How We Treat You
Medicine and Mind
The medications used here are not unique to this practice. What varies is how treatment is selected, dosed, delivered, and adapted to the individual patient. Treatment remains individualized throughout, with a board-certified clinician present to make medical and psychiatric adjustments as they are needed.
Dosing, Infusion Dynamics, and Duration
Ketamine dosing and delivery practices vary. Our protocol incorporates multiple variables reflecting the individual patient: body composition, dosing body weight, modeled pharmacokinetics, medical history, current medications, and clinically relevant pharmacogenetic information when available.
Once treatment begins, psychiatric response becomes the guiding principle. The variables considered at the outset continue to define the medical framework, and we remain vigilant about each throughout treatment. Within that framework, infusion dynamics are adjusted in service of the patient's psychiatric progress. This is where combined medical and psychiatric training matters.
Choosing IV or Intranasal Ketamine
We provide ketamine by two routes: intravenously, or intranasally — by nasal spray. These are not simply different ways of delivering the same treatment. They differ in how precisely the dose can be controlled, how the medication is absorbed, how treatment is monitored, and in the regulatory and insurance frameworks surrounding them.
Intravenous ketamine allows the greatest control over both the amount of medication delivered and the rate at which it reaches the patient. Dose, infusion speed, and duration can all be adjusted during treatment in response to tolerability and psychiatric response.
Nasal-spray treatment avoids IV placement and may be preferable for some patients, although absorption through the nose is less predictable than delivery through an IV. Nasal-spray treatment takes two different forms:
Spravato (esketamine) is an FDA-approved nasal spray for certain depressive conditions. When nasal-spray treatment is appropriate, Spravato is generally our first consideration. It is administered in the office under a defined monitoring program and may be covered by insurance.
Compounded intranasal ketamine is a nasal spray prepared by a compounding pharmacy using ketamine rather than esketamine. It is not simply a generic version of Spravato. The medication, dosing, absorption, and regulatory framework are different.
When Spravato is unavailable, poorly suited to a particular patient, or otherwise not the best clinical option, compounded nasal-spray ketamine may be considered individually.
We weigh the advantages and limitations of each approach and recommend the route and formulation that best fit the individual patient.
A Note on FDA Status
Ketamine itself has been an FDA-approved medication for decades, primarily for use as an anesthetic. Its use for depression and other psychiatric conditions is off-label — meaning the medication is approved, but its use for these conditions is not.
Spravato is different. It is specifically FDA-approved for certain depressive conditions.