This is the companion article to Episode 10, Season 2 of the Ketamine Insights podcast.
Ketamine therapy has emerged as a promising treatment option for those suffering from depression and other mental illnesses. I have been using therapeutic ketamine for over five years and have navigated through most of the various ways to access this care in the US. Here's a guide to help you understand the different avenues available to accessing ketamine care in 2024, including the benefits, downsides, and estimated costs.
The website KetamineTherapyforMentalHealth.com can help you find ketamine providers licensed in your state.
It's important to note that the information shared here comes from my personal journey and additional research. The landscape of therapeutic ketamine care is constantly evolving, so consider this as a snapshot of where things stand in 2024.
The Gold Standard: Combined Care
The gold standard of ketamine care integrates both the administration of ketamine and talk therapy within the same practice. This means you don't have to find separate providers for your treatment. Psychiatrists or therapists may offer this holistic care, often with the help of a nurse anesthetist who administers the ketamine.
Benefits
Convenience: Everything is available in one place, saving you from the hassle of coordinating between multiple providers.
Comprehensive Care: You receive medical supervision during your ketamine treatment and can have a therapy session immediately after.
Holistic Approach: Providers in these practices often have a deep understanding of both ketamine therapy and the importance of mental health support.
Downsides
Cost: Each session ranges from $300 to $600, depending on your location and your insurance status.
Availability: This model is not available everywhere.
Ketamine Clinics
Ketamine clinics specialize in prescribing and administering ketamine, but they typically do not provide the associated therapy. It's up to you to find a therapist and coordinate your sessions.
Benefits
Access to Medical Professionals: Clinics are equipped with trained medical staff to administer ketamine safely.
Variety in Administration Forms: Clinics may offer IV, intramuscular injections, or Spravato (esketamine nasal spray).
Downsides
Lack of Integrated Therapy: You need to find a therapist and schedule your therapy sessions separately.
Quality Variations: Clinics can vary widely in quality, so thorough research and vetting clinics are crucial.
Costs: Expect each visit to cost between $300 and $600. Therapy sessions, which are not included, range from $90 to $200 per hour.
At-Home Ketamine Treatment
At-home treatment involves administering ketamine lozenges or quick-dissolve tablets yourself. This option is entirely different from clinic settings and offers a range of dose levels. There are three main ways to get ketamine for at-home use:
1. Through Ketamine Clinics:
You may receive a prescription for at-home lozenges from the same clinic where you got your IV, IM, or Spravato treatments. The clinic sends the prescription to a compounding pharmacy, which mails the medication directly to you.
2. Physicians and Registered Nurses' Practices:
Some physicians or registered nurses prescribe ketamine tablets after an in-person or online consultation. A compounding pharmacy prepares and mails the lozenges to you.
3. Online Mail-Order Services:
Companies like Mindbloom, Joyous, or BetterUCare offer a completely online process for obtaining ketamine. You'll have a virtual consultation with a healthcare provider who will prescribe ketamine, which is then mailed to you (usually in fancy packaging).
Benefits
Convenience: You can take the treatment in the comfort of your home.
Prices vary, but they are usually lower than the integrated practices and the ketamine clinics.
Downsides
Limited Oversight: Concerns about proper patient monitoring, particularly for those with suicidal ideation.
Variable Dosages: The doses prescribed largely depend on the prescribing physician. Work with your prescriber to find the right dose for you, being careful to use the smallest efficacious dose.
No Immediate Medical Supervision: You are responsible for administering the drug and for ensuring your own safety.
A Note on Safety and Side Effects
At-home ketamine treatments come in varying doses from 50mg to 400mg. It's essential to discuss with your prescriber what dose works best for you. Lower doses like 50mg generally do not cause dissociation, while doses around 200mg will usually induce a trip.
Short-term side effects: Nausea, dizziness, and disorientation.
Long-term side effects: Potential for permanent bladder issues (see here). Dependence can also become a problem for some people (see here).
Importance of Therapy
Regardless of the method you choose, it's best to integrate ketamine treatment with therapy. Working with a therapist trained in psychedelics can significantly enhance the benefits of your treatment. If you do not have access to a therapist, resources like the workbook here can be very helpful.
Conclusion
Whether you choose to receive ketamine treatment in a therapist's office, at a dedicated ketamine clinic, or at home, each method has its benefits and downsides. The most important aspects to consider are the comprehensiveness of care and ensuring you have the necessary support systems in place. Always do thorough research and don't hesitate to ask questions to ensure you are getting the best possible care.
Remember to advocate for yourself and never ration your joy.
This is so helpful. I wish the drug were available and licensed in this way in the UK, though I imagine there would need to be a long and difficult fight to get the NHS to use it. Sadly care for mental health in the UK is very primitive and not yet trauma informed. (It's basically the antidepressant roulette wheel, outdated CBT or nonexistent. )