Ketamine has been used extensively in emergency departments, operating rooms, and military conflicts with a very safe track record. Ketamine causes very little depression in a patient’s respiratory drive, which is why it has been attractive as an anesthetic agent in the military and in developing countries. Outpatient IM treatments at Klarisana are fundamentally different than the use of ketamine in an ER or operating room. The doses of ketamine are much lower than those used in a hospital setting. Patients are still conversant and very aware during the IM treatments. Additionally, there is no “bolus” of ketamine. The ketamine is administered through injections and the sessions last about an hour to two hours. Patients vitals are monitored at regular intervals to ensure they are maintaining within safe parameters. Patients are under continuous visual observation by clinic staff.
What To Expect
Most of the IM treatments at Klarisana centers are overseen by our nurse practitioners or physician assistants. We feel that Advanced Practice Practitioners (APP’s) are the ideal providers to administer ketamine IM treatments. Our goal at Klarisana is to make ketamine therapy accessible to the largest number of people possible in an economically feasible way. Our founder and Medical Director, Dr. Bonnett, has served on several combat tours in the Middle East. He developed a great respect and admiration for the APP’s who were the sole providers on Forward Operating Bases (FOB’s). The United States Military entrusts the care of it’s soldiers in forward deployed areas to APP’s and so does Klarisana. There is a rapidly growing trend nationwide to recognize the incredibly valuable role that APP’s play in many aspects of healthcare. Our Nurse Practitioners and Physician Assistants have many years of clinical…and just as importantly…life experience. We feel that Nurse Practitioners and Physician Assistants have a very important role to play in every aspect of American healthcare and will play a vital role in solving the problem of access to healthcare in the United States.
Running through the core of Klarisana is the concept of Crew Resource Management. This is an operational mindset that we have adopted from the aviation industry…and more specifically from Dr. Bonnett’s experience as a flight surgeon in Army Aviation. One of the main principles of CRM is that there is “no rank in the cockpit.” Any member of the Klarisana staff is empowered to call a halt to an IM treatment or the mixing of medications if they witness any unsafe act. All medications are prepared with two staff members present and every single dose is confirmed by two people. Additionally, even though ketamine has a very reassuring safety profile, all patients vitals are continuously monitored throughout their ketamine session. Klarisana sets the standard for patient safety.
Many clinics try to save money by administering IM treatments to multiple people in the same room. They cut costs in this way because they can use less space and less staff. Another common strategy to save money is to have no one in the room…patients infuse by themselves. At Klarisana, each patient receives their Intramuscular Ketamine treatment in a private room with live stream video observation by Klarisana staff. We believe that the experience and the environment in which a patient receives their IM treatment plays a big part in how effective the treatment will be. Our patients comfort and privacy is very important to us. Having a ketamine journey with several others in the same room would be very counterproductive. Ketamine therapy partnered with privacy allows for the patient to guide themselves through their journey without the feeling of judgement. Patients are equipped with the ability to request staff to enter the room and a Klarisana staff member is always available to immediately join the patient at their request.
Generally not. Ketamine definitely elicits changes in perception of sights, sounds, time, and space. We find that carefully explaining what to expect ahead of time alleviates most of the anxiety that might otherwise occur. Also, by creating a private, safe and comfortable space helps alleviate any anxiety about the experience. Klarisana staff is always available to join the patient in the event that they feel more comfortable with the guidance of an experienced staff member. The vast majority of our patients report that it is a very positive, relaxing, and enlightening experience. Some of our patients have received Ketamine Therapy at other centers which do group ketamine treatment and report that this can be a very counterproductive experience.
Our rooms are decorated so that they are relaxing, tranquil, and peaceful. Patients receive their IM treatments in privacy while under constant observation during the Ketamine session. The provider performs an initial evaluation and physical exam, he/she steps out of the room and the IM treatment is started. Most Ketamine sessions last about one hour. Our rooms have TV’s where patients may watch videos of nature scenes, aquatic scapes, or they may bring in their own DVD or cast to one of our SmartTV’s. We strive to minimize distractions and interruptions during the Ketamine treatment process. Our goal is to make the session a fluid and peaceful experience.
One would think that “sounds of the rainforest” would be ideal. What we have found however is that it is a very personal choice and spans a wide range of musical genres. Our patients listen to all sorts of music..the genre is not as important as the meaning the music has for you. The important thing is that the music selection puts you in a good “headspace.” Our patients listen to everything from John Coltrane, to Nine Inch Nails.
You will not stop breathing. Ketamine has a very reassuring safety profile. There have been case reports of brief periods of apnea (no breathing) with a rapid push of a large amount of ketamine such as might be used to induce anesthesia in an operating room. With a low dose administration at Klarisana there is no respiratory depression. Our patients are responsive and able to talk throughout the Ketamine session. The most common side effect is mild nausea in some patients. We do offer anti-nausea medication prior to treatment. We feel that the alterations in perception with ketamine should not be categorized as “side effects.” As we describe elsewhere in the FAQ, they are part of the therapy.
Ketamine is extensively used in emergency medicine and, in fact, is the “go to” medication for procedural sedation in kids. It is routinely used in ER’s across America every day in young children who require sedation for painful procedures such as facial lacerations and reduction of broken bones. We have a number of patients with mental health conditions and chronic pain who are teenagers. That being said when we consider Ketamine Therapy for patients under the age of 18 we require approval of and close cooperation with, the patient’s primary care and mental health provider.
I read an article where a university professor said that ketamine is promising but that it is not ready for prime time. If she is a professor she is not biased, right?
Whenever you hear anyone make a statement for or against the clinical use of ketamine it is very important to assess what their motivation for making that statement is. Ketamine is a real game changer but it is a generic medication. If a company could create a medication similar to ketamine and put it under patent that could make them a tremendous amount of money. Many universities will enter into agreements with private companies to share or sell patents that come out of their research. This can lead to significant revenue for universities. If someone from a university says that we need to hold off on using ketamine until a new version can be developed it is important to ask whether that individual and their institution might stand to gain financially through the development of the new version of ketamine.
Ketamine is approved by the US Food & Drug Administration for use in humans as an anesthetic agent and as an analgesic agent to supplement low-potency medications such as nitrous oxide. The use of ketamine for treatment resistant depression is considered “off-label” by the FDA. Once a drug is approved by the FDA for one indication, then clinicians may use that same medication for other indications if they feel that the evidence supports the practice. Ketamine is off-label because no one has invested the millions of dollars necessary to go through the multi-phase process of getting ketamine “approved” by the FDA for these indications. The fact that ketamine is a generic medication means that it is unlikely that any company or organization will EVER spend the money to get ketamine “FDA approved.” The issue of whether there is good evidence to support the use of ketamine for the indications for which Klarisana is using it is separate from the simple discussion of FDA approval. There are many medications that are prescribed and administered every day that are off-label. For example, Compazine (prochlorperazine) is indicated for nausea but frequently used to treat migraine headaches. A common misconception is that just because a medication is not “FDA Approved” for a certain indication that this means the FDA has prohibited its use for that indication. If the FDA wanted to prevent the use of a medication they would issue a “black box” warning; this is not the case for ketamine.
Like most things in life, there is linear relationship between the money spent and quality received. At Klarisana, we offer very personalized service and treatment in a private and fully monitored setting. In our experience, we believe that the setting and the experience are critical to success. After you contact us, you have a non-pressured discussion with our Behavioral Health Coordinators. If you are seeing us for a mental health condition, you will then have an intake session with one of our Licensed Behavioral Health professionals. You will also have an intake session either via telehealth or in clinic with one of our Advanced Practice Providers (NP or PA). Once you start your Ketamine treatments, you will be treated in a private room with constant clinical observation. As one of our patients, we will develop a customized dosing protocol that works for you. It is Klarisana’s mission to make quality Mental Health treatment as accessible to the population as possible, so we are constantly seeking to add more insurance companies that we can participate with, including Texas & Colorado Medicaid. Please visit our “Financial Information” page to find an updated list of insurance carriers we participate with as well as available discounts. Klarisana also offers in-house and third-party payment plan options to those who qualify.
Some critics on the internet will smugly refer to ketamine as a “horse tranquilizer.” Ketamine is, in fact, used extensively in both human and veterinary medicine. The reason that veterinarians use ketamine is because it generally does not suppress respirations. Said a different way, it does not make the patient stop breathing. This important quality of ketamine makes it not only desirable in veterinary medicine but it makes it very desirable in human medicine…particularly in pediatrics. Ketamine is the “go-to” medication for the sedation of children in emergency departments across the United States. In the same way, if a veterinarian has to do a procedure on a large animal like a horse, they would prefer to use a sedative agent that does not make the animal stop breathing. If a horse stops breathing, this poses some huge logistical challenges for the veterinarian. Horses and humans share a great deal of the same anatomy and physiology. The fact that a pharmaceutical agent can be useful in both the human and veterinary medicine does not represent any kind of earth-shattering revelation. Penicillin is also a medication used extensively in human and veterinary medicine. When critics try to label ketamine as a “horse tranquilizer” in social media outlets, one should recognize this as the uninformed and sophomorish comment that it is.
Klarisana is not a clinic…it’s an idea. It is the idea that we can help people who are in a dark season of life, realign themselves with the unique mission for which each of them was created. We believe that each person was created for a purpose and has an important mission in this life. Chronic pain, severe depression, post-traumatic stress disorder (PTSD), and other mental health conditions derail a person’s ability to carry out their mission. We offer Ketamine Therapy, which represents a totally different paradigm in treatment. Klarisana was born out of a response to the alarming veteran suicide rate in the United States. Our founder, Dr. Carl J. Bonnett, MD is a twenty-year veteran of the Army National Guard with four overseas deployments to the Middle East. He has a great deal of experience with PTSD and the toll that it takes on veterans and their families. As the lives lost to suicide grew higher, he became more and more frustrated with the limited options available to give patients with severe PTSD and depression any meaningful relief. As more and more research articles demonstrating that Ketamine could be a powerful treatment for depression, PTSD, and chronic pain were published, Dr. Bonnett recognized how important it was to make Ketamine Therapy available to patients. In response to this, he opened the first Klarisana center in San Antonio, Texas. Klarisana quickly expanded beyond this initial vision and now provides care to people from all walks of life and from all backgrounds. Our goal is to make Ketamine Therapy accessible to the largest number of people possible so that we can truly “Rebuild Lives.”
How did you come up with the idea that the experiential aspect of ketamine is an important part of the therapy?
We were heavily influenced by the work of Dr. Phil Wolfson and Dr. Terry Early. These gentlemen are psychiatrists who have been working clinically with ketamine for a very long time and are real pioneers in the field of outpatient ketamine therapy.
Klarisana does accept insurance. Please visit our “Financial Information” page to see an updated list of insurance carriers that we participate with. Klarisana also works with out-of-network benefits so if we are not in network with your carrier, but you have out of network benefits, Klarisana as a courtesy will file those claims so that our patients do not have to go through the trouble of filing for reimbursements. For services such as Psychotropic Therapy that does not have a CPT code, a small non-covered services fee will be applied. Contact Klarisana to find out more about insurance coverage and costs.
Other clinics have trademarked proprietary formulations of ketamine with catchy names. Do they know something that you guys don’t?
No they don’t. At Klarisana we embrace the concept of Evidence Based Medicine (EBM). The foundational principle of EBM is that the evidence for a given treatment and/or procedure is clearly laid out for scrutiny by the medical community. In that way, patients can have a reasonable assurance of safety and effectiveness. In certain circumstances the evidence for a treatment is either anecdotal or otherwise not very robust. In these cases, a patient can at least make an educated decision as to whether the potential benefits outweigh and potential risks. When certain clinicians say they have “special formulations” and “proprietary blends” of ketamine and other medications this is disingenuous and does not support the idea of true informed consent for the patient. At Klarisana, we will let you know our dosing protocols…we will let you know every medication we plan to administer…and we will share with you what the evidence is for everything we do. If the evidence is purely anecdotal, then we will be very transparent with this. We are currently engaged in research that has been approved by Integreview, an Institutional Review Board in Austin, Texas. We plan to publish our results for review by the medical community. For more information please see Dr. Bonnett’s video entitled “Ketamine Therapy – Is there a Secret Sauce?”
Patients eighteen years of age and older do not require a referral. Prospective patients will be evaluated by one of our Advanced Practice Providers which will determine whether any further clearance is required. Subsequently, patients will often have a psychological screening completed by one of our Licensed Behavioral Health professionals. For patients younger than 18 years of age, we do require communication with, and approval of, the patient’s primary care provider.
Ketamine therapy is a rather unique entity because it represents a fundamentally different use of a time-tested medication. Ketamine has traditionally been used as an anesthetic by emergency physicians and anesthesiologists. The way in which ketamine is currently being offered at centers like Klarisana represents an entirely different paradigm. At Klarisana, we feel that ketamine for mental health and chronic pain conditions should be more accurately described as Ketamine for Non-Anesthetic Indications (KNAI). In light of this, one will see clinics that come from several different specialties. There are many clinics that are operated by either emergency physicians or anesthesiologists; which makes sense given the historical familiarity with ketamine by these disciplines. One will also see clinics that are operated by psychiatrists, which is understandable given the important role that ketamine can play in the treatment of mental health disorders. We feel that the important thing is not so much the specialty of the clinician’s who opened the clinic but rather the way in which they have structured their practice and the intent behind it. Ketamine is a relatively safe medication but still needs to be treated with respect. The important thing is that the clinicians who operate the clinic have ensured that they place a top priority on safety and have taken the time to undergo any additional training as necessary to administer intramuscular ketamine therapy. The founder of Klarisana is Dr. Carl J. Bonnett, MD who is Board Certified by the American Board of Emergency Medicine and has extensive clinical experience with ketamine.
This issue can be very challenging for patients because the field of ketamine therapy is relatively new and has not been well defined. Many interested parties have recognized that ketamine represents a potential “game changer” for mental health and for the management of chronic pain. Some clinicians see this as an amazing opportunity to change the lives of countless people. Some, unfortunately, see this as a way to make more money. A quick search of the internet will show that some groups offer training programs to teach clinicians how to set up ketamine clinics in order to make extra money from this “amazing revenue stream.” Against this backdrop Dr. Bonnett was one of the founding members of the American Society of Ketamine Physicians (ASKP.org) which is the first professional society of ketamine providers. ASKP was formed by the leaders in the field of ketamine therapy to try and establish some basic standards and best practices for ketamine therapy. We would recommend you chose a center that is a member of ASKP.
No. When we opened in 2015, Dr. Bonnett made the conscious decision to not register for OBA because he felt strongly that what Klarisana offers is not OBA…it is Ketamine for Non-Anesthetic Indications (KNAI); a fundamentally different clinical entity. In 2017, one of our competitors filed a complaint with the Texas Medical Board against Klarisana and several other clinics in Texas that offer ketamine therapy and haven’t obtained an OBA certificate. Klarisana and the other clinicians in Texas presented their argument to the TMB as to why this clinical use of ketamine should be considered KNAI and not OBA. The TMB agreed with us and the complaint was quickly dismissed. We applaud the forward thinking of the TMB and are pleased that their decision set an important precedent for the clinical use of outpatient ketamine in the United States.
Certain Klarisana locations do provide Ketamine-assisted Psychotherapy. Klarisana patients are welcome to continue to see our Licensed Mental Health providers for therapy outside of ketamine-assisted psychotherapy. However, Klarisana does not manage medications nor do we prescribe for our patients. We are a healthcare organization that works very hard to perfect the art of administering ketamine for mental health conditions and chronic pain, as well as providing quality mental health care access. Although in certain locations we do provide mental health services outside of Ketamine therapy, we still work closely with psychiatrists and psychologists in our communities to partner with them to offer a valuable treatment option to their patients. If a patient presents to Klarisana who doesn’t have a psychiatrist or psychologist, we can introduce them to our Mental Health providers, or we will work hard to set them up with one who has an understanding of ketamine therapy. The environment in which ketamine is administered and the experience that a patient has is absolutely vital to increasing a patient’s chance of success. This is not the kind of therapy that lends itself to just being an “add-on” revenue stream for a clinic has an “extra office.” We do it right and we do it effectively. We feel that the role of the psychiatrist in a patient’s care is vital but there is nothing to be gained from having them present during the actual session. Far from trying to replace or compete with local psychiatrists, we strive to be an effective resource that they can have at their disposal to treat their patients.
No. We focus on providing outstanding clinical care. Most of our “secrets” are laid out on this document, our web page, or on our YouTube channel. We view ketamine as an incredibly valuable treatment option that should be performed at centers who are very serious about its use and have a mission to serve humanity.
I read some articles that marijuana and LSD can be helpful for treating depression. Would it be a good idea for me to do one or both of these before my session and not tell you about it?
No, this would not be a good idea. While there is literature out there suggesting that marijuana, LSD, and psilocybin (“Magic Mushrooms”) may have a role to play in the treatment of depression and/or PTSD, combining them with ketamine…especially if you do not tell our clinical staff…can lead to a very unpredictable reaction. This will most likely be a very counterproductive experience for you.
My boyfriend is an ER nurse and he has administered ketamine many times. Would it be helpful if I brought him along to give you some suggestions regarding dosing?
No. The use of ketamine in this setting is very different from the way it is traditionally used in emergency departments and operating rooms. For our mental health patients, we are trying to achieve what we call the Psychotropic Therapeutic Response (PTR). This is a very different end state than what is being used in traditional settings. We have a great deal of experience at dialing in on the correct dose through careful interviewing of the patient. We are happy to explain the process to your loved one who may work in the medical field but we would respectfully request that they refrain from demanding a particular dose or rate of delivery as this can be counterproductive to your treatment.