The options

Living in Florida I suspected there would be no clinics providing Ketamine therapy.  We had enough trouble getting medical marijuana despite voting resoundingly for it.  Even then they dumbed it all down resulting in years of battles to even get the basics.  So when my friend suggested I seek a clinic I imagined it would not be “near me” as the google search suggests.

To my shock, there were actually several!  None under 45 minutes from my house but they were there nonetheless.  I honed in on one in an area I am relatively familiar with as I guess that gave me some small comfort and I scrolled thru every review.  It shocked me that there were really no negative reviews and so I went ahead and read every tab on their website to learn about what they offered and what my options would be.  Although it did not list financial costs it did mention accepting insurance so I decided to make the official call.

Although all clinics are different I can give you an idea of what you might be facing at your own.  Obviously all clinics have different costs and protocols and requirements but I imagine they are quite similar across the board. 

Things I looked for and have with this clinic are as follows.  (I think these are things you should look for and beware of any red flags.  Not all clinics or providers are certainly equal in this and much is very unregulated so it pays to be vigilant about choosing wisely.)

The first thing I was looking for was a clean clinic with a nurturing environment.  People describe mine as spa-like and very relaxing in its atmosphere.  I even heard there is a waterfall!  I have not been to the clinic yet but it sounds inviting and I suspect it will be pretty accurate to the photos on their website. 

Another thing the reviews touched on and I have experienced positively as well so far is staff.  I have had several calls and texts with staff and have always felt very welcomed and cared for.  Now yes I am aware I am still early stages and this is a sales situation so I understand that it could change but again reviews do not bare that out and again I will say that if your clinic reviews mention this as a problem you may want to look elsewhere.  This process has enough pitfalls and dealing with bad staff will not help that process.

This clinic, and also a huge requirement for me, has a doctor and medical staff who will monitor me during the entire treatment and I will remain there for 2 hours to make sure there are no side effects.  They also provide other medicines necessary for a good experience like anti-nausea meds if needed. I was told that they will administer anti-nausea meds to everyone preemptively since nausea is one of the most frequently reported side effects and one I worry about.   I tend to be a bit of a puker so I worry I will throw up during treatment.  They also have an injection to provide if I do.  So they really covered a lot of my fear bases for me which I appreciated.

This clinic also requires a full psychiatric evaluation as well as talk therapy to help you navigate the best possible experience.  This was very important to me.  The requirement and cost associated with that for me would be $325 for the medical/psychological evaluation and the talk therapy but my insurance does cover a portion of this so I paid $75 for the talk therapy and $30 for the psychiatrist.  That can of course vary per insurance plan but the most out of pocket there would have been $325.  They also recommend but do not require ongoing talk therapy through out the treatment which I will do on my own via my insurance and not thru the clinic but that is also available at cost within. I do feel that using talk therapy both before (in preparation for), during and after the treatments is something that is a huge benefit and this should not at all a “drug only” journey if you want to get the most out of the treatment that you can.

The treatments themselves come in varied forms.  The clinic I am going to uses 3 modalities.  IV, intramuscular and nasal spray (Spravato). 

The nasal spray is the only FDA approved treatment and will be the only one that insurance might cover.  I say might as I am in that process now.  My specific insurance does cover Spravato but it is on an approval process and not just automatic.  But if my insurance approves me my out of pocket for those treatments will likely be about $30 per session which is $20 for the Dr and $10 for the drug. The protocol for Spravato is rigid and requires 2 sessions a week for 4 weeks and then 1 per week for 4 weeks.  That is a total of 12 sessions.  You must do the protocol the way it is laid out and there is no wiggle room.  This is mandated by the drug company and not the clinic so this is the hard part for me as I work out of town a lot and so finding a month where I can do 2 a week is hard.  This will be the first hurdle I will need to overcome.  They did agree to do 2 back to back days when necessary so I think I can make this work in June and July by limiting my work. 

The second downfall of all and any Ketamine based therapy is the need to have a driver.  You cannot drive the entire day of the treatment.  I do not have any help here so my husband will need to be my driver and we will need to attempt to adjust his work schedule to accommodate this which will be difficult. It should be noted that I am allowed to use Uber (which kind of surprised me as I am expecting to feel much like I do after surgery, very tired and groggy and would not personally get in a car with a stranger in this condition) but I live far too far away to use an Uber for this.   

It should also be noted that the nasal spray option is not straight Ketamine but is esketamine which is a part of the Ketamine molecule. It is said to be 2 to 5 times more potent which means you can use lower doses but with better results. 

The other options available outside the bounds of insurance would be the gold standard treatment of IV therapy.  This runs about $500 a session and requires 8 sessions in 5 weeks.  Doing the math on this plus the therapy etc you out of pocket would be around $4500.  That is quite steep and inaccessible to many.  The advantage of the IV is that it is straight Ketamine and provided in a controlled drip so you ingest it at a slower rate.  I am told this modality can cause more nausea than the nasal spray does, combined with the cost-prohibitive nature makes this option not a good one for me. 

The last option would be an intramuscular injection which runs about $300 per session and also requires 8 sessions in 5 weeks.  Both this and the IV are more easily adaptable in their protocol because they are not monitored or controlled via a drug company or insurance so if you require flexibility in treatment this might be a good option.  This would come in slightly cheaper at under $3000 for the whole deal out of pocket.  The downside of this is that it is an injection so the experience is said to be slightly more intense which was not something I was looking for.  But it is a cheaper option if the IV therapy is out of reach.

I feel that I am also not the best person to speak to the therapy itself or what Ketamine is professed to do but I do extensive research from reputable sites and found these 2 sites quite helpful if you are looking for more information on what Ketamine is and how this all works.  I highly recommend the reading and of course any and all of your own REPUTABLE research from trusted sites.  These are just 2 that I found particularly informative.

https://www.yalemedicine.org/news/ketamine-depression

https://www.flmindhealth.com/bipolar-disorder/