Determining if Ketamine is Right for You
Determining whether ketamine is a good treatment option for pain and mood disorders is a big undertaking for a patient and the decision should not be taken lightly. Treatment is a large financial and time commitment. Optimizing the outcome requires proper pre- and post-treatment care with a medical team and family support. It is critical that patients understand the benefits and risks associated with ketamine in order to determine if treatment is a good course of action. This section outlines when ketamine is deemed a potentially good fit for a patient, when it is not a good treatment option, and how a patient might consider discussing the treatment option with their own medical team (primary care practitioner, psychotherapist, and/or medication prescriber).
When Is Ketamine a Good Fit?
Ketamine is recommended for patients suffering from major depression, suicidal ideation, anxiety, PTSD, and chronic pain, who have tried other treatments without success. Ketamine is safe. It is associated with fewer side effects than traditional pharmaceuticals. It works more quickly than other treatments. Ketamine may also be a good fit for individuals who are on a healing journey and feel “stuck” in therapy.
Ideally, a patient seeking ketamine treatment should be physically healthy, have discussed ketamine as an option with their medical provider in charge of their mood or pain disorder care (e.g. primary care practitioner, psychotherapist, and/or medication prescriber), have a documented history of past unsuccessful treatments in alleviating pain and/or mood disorder symptoms, and have a full psychiatric work up.
Ketamine may a good treatment for people who have considered the following:
When Is Ketamine Not a Good Treatment Option?
It is important for individuals considering ketamine to know the status of their physical and mental health. There are risks to any medication and those risks will vary with the patient’s other underlying medical conditions and medications. Chief risks include temporary increase in blood pressure and may worsen existing symptoms of psychosis or bipolar mania. Ketamine is not a good treatment option for individuals with certain medical and psychiatric conditions, including pregnancy, cardiovascular disease, uncontrolled hypertension, schizophrenia, schizoaffective disorder, active illicit drug use, active psychosis, and active mania.
Ketamine is a treatment. It is not a cure for mood or pain disorders. It is common for patients to not experience immediate relief and treatment involves significant emotional investment on the part of individuals undergoing treatment and their support networks. Ketamine is not a good treatment option for someone who is not ready or interested in engaging in therapy or other growth work in conjunction with their treatment.
Ketamine treatment can be physically and emotionally taxing. It is best for patients seeking treatment to have a committed medical team working with them to manage their pain and mood disorders. Patients who are not working with someone prior to ketamine treatment, such as a pain specialist, primary care practitioner, psychotherapist, or psychiatrist, do not have a current diagnosis for pain or mood disorders, or do not have an active treatment plan for their pain or mood disorders are not good candidates for ketamine treatment. Further, ketamine is not a good treatment option for individuals living in unstable environments, experiencing ongoing trauma, or for people with limited social support networks.
Ketamine treatment typically initiates with a set of 6-8 treatments over a period of two to four weeks. Additionally, most patients require maintenance treatments, which will vary greatly depending on each individual’s diagnosis and severity. As a result, maintenance frequency can range anywhere from 2 weeks to 3 months. Each ketamine session lasts a couple of hours, and patients are advised not to drive, work, care for small children, or engage in stressful tasks for the rest of the day after a treatment. Patients may also feel more emotionally raw after ketamine treatments and may need to spend more time engaging in self-care and supportive activities like therapy. For individuals who are unable to commit enough time to the process, ketamine may not be a good treatment option.
The high out-of-pocket cost of ketamine is a big factor in determining whether ketamine is a good treatment option. An initial course of ketamine treatment costs between $3,000-$5,000, and many patients require additional maintenance infusions to maintain improvements, which could range between $400-$800 for a single treatment. Ketamine is typically not covered by insurance and a person considering ketamine will need to have enough money set aside to cover the first couple months of treatments. That said, there is some progress on insurance coverage: 1) some insurances cover the cost of esketamine nasal spray; and 2) some patients submit superbills for ketamine treatment to insurance companies and get partially reimbursed. Patients considering ketamine treatment should reach out to their insurance provider ahead of time to see if this is an option.
How To Discuss Treatment Options With Your Doctor
It is always in the best interest of the patient to engage with their medical team about starting any new medical treatment. The first step for a patient should be to reach out to their primary care practitioner, psychotherapist, and/or medication prescriber and have a conversation about their diagnoses, the medications they are currently taking, the benefits that ketamine treatment could provide, and the risks associated with ketamine treatment.
Some questions patients could consider when talking with their medical team:
Because ketamine is a relatively new treatment option, not all doctors are up to date on the research, risks, and benefits of ketamine. There are a couple options available to patients if their doctor cannot answer questions about ketamine or has concerns about its role in patient care, such as signing medical release documents to allow a ketamine clinic to engage with the doctor directly or referring the doctor to the ASKP3 website, where they can find medical reference materials about ketamine research and treatment.