Frequently Asked Questions
Frequently Asked Questions About Ketamine
Ketamine infusions may help patients with treatment-resistant severe depression, bi-polar depression, PTSD, and major depressive disorder. Ketamine infusions may also help some patients with Reflex Sympathetic Dystrophy (RSD) – now called Complex Regional Pain Syndrome (CRPS). Ketamine infusion therapeutics do not guarantee successful symptom relief for depression or CRPS/RSD. However, thousands of patients treated with ketamine have shown significant improvement in their symptoms. You can read more about what ketamine is and how it works in About Ketamine .
Addiction has not been described in ketamine infusion therapeutics given the dose used, treatment schedule, supervised medical setting, and lack of withdrawal symptoms. Ketamine has a proven track record of being an FDA-approved anesthetic medication since the mid 1960’s.
Answer for that question: It is important to have an initial consultation with a physician to determine if any interactions amongst your present daily prescribed and over the counter medications and nutritional supplements may occur. Instances are very rare, but we care to evaluate each patient’s unique situation individually with a board certified physician.
Two classes of medications may commonly interfere with your ketamine therapy: Benzodiazepines and Lomotrigine (Lamictal).
The first of which is benzodiazepines, which includes Diazepam, Clonazepam, Alprazolam, et cetera, have been shown to decrease the efficacy of ketamine by likely inhibiting or decreasing the neuroplasticity and the dendritic spine growth amongst the nerves after the ketamine infusion has stopped. The latest studies indicate that dosages over 7.5mg of diazepam or equivalent to diazepam per day is the dosage at which this may become an issue, but smaller dosages do not appear to have the same issue. These conversions may be done by a benzodiazepine calculator online or with one of our physicians to determine if the level of the benzodiazepines you are taking is above that level. It might be appropriate for some patients to wean down on the levels of benzodiazepines or to completely wean off of their benzodiazepines, and we insist that this be done in coordination and under the care of the physician who prescribed these medications.
Lamotrigine (Lamictal) is a medication used as a mood stabilizer that works at the NMDA receptor and competitively blocks how Ketamine interacts with that receptor and can block the efficacy of ketamine. We traditionally ask that our patient’s hold the Lamotrigine for 24 hours before and 12 hours after the ketamine infusion. It is important to discuss these changes to your medication regimen with your prescribing physician.
Additionally, individuals who drink more than two alcoholic drinks a day may experience similar blocking of dendritic spine growth. We will discuss the usage of alcohol and the intake levels on a regular basis during your initial consultation to determine if the amount may cause decreased efficacy of the ketamine infusion therapy.
Any medical condition that is not well managed may preclude you from treatment. Uncontrolled high blood pressure or any serious cardiac or respiratory conditions need to be disclosed to avoid complications. A physician at MindPeace Clinics will review all your conditions and medications with you when they review your patient health questionnaire.
Some patients have reported mild, short-lived dissociative symptoms during their infusions. While not unpleasant usually, some effects of floating, blurry visual changes, and dizziness can occur. These effects can be treated with other medications to make your infusion a more relaxing experience.
While Ketamine is safely used daily in Emergency Departments and Operating Rooms both in the United States and around the world, the medication carries a stigma due to its history as a “party drug.” Additionally, administering this medication requires a set of skills with emergency airway, cardiac, and vascular management, which are possessed by physicians working in a hospital based setting.
Unfortunately, studies have not found the nasal Ketamine sprays to be as effective as the intravenous administration. Nasal spray typically gives patients 30-50% of the effective dose of the medication administered, whereas more than 95% arrives where needed when we give the medication through an IV.
The mechanism of Ketamine is complicated because it affects many different receptors in the brain. The best scientific understanding is that it works at the N-methyl-D-aspartate (NMDA) receptor in the brain in an area called the lateral habenula, which is responsible for the process of emotions. Ketamine and its metabolites also have an affinity for narcotic receptors all over the brain, which may be contributing to the effects of it as an analgesic, which is a medication for pain.
During the Consultation visit, we start by establishing a mood or pain baseline with digital mood monitoring, and ask you to fill out a brief survey called a Patient Health Questionnaire – 9, which was developed at Columbia University. We then measure the progress using this tool and define success as 50% improvement in mood based on this scale.
Often, close friends, loved ones and even coworkers might notice subtle improvements in mood prior to the patient’s awareness that the Ketamine infusions are beginning to work.
Finally, we communicate with the physicians, as well as any other mental health providers, who give us an independent subjective verification of the success of the treatment.
Often, close friends, loved ones and even coworkers might notice subtle improvements in mood prior to the patient’s awareness that the Ketamine infusions are beginning to work.
Finally, we communicate with the physicians, as well as any other mental health providers, who give us an independent subjective verification of the success of the treatment.
At the MindPeace Clinics, we base our practice on the latest published articles and the work being done at the National Institute of Mental Health. We strongly encourage our patients to complete the initial series of infusions to ensure the greatest chance of success and longevity of symptom remission.
The published rates of success vary from 62% to 85%. In our practice, we have seen success of approximately 75% across patients who complete all six Ketamine infusions. The overwhelming majority of these patients continue to have remission of their symptoms with “Booster Infusions” provided on an as needed basis.
Many first-line treatment options are medications in pill form. It can take several weeks to a few months to determine if they are affecting a patient’s mood, and they may depress your mood for the first few weeks. Many of these medications have side effects that include weight gain, sexual dysfunction, interruptions in sleeping patterns, and blunting of emotions. Some other medications that may may be added onto other medications may cause diabetes.
Other options may include:
Other options may include:
- Transcranial Magnetic Stimulation (TMS) Therapy, which uses magnets on the outside of your head to attempt to stimulate brain cells to improve your mood. The exact mechanism of action isn’t well understood. This course of treatment isn’t invasive, but requires treatment five days a week for up to six weeks. Each session lasts approximately 20-40 minutes.
- ElectroConvulsive Therapy (ECT) works by putting you to sleep and inducing a seizure in your brain. You are sedated using medications, so that your body does not shake. Many individuals who undergo an initial series of ECT have depression relapse and require additional sessions. The mechanism of ECT is not well understood, but one major side effect can be permanent memory loss.
Clinic Frequently Asked Questions & Policies
We understand sometimes missing an appointment due to an emergency is unavoidable. However, by not calling to cancel an appointment, you may be preventing another patient from getting much-needed treatment. If an appointment is not cancelled at least 24 hours in advance, you will be charged for the full cost of your appointment. If you are more than 15 minutes late for your scheduled appointment time, we will reschedule you and charge you for a no-show appointment. All patients are required to keep a valid credit card on file with the clinic. Please let us know of any changes in payment information.
MindPeace Clinics does not participate with insurance plans. Your payment is due in full at the time of service. We accept payments made by credit card, cash, or check.
We are considered an out-of-network provider. At the time of service, you will receive an itemized receipt (super-bill) that you can submit to your insurance company. Please contact your insurance company to learn more about your reimbursement options for an out-of-network provider. You are solely responsible for obtaining reimbursement from your insurance company.
This treatment is recommended by the American Psychiatric Association’s Consensus Statement published in 2017 to be tried by patients who have failed other treatments. Based on this, and a growing number of studies that have replicated the tremendous success, more insurance companies are starting to reimburse some, if not all, of the costs associated with ketamine therapeutics.
Not all insurance companies are so progressive, so please check with your insurance company to see how much they might reimburse you for this treatment. MindPeace Clinics have opted out of the Medicare and Medicaid system. We do not participate in any insurance plans. We do not guarantee any outside reimbursement for the services we provide.
We are happy to assist you with the documentation to obtain reimbursement from your insurance company.
Yes. We request that you continue your relationship with your primary care provider. Our physicians will communicate with them directly to coordinate medical care after providing the initial care for any non-infusion related issues.
We act as consultants for your psychiatrist, primary care physician, and other mental health providers. We ensure that the ketamine infusions are provided in a relaxing and safe environment, with experienced critical care and emergency registered nurses, and a board-certified physician.
If you are experiencing a life-threatening emergency, call 9-1-1, and go to the nearest hospital emergency department prior to contacting MindPeace Clinics.
For extremely urgent matters, please call your clinic and leave a message. Extremely urgent matters may include:
- Suicidal thoughts or thoughts of harming others
- Unexpected medication reaction with moderate-to-severe symptoms
- Any unusual behavior or reaction that you fear could lead to physical harm
Once we receive your call or message, a doctor will call you back as soon as they can. If you are unable to wait for a response, dial 9-1-1, and go to the nearest hospital emergency department.
Controlled medications are easily abused, and there is an illegal market for these medications. The DEA and the Virginia Board of Medicine monitor prescribing and refill practices for these medications.
If you are prescribed a controlled medication, it is critical that you follow the controlled medication policy:
You MUST take these medications as directed.
If you feel you need to adjust your dose to a higher dose of the medication, you must call the office, and consult with your physician prior to making any adjustments to your dose.
You must be responsible with your medication, and take measures to ensure that your medication is not lost or stolen.
If you require an early refill of your medication because you increased your dose without consulting your doctor, or because your medication was lost/stolen, you are in violation of the controlled medication policy. We understand that circumstances outside of your control may result in you needing an early refill for your medication. We allow ONE violation of the controlled medication policy to allow for these circumstances. You will be charged a $100 fee for an early refill of your controlled medication. Any subsequent violations of the policy will result in your termination as a patient with MindPeace Clinics. Due to the nature of these medications, MindPeace Clinics must be able to manage these prescriptions responsibly and in a manner consistent with minimizing any potential abuse.
If you are prescribed a controlled medication, it is critical that you follow the controlled medication policy:
You MUST take these medications as directed.
If you feel you need to adjust your dose to a higher dose of the medication, you must call the office, and consult with your physician prior to making any adjustments to your dose.
You must be responsible with your medication, and take measures to ensure that your medication is not lost or stolen.
If you require an early refill of your medication because you increased your dose without consulting your doctor, or because your medication was lost/stolen, you are in violation of the controlled medication policy. We understand that circumstances outside of your control may result in you needing an early refill for your medication. We allow ONE violation of the controlled medication policy to allow for these circumstances. You will be charged a $100 fee for an early refill of your controlled medication. Any subsequent violations of the policy will result in your termination as a patient with MindPeace Clinics. Due to the nature of these medications, MindPeace Clinics must be able to manage these prescriptions responsibly and in a manner consistent with minimizing any potential abuse.
Letter writing fees are based on the time required to compose the letter. Excused absence notes, brief accommodation notes, and other short notes will generally not incur a fee. Other types of letters often require a more substantial amount of time and will be charged at your regular session fee.
Office Hours: Monday – Friday, 9am to 5pm
Appointment Hours in Richmond: Monday – Friday, 9am to 6pm
Appointment Hours in Arlington: Monday – Friday, 8am to 7pm
Appointment Hours in Norfolk: Monday – Friday, 9am to 7pm
We see patients by appointment only. Walk-ins are not accepted at any location.
Initial Medical Evaluations are one (1) hour. Mood Disorder Treatments are 90 minutes or two and a half (2.5) hours depending on the treatment. Migraine Treatments are two and a half (2.5) hours. Chronic Pain Treatments are five (5) hours.
Appointment Hours in Richmond: Monday – Friday, 9am to 6pm
Appointment Hours in Arlington: Monday – Friday, 8am to 7pm
Appointment Hours in Norfolk: Monday – Friday, 9am to 7pm
We see patients by appointment only. Walk-ins are not accepted at any location.
Initial Medical Evaluations are one (1) hour. Mood Disorder Treatments are 90 minutes or two and a half (2.5) hours depending on the treatment. Migraine Treatments are two and a half (2.5) hours. Chronic Pain Treatments are five (5) hours.
A fee of $50 will be charged for all returned checks.
WHAT CONDITIONS DOES KETAMINE TREAT?
Ketamine infusions may help patients with treatment-resistant severe depression, bi-polar depression, PTSD, and major depressive disorder. Ketamine infusions may also help some patients with Reflex Sympathetic Dystrophy (RSD), now called Complex Regional Pain Syndrome (CRPS). It should be noted that ketamine infusion therapy does not guarantee success with your depression or CRPS/RSD. However, thousands of patients treated with ketamine have shown significant improvement in their symptoms. The highest chances for successful treatment begins with a proper diagnosis.
IS KETAMINE ADDICTIVE?
Addiction has not been described in ketamine infusion therapy given the dose used, treatment schedule, supervised medical setting, and lack of withdrawal symptoms. Ketamine has a proven track record of being an FDA-approved anesthetic medication since the mid 1960’s.
WILL KETAMINE TREATMENT AFFECT MY CURRENT MEDICATIONS?
Chronic use of or dependence on benzodiazepines may be detrimental to ketamine therapy. At the initial medical evaluation, the attending physician will create a treatment plan based on your medical history and current medications.
WHAT MEDICAL CONDITIONS WILL EXCLUDE ME FROM KETAMINE TREATMENT?
Any medical condition that is not well managed may preclude you from treatment. Uncontrolled high blood pressure or any serious cardiac or respiratory conditions need to be disclosed to avoid complications. Dr. Oliver will review all your conditions and medications with you when he goes over your patient health questionnaire.
WHAT ARE THE SIDE EFFECTS OF KETAMINE?
Some patients have reported mild dissociative symptoms during their infusions, which are short-lived. While not unpleasant usually, some effects of floating, blurry visual changes, and dizziness can occur. These effects can be treated with other medications to make your infusion be a relaxing experience and not daunting.
WHY AREN’T OTHER DOCTORS PERFORMING THIS TREATMENT?
While Ketamine is used daily in Emergency Departments and Operating Rooms both in the United States and around the world safely, the medication carries a stigma about it due to its history as a “party drug.” Additionally, administering this medication requires a set of skills with emergency airway, cardiac, and vascular management, which is possessed by physicians who work in a hospital based setting.
IS THE NASAL APPLICATION OF KETAMINE JUST AS EFFECTIVE?
Unfortunately, studies have not found the nasal Ketamine sprays to be nearly as effective as the intravenous administration. When one takes a nasal spray, they get 30-50% of the effective dose of the medication administered, whereas more than 95% arrives where needed when we give the medication through an IV.
HOW DOES KETAMINE WORK?
The mechanism of Ketamine is complicated because if affects many different receptors in the brain. The best scientific understanding is that it works at the N-methyl-D-aspartate (NMDA) receptor in the brain in an area called the lateral habenula, which is responsible for the process of emotions. Ketamine and its metabolites also have an affinity for narcotic receptors all over the brain, which may be contributing to the effects of it as an analgesic, which is a medication for pain.
HOW WILL I KNOW IF THE TREATMENT IS WORKING?
During the Consultation visit, we start by establishing a mood or pain baseline with digital mood monitoring, and ask you to fill out a brief survey called a Patient Health Questionnaire – 9, which was developed at Columbia University. We then measure the progress using this tool and define success as 50% improvement in mood based on this scale.
Often, close friends, loved ones and even coworkers might notice subtle improvements in mood prior to the patient’s awareness that the Ketamine infusions are beginning to work.
Finally, we communicate with the physicians, as well as any other mental health providers, who give us an independent subjective verification of the success of the treatment.
WHAT IS YOUR CANCELLATION POLICY?
We understand that there are times when you must miss an appointment due to an emergency. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seemingly “full” appointment book. If an appointment is not cancelled at least 24 hours in advance you will be charged for the full cost of your appointment ($295 for an Initial Consultation, $495 for a Mood Infusions, $1750 for a Pain Infusion). If you more than 15 minutes late for your scheduled appointment time, we will be forced to reschedule and charge you for a no-show appointment. All patients are required to keep a valid credit card on file with the clinic. Please let us know of any changes in payment information.
DO I NEED TO FINISH ALL 6 INFUSIONS IN THE INITIAL SERIES IF I START TO FEEL BETTER?
At the MindPeace Clinics, we base our practice on the latest published articles and the work that is being done at the National Institutes of Mental Health. We strongly encourage all of our patients to complete the initial series of infusions to ensure the greatest chance of success and longevity of symptom remission.
HOW DOES KETAMINE COMPARE TO OTHER TREATMENT OPTIONS?
Many first line treatment options are medications in pill form and take between several weeks to a few months to determine if they are affecting a patient’s mood and may initially depress your mood for the first few weeks. Additionally, many of these medications have side effects that include weight gain, sexual dysfunction, interruptions in sleeping patterns and blunting of emotions. Additionally, some other medications that may be “added” onto other medications may cause diabetes.
Other options may include:
- Transcranial Magnetic Stimulation (TMS) Therapy, which uses magnets outside of your head and attempts to stimulate the brain cells to improve your mood. The exact mechanism of action isn’t well understood. This course of treatment isn’t invasive, but requires treatment five days a week for up to six weeks. Each session lasts approximately 20-40 minutes per treatment.
- Electro Convulsive Therapy (ECT) works by putting you to sleep and inducing a seizure in your brain. You are sedated using medications, so that your body does not shake. Many inpiduals who undergo an initial series of ECT have depression relapse, and require additional sessions. The mechanism of ECT is not well understood, but one of the major side effects can be permanent memory loss.
WILL MY INSURANCE COVER THIS?
This treatment is recommended by the American Psychiatric Association’s Consensus Statement that was published in 2017 to be tried by patients who have failed other treatments. Based on this statement, and a growing number of studies that have replicated the tremendous success, more insurance companies are starting to reimburse some if not all of the costs associated with this treatment.
That being said, not all insurance companies are so progressive, so please check with your insurance company to see what percentage they might reimburse you for this treatment. We have opted out of the Medicare and Medicaid system and do not participate in any insurance plans. We do not guarantee any outside reimbursement for the services we provide.
We are happy to assist you with the documentation that you will need to provide to your insurance company to obtain reimbursement, and provide a “super bill” that details all costs associated with the services we provide.
WHAT ARE THE SUCCESS RATES?
The published rates of success vary from 62% to 85%. In our practice, we have seen success of approximately 75%, or three of four patients who complete all six Ketamine infusions. The overwhelming majority of these patients continue to have remission of their symptoms with “Booster Infusions” provided on an as needed basis.
WILL I CONTINUE MY RELATIONSHIPS WITH MY PSYCHIATRIST, PRIMARY CARE PHYSICIAN AND OTHER MENTAL HEALTH PROVIDERS?
We act as consultants for your Psychiatrist and Mental Health Providers, very similar in relationship as a Radiation Oncologist will act to a Medical Oncologist. We ensure that the Ketamine infusions are provided in a relaxing and safe environment with experienced critical care and emergency Registered Nurses and a board-certified physician.
Additionally, we request that you continue your relationship with your primary care provider. Our physicians will communicate with them directly to coordinate care that is medical in nature after providing the initial care for any non-infusion related issues.