Ketamine has been used extensively in emergency departments, operating rooms, and in military conflicts with a very safe track record. Ketamine causes very little depression of a patient’s respiratory drive, which is why is has been attractive as an anesthetic agent in the military and in developing countries. Outpatient infusions 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 infusions. Additionally, there is no “bolus” of ketamine. We administer ketamine as a slow steady drip; usually over an hour but sometimes longer for certain pain conditions. Patients are monitored with continuous cardiac monitoring, pulse oxygen monitoring, and monitoring of the patient’s blood pressure at regular intervals. Patients are under continuous visual observation by clinic staff.

Most of the infusions 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 infusions. 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 infusion or the mixing of medications if they witness any unsafe act. All infusion bags are mixed 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 are placed on cardiac monitoring and pulse oxygenation monitoring. Klarisana sets the standard for patient safety.

Many clinics try to save money by administering infusions 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 an infusion in a private room with one-to-one observation by Klarisana staff. We believe that the experience and the environment in which a patient receives their infusion plays a big part in how effective the treatment will be. Have a ketamine journey with several other patients in the same room would be very counterproductive. Having a ketamine infusion all by yourself with no one in the room can also be uncomfortable and counterproductive.

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, comfortable space with one-to one observation by clinic staff this also alleviates any anxiety about the experience. The vast majority of our patients actually report that it is a very positive, relaxing, and enlightening experience. Some of our patients have received infusions at other centers which do group infusions 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 infusions in privacy with one of our Medics present during the whole infusion. The provider performs an initial evaluation and physical exam, he/she steps out of the room and the infusion is started. Most mental health infusions last for one hour. Some pain management infusions last two hours. Our rooms have TV’s where patients may watch videos of nature scenes, aquatic scapes, or they may bring in their own DVD or Google Chrome or Amazon Firestick. We strive to minimize distractions and interruptions during the infusion 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 drip at Klarisana there is no respiratory depression. Our patients are responsive and able to talk throughout the infusion. The most common side effect is mild nausea in some patients. We do offer anti-nausea medication prior to infusions. 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 infusion 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.

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 Patient Care Coordinator. If you are seeing us for a mental health condition, you will then have an intake session with one of our Licensed Professional Counselors (LPC) or Licensed Clinical Social Workers (LCSW). You then have an intake session either by phone or in clinic with one of our Advanced Practice Providers (NP or PA). Once you start your infusion therapy, you will receive your infusions in a private room with one of our Medics in attendance at all times. As one of our patients, we will develop a customized dosing protocol that works for you. If you are seeing us for chronic pain we will also create a custom regimen of adjunctive medications to target other receptors related to the pain pathway (e.g lidocaine, magnesium, etc.). It is not hard to find a center that is cheaper. Keep in mind however that the way in which many centers cut costs is to do two things. First, to put you in a communal room with several other patients where you all get infused together. Receiving an infusion sitting right next to several complete strangers is not only ineffective, we feel it is counterproductive to success with ketamine. Secondly, clinics that offer “discount ketamine” tend to follow a “one size fits all” model of ketamine therapy. Many of these are what we call “Oil Change Clinics” where they follow the (unvalidated) “NIH Protocol” of 0.5 mg of ketamine per kilogram of body weight and administer this over forty minutes. As described elsewhere on this website and FAQ, we feel that this only addresses the biochemical aspect of ketamine therapy but not the experiential. There is no effort on the part of “discount” clinics to maximize the experiential aspect of ketamine therapy.

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.