If you live in New York City, you’ve likely passed or heard of a clinic where ketamine — a hospital anesthetic and psychedelic party drug — is used as a mental health treatment.
Locations now operate in the Financial District and Brooklyn Heights. Walk up 5th Avenue and a New Yorker will encounter five clinics off this street alone.
No official tally exists, but the nonprofit American Society of Ketamine Physicians, Psychotherapists and Practitioners lists seven members as practicing in New York City and 24 members listed in New York state overall. This number likely represents a low estimate of clinics given a quick internet search reveals way more on Yelp.
According to U.S. surveys, people are increasingly seeking mental health services and becoming open to the idea of psychedelics to address those ailments. Ketamine clinics are where these ideas and wants meet. But while each space may claim to provide ketamine therapeutically, they can differ in approach, what they require of patients, vibes and safety.
Formally known as ketamine hydrochloride, the drug is a mixture of two mirror-image molecules, R-ketamine and S-ketamine. Scientists first synthesized ketamine in the 1960s, and during this time, they found the drug causes “dissociative anesthesia.” That means — along with numbing the body as an anesthetic, it also distorts senses and causes people to feel detached from reality.
These hallucinogenic effects explain why ketamine is often considered a psychedelic, and federal regulators classify it as a Schedule III drug, meaning it has a low to moderate potential for physical and psychological dependence.
The Food and Drug Administration has not approved ketamine for the treatment of any psychiatric disorder, but the agency sanctioned the drug as an anesthetic without restrictions back in 1970. That means the drug can be prescribed off-label — or for unapproved purposes.
A growing body of evidence and personal stories show the drug can help with conditions like treatment-resistant depression when taken intravenously, or via IVs. While it can take a few weeks to feel the full effects of standard antidepressants, ketamine can offer quick relief in just a few hours. But it can also be an expensive process complicated by a few unknowns.
But not all ketamine drugs and therapies offer the same effects or safety. On Oct.10, the FDA warned against using compounded versions of ketamine—variations of the drug like lozenges and tablets—especially while unsupervised at home.
This October alert has more to do with the boom of online prescribers dispensing ketamine that began in 2020 after pandemic-related telemedicine changes, than with the clinics offering off-label supervised intravenous infusions. In the alert, the FDA warns that patients who receive compounded ketamine products from telemedicine platforms may not receive information about potential risks. In turn, some working in ketamine clinics welcomed the FDA alert.
“The FDA guidance offers some real clarity in the field,” said Dr. Nico Grundmann, an emergency-medicine physician and the co-founder and the medical director of Ember Health. “There really is only one way of doing this in an evidence-based, data-backed way, which is office treatments through an IV. The guidelines, if anything, should help clarify that the other options people are seeing are not yet safe or supportive.”
If you’re a New Yorker considering ketamine for your mental health, here’s what to consider.
What is ketamine and what does it have to do with mental health?
Ketamine differs from most anesthetics because it doesn’t totally suppress brain activity. After its discovery in the 1960s, interest in ketamine as a psychiatric therapy came and went for a few decades, but blossomed in 2000 when a clinical trial found the drug caused rapid antidepressant effects. While it’s not exactly clear yet why ketamine seems to have this positive influence, animal studies on mice show the drug can increase the activity of newborn neurons and change neuronal activity patterns. Overall, this suggests ketamine supports new connections in the brain.
Because ketamine can relieve depression within hours, it’s emerged as an option for immediately treating people with suicidal feelings.
Dr. Michael Grunebaum is an associate professor of psychiatry at Columbia University Medical Center and a research psychiatrist at the New York State Psychiatric Institute. His research shows that ketamine can reduce suicidal ideation in people with depression, which is one of the most favorable aspects of the drug.
Another group who could benefit most from ketamine-assisted therapy are those with treatment-resistant depression, Grunebaum told Gothamist. Treatment-resistant depression is a type of major depressive disorder where people do not experience relief from antidepressant medications.
“Depression is such a common illness,” Grunebaum said. “If 30 to 50% [of people with depression] don’t really get an adequate response or improvement from standard antidepressants, that is a lot of people who need alternative kinds of treatment to feel better.”
A sizeable amount of research — The New Yorker tallied up to 300 studies — shows ketamine can improve symptoms of mood disorders, especially depression. Some recent examples include a 2023 paper published in The British Journal of Psychiatry that found one in five study participants achieved total remission from their treatment-resistant depression symptoms after a month of bi-weekly injections. Another 2023 paper published in The New England Journal of Medicine found ketamine delivered through an IV to be just as effective as electroconvulsive therapy (ECT) for alleviating treatment-resistant depression. ECT has been viewed as the “gold standard” for treating severe depression.
But the psychiatric field disagrees over whether enough data supports the long-term use of ketamine when it comes to safety and effectiveness. Depression can be a life-long illness and “we simply don’t know how safe ketamine is over that length of time,” Grunebaum said.
Research shows that while ketamine can induce a transformative state of mind, that feeling doesn’t necessarily last. A 2019 review of 14 studies published in the journal Drug Design, Development, and Therapy concluded that a single IV infusion of ketamine can cause a “rapid and robust antidepressant effect” within 40 minutes of a single infusion. The influence was especially profound 24 hours after the treatment, but the improvement also disappeared within one to two weeks.
“While ketamine works rapidly, the improvement doesn’t last — it’s not a cure,” Grunebaum said. “If you stop ketamine treatments, usually depression will come back.”
Most clinics offer a treatment plan that includes multiple transfusions. At Ember Health, treatment begins with four infusions spread over two weeks. There’s also an option to return for booster infusions if depression starts to return. The goal then is to see the patient within a week, for a single treatment session. Grundmann said that about 10% of patients come twice a month, while another 10% come in closer to twice a year.
Will ketamine ever be approved? What are the side effects?
In 2021, a consortium of drug researchers wrote that ketamine IVs are unlikely to ever be FDA-approved for mental health — mostly for economic reasons. Seeking a drug approval for a specific purpose — such as mental health — can be expensive, but a drug company would be unlikely to profit afterward because the medicine is already easily available as a generic drug that’s commonly used off-label.
Other chemical versions of ketamine have made it through this process, though. The FDA approved the nasal spray S-ketamine or esketamine (under the brand name Spravato) in 2019 as a medication for treatment-resistant depression. Though it’s derived from ketamine, it’s technically a different drug.
Spravato also comes with strict safety controls, must be administered in a clinical setting by medical professionals, and cannot be sold directly to patients. Back in February 2022, the FDA also warned against people using knock-offs of Spravato.
Regarding safety, studies suggest ketamine is safe and tolerable at low doses and within the context of short-term treatment. The out-of-body experience it can induce is pleasant for some, but can be scary for others, Grunebaum said. Other brief side effects can include dizziness, an increase in blood pressure, and nausea. Rare side effects, which typically occur at frequent use at much higher doses, include mania and liver damage.
Overall, side effects underscore why ketamine is not, “something people should take home and use in an unsupervised way,” explained Grunebaum.
Grunebaum views ketamine as a “last resort kind of treatment”— something to try once other methods, like antidepressants and psychotherapy, have failed. This is primarily because he sees a need for more research on long-term use.
What is ketamine therapy like?
While legal off-label use of ketamine is still contingent on a doctor prescribing it, there’s no legal requirement for a mental health provider to be involved at any point in the process. Individual centers determine how they want to integrate mental health care into the process. Grunebaum recommends a mental health provider be involved in some capacity.
At a minimum, this may mean a therapist or psychiatrist helping you decide whether or not this is the right type of treatment for you. Later on, this could mean a mental health professional helping guide you through the process during and after sessions. A 2022 review of studies on ketamine-assisted psychotherapy published in the Journal of Pain Research concluded that psychotherapy provided before, during, and following sessions can maximize and prolong ketamine’s benefits.
Intravenous ketamine treatment can be expensive, costing between $300 to $1,000 per session. Insurance does not generally cover these IVs for psychological conditions given their off-label prescriptions, but some providers accept out-of-network claims depending on a person’s individual coverage. Depending on your health care plan and diagnosis, Spravato nasal spray may be covered by insurance.
Ember Health charges $275 for a one-time orientation visit and $550 per treatment visit. Because their foundational series includes four infusion treatments over two weeks, clients should expect to pay $2,475. But the clinic also offers a sliding scale program and states that their clients with out-of-network benefits are often able to receive reimbursement for their care.
Ember Health co-founder Tiffany Franke said that, on average, 70% of their clients receive out-of-network reimbursement and up to 20% of their patients are eligible for the sliding scale, reduced cost.
Treatment at Ember Health begins with an intake session, during which a prospective patient speaks with a doctor about ketamine-assisted therapy. These sessions also determine whether the patient’s mental health provider has recommended ketamine as an appropriate treatment for depression. Later, the patient comes in for four 90-minute sessions — 40 of those minutes is the ketamine infusion administered through an IV.
“Our objective is to provide this treatment in a place and in a way that provides clinical and psychological safety,” Franke said. The clinic is entirely staffed by doctors and nurses, who are constantly monitoring the process and trained in guiding the patient through intention setting and creating rituals of care. Each clinic has three suites. Patients are set up with eyeshades and headphones in reclining chairs, and they have the option to incorporate aromatherapy and music.
“Patients have talked about how it’s kind of a cocoon-like state,” Franke said.
When the infusion ends, there’s a 10 to 15-minute stretch that Franke describes as the “washout period.” This is when the effects of ketamine are wearing off. Once this ends a clinician speaks to the patient about how they’re feeling and if they would rather reflect on the experience with them or in private. After the clinician determines that the patient is safe to leave, they are welcomed to a designated reflection and recovery space, where they can journal, read, draw, and gather their thoughts before going back into the world.
Some of the reflections that come up center around feeling small in the scope of the universe — and feeling comforted by that, Franke said.
“People often talk about feelings of connectivity with all living things and beings in a way that’s very gratifying,” she said. “We very much encourage people to use whatever comes up as something to think and work on in a therapeutic context.”
Franke also said it’s important to note that the experience can be psychologically disturbing, especially for people with a trauma history. If this happens to a patient at Ember Health, a clinician is there to “engage them in grounding exercises, and make sure they feel safe and secure,” she said.
How can you judge the quality of care?
If you’re trying to pick a place to receive this type of treatment, it might be hard to decide where to go.
You might want to start by reviewing a consensus statement issued by the American Psychiatric Association in 2017. This statement goes over how patients should be selected, guidance on training clinicians, how to deliver the medication, and how to proceed after the initial infusions are provided.
Other best practices have been collected by the U.S. Veterans Affairs office and the American Society of Ketamine Physicians, Psychotherapists and Practitioners, a group of more than 400 medical professionals. The nonprofit’s “standards of practice and ethics statement” was created in response to the observation that there’s a “lack of formal guidance” and “significant variability between clinics administering ketamine.”
Reviewing this guidance can show a patient whether or not the clinic they’re considering receiving care from has practices aligned with what’s viewed as ideal. Grunebaum also recommended that people consider how mental health professionals are involved — do they recommend this clinic? Does the clinic actively work with mental health professionals throughout the process? Who’s involved in creating the treatment plan? These are all questions to consider.
For example, Ember Health, for its part, only accepts clients who are already being treated by a mental health professional.
“We require that we speak to those individuals before a patient has their first treatment with us,” said Grundmann. “We require that those providers give us their opinion about the initial treatment success after the foundation period. And then we continually engage with those individuals over time to ensure that the patients continue to do well.”
It’s important, Grundmann said, that “these treatments are not viewed as a silver bullet, they’re viewed as part of a larger care plan.”