Dr. Haviva Malina, co-founder of Keta Medical Center and a licensed emergency medicine physician, recently sat down for a live Ask Me Anything session on Reddit to answer questions about ketamine therapy. Over the course of the discussion, prospective and existing patients asked about everything from candidacy to safety to insurance coverage, as well as how ketamine infusions compare to other treatments for depression.
We’ve pulled together the most helpful questions from that conversation below, along with expanded answers. If you’d like to see the full discussion, including the community’s questions and follow-up comments, you can read it in its entirety on Reddit here.
Top questions from our Ask Me Anything
What types of patients are not well suited for ketamine therapy?
Candidacy for ketamine therapy depends on a person’s full medical and psychiatric history, which is why every prospective patient completes a medical intake before starting treatment. Some psychiatric conditions can rule a patient out entirely. People with schizophrenia, active psychosis or active mania are not good candidates, since ketamine can worsen these conditions. Additionally, uncontrolled high blood pressure and a history of aneurysm may disqualify someone from treatment. Dr. Malina conducts a one-on-one consultation with each potential patient to determine whether ketamine therapy is an appropriate option.
For a deeper dive, check out our article, “Who is a Good Candidate for Ketamine Therapy?”
Is there a set ketamine treatment schedule, or does it vary by patient?
There’s a set induction phase, and it’s not arbitrary. The standard IV ketamine induction is 6 infusions, based on repeated infusion protocols studied in clinical trials for depression. Spravato follows its own FDA-approved induction schedule: twice weekly for 4 weeks, or 8 treatments total.
What varies is what happens after induction. Once you complete the initial series, your provider evaluates your response and builds a maintenance schedule around it, which could mean sessions every few weeks or longer, depending on how you’re doing.
How many psychiatrists does Keta Medical Center employ, and how does the clinical team work together?
Ketamine therapy works best as part of a coordinated, multidisciplinary approach, so it’s worth explaining how our clinical team is structured. Keta Medical Center’s psychiatric team currently includes two board-certified psychiatrists and two psychiatric nurse practitioners (PMHNPs), working alongside eight therapists, providing therapy virtually and in-person across our locations.
These roles are related but distinct. Psychiatrists are medical doctors who complete a residency in psychiatry and are trained to independently diagnose and manage complex psychiatric conditions, including prescribing and adjusting medication. Psychiatric nurse practitioners complete graduate-level training in psychiatric and mental health care and are licensed to evaluate, diagnose, and manage many of the same conditions. Both play an important role in patient care, and we’re transparent about which type of clinician a patient is working with.
Because Keta Medical Center operates across multiple locations, our psychiatric team and therapists are shared clinical resources rather than being assigned to a single center. This allows every patient, regardless of which location they visit, to have access to psychiatric evaluation and therapy, whether through our in-house team or in coordination with a psychiatrist or therapist a patient already sees outside our practice.
Separately, the nurses who supervise ketamine infusions and Spravato® sessions in-office are emergency medicine trained, since they are well equipped to monitor vitals such as blood pressure and pulse throughout treatment and help patients manage any side effects.
Diagnosis, ongoing psychiatric care planning, and medication management are handled by our psychiatric team, while medical administration and safety monitoring during sessions are handled by our on-site physicians and nurses. For current details on individual clinicians’ credentials and experience, visit our Meet the Team page.
Is Spravato covered by insurance, and what about ketamine infusions?
Spravato (esketamine nasal spray) is FDA-approved for treatment-resistant depression and is covered by many insurance plans, including Medicare. Our intake and billing team manages prior authorizations and payment assistance programs on behalf of patients to make the process as smooth as possible.
Ketamine infusions are a different story. Because IV ketamine is used off-label (meaning the FDA hasn’t specifically approved IV ketamine for this use, even though the drug itself is FDA-approved for other purposes), it’s generally not covered by insurance and is a private-pay treatment. At Keta Medical Center, ketamine infusion sessions are $500 each, which includes two hours in a private room supervised by an emergency medicine physician and a nurse. Most patients complete six sessions during the initial induction phase. We accept CareCredit and flexible spending cards to help make treatment more accessible.
How does Keta Medical Center address bladder-related side effects?
Bladder issues linked to ketamine use have been documented in cases of unsupervised, recreational use— not in medically-supervised treatment. While it is a recognized side effect, it is usually self limited and doesn’t cause long term issues in patients without underlying bladder disease.
At Keta Medical Center, we reduce this risk through careful patient screening, physician-oversight and appropriate dosing and treatment intervals: evidence-informed protocols for ketamine infusions, which are used off-label for psychiatric conditions, and the FDA-mandated monitoring requirements that apply specifically to Spravato.
That said, patients with an existing bladder condition, such as interstitial cystitis, need urologic clearance before beginning treatment. This is one of the many factors we review during the medical intake process to help confirm ketamine therapy is a safe fit.
How addictive is ketamine, and how is that risk managed?
When ketamine is administered under medical supervision with appropriate dosing and treatment intervals, addiction risk has been shown to be very low. Spravato is FDA-approved and administered under a Risk Evaluation and Mitigation Strategy (REMS) program with specific monitoring requirements.
Ketamine infusions, are used off-label for psychiatric conditions but its effectiveness is well-researched . We follow medically supervised, evidence-informed protocols. We also build in ongoing check-ins with patients, and with their psychiatrists when applicable, to reassess treatment goals and adjust the visit schedule as needed over time.
What’s the difference in dosing between ketamine infusions and Spravato?
Because IV ketamine and Spravato are administered differently, their dosing differs as well. Ketamine infusions are weight-based, while Spravato uses standard dosing regardless of a patient’s weight. A ketamine infusion typically runs about 45 minutes plus recovery time, while Spravato visits last two hours, a timeline mandated by the FDA. Eight of Keta Medical Center’s nine locations currently offer IV ketamine infusions.
What happens after completing a Spravato induction series?
Once a patient completes the initial induction phase, next steps depend on how they’re responding to treatment. Some patients find that their symptoms have stabilized and no longer need ongoing sessions. Others continue with less frequent visits, described as booster sessions for IV ketamine and maintenance sessions for Spravato, to help maintain their progress. Because everyone’s treatment goals evolve differently, we work with each patient individually, and with their psychiatrist when applicable, to determine the right interval going forward.
How does ketamine therapy compare to electroconvulsive therapy for treatment-resistant depression?
Comparative research has found ketamine to be an effective, less invasive option relative to electroconvulsive therapy (ECT) for treatment-resistant depression, generally with an easier recovery and without some of the long-term side effects associated with ECT, such as memory loss.
Can ketamine therapy help with complex post-traumatic stress disorder?
Ketamine appears to support recovery from complex post-traumatic stress disorder (cPTSD) in part through its effect on neuroplasticity, the brain’s ability to form new neural pathways. This process can help patients reframe old memories or triggers rather than remaining locked into familiar response patterns. Pairing ketamine treatment with therapy is an important part of making these new patterns lasting.
Is ketamine therapy effective for obsessive-compulsive disorder?
Spravato is not a direct treatment for obsessive-compulsive disorder (OCD) itself, but it can help by targeting the depression that often accompany or contributes to OCD symptoms. Many patients describe feeling less “stuck” in compulsive patterns after treatment. As with other conditions, pairing ketamine with therapy tends to produce the most meaningful and lasting results.
Can ketamine therapy help reduce alcohol cravings?
Several published studies suggest ketamine may help reduce alcohol cravings and reliance in people working to change their relationship with alcohol, and this pattern has also been reported anecdotally among our own patients. As with other applications, ketamine tends to work best as part of a broader plan that includes therapy and other forms of support rather than as a standalone solution.
What is a “K-hole,” and how is that different from medical ketamine treatment?
A “K-hole” is a slang term describing an intense state of dissociation, typically associated with high, unsupervised doses of ketamine taken recreationally, sometimes in combination with other substances. It is not a medical diagnosis. In a supervised clinical setting, dosing is calculated according to established medical protocols, and the resulting dissociative effect is milder and short-lived, resolving before a patient leaves the office.
Are there special considerations for patients who have diabetes?
There are no specific concerns for people who have diabetes receiving ketamine therapy. The main adjustment is that patients are asked not to eat or drink for one hour before treatment, so diabetic patients may need to plan their insulin or meal timing around that window in coordination with their endocrinologist. We treat many patients who have diabetes and work with each person individually to plan around their needs.
Wrapping up
We loved seeing everyone show up with such thoughtful, insightful questions during our AMA. It’s clear how much this community cares about finding real answers, and we’re grateful for the chance to help provide them. If you still have questions we didn’t get to, or anything else comes to mind, don’t hesitate to reach out to our team here.
Ketamine therapy is not the right fit for everyone, and determining candidacy depends on individual history and treatment goals. If you’re considering whether ketamine infusions or Spravato might be appropriate for you, connect with our clinical team for a consultation.
