF”) is the leading organization in the United States that accredits ambulatory, or outpatient, surgery clinics. AAAASF was founded in 1980 to develop an accreditation program to help establish and oversee quality assurance measures toward creating and improving industry standards that help assure patient safety. They are considered the gold-standard in accreditation.
- Holds outpatient and office-based facilities to hospital standards.
- Requires surgeons to be board certified and have hospital privileges for any procedure they perform.
- Requires the use of anesthesia professionals for deeper levels of anesthesia.
- Requires a safe and clean environment that meets stringent standards.
- Requires peer review (peer oversight) and tracks data for thousands of individual cases.
- Champions patient safety worldwide and has for nearly 40 years.