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Frequently Asked Questions

There are no "dumb questions". If you aren't finding the information you need, please contact us by phone or by email and we will be happy to help you in person. Here are some questions we are commonly asked.

  • Is ketamine therapy covered by insurance?
    Because ketamine therapy for mood and anxiety disorders is relatively new and still viewed as experimental, insurance companies do not provide reimbursement.
  • What is it like to receive ketamine infusion therapy?
    To begin, all patients with symptoms that include depression are asked to complete a brief depression questionnaire and new patients are also asked take a brief one-time history questionnaire. After a few minutes checking in and a minimal wait, each patient then has a brief meeting with the doctor or a nurse practitioner. The therapy and side-effects are discussed and all questions are answered. The patient history and indications for the treatment are reviewed. The EKG, blood pressure, oxygenation monitors are applied to the upper chest, upper arm and finger respectively and a very small IV is started in the hand or forearm. Once the infusion is started, patients are monitored closely to ensure that they are experiencing a pleasant floating feeling with some gentle, comfortable hallucinations. We strive to fall in a happy medium between too little and too much. There is no indication that a “mega-dose,” which can induce general anesthesia and may induce negative feelings, relieves depression and other mood disorder symptoms better or longer. Rather, a high dose may induce unhappy feelings without further benefit, and may even be less effective than the lower dose. Patients receiving the right dose often describe themselves as feeling “impaired” – for instance they may not be able type coherent texts on their phone. We begin low-dose infusions for the treatment of mood disorders with a 0.5 mg/kg dose consistent with protocols developed and used in research from the last 2 decades. But to get to the right place for each patient we are able to raise the dose, or lower the dose, as needed. The doctor may make these adjustments during an infusion as well as from one infusion to the next. Each patient has a slightly different experience with ketamine and even the same patient may experience different feelings during two separate infusions. This is all very normal. There is no singular experience we are seeking in order to have a good effect. Some patients may dwell on people or events from their past, some see colors, some describe interesting feelings in their bodies like tingling or increased size of arms or legs. Once the infusion is over, the funny feelings fade gradually away over the next 20 minutes or so. Occasionally patients feel a little nausea or dizziness, which is relieved with time and can also be relieved with medications if appropriate. After recovery, when the patients begin to feel ready, the monitors are taken off and the patient may be released to leave with a trusted family member or friend. We also have patients who take a cab or an Uber, and we do ask that those patients remain with us until they are more fully recovered which may be an as much as an hour after the infusion. Some patients have a slight headache in the afternoon after an infusion. Many patients describe feeling like they have “just studied for a hard test” or “ran a marathon with their minds”. Some patients feel tired and mostly rest during the afternoon of the infusion day but others are up and active. We enjoy seeing our patients return for subsequent treatments and reviewing their progress. The experience of an infusion is slightly different from patient to patient and from visit to visit, but we work towards the best-possible results and comfort for each infusion. Visiting us for an infusion is something to look forward to.
  • What is ketamine?
    Ketamine is a well-established medication most commonly used for surgery and pain relief. It was developed in 1962 in an attempt to create a useful drug without any side effects or risk for addiction. It’s impressively safe and versatile and remains one of the most common medications used by physicians for pain treatment and anesthesia. Recently, ketamine has been approved as an incredibly effective treatment option for psychological disorders.
  • How is ketamine different from traditional medications?
    Mental illnesses have many interweaving causes that can be hard to identify. When medications targeting certain neurotransmitters showed positive effects, they largely became the focus for intervention. However, for many people, these medications can give limited improvements or even be ineffective. Ketamine is a recent revolutionary breakthrough, as it looks at mental treatment from an entirely new perspective. Instead of targeting neurotransmitters like traditional medications, it focuses on radically changing neural passageways and developing healthy neurons. This has proved to be far more effective. In addition to this, ketamine infusion therapy can often change the way the brain responds to medications, increasing the effectiveness of already prescribed drugs. Many people who haven’t found adequate improvement through traditional treatments are now able to experience life-changing relief.
  • What conditions can ketamine infusion therapy help treat?
    Ketamine infusion therapy can help treat many different disorders. It can help with depression, suicidality, anxiety, bipolar, PTSD, OCD, BPD, sleep disorders, and pain disorders such as fibromyalgia or complex regional pain syndrome.
  • Is there a risk of addiction with ketamine?
    There is no evidence that ketamine infusion therapy causes addiction, although there aren’t many widespread studies regarding ketamine. Ketamine infusions use a lower dose than when taken recreationally, and the clinical setting hinders the possibility of addiction.
  • What are the possible side effects of ketamine therapy?
    Unlike many other medications, ketamine has few side effects. During the infusions, ketamine can cause nausea, temporary hallucinations, and a lack of appetite. These are often very short-lived and mild. Patients commonly feel tired and groggy after an infusion, but this goes away completely after a night of sleep.
  • Do I need a referral to receive ketamine therapy?
    We require that you consult with one of our psychiatrist providers to see if ketamine infusion therapy is right for you. If you are currently seeing a psychiatrist that is providing you medication management, we can collaborate to determine if Ketamine treatment would be a good course of action for you.
  • Are there any medications or health conditions that make ketamine infusions unsafe?
    Benzodiazepines (such as Xanax, Klonopin, Librium, or Valium) interfere with ketamine if they are at a high dose or are used daily. If you are currently on benzodiazepines, our suggestion is to avoid the medication 4-6 hours before the infusion as it makes it less effective. Our evaluation with the psychiatry team will review your medical history and current medications to ensure that ketamine infusions are safe for you.
  • Is there an age requirement for treatment with ketamine?
    At Ketamine Treatment Center Loudoun we provide treatment only to individuals who are 18 years or older.
  • How quickly will I feel relief?
    Many patients feel relief within a few hours or days. Usually, those who struggle with thoughts of self-harm and suicide notice those thoughts and feelings go away first, bringing immense relief. Many times people notice a gradual improvement from their disorder as they go through the course of their treatments.
  • Will I be able to drive home after ketamine therapy?
    It is important that you arrange transportation for after your infusions, as it is highly recommended that you do not drive or operate any dangerous machinery until the next day.
  • Does ketamine therapy replace my antidepressants?
    No. Our primary focus is to provide safe and effective ketamine infusions, we will not be managing any of your other medications or refill prescriptions. Ketamine infusions are meant to be an adjunct to your current mental health treatments and we are happy to collaborate with your psychiatrist and/or therapist. It is recommended that you wait at least 3 weeks after changing your medications before starting infusions. Please let the doctor know if you have recently changed any of your medications.
  • How should I prepare for my ketamine treatments?
    A patient’s “set and setting” are the most important aspects of a good infusion. “Set” refers to the patient’s mindset coming into the infusion. Having an open mind to the experience and avoiding any negative triggers prior to your appointment, will help you have the best outcome. Examples would include avoiding any confrontational conversations with loved ones or watching the news. With that said, 99% of our patients have expressed feeling nervous before their first infusion; this is completely normal! We highly recommend setting up appointments with your therapist during the first two weeks of treatment. The dissociation that occurs during your first couple ketamine infusions can be intense and most patients find it helpful to process the experience. Let us know if you need a referral for a therapist.
  • Can I eat or drink before my appointment?
    You should eat no solid food for 6 hours before receiving infusion therapy. You may have coffee, tea or something like broth. You should have nothing whatsoever to eat 2 hours before treatment.
  • How will I feel after my infusion? Can I return to work?
    We advise you to go directly home after your first infusion. After you have had a couple of treatments, you’ll have a better idea of how the medication makes you feel. It’s normal to feel a little intoxicated, tipsy or nauseous directly after your infusion. You may even feel tired and fatigued for the remainder of the day. Many people are able to return to work 1-2 hours after their infusion, but we advise you to take the remainder of the day off after your first visit to see how you feel.
  • How long does a ketamine infusion take?
    Mood infusions run for 45 minutes. We recommend patients plan for 75 minutes in the office to allow time for IV placement and relaxing after the infusion is complete before leaving our office. Infusions for our pain patients run for 3 hours.
  • Are there any medical conditions that may preclude me from treatment?
    Ketamine is a very safe medication overall. Patients with a history of uncontrolled high blood pressure, liver disease, kidney disease or neurological disorders may require a letter of clearance from their primary care physician.
  • Is ketamine therapy for mood disorders approved by the FDA?
    Ketamine is an FDA-approved medication. The FDA approved indication for ketamine is as a sole anesthetic agent for diagnostic and surgical procedures. Ketamine is not currently FDA-approved for other indications, but that does not prohibit its use for other indications. Many drugs are used for non-FDA-approved indications – called off-label use – at the discretion of the administering or prescribing physician. It would be prohibitive to pursue an FDA indication for ketamine for the treatment of mood disorders or pain. Ketamine is a generic drug that is not owned by one person or company. No pharmaceutical company or other entity has chosen to submit to hundreds of millions of dollars of testing and years of hard work to gain a new indication for this widely-available, inexpensive, generic drug. Typically, a drug manufacturer chooses a specific symptom or need for a medication and then devotes resources to studying how that medication treats that particular symptom or need – This decision is based on the return on investment considering the prevalence of the symptom being treated as well as other factors and the probable price that can be charged for the drug. If the studies show that the medication is safe and effective, then the FDA then gives its approval and the medicine is now considered “FDA approved” for that indication. For better and for worse, off-label use is quite prevalent. One study showed that more than one in five prescriptions is off-label, noting that “21% of all estimated uses for commonly prescribed medications were off-label.” Professor Caleb Alexander, MD, MS notes “Off-label use is so common, that virtually every drug has been used off-label in some circumstances.” Examples of Off-Label Use of Drugs Chemotherapy drugs are often FDA approved for one kind of cancer, but they are often used in un-approved combinations with other drugs and for many different kinds of cancers. Because of this, the American Cancer Society says off-label use of a drug or combinations of drugs often represents the standard of care. Another example is beta blockers; they were approved by the FDA for the indications of treating high blood pressure. However, they are often used for heart failure, tremors, and preventing migraines all of which are off-label uses. Insurance Coverage for Off-Label Use Most off-label uses are covered by insurance. Insurers cover chemotherapy combinations and Beta-blockers for migraines and many other examples of off-label uses. It is my understanding that ketamine for uses beyond anesthesia will likely be covered by insurance when there is broad consensus on its use and pressure from patients and physicians. Pharmaceutical companies are hoping to profit from ketamine’s consistent efficacy for successfully treating mood disorders in the research to date. At least three drugs that are based on ketamine, or almost exactly like ketamine, or that are actually part of the current formulation of ketamine are in the process of gaining FDA approval for the indication of mood disorders right now. Will insurance pay for these? Probably. Will insurance coverage extend to generic ketamine infusions at that time? Maybe. Waiting for FDA approval of new drugs is a burden that is not necessary for patients who may benefit by ketamine today. These medications have no long-term safety data and with their added name-brand prices they may ultimately add expense to this already labor intensive treatment. Off-Label use of Ketamine is Consistent with Good Medicine The off-label use of ketamine for the treatment of mood disorders and pain is supported by a growing body of research. Ketamine may be administered for indications outside of its FDA-approved indications, consistent with medical standards and regulations. Careful practice of evidence-based medicine supports its use by appropriately-trained physicians.
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