TLDR: If you live conveniently near a ketamine clinic, then that clinic is apt to be your best alternative. Conversely, if there is no ketamine clinic where you can conveniently receive an in-clinic administration, then tele-ketamine is your only alternative.
Most patients will be in the middle. It’s possible to drive, say, 100 miles to the nearest clinic, but the days and hours of appointments would disrupt work/school/home life. So, in the majority of cases, prospective patients will have to thoroughly study the issues (in the sections titled In-Clinic vs. At-Home and ROA – Routes of Administration) to understand what choices and trade-offs are involved. We suggest the following approach:
First, use the pages describing ROAs (Routes of Administration) and In-clinic vs. At-home administration to get some idea of whether you prefer IV/IM/Spravato vs. the alternatives available at-home. Whether you prefer the in-clinic experience vs. the at-home experience.
Second, use the Providers by State page to locate providers serving your state (or a nearby state). Use this to make a shortlist of candidate providers. Google “ketamine clinics near me” to see if it returns any providers near your location whom we overlooked in our directories. Add them to your shortlist.
(Bear in mind that our directories will unavoidably be incomplete. This limitation is less important for identifying clinics that you can google for. It’s more important for identifying tele-ketamine providers. However, in the latter case, it is utterly unimportant where a tele-ketamine provider is located. If we have discovered enough tele-ketamine providers to choose from, then that is sufficient for you to shop effectively.)
Here is a tip. If a provider’s row has just one, two or three states filled-in, that’s a strong indication that it is a ketamine clinic not likely to offer at-home self-administered ketamine prescriptions. Conversely, if a provider’s row has 3 – 6 – 9 – 12 or more states filled-in, that’s a strong indication that it is a tele-ketamine provider offering at-home self-administered ketamine prescriptions. If you have a strong preference for either the in-clinic or at-home alternatives then this tip will help you to cull your short-list more swiftly.
Third, review the brief descriptions on our Provider Information pages. Perhaps a provider is located in your state but is too far away to be practical to travel to. Perhaps a provider only serves your state via tele-ketamine, and you prefer the in-clinic experience. Strike out these providers from your shortlist. Look up the surviving providers’ websites and see whether you find anything that intrigues you or reduces your interest. Annotate your shortlist.
Fourth, review each provider’s pricing and availability. Don’t be surprised to discover that the more attractive providers aren’t the low-cost price leaders. Nor need you to be surprised that they have long lead times for appointments. Prioritize your shortlisted providers according to your selection criteria: ROA, In-clinic/At-home, pricing, availability, and any other considerations.
If you find an appealing provider with a long lead time for appointments, then immediately make an appointment and inquire about working the cancellation list procedure. It’s commonplace for a patient to get an initial appointment for 3 months in the future, then, a week or two later, be offered a canceled time slot in 3 days. You can always cancel this appointment if you choose to pursue some other provider you discover in the Fifth and following steps.
Fifth, start calling providers and make note of their customer-service level, whether what they tell you seems appealing/off-putting. Begin prioritizing the surviving shortlisted providers.
Theoretically, you want a: safe, effective, and comfortable experience. But it’s hard to figure this out before you have actually begun treatment with a provider. By then, it’s somewhat late to indulge in buyer’s remorse.
You could study the credentials of the provider’s personnel. Does the provider have an MD/DO or a lesser license? Is the provider an anesthesiologist, psychiatrist, or “boarded” in some other specialty such as Family Medicine or Emergency Medicine? How much do you care about the provider’s credentials? Do you care more about his experience with ketamine for mental health indications?
If you have multiple other psychiatric medications that you may prefer to be managed by your ketamine provider, then that is a good reason to rank a psychiatrist higher on your shortlist. Otherwise, it’s probably more important to understand how much experience (how many patients) each provider has treated with ketamine for mental health indications. It probably matters little that an anesthesiologist has anesthetized countless patients with ketamine. It probably matters more that an NP has treated many mental health patients with ketamine.
Ask about who it is who will be attending to you regularly throughout your course of treatment. It’s not uncommon to see a licensed physician once or twice at the beginning of treatment. Thereafter, most of the patient’s consultations will be with RNs, or non-licensed “guides.” There is nothing wrong with the latter practice. These RNs/guides might be very competent and highly experienced. And have more time to attend to your questions and concerns than does the prescribing physician. The point of this paragraph is to learn who will be attending to you regularly and make that a basis for preferring one provider over another. It makes no sense to choose a provider because of the eminent qualifications of the physician directing the clinic if you will see him just once or not at all.
If you are considering an in-clinic administration, you want to see the provider’s facilities and discuss how they handle administration. Do their protocol and premises appeal to you? Or are they off-putting? If you were heavily weighing the advantages of an in-clinic experience but find a provider’s administration protocol/premises not to your taste, that will affect your evaluation of that clinic’s offering.
The American Society of Ketamine Physicians, Psychotherapists & Practitioners has a useful page of recommendations for evaluating a ketamine clinic. See: https://www.askp.org/patients/what-to-look-for-in-a-clinic/ Much of what they say about evaluating a clinic is useful for evaluating a tele-ketamine provider.
If considering an in-clinic experience, you must consider the clinic’s travel distance, availability hours, and how that fits into your ability to get to – and more importantly from – the clinic for your administrations.
Finally, look for patient reviews of the providers surviving on your shortlist. Search r/TherapeuticKetamine and r/KetamineTherapy for the name of the provider you are researching. Heavily weigh numerous positive reviews of providers that have them. Ever more heavily weigh any negative reviews of providers that don’t have numerous offsetting positive reviews. Consider critiques (positive and negative) about the “customer service” aspects of patient reviews. If price is a major consideration, you might reasonably tolerate regular complaints from a low-cost or convenient provider about poor service. Conversely, if you can afford a higher price and insist on a higher level of service, that should weigh heavily on your decision. Don’t expect a Cadillac product for a Chevy price.
You might be favorably impressed by the physician who first sees you to prescribe ketamine. Or not; his bedside manner may lack qualities you value in a medical relationship. However, depending on the practice’s protocol, you are apt to see someone else for your monthly follow-ups. Your working relationship with the follow-up person is apt to be vastly more important than your impression of the prescriber’s bedside manner. Evaluate how the follow-up person interacts with the prescriber. If your “guide” has a functional relationship with your prescriber, then that’s all you need. Conversely, if their communication isn’t effective, you will soon notice. Unfortunately, that communication will be opaque to you until you see how your questions for the doctor are followed-up. Your best insight will be reviews of patient satisfaction with each practice’s protocols.
There are two common complaints about ketamine providers which you should take into consideration.
First, some providers “sell” prospective patients on the prospect of ketamine being a sort of quick and permanent fix. They either neglect to mention or soft play, the need for ongoing maintenance. In either case, a patient might come away with the impression that ketamine therapy is the initial “six-pack” with no follow-up maintenance. This simply is not realistic. You may be budgeting (say) $3,000 for the initial protocol and then be surprised that you will be spending another $3,000 in the first year for a half-dozen maintenance doses. Take note of how forthcoming and candid the candidate provider is about your first year’s course of treatment is likely to play out in terms of doses and cost.
Second, how much coaching/guidance will the provider deliver? Doctors are accustomed to seeing patients for a 30-minute consultation, and the patient walks out the door with a prescription in hand and a few words of instruction as to dosing. Patients are accustomed to this procedure for all their other medical care. Only a minority of patients will find this adequate for ketamine.
Read the ketamine subReddits. Patients routinely report on their anxiety, questions, trials and tribulations using ketamine. Most patients expect a provider to deliver a lot of hand-holding: guidance, coaching. Generally, patients are disappointed that they have so little time with their provider or his personnel.
With each candidate provider, ask how much time you will have for guidance, coaching, and answering questions. How much prior to the first dose? How much time after each of the first few doses? How much in the first few months? Will they answer questions via email or their patient portal? If you want a lot of guidence/coaching expect to pay for it in the form of a higher fee.
If you can’t afford a “Cadillac” level of service, then your best option is to study the ketamine subReddits and this site for as much information as you can absorb. Post questions on the subReddits.
We choose not to weigh in on the diverse protocols pursued by various providers. Whether to dose daily, twice a week, or less frequently. Nor to express a preference for in-clinic IV/IM/Spravato ROAs vs. at-home lozenges/suppositories/nasal-sprays ROAs. Whether to titrate to higher doses slowly or more rapidly. How aggressively to reduce the frequency of follow-up dosing. These are mostly choices to be made according to the respective tastes of each patient and each provider. Also, there are alternatives to be thrashed out in the academic literature. We will do our best to describe the debate on this site but hesitate to articulate our own conclusion. In any case, these are decisions (protocols, dosing, in-clinic/at-home, titration) that you must make according to your taste.
If you are desperate for immediate relief, you should strongly consider a provider who has a more aggressive titration protocol. (Probably an in-clinic provider). Conversely, if you are not desperate for immediate relief and prefer to approach the anticipated side effects more gingerly, then you should strongly consider a provider who has a more extended titration protocol. (Probably a tele-ketamine provider.) You can always ask your provider to accelerate your titration. Or change to a new provider with a more aggressive protocol. If you expect to be squeamish, then it would be a tragedy to choose a provider with an aggressive protocol but then be put-off by early intolerable side-effects. Such an imprudent choice might dissuade you from pursuing ketamine therapy when it would have, eventually, delivered the relief you sought.
There is a legitimate debate about how thorough an initial screening of patients ought to be. We think that there is some minimal level of screening, including:
- symptoms of an indication to which ketamine is believed to be applicable;
- absence of symptoms of a known contraindication;
- presence of conditions warranting caution (e.g., high blood pressure, urinary tract symptoms).
Beyond these obvious screens, diminishing returns set in quickly. No doctor can know with any reasonable level of confidence whether ketamine will work for a given patient until the patient has pursued a reasonable course of therapy. No doctor can anticipate side effects serious enough to contraindicate continuing therapy until the patient has encountered those side effects. So, a very thorough examination and screening protocol seems to be expensive “defensive medicine” that isn’t serving patients‘ interests.
Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., … & Nemeroff, C. B. (2017). A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA psychiatry, 74(4), 399-405. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2605202
Mema, D., & Mema, S. (2021). The Role of Telemedicine in Ketamine Therapy for Mental Health: An Overview. Cureus, 13(9). Retrieved from https://www.cureus.com/articles/72716-the-role-of-telemedicine-in-ketamine-therapy-for-mental-health-an-overview
Williams, N. R., Heifets, B. D., Blasey, C., Sudheimer, K., Pannu, J., Pankow, H., … & Schatzberg, A. F. (2018). Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry, 175(12), 1205-1215. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2018.18020138