Answers, before you begin

We decide that together, carefully. Every patient completes a comprehensive screening and medical intake with our physician before any treatment is scheduled. The short version: these treatments are generally for people whose depression, anxiety, PTSD, or pain has not responded to first-line care. If you have not yet had a proper course of therapy or a well-run medication trial, we will usually tell you to start there.

Fifteen minutes, free, no card. You describe what is going on and what you have already tried; we tell you honestly whether we are the right place and what a realistic next step looks like. Nothing is scheduled on that call and nobody will pressure you.

Usually within the same week for an initial consultation. From first call to first treatment is typically two to three weeks, most of which is insurance authorization rather than our availability. If you are in crisis, do not wait for an appointment: call or text 988.

Spravato is esketamine, FDA approved for treatment-resistant depression, given as a nasal spray in a REMS-certified clinic, and often covered by insurance. Ketamine therapy uses a related medicine prescribed off-label, is self-pay, and allows more flexibility in dose, route, and how much psychotherapy is built around it. Neither is better in the abstract. If you meet the criteria and your plan covers Spravato, that is often the more sensible starting point.

It varies by person. We typically suggest starting with an initial course to assess response and adjust, then building the rest of the plan around your progress. You will never be sold a package you do not need, and we would rather you did not commit to six sessions before anyone knows whether the first one helps.

Yes. Psychotherapy, breathwork, mindfulness, and integrative approaches can do a great deal on their own, and many people begin there. If a medication-based path ever makes sense, that conversation happens with a physician rather than on a sales page.

Then we tell you, and we stop. A proportion of people in every trial of every treatment do not respond, and whether you are one of them is not knowable in advance. That is exactly why the first weeks are treated as a trial rather than a commitment, and why progress is measured rather than assumed.

Ketamine has been used in medicine for over fifty years and has a well-characterised safety profile when administered and monitored by trained clinicians. Every patient is medically screened first, every session is supervised, and you are monitored throughout. Like any medical treatment it carries risks, which your physician will review with you in detail before you decide anything.

Dissociation, dizziness, nausea, sedation, and a temporary rise in blood pressure. These begin during the session and generally settle before you leave. Less commonly, anxiety or vomiting. You cannot drive afterward, so you will need to arrange a ride.

Active uncontrolled psychosis or mania, a known allergy to ketamine or esketamine, and certain vascular conditions are absolute or near-absolute contraindications. Unstable cardiovascular disease or uncontrolled hypertension require clinical discussion first. We assess every patient individually and we decline people for whom it is not appropriate.

It depends on the treatment. Spravato, psychiatry, psychotherapy, and medical visits are covered by many major plans, and we verify your benefits up front so there are no surprises. Ketamine therapy is self-pay because it is prescribed off-label, though we provide itemized superbills you can submit to your insurer for possible reimbursement, and financing is available.

Spravato is FDA approved for treatment-resistant depression, so insurers have an established pathway to pay for it. Ketamine is prescribed off-label for psychiatric conditions, and insurers generally treat off-label psychiatric use as not covered. It is a regulatory and billing distinction rather than a statement about whether the treatment works.

We genuinely cannot tell you, and you should be wary of anyone who does. It depends on whether your plan has out-of-network benefits, what it considers an allowed amount, and how much of your deductible you have met. Some people recover a meaningful share; some recover nothing.