Ketamine Therapy
Subanesthetic, NMDA-modulating IV ketamine infusion protocols for treatment-resistant depression, PTSD, and refractory chronic pain. Physician-supervised, integrated with mental-health follow-through — a separate clinical indication, treated as one.
- Class
- Neuroplastic
- Delivery
- IV, in-clinic
- Indication
- Mood · pain
- Supervision
- Physician on-site
01 About
What it is.
Ketamine is an NMDA-receptor antagonist with decades of use as a hospital anesthetic. At subanesthetic doses — far below those used in surgery — repeated infusion produces a rapid, durable antidepressant effect in patients who have not responded to multiple conventional antidepressants. The same mechanism makes it a tool in PTSD, suicidal ideation, and a defined set of refractory chronic-pain conditions.
Ketamine therapy at Apex is a separate clinical indication from our regenerative work — but it lives at the same clinic because the underlying philosophy is the same: physician-led, diagnostically rigorous, and accountable for outcomes. We do not run ketamine as a wellness drip. Every patient is screened, supervised during infusion, and integrated with appropriate mental-health follow-through.
02 How it works
How ketamine works.
Ketamine antagonizes NMDA receptors, transiently up-regulating BDNF (brain-derived neurotrophic factor) and driving rapid synaptogenesis in the prefrontal cortex and hippocampus. The clinical effect is unlike conventional SSRIs — onset within hours rather than weeks, with durable response after a defined induction series.
The dissociative experience that occurs during infusion is part of the mechanism, not a side effect. We dose to a therapeutic range, monitor vitals continuously, and provide a calm, supervised environment. Set, setting, and physician presence matter — they materially affect both the experience and the outcome.
03 What the research shows
What the studies show.
Ketamine has the strongest randomized-trial evidence base of any rapid-acting antidepressant. The published outcomes in treatment-resistant depression, suicidal ideation, and PTSD have driven its incorporation into mainstream psychiatric practice — and into FDA-approved esketamine (Spravato) in 2019.
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Ketamine for rapid reduction of suicidal ideation: a systematic review and individual-patient meta-analysis
Pooled patient-level data from 10 randomized trials demonstrated significant, rapid reduction in suicidal ideation within 24 hours of a single ketamine infusion, with effect sustained at one week. Among the most robust signals in modern psychiatric trial literature.
Read on PubMed -
Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder
A randomized controlled trial in 41 patients with chronic PTSD found a single ketamine infusion produced significantly greater PTSD symptom reduction than active control (midazolam) at 24 hours, with sustained benefit through one week.
Read on PubMed -
Consensus guidelines on the use of intravenous ketamine infusions for chronic pain
A multidisciplinary consensus from the American Society of Regional Anesthesia, American Academy of Pain Medicine, and American Society of Anesthesiologists. IV ketamine has demonstrated efficacy in CRPS, neuropathic pain, and refractory chronic pain — particularly when conventional approaches have failed.
Read on PubMed
Ketamine works best when combined with active mental-health follow-through (psychotherapy, medication management, integration). It is not a one-time fix. We screen for appropriate candidacy and decline patients better served by conventional psychiatric care.
04 Are you a candidate
Who's a candidate. Who isn't.
Candidates:
- Treatment-resistant depression: failed two or more adequate trials of conventional antidepressants.
- Active suicidal ideation requiring rapid stabilization (with active psychiatric follow-up).
- PTSD that has not responded to first-line therapy.
- Refractory neuropathic pain, CRPS, or chronic pain syndromes that have failed standard pharmacologic and interventional approaches.
- Patients with active mental-health treatment in place — psychiatrist, therapist, or both.
When we will not recommend it:
- Active psychotic disorder, schizophrenia, or mania.
- Uncontrolled hypertension or active cardiovascular disease.
- Active substance-use disorder (alcohol, ketamine, or other dissociatives) without stable recovery support.
- Pregnancy.
- Patients without an active outpatient mental-health relationship — we coordinate before treatment.
Think you might be a candidate?
The first step is a 60–90 minute consultation. We review your imaging, history, and goals — and tell you honestly whether this is the right next step.
07What happens at your consultation
A conversation, not a sales meeting.
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01
Intake & history
60–90 minutes. We review imaging, prior treatments, current medications, and goals. Most of this hour is listening.
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02
Focused exam
A clinical exam tailored to your indication. Range of motion, strength, functional testing — what the literature actually predicts response on.
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03
Honest candidacy review
If we think you're a candidate, we'll tell you why. If we don't, we'll tell you what we'd recommend instead — surgery, PT, watchful waiting.
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04
Written plan & pricing
A defined treatment plan with modality, sequence, follow-up cadence, and total cost — before any commitment.
06 What treatment looks like
What treatment looks like.
A typical ketamine protocol begins with a thorough medical and psychiatric intake, including communication with your existing psychiatrist or therapist. Standard induction is six infusions over 2–3 weeks, each lasting approximately 40 minutes with continuous physician monitoring. A brief integration conversation follows each session.
Reassessment at 4 weeks. Maintenance infusions, when indicated, are individualized to response — we do not run open-ended schedules. Outcome tracking is documented (PHQ-9, MADRS, or pain scales as appropriate) and shared with your treatment team.
09 Common questions
Ketamine Therapy, answered.
How is this different from antidepressants?
Conventional SSRIs and SNRIs work over weeks via monoamine modulation. Ketamine works within hours via NMDA antagonism and rapid synaptogenesis — a fundamentally different mechanism. It is most useful for patients who have failed conventional antidepressants, not as a first-line replacement for them.
How many infusions will I need?
Standard induction is six infusions over 2–3 weeks. Maintenance is individualized to response — some patients return monthly, others quarterly, some not at all. We do not run open-ended schedules.
Will I dissociate during the infusion?
Yes, mildly. The dissociative state is part of the mechanism, not a side effect. We dose to a therapeutic range, monitor vitals continuously, and provide a calm, supervised environment. Most patients describe it as a quiet, introspective experience that resolves shortly after the infusion ends.
Is ketamine safe?
Subanesthetic IV ketamine has been studied extensively in randomized trials with a favorable safety profile. The most common short-term effects are transient dissociation, mild blood-pressure elevation, and nausea — all monitored continuously and managed in-clinic. We screen for cardiovascular and psychiatric contraindications before treatment.
What does integration look like?
Each infusion is followed by a brief integration conversation. We coordinate with your existing psychiatrist or therapist — not as a replacement but as part of an active treatment team. Patients without an outpatient mental-health relationship are referred before we begin.
Is it covered by insurance?
IV ketamine for off-label psychiatric and chronic-pain use is generally not covered by insurance. We discuss pricing in writing before commitment. Some patients have used HSA/FSA funds; we provide receipts and superbills as requested.
10 Coverage & cost
IV ketamine therapy is not covered by insurance for off-label psychiatric or chronic-pain indications. Pricing is discussed in writing before any commitment. We provide receipts and superbills for HSA/FSA reimbursement and out-of-network claims. Financing options are available.
Begin with a consultation.
A 60–90 minute first visit. We review your psychiatric and medical history, confirm whether ketamine is the right tool for you, and coordinate with your existing care team — before any commitment.