IM Ketamine
In addition to esketamine/Spravato, Goodwin Health Café also offers intramuscular ketamine. IM Ketamine is also for treatment resistant Depression. But unlike Esketamine is off label.
At this time insurance does not cover IM Ketamine and is therefore an out-of-pocket expense. See pricing page or below for price breakdown.
If you are interested in receiving IM Ketamine for TRD please fill out the following survey:
Pricing:
Intake: $150 one time (to be completed prior to ketamine treatment)
IM ketamine appointment: $150 per visit (includes medication, administration and observation)
PROCESS:
SCREENER
Fill out the Ketamine screening form. If you can answer yes to all the questions, submit the form. We will reach out to you or you can call us to get started.
PAPERWORK
Intake paperwork will be emailed to you to fill out. Once intake paperwork is completed, we will call to schedule you.
INTAKE/INITIAL ASSESSMENT
An initial intake will be scheduled to review history, current history, treatment implications and safety information. In this appointment appropriateness for Ketamine treatment will be determined. Ketamine treatment will not be guaranteed.
If you have insurance that we are in network with we can bill insurance for the initial intake. Or it will cost $150.
During the intake we will do a Drug screen.
INDUCTION
If Ketamine is determined to be medically appropriate, then we will schedule your first appointments. It is important to have 6-8 appointments in 3-4 weeks to maximize the antidepressant effect of ketamine. We will schedule these all at once after intake.
These appointments are not billable to insurance, as insurance does not pay for ketamine, or the observation required to ensure safety. Out of pocket only, please see pricing above.
APPOINTMENTS
Ketamine can cause disassociation and often relaxation. We will provide a private room with a recliner or mat to lay down on. The room can be darkened. Staff will administer the medication then monitor the patient remotely through a caretaker vital device that sends vital sign information to our nursing station, so we can make sure you are safe during the appointment.
We recommend clients bring headphones and access to music, preferably non-lyrical. There are ketamine playlists on spotify/apple music/amazon
Sometimes clients like to bring eye masks, blankets, pillows, warm clothes, water etc.
MAINTENANCE
If ketamine is effective for depression, studies have really shown that maintenance treatment is necessary to keep the antidepressant effect. This can look different for everyone. Sometimes this is weekly, twice a week, monthly or as needed. Some clients do seem to have prolonged antidepressant effect and require minimal maintenance treatment. There is some thought that other NMDA antagonists (Auvelity, nuedexta) may help prolong effect of the ketamine, but this has not been studied, and the providers at the clinic can discuss this in more detail.
It may also be reasonable to use IM Ketamine to help bridge another treatment. Either a medication change, waiting for esketamine/spravato to be approved, or even starting tms may be reasonable examples of this. These changes may prevent the need for maintenance treatment and limit out-of-pocket expenses.
QUESTIONS:
See FAQ below, or call/text 509-415-3507
FAQ: Frequently Asked Questions
Q1: What is ketamine, and how does it work for depression? Ketamine is a medication known for its anesthetic properties. In lower doses, it has shown promising results in rapidly alleviating symptoms of depression. It works by blocking the NMDA receptor in the brain, which can increase glutamate and other neurotransmitters, which are involved in mood regulation. This can provide rapid antidepressant effect for some people.
Q2: What is Treatment-Resistant Depression (TRD)? Treatment-Resistant Depression refers to a condition where individuals do not respond to 2 conventional antidepressant medications. It’s characterized by persistent depressive symptoms despite multiple treatment attempts.
Q3: What is Intramuscular Ketamine, and how is it different from intravenous (IV) administration? Intramuscular Ketamine involves administering the medication via an injection into the muscle. This method provides a similar therapeutic effect to IV administration but allows for a slower absorption rate, potentially reducing the intensity of certain side effects.
IV ketamine has been studied the most and is standard. The Ketamine clinic of Spokane is another local option that does offer IV ketamine. IM ketamine is less clinically involved and feasible for Goodwin Health Café. IV ketamine can be dosed more aggressively as it can be stopped abruptly with negative effects. With IM ketamine we are very cautious with dosing, this can delay response if it takes a few appointments to reach therapeutic dose.
Q4: Why does our clinic use Intramuscular ketamine instead of IV? Intramuscular administration can offer similar availability as IV. IM ketamine is 93% available whereas IV ketamine is %100. Intranasal is less than 50%. It is also less clinically involved and less invasive.
The cons of IM ketamine are that it is less studied than IV ketamine for depression, though likely the studies can translate. Also, we are more cautious with inductions, and it may take 1-2 appointments to get to therapeutic dosing.
Q5: Why doesn’t insurance cover Ketamine? Insurance coverage for Ketamine treatments can vary. Currently, Ketamine for depression is off-label use and the medication itself is not covered by insurance providers. However, this landscape is evolving as more research supports its effectiveness.
There are no specific codes for ketamine, or the observation required to safely make sure the med is tolerable and effective. Spravato codes may be thought that they can be translatable but there are no guidelines to confirm that. Until insurance confirms these codes are useable for ketamine, ketamine will probably remain mostly cash only.
Q6: What are contraindications of Ketamine? Contraindications for Ketamine include uncontrolled high blood pressure, hypersensitivity to Esketamine or Ketamine, Aneurysmal Vascular disease, Arteriovenous Malformation, history of Intracerebral Hemorrhage, Severe Hepatic impairment or pregnancy/breastfeeding, Moderate Hepatic Impairment, Cardiovascular Disease, Cerebrovascular Disease, history of Hypertensive Encephalopathy, history of Psychosis It’s crucial to undergo a thorough evaluation by a healthcare professional to determine suitability.
Q7: What are common side effects of ketamine? Common side effects of Ketamine may include dizziness, dissociation, changes in blood pressure, nausea, and potential changes in perception. These effects are typically short-lived and monitored closely during and after treatment.
Q8: Why do I need to secure a ride home, and not drive the rest of the day? Ketamine is an anesthesia medication. It can have effects that impair peoples ability to drive for prolonged periods of time, which vary person to person. People sometimes can tell they are impaired, and sometimes can’t. To be safe it is important to wait until the next day after a good nights rest before driving.
Q9: How should I prepare for my Ketamine session? Before your session, it’s helpful to have a light meal that day. For the first appointment do not eat 2 hours prior or drink 30 minutes prior. Wear comfortable clothing and plan for a calm and relaxing environment post-treatment. Ensure you’ve arranged transportation for your return home, and it’s beneficial to have a trusted support person available if needed.
Q10: How many sessions will I need? The number of sessions can vary based on individual response. Typically, an initial induction phase of 6-8 sessions over 3-4 weeks is recommended. Following this, maintenance sessions may be necessary, varying from weekly to monthly or as determined by your healthcare provider based on your response and needs.
Q11: Will I need to continued ketamine treatments? Many individuals benefit from maintenance treatments to sustain the positive effects of Ketamine. This could involve weekly, bi-weekly, monthly, or as-needed sessions, tailored to maintain your response. Additionally, your healthcare provider may explore other medication options to complement and prolong the positive outcomes.
Q12: Can I start with IM ketamine then transition to esketamine/Spravato? Since IM ketamine does not require insurance prior approval, it can be started much quicker. Which is often necessary for acute or severe symptoms. Also due to scrutinous requirements for insurance, often people with TRD still don’t meet insurance requirements for Spravato. It is reasonable to start IM Ketamine to achieve symptom relieve faster, and begin the prior approval process for esketamine, in order to transition later, so insurance can pay for treatment. Or we can work with your current prescriber to trial different medications that insurance requires to get Spravato approved.