Ketamine Frequently Asked Questions

Absolutely. Ketamine has been used safely for decades in emergency rooms, operating rooms, and in the military around the world. We have extensive knowledge and a deep understanding of ketamine and know how to carefully administer it. The dose is low and given as a slow infusion so you remain awake. Dr. Mallek has over 10 years of experience administering ketamine. We closely monitor your infusions and know how to manage the extremely rare event of a complication. Ketamine has shown to be both safe and beneficial in many settings, including the treatment for mood disorders and chronic pain.

Ketamine is approved by the FDA for use as an anesthetic and analgesic in the setting of operating rooms and emergency departments. Outpatient ketamine treatment for depression, along with PTSD, anxiety, OCD, postpartum depression, and bipolar disorder are not approved by the FDA. When it is used in this way, it is considered an “off-label” use of the medicine.

Ketamine therapy has shown to be effective for people suffering from depression, anxiety, bipolar disorder, PTSD, OCD, and addiction. There is also evidence of its effectiveness in treating chronic pain conditions, particularly those that are neuropathic in origin, such as CRPS, phantom limb syndrome, 

A meta-analysis of multiple research studies has demonstrated that 70% or more of treatment resistant patients will experience significant symptom relief after receiving the initial round of six low-dose infusions. This is a drastic improvement compared to the 40% success rate of traditional antidepressant medications. Even with such a high success rate, it is important to note that ketamine therapy does not work for everyone. Ketamine is a powerful tool and should be used alongside therapy to increase the likelihood of success. 

Ketamine has been shown to be extremely effective in treating neuropathic type pain. Neuropathic pain is a type of pain that originates in the nerves and brain. The brain eventually learns that pain is the baseline sensation even though there might not be a physical problem. This phenomenon is called “wind up” and ketamine helps reverse it. The conditions such as Phantom Limb Pain Syndrome, Chronic Regional Pain Syndrome (CRPS) and certain types of headache respond very well for pain. Pain that is not neuropathic in origin such as joint pain or low back pain respond well but the results tend to be short lived. The infusions for treating pain typically requires higher doses and are longer than those used for mental health. Many pain patients report improvement in their mood as well. Ketamine can also help patients to significantly decrease their opioid requirements and ideally get off them completely. Ketamine is a powerful tool and it’s effectiveness is likely increased when used alongside adequate physical therapy and other positive lifestyle changes.

Yes, we have seen great results using ketamine therapy for all of these conditions. The best data to date is in the treatment of depression however what we know so far is promising. Just as with treatment for depression, we can not guarantee that it will work for everyone. We believe in a team model and working with the right team, including mental health therapist, will increase your odds of success.  

It depends, everyone is different. The majority of the patients experience notable improvements after the 2nd or 3rd infusions. Most also feel better after their first infusion, others may experience a more gradual improvement. The work that you do for yourself and with your mental health provider can impact your results significantly.

Research has shown that an initial series of 6 infusions given over a 3-4 week period provides the greatest symptom relief for our mental health patients. You will then enter the “maintenance phase” and return for booster infusions, if needed. A third of patients do not need any boosters, a third will need boosters within a couple of weeks and a third will benefit from boosters in a six month to one year range. Care at Relevare is always individualized.

Our chronic pain patients receive an initial series of 3 infusion days. These can be scheduled consecutively or every other day. Some of our pain patients may need a series of up to 5 consecutive days to experience the greatest relief. At this point we will reevaluate your pain to see if you would benefit from another series versus entering the “maintenance phase” and returning for boosters as needed.

Every patient is unique. The duration of relief between infusions varies from person to person. Some patients will have relief for 1-2 months while others have longer lasting relief of 3-6 months. This is why we recommend you continue to work with your mental health specialist and partake in ongoing mood monitoring. Boosters are available when you need them. 

Ketamine infusions are generally well tolerated. It is possible to experience dizziness or mild nausea immedietly after your infusion. Anti nausea medication, if needed, is included with your treatment. Some can report dysphoria and hallucinations although these are rare. Ketamine can also cause your heart rate and blood pressure to increase. Blood pressure treatments are included as well (any adjuvant treatments). We will be monitoring your vital signs to insure they stay in a safe range. Following the treatment patients can feel groggy and/or experience nausea. Some may exprience a light “hang over” feeling the following day although uncommon. 

Please continue to take your regularly scheduled medications. We will work with your primary care doctor or specialist and if a medication is to be help for treatment we will inform you. If you are wanting to work off a specific medication please let us know and we will work with your specialist/primary care doctor to help you achieve that goal! Please do not stop taking any medication without telling us. We want to make sure this is as safe and effective for you as possible. 

You will require a ride home from the treatment and will not be allowed to operate heavy machinery or drive a car for the remainder of the day. 

The treatments themselves tend to be a private experience however if you feel more comfortable with someone accompanying you they are most welcome. 

Your initial phone consultation will be free. The fee for the infusion will depend on whether you are receiving a mood or pain infusion and if you buy a package or not. 

An intake appointment with the doctor involves a 1 – 1.5 hour visit where a personalized treatment plan, utilizing a holistic approach and the most up-to-date evidence-based medicine, is designed to address your specific goals.  During this intake, we will prepare you for your ketamine journey and approve you for any other infusions that are deemed appropriate. There is a one-time fee of $200. Veterans, EMS providers, and patients with referrals from psychiatric providers get 1/2 off their intake (so $100).

A standard mental health infusion is $500. Studies to date recommend better outcomes with a treatment series. If a treatment series is purchased each treatment costs $400. This includes any medications that are needed during the treatment, integration, and follow-up following each treatment. 

We accept all payment methods, but unfortunately, we do not accept insurance or Medicare. There is 0% financing available through AdvanceCare. We also accept FSA and HSA cards for payment. We will provide you with a Superbill upon request however understand that our treatments are off-label and unlikely to be reimbursed. Treatments for CRPS and migraines are historically more likely to get reimbursed. We are unfortunately unable to provide forms for Medicare reimbursement.

Most patients are required to get a CMP (to check liver and kidney function), CBC (to check for anemia and risk of bleeding), and TSH/free T4 (to check for thyroid function). Depending on your history following your free phone consultation other labs might be recommended but they are not typically required.

We provide financing options through Advanced Care Card. It is a medical treatment financing company that provides 0% interest for 14 months for medical treatments. For details please visit their website at call them directly at 1-800-432-9470.

Your phone consultation with the provider typically lasts about 10-20 minutes. We use this time to answer all your questions and concerns, determine if you are an appropriate candidate for ketamine therapy, and formulate a treatment plan for you. Your first ketamine infusion visit will last around 1.5 hours- 2 hours for mental health and 5 hours for pain infusions. Subsequent visits are usually around 90 minutes for mental health infusions. Ketamine infusions last 40 minutes for mental health and 4 hours for pain. You will need to recover from the treatment prior to leaving our office. That includes drinking some water and eating a snack to ensure that you are safe to leave. We do not rush any of our patients. You will remain in our care until it is safe to go home.

Ketamine works in an entirely different way compared to common antidepressant medications. Ketamine has shown to increase neurogenesis (the formation of new nerve cells) and synaptogensis (increased connections between nerve cells) in areas of the brain associated with memory and personality.  This is also why results are seen so much faster with ketamine therapy. Ketamine therapy works a lot faster than traditional antidepressants. 

Though ketamine has been abused when used recreationally, there is no evidence that ketamine is addictive. When given in a clinical environment with controlled administration and dosing, the risk of abuse is exceedingly low.

Unlikely but possibly. It depends on what your employer tests for but typically a drug panel does not test for ketamine. Regardless, if you are a current patient of ours and require a drug test, we will gladly provide records of your infusions, upon your request.

Ketamine is a racemic mixture. Organic compounds come in two flavors (S and D). A racemic mixture is a 50 50 mix of these two flavors. Jansen pharmaceuticals isolated the S flavor of ketamine and patented the nasal formulation as Spravato. At our clinic we offer racemic ketamine because of it’s more favorable outcomes. There has been data showing that the D flavor of ketamine has mechanisms that contribute to its anti-depressive effect. 

For your safety, do not eat any solid foods for at least 6 hours prior to your treatment. However, you can have clear liquids (water, tea, coffee, juice (withOUT pulp), etc) up to 2 hours prior to your treatment.

No, it is not safe to drive or operate heavy machinery on the day of treatment. You will need a ride home planned out beforehand by either family, a friend. We do not allow our patients to have rides home from ride sharing services.

We recommend getting your treatments on a day when you are not working or after work. You can resume normal function the following day.