Road Map - Choosing Which Ketamine is Right for You

The second part of the ‘Road Map” on this Ketamine journey is CHOOSING YOUR TREATMENT PATH.

There are a various number of ways for you to ingest Ketamine for this therapy and being aware of the choices and their pros and cons will help you figure out which one is right for you.  With all of these treatments you should not drive, make important decisions or participate in dangerous activity the day of treatment.  All in-clinic treatments require you to fast prior to the session. The choice to do so is ultimately yours but as referenced by the numerous piles of vomit in the parking garage I can safely say you will regret NOT fasting if you become ill.

Prior to beginning any treatment you will be required by the clinic to undergo a psychiatric evaluation (this can cost $325 if you do not have insurance, my insurance provided at a $20 copay) as well as a talk therapy session with a therapist at their clinic (at the time of my treatment this was NOT covered by my insurance and was $75).

 

SPRAVATO:

This was my choice simply because it was covered by my insurance, FDA approved and the easiest option to get it into my body.  Spravato is the only FDA approved ketamine treatment and the only one insurance will cover currently although I have hope that other forms will be covered in the future.  Ask your clinic if they take your insurance and what it will cover.  For me, there was a copay for the medicine itself which I had to order weekly and pay for prior to my treatment.  This came from a compounding pharmacy.  The medicine is then delivered to the clinic in my name and provided to me when I arrive for the treatment session. The second cost is a copay to the clinic for monitoring (which is required, you cannot just do this at home).  You will be monitored for 2 hours during and after treatment before you are released to go home.

Spravato is a nasal spray which requires 3 dosings (one squirt in each nose each time) at 5 minute intervals (you can choose to only do 2 if you feel 3 is too strong). It is not straight Ketamine but actually the “s” molecule which is isolated as the healing part of the ketamine drug.  There is a strict protocol which is controlled by the drug maker and the FDA NOT the clinic so there is no wiggle room to deviate from the initial 12 sessions which must be completed as 2 sessions per week for 4 weeks then 1 session per week for 4 weeks. 

The obvious pros of this option:

-          FDA approved

-          Easy nasal spray administration

-          Covered by many insurance companies

-          The least chance for nausea and vomiting

Cons:

-          Bad taste in your mouth (can be mitigated with a tasty fruit lozenge)

-          Strict protocol

 

IV therapy:

This is considered by most to be the gold standard in care and subsequently also the most expensive.  They claim high bioavailability. Runs about $500 per session with 8 sessions in 5 weeks in the protocol.

Pros:

-          Considered the best

-          Can be administered via a controlled drip so you get the medicine at the best rate

-          You can more easily adjust the protocol because it is not monitored by the FDA

Cons:

-          Expensive cost

-          IV (ouch)

-          Higher chance of nausea and vomiting

 

Intramuscular Injection:

This runs slightly cheaper than IV therapy at around $300 per session and is also 8 sessions in 5 weeks. It is considered the most intense option as it is an immediate injection so it does nit enter the body slowly like the IV does. 

Pros:

-          Cheaper than IV therapy

-          Can more easily adapt protocol to your needs as it is not monitored by the drug company or FDA

Cons:

-          Intense experience (this might be a pro if you are into that sort of thing)

-          It’s a shot (again you might enjoy that sort of thing. I would not)

 

Lozenges:

The last of my options was lozenges.  Many online companies such as MindBloom offer lozenges as a full treatment plan.  These can be shipped to your home and you administer them yourself.  In my clinic these are offered as supplemental when you decrease your treatments in the clinic.  So now that I have exited the 12 session protocol I can choose to go weekly or every other week or once a month, whatever I decide.  To fill the gaps on the weeks I do not get Spravato I can opt to so an at-home lozenge which is less intense than the clinic experience and I assume less effective but continues my treatment in an easier to manage way. I am considering this option currently and will of course update my blog entries accordingly.  Mine would be made at a compound pharmacy and is available in multiple flavors to help mask the taste.  They would run $125 for the first month which is a dose adjustment period and then $175 for 2 months once a proper dose is set (which you can stretch out if you are only doing them say twice a month and doing in clinic the other weeks).

Pros:

-          At-home treatment

-          Easy lozenge, no pain

Cons:

-          Cost – not covered by insurance

-          Not as effective

These were the options available to me.  Your choices (and costs) may vary by state and facility.  This is only an example to give people an idea of the options and financial commitments.  When you choose a clinic they will go over all of the options available to you.  This is only intended to give you an idea of what is out there and give you some food for thought as you contemplate what might be a good fit for you. 

I will also say on the insurance front that the clinic made that process easier for me.  They handled most of the heavy lifting getting it approved and are in the position to understand what is required to get it approved.  Thankfully I have a decent insurance when it comes to this treatment and it was approved and even given a year of pre-approval which is not always common.  Insurance coverage will vary wildly but the clinic should be able to guide you in those regards.