Who is Eligible for Ketamine Therapy?

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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