While it's legal for doctors to prescribe ketamine, the FDA hasn't approved it for mental health treatment, which means that individual practitioners develop their own treatment protocols. The result is wide variability among providers, with some favoring gradual, low-dosage treatments while others advocate larger amounts that can induce hallucinations, as the drug is a psychedelic at the right doses.
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Commercial ketamine clinics often offer same-day appointments in which patients can pay out-of-pocket for a drug that renders immediate results. The ketamine is administered intravenously, and patients are often given blankets, headphones and an eye mask to heighten the dissociative feeling of not being in one's body. A typical dose of ketamine to treat depression, which is one-tenth the dosage used in anesthesia, costs clinics about $1, but clinics charge $600 to $1,000 per treatment.
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Generic ketamine, by contrast, has no REMS requirements. And because it is generic, cheap and already on the market, drugmakers have little financial incentive to undertake the costly clinical trials that would be required for FDA approval for specific psychiatric conditions.
That leaves it to the patient to assess ketamine providers. Clinics dedicated to intravenous infusions, rather than offering the treatment as an add-on, may be more familiar with the nuances of administering the drug. Ideally, practitioners should have mental health and anesthesia expertise or have multiple specialties under one roof, and clinics should be equipped with hospital-grade monitoring equipment, Mandel says.
