Ketamine is an anesthic drug and its intravenous administration must be supervised closely by a board certified MD. Internists, emergency medicine physicians, intensvists and anesthesiologists usually have adequate ketamine use training and therefore should be preferred. 

Other specialties or nurse practioners who have no or little  ketamine exposure during their training often lack expertise to tackle unexpected situations that can arise from IV ketamine use. Such practices might offer cheaper or negotiable rates, but are not safe and therefore must be  avoided. 

In NY, most providers are busy. Providers write medication orders and then nurse implements those orders and supervises each patient.  Unfortunately provider-patient interaction remains limited only to the initial consultation. 

Luckily, Ketamine Wellness Medical Practice is an exception to this bitter reality. Our ketamine specialist Dr. Goyal puts himself out there during each step of our patient's treatment process. Besides providing initial consulation and formulating  individualized treatment plan,  he administers as well supervises each ketamine infusion himself. This helps him to micromanage each session to achieve the safest and the most effective treatment response. His patients LOVE him.

Ketamine use is safe but not without any risk. Ketamine can increase patient's blood pressure as well as heart rate. Patient's  vital signs such as blood pressure, heart rate, oxygen saturation and respiratory rate must be monitored closely during and 15-20 mins after the ketamine infusion is finished. 

At ketamine Wellness Medical Practice,  we use state of the art infusion pumps to administer and titrate each ketamine infusion reducing human error rate close to zero. Automated vital signs monitoring machines are used to check blood pressure every 10 mins. Patient's heart rate, heart rhythm and oxygen saturation are monitored continuously throughout each ketamine infusion. 

We belive in the first principal of Medicine "Do No Harm."

In our practice, we charge $470 for each ketamine session for mental health illness. We waive $20 (credit card service fee) for each session if our patient decides to pay cash. For chronic refractory pain the cost is $450/hour for 2-5 hours session. 

Most insurances do not cover ketamine infusion therapy. Our practice does not file insurance claims but does provide a superbill that has all the necessary information for the patients to file insurance claims. Recently, we have seen more and more of our patients receiving partial insurance reimbursements. 

Yes, our patients can participate in  CARECREDIT and ADVANCECARE CARD financing services. Patients can also get free access to evidence-based, internet-delivered Cognitive Behavioural therapy (iCBT) programs at THIS WAY UP. 

Most insurance companies require a diagnosis code and a CPT code to process a medical claim. A diagnosis code indicates the medical condition for which the treatment is provided and a CPT code is used for the actual treatment or intervention that the patient has received. For example, a diagnosis code for unspecifed depression is F33.0 and a CPT code for one hour IV ketamine infusion is 96365. These codes can be given to the insurance representative while inquiring about insurance coverage of ketamine infusions for depression.

Based on multiple clinical trials conducted over the last 20 years ketamine infusion therapy can achieve significant and rapid relief in up to 60-70% of all patients. In our Practice, over 80% of the patients (who have finished recommended six ketamine infusions) have shown significant improvement in their symptoms.

Onset of improvement with iv ketamine infusions varies in patients. Some patients begin to feel better within 24 hours of their ketamine infusion session, but some patients can take 1-2 weeks before noticing any significant improvement. Patients with suicidal thoughts can see 50% reduction in their symptoms after their first ketamine infusion session. 

 Most patients are recommended to receive a series of six infusions over a 2-week period to achieve sustained improvement in their symptoms. 

For refractory chronic pain syndrome and migraine headaches, patients receive 2–5-hour sessions of iv ketamine infusion and their frequency of sessions is usually customized based on their response. 

During initial consultation, we ask you to fill out a Patient Health Questionnaire (PHQ-9) and then again prior to your sixth iv ketamine infusion session. PHQ-9 score reduction of 50% or more indicates good response and PHQ-9 score of <5 indicates the remission. 

Often, close friends, family members notice subtle improvements in mood prior to the patient’s awareness. 

Finally, patients' mental health providers sometimes give us an independent subjective verification of the treatment success.  

It is recommended to finish six sessions to achieve optimum and sustained treatment response but our patients have the right to opt out anytime. 

Yes, you will require maintenance ketamine sessions for the rest of our life if you respond to initial ketamine treatment. Frequency of maintenance sessions varies from patient to patient. Most patients receive a once-a-month maintenance session, but some patients need more or less frequent maintenance sessions based on their response sustainability.  

So far, ketamine therapy has shown no long-term adverse effects when administered at prescribed low doses for mental health disorders.

No.  When given in small, prescribed doses in a controlled supervised setting, Ketamine has minimal risk of addiction.  In fact, ketamine has been shown to help patients trying to overcome addiction disorders commonly associated with depression or other mental health conditions.  

You should not make any changes in any of your current prescribed medication without first consulting your prescribing physician. Ketamine does not interact with most prescribed antidepressants. Dr Goyal usually customize each patient’s ketamine dose based on their response and current medications to blunt any rare drug-drug interaction effect.  

Patients with uncontrolled high blood pressure, severe kidney function problems, psychotic disorders, or active mania should not receive ketamine. Pregnant females should not receive ketamine. 

It is recommended not to eat any solid food for at least 4 hours prior to your scheduled infusion. You may have clear liquids up until 2 hours before your infusion session.

During the infusion, most patients feel relaxed and find their experience pleasant. We encourage you to listen to relaxing music and make yourself as comfortable as you can in our recliner.  

Some patients can feel “dissociative” or “out of body” experience.  But these are expected effects of ketamine and usually dissipate rapidly within minutes after a ketamine session.

It is recommended that you don't indulge in any activity that requires precise judgement such as driving, swimming or fine machinery work on the day of infusion. It is recommended that someone you trust should drive you home. You can also take Lyft or Uber at your discretion. 

No. We don’t require any referral, but we can ask for documentation showing your established diagnosis and current medications from your provider (provider can be your Primary care doctor or psychiatrist). You can either sign our office medical release document and fax it to us so we can contact your provider for the required documents, or you can contact your provider to provide us the necessary documents via fax (516-366-1649) or email (contact@ketamine-wellness.com).

Esketamine has only S enantiomer form while IV ketamine has both S and R enantiomers. Absorption amount and speed with nasal sprays vary with each patient’s nasal cavity blood supply making it less effective and riskier as compared to intravenous ketamine. Dose can be easily titrated with intravenous ketamine as compared to nasal ketamine. Finally, the patient must be monitored for at least 2 hours after Esketamine administration in the office whereas the patient can be discharged safely 20-30 minutes after IV ketamine session. 

Ketamine infusions have shown promising results in patient who have quit alcohol drinking and would like to stay sober longer. 

In a recently conducted phase II clinical trial, IV ketamine infusions helped more patients stay sober in first 6 months of their recovery period. Phase III trial is currently in progress to establish efficacy of intravenous ketamine in the reduction of alcohol relapse. 

Can ketamine help patients to quit if they are actively abusing alcohol---WE DON'T KNOW YET.