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Who is Eligible for Ketamine Therapy?
2022-07-28T21:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
If you’ve tried various ways to treat depression, and you’re looking for another option, you might wonder about ketamine therapy. You may also be wondering who is eligible for ketamine therapy.
Two types of ketamine are currently used for mental health conditions.
Esketamine nasal spray (SPRAVATO®) is an FDA-approved ketamine-based therapy for treatment resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). Intravenous (IV) ketamine therapy, on the other hand, is also used to treat depression, but as an off-label treatment. Ketamine is a mixture of arketamine and esketamine (pronounced like “R-ketamine” and “S-ketamine). SPRAVATO®, on the other hand, is just the esketamine..
How Can I Qualify for Ketamine IV Treatments?
There’s no universal set of guidelines outlining who is eligible for ketamine IV therapy because ketamine IV treatments are not FDA-approved for depression and mood disorders. Instead, ketamine is FDA-approved for use as an anesthetic.
Each clinic may have its own requirements, with some offering ketamine to patients in their teens and others limiting IV ketamine to patients 18 and older. Despite not having FDA approval, ketamine IV therapy for depression has been widely practiced since the 2000s. The
American Psychiatric Nurses Association (APNA) recommends ketamine treatments for adults with moderate to severe depression, individuals with bipolar disorder, and people with mood disorders.
In addition, the
American Psychiatric Association (APA) has published recommendations on ketamine treatment. Per the APA, it’s important to consider whether you or anyone in your family has a history of substance abuse or psychosis. Ketamine treatment could exacerbate these conditions, so talk to your doctor about whether the benefits outweigh the risks. The APA also recommends giving oral antidepressants a chance to work before trying ketamine IV treatments.
Make sure you bring a list of current medications, health conditions, and allergies to any consultation with a ketamine provider to help ensure a safe therapeutic experience. Before each ketamine IV session, a provider should have you complete an assessment to determine how well the medication is working.
Ketamine can cause a spike in blood pressure. If you have a history of high blood pressure or cardiovascular disease, ketamine may not be right for you. To help manage potential complications of ketamine IV treatment, the APA recommends that all treatment centers that provide IV ketamine be Advanced Cardiovascular Life Support (ACLS) certified.
Finally, tell your provider if you are pregnant or breastfeeding, or are planning to become pregnant or breastfeed. Ketamine should not be taken in these situations.
What Happens During Ketamine IV Injection?
In the best clinics, a ketamine IV injection will happen in a clean, comfortable treatment room with equipment set up to monitor your heart rate, blood pressure, respiratory rate, and oxygen saturation. Because ketamine often has a dissociative effect, the clinic should be prepared to accommodate any concerns you have about feeling detached or separate from yourself. Some people experience nausea during ketamine treatment, making it helpful to have emesis bags ready.
Dosage can vary based on your weight and symptoms, but a regimen of 0.5 mg/kg over the duration of 40 minutes is common. For comparison, a dose of 1 to 2 mg/kg is used to induce anesthesia. A medical provider will insert an IV needle into your arm. The medication will go directly into your bloodstream. During treatment, you may feel drowsy, nauseated, and detached from yourself, almost as though you are floating.
After the 40-minute IV therapy, you need to remain at the clinic for monitoring. Your healthcare team should ensure that your vital signs return to baseline and that any dissociative effects wear off before dismissing you for the day. Because ketamine causes patients to feel sleepy, the APA and APNA strongly recommend making plans for a friend or family member to drive you.
You’ll likely return for additional sessions twice a week for the next four to five weeks. After this, you’ll enter the maintenance phase, which can look different for each patient. For example, some return for an IV session every two weeks, while others come in every six weeks. Unfortunately, because IV ketamine treatments aren’t FDA-approved, most insurance companies do not cover these sessions.
What is the Difference Between Esketamine and Ketamine Treatments?
While ketamine IV injections are not FDA approved for depression, esketamine nasal spray is. This is the biggest difference between esketamine nasal spray and ketamine IV treatments. Because the FDA regulates it, esketamine nasal spray comes with a very specific set of protocols that must be followed during treatment. For example, patients must arrange for a ride home after a mandatory two-hour observation period. In addition, SPRAVATO® can only be administered at locations certified by the SPRAVATO® Risk Evaluation and Management Strategy (REMS) program.
You may be wondering, “Who is eligible for SPRAVATO® ketamine therapy?” To qualify for esketamine nasal spray, patients must have tried at least two antidepressants for six weeks each with little to no improvement. SPRAVATO® is only indicated for two conditions: treatment resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). If you have either of these conditions, talk to your provider about trying SPRAVATO®.
At Greenbrook TMS,
we offer SPRAVATO® treatment at our REMS-certified treatment centers. We provide a safe environment with blood pressure monitoring, psychiatrist rounds, immediate access to assistance, private rooms or bays, and comfortable reclining chairs. We also help you fill out the necessary paperwork for insurance coverage. Thanks to its FDA approval for TRD and MDSI, esketamine nasal spray is covered by insurance.
Should you learn that you’re ineligible for ketamine therapy, Greenbrook TMS also offers transcranial magnetic stimulation (TMS), an FDA-cleared depression treatment that comes with minimal side effects and no observation period. Learn more about
how TMS works.
Whether you have more questions about how to get ketamine prescribed or wish to set up your first appointment, you can
schedule a free consultation online. We look forward to helping you navigate your mental health treatment.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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