Question 1

What does "off-label" mean, and is it safe?

Accepted Answer

"Off-label" means a medication that is FDA-approved is being prescribed for a condition, dose, or patient group outside its original approval. It does not mean the treatment is experimental, unregulated, or unproven.The FDA approves drugs for specific uses, but it does not regulate the practice of medicine. Once a medication is approved and on the market, physicians may prescribe it for other purposes when clinical evidence and their medical judgment support doing so. This is common across every field of medicine, and many widely used treatments in psychiatry, cardiology, oncology, and pediatrics are prescribed off-label.Ketamine has been FDA-approved as an anesthetic since 1970, so its safety profile at these doses is well characterized. Its use for depression, anxiety, PTSD, and related conditions is supported by two decades of published research, including randomized controlled trials at Yale and the National Institute of Mental Health. A closely related medication, esketamine (Spravato), received FDA approval for treatment-resistant depression in 2019.At our practice, every patient is evaluated by a psychiatrist to determine whether IV ketamine is appropriate, and all infusions are administered under continuous medical monitoring.

Question 2

Are there any side effects with ketamine therapy?

Accepted Answer

Most patients tolerate infusions well; some experience temporary side effects during or shortly after treatment, such as dissociation (a dream-like or floating sensation), elevated blood pressure, nausea, or dizziness, which typically resolve within a short time after the infusion ends. If you need immediate treatment for nausea or dizziness, we have options available to ensure a comfortable experience. Published research on ketamine at therapeutic doses has not reported long-term adverse effects. It is important not to drive, operate any dangerous machinery, or make any important decisions until the day after a ketamine infusion, as reaction times can be significantly diminished immediately following the infusion.

Question 3

Do I need a referral to begin therapy?

Accepted Answer

No. If you are not currently a patient of Dr. Kim’s, she will meet with you to discuss your diagnosis prior to beginning treatment. Patients who are already seeing Dr. Kim will work with her to determine readiness during a pre-infusion consultation.

Question 4

Why is there a fee for the initial consultation and is it refundable?

Accepted Answer

Unlike the "free consultation" at some clinics, which is typically a 10-minute phone screen with a coordinator to check eligibility and get you on the schedule, our consultation is a comprehensive 60-minute evaluation with a board-certified psychiatrist covering your medical and psychiatric history, and anything else that would make ketamine unsafe or unlikely to work for you.You leave with a clinical opinion and a recommended path forward, and sometimes that path isn't ketamine, in which case we'll tell you and provide guidance for the next best steps in your care. The fee reflects the psychiatrist's time and clinical judgment, so it's non-refundable, including if we determine you aren't a candidate or you decide not to move forward with treatment. It is billed independently of any treatment recommendation, so the assessment stands on its own merits.If you are approved for ketamine and chose to move forward, this fee is credited towards your initial series.

Question 5

Where is the treatment performed?

Accepted Answer

All treatments are performed, on an outpatient basis, in Dr. Kim’s relaxing and private treatment room.

Question 6

Will I require ketamine infusions for the rest of my life?

Accepted Answer

Not necessarily, and that isn't the goal. Treatment starts with a series of 6 infusions; if you respond, we work to space maintenance infusions as far apart as your response allows, which varies a lot from person to person. The aim is the smallest amount of treatment that keeps you well, ideally alongside therapy or medication management that supports the improvement. We reassess as we go rather than assuming an indefinite schedule. Aftercare is an important part of ketamine therapy and Dr. Kim will work with you to determine the best approach for you to achieve lasting relief.

Question 7

Do I need to stop taking any of my current medications before I begin ketamine therapy?

Accepted Answer

No. You should not make any adjustments in your current medications without specific approval from the prescriber. Some medications have been studied for their potential interaction with ketamine. Benzodiazepines, in particular, have been examined in several studies, with mixed findings. Some suggest they may reduce or delay ketamine's antidepressant effect, while others have not found a meaningful difference. Lamotrigine has been studied primarily for its effect on dissociation during infusion rather than on treatment outcome.Because the evidence is not settled, we do not routinely ask patients to discontinue these medications. Your full medication list is reviewed during your initial evaluation, and if any adjustment seems warranted, our psychiatrist will discuss it with you and coordinate with your prescriber.

Question 8

Is oral, nasal, or IM ketamine a viable alternative to IV therapy?

Accepted Answer

While these alternative routes can be effective for some patients, we've chosen to offer IV exclusively because we want to give each patient the best chance at a good outcome. IV is the route used in the majority of the research establishing ketamine's antidepressant effects, and it delivers 100% bioavailability, compared to roughly 93% for IM, 25-50% for nasal, and 16-25% for oral, with wide variation between individuals. IV also allows precise weight-based dosing tailored to each patient, and lets the physician adjust or stop the infusion in real time, something no alternative route allows.

Question 9

Can a medical condition keep me from receiving ketamine?

Accepted Answer

There are very few conditions that would prevent you from receiving ketamine. The main contraindication is uncontrolled high blood pressure. Dr. Kim will discuss contraindications with you before you receive your first infusion.We've safely treated many patients in their 80s and 90s!

Question 10

Are ketamine infusions addictive?

Accepted Answer

Ketamine is a controlled substance with recognized potential for misuse, which is why we treat it with the seriousness it deserves. In supervised clinical settings using low, infrequent, weight-based dosing, the risk of dependence is low. Patients receive a limited number of infusions under medical observation, and no medication leaves our office. Every patient is screened for substance use history as part of the initial evaluation, and treatment is managed by a psychiatrist throughout.

Question 11

Will my insurance company pay for ketamine therapy?

Accepted Answer

No. Our practice is cash-pay, and we do not bill insurance. Most insurers classify IV ketamine for psychiatric conditions as investigational and do not cover it, though coverage policies vary.We can provide documentation for you to submit to your insurer if you'd like to pursue out-of-network reimbursement, though we cannot guarantee any coverage. Many patients also use HSA or FSA funds toward treatment.

Question 12

Will Dr. Kim take over my clinical care?

Accepted Answer

In most cases, no. Your current prescriber will continue to manage your psychiatric medications.With your permission, Dr. Kim can coordinate directly with your prescriber and therapist, answering any clinical questions they have about the treatment and providing response updates.Dr. Kim does accept a limited number of patients into her practice each year. If you're without a prescriber or would like to inquire about establishing care with her, please mention it when you contact us and we'll let you know about current availability.

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