Frequently Asked Questions

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There are many common questions surrounding ketamine therapy and the type of treatment we provide at Klarisana. Here are our answers to them.

Yes. 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 highly reputed 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. Ketamine is administered through injections and the sessions last up to two hours. The patients’ are under continuous visual observation by the clinical staff and their vitals are monitored at regular intervals to ensure they are maintained within safe parameters.

Most of the intramuscular (IM) treatments at Klarisana centers are overseen by our nurse practitioners or physician assistants. We feel that Advanced Practice Practitioners (APPs) 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. Since then, he developed a great respect and admiration for the APPs who were the sole providers of Forward Operating Bases (FOBs). The United States Military entrusts the care of its soldiers in Forward Deployed Areas to APPs, and so does Klarisana. There is a rapidly growing trend nationwide to recognize the incredibly valuable role that APPs play in many aspects of healthcare. Our Nurse Practitioners and Physician Assistants have many years of both clinical and 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 sessions.

At Klarisana, each patient receives their intramuscular ketamine treatment in a private room being observed through a live streaming video led by the Klarisana medical team. We believe that 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 are 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 judgment. 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.

Our rooms are decorated in order to convey sensations of relaxation, tranquility and peacefulness. Patients receive their IM treatments in privacy while under constant observation during the ketamine session. The provider performs an initial evaluation and physical exam and steps out of the room once the IM treatment has started. Most ketamine sessions last about one hour.

Our rooms are equipped with TVs so that patients can watch videos of nature scenes or aquatic scapes. They may also bring in their own DVD or cast to one of our Smart TVs. We strive to minimize distractions and interruptions during the ketamine treatment process in order to make the session a fluid and peaceful experience.

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 is frequently used to treat migraine headaches. A common misconception is that just because a medication is not “FDA approved” for a certain indication, it means the FDA has prohibited its use for that indication. If the FDA wanted to prevent the use of any medication, it would issue a “black box” warning; this is not the case for ketamine.

Ketamine is, in fact, used extensively in both human and veterinary medicine contexts. The reason why veterinarians use ketamine is that it generally does not suppress respiration. In other words, it does not make the patient stop breathing. This important quality of ketamine makes it not only desirable in veterinary medicine but also 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, it poses 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 human and veterinary medicine does not represent any kind of earth-shattering revelation. Penicillin, for instance, is also a medication used extensively in human and veterinary medicine.

Ketamine is a mix of molecules that are mirror images of one another. Like two hands, they look similar but they are not exactly the same. Although Esketamine’s chemical composition is indeed quite similar to ketamine itself, it is a filtered-out version of ketamine in the sense that it is devoid of any mystical potential.

The central theme of Klarisana’s treatment strategy is that the experiential (or psychedelic) effect of ketamine is not a side effect to be eliminated, but rather a foundational component of how it treats depression. Our doses are much higher than the traditional “NIH protocol” and we seek to create an intense transformational experience, which can’t be achieved neither through a low-dose nasal spray like Spravata nor when clinicians administer concurrent doses of benzodiazepines, such as Valium.

Klarisana is not just a clinic, it’s also the fruition of our belief 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 to fulfill in this lifetime. 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 number of 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 panorama, Carl 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 help people “Break Through Chaos”.

Ketamine treatment is exclusively covered by Medicaid Colorado at Klarisana, but we also work with a number of private insurance programs that cover other Behavioral Health Services. Please visit our Insurance page to see an updated list of insurance carriers that we work with.

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 treatment is either very questionable or otherwise not very robust. In these cases, a patient can at least make an educated decision as to whether the potential benefits outweigh any potential risks. At Klarisana, we will let you know our dosing protocols and every medication we plan to administer, as well as all the evidence behind it.

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 this light, 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 clinicians 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 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 on 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 better practices for ketamine therapy. We would recommend you chose a center that is a member of the ASKP.

No, we haven’t. 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 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 appreciate 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.

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 them 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. Patients without a psychiatrist or psychologist can still access our mental health providers.

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 that 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.