Ketamine Assisted Psychotherapy
Spravato
treating treatment-resistant depression
At Wirsa Wellness, we are proud to be a certified Spravato treatment center, offering this FDA-approved nasal spray therapy for individuals struggling with treatment-resistant depression. Our providers are experienced and fully registered to administer Spravato in a safe, monitored setting. Our providers have pursued advance fellowship trainings in Ketamine-Assisted Psychotherapy, enabling them to integrate profound therapeutic support alongside Spravato treatment - an approach that has been shown to significantly enhance outcomes, deepen healing, and restore hope in patients navigating complex mental health conditions.
IV or IM Ketamine
Alternate routes of medication delivery
We are actively preparing to expand our innovative treatment services to include intravenous (IV) or intramuscular (IM) Ketamine therapy, offering a powerful alternative for individuals who are not candidates for Spravato. While Spravato has high safety profile and has transformed the landscape of treatment resistant depression, the nasal administration route is contraindicated in some patients who have had nasal or sinus surgeries. For those patients, IV or IM Ketamine presents a promising and an alternative route that bypasses nasal administration.
No matter the modality of administration, our providers do a through assessment and offer a rapid-acting, well-tolerated option of administration of Ketamine treatment that has shown profound benefits in both mood and trauma-related disorders. Our commitment is to ensure every patient receives personalized, evidence-based care, guided by safety, compassion, and the most current advancements in mental health treatments.
(es)ketamine and Kap faq's
At Wirsa Wellness, we believe that healing extends far beyond simply receiving a medication. While many clinics offer (Es)ketamine treatments under a purely medical model, we view this approach as a profound disservice to patients seeking true transformation. Unfortunately, many clinics are founded by providers without mental health training—let alone specialized training in Ketamine-Assisted Psychotherapy (KAP). This lack of expertise often results in a superficial treatment experience that overlooks the deeper therapeutic potential of ketamine that needs to be harnessed for its highest healing impact.
At Wirsa Wellness, every provider is rigorously trained in mental health and has pursued advanced, specialized training in KAP to guide patients through the psychological and emotional dimensions of their healing journey. We believe that ketamine, when integrated thoughtfully into a comprehensive treatment plan, can unlock doors that conventional therapies alone cannot. But this healing requires more than just a medical procedure—it demands a therapeutic partnership rooted in compassion, expertise, and respect for your unique experience.
We urge every prospective patient to research the background and training of any clinic and its providers before starting treatment. A clinic should be more than a place where medications are administered—it should be a sanctuary of support, education, and healing. At Wirsa Wellness, we pride ourselves on offering holistic, personalized care that empowers those with treatment-resistant conditions to reclaim their lives and find renewed hope.
Choose a clinic that treats the whole person, not just the diagnosis. Choose Wirsa Wellness—where expertise meets empathy, and where your journey to wellness is always guided by a deeply informed and caring team.
(Es)ketamine, a Schedule III medication used in assisted psychotherapy at our clinic. FDA approval is limited at this time, although (es)ketamine has been studied extensively in recent years for a wide range of psychiatric and medical indications. Here is a list of diagnoses and clinical indications investigated in clinical trials or published studies (**only Spravato/Esketamine has limited FDA approval):
- Treatment-Resistant Major Depressive Disorder**
- Major Depressive Disorder with acute suicidal ideation**
- Bipolar depression
- Acute suicidal ideation and behaviors
- Generalized Anxiety Disorder
- Social Anxiety Diosrder
- Obsessive-Compulsive Disorder
- Post-traumatic Stress Disorder
- Chronic Pain Disorders
- Eating Disorders
- Borderline Personality Disorder
- Parkinson's Disorder for non-motor symptoms
- Palliative Care in targeting existential distress, depression, and anxiety
- Substance Use Disorder (although controversial, studies have shown reduction in cravings for alcohol and opioids, with mixed results for cocaine and substance use)
Individuals taking (es)ketamine either during therapy or at home may experience positive changes in cognition, mood, and personality during treatment and in the hours, days and weeks that follow. The medication allows people to access and benefit from it sooner than traditional oral antidepressants. The psychotherapy support that patients access during these treatments can also be transformative.
(Es)ketamine, when taken in a psychotherapy session, can be beneficial. The medication can stabilize patients with severe depression swiftly. Scientists from the University of Texas (UT) have identified the key protein that helps activate the rapid antidepressant effects of (es)ketamine in the brain. Their study, published in the journal Nature, revealed that (es)ketamine inhibits a protein responsible for an array of normal brain functions. The medication blocks the N-methyl-D-aspartate (NMDA) receptor, an ion channel protein and glutamate receptor found in nerve cells. Inhibiting NMDA produces an initial antidepressant reaction. A metabolite found in (es)ketamine is responsible for prolonging the effect’s duration.
Stabilization is not the only effect of (es)ketamine depression therapy. The blocking of the NMDA receptor also induces the hallucinogenic responses of ketamine. When taken with proper care, however, the drug may help severely suicidal or depressed patients get effective and fast treatment.
People undergoing (es)ketamine therapy can take the drug in various ways. Esketamine is administered through the intranasal route, while ketamine can be injected into the muscle or given via the intravenous route. Although ketamine is also available in the form of a low-dose, sublingual lozenge, that route is only reserved for those who have contraindications via other routes. A thorough assessment and subsequent preparation sessions prior to the medication session will allow our providers to gauge and discuss which route is recommended.
With (es)ketamine psychotherapy, we make sure that the patient reaps the benefits of the medication. We evaluate the individual’s responsiveness. This allows us to adjust the dose and come up with a decision regarding the effectiveness of the medication. Together psychotherapy and the accompanying (es)ketamine, leads to successful results.
Before you undergo (es)ketamine therapy we first interview and assess carefully to find out if you’re eligible to receive this medication. We have you go through the following procedures:
- Assessment of Your Medical History
- Assessment of Your Psychiatric History
- Review of Your Psychiatric and Medical Records• Physical Examination (If Needed)
- Short Psychological Tests to Evaluate Your Current State of Mind
Apart from these procedures, we look for specific criteria that would make you ineligible for (es)ketamine depression therapy. You may not undergo the treatment if you belong in one (or more) of these categories:
- Nursing Mothers and Pregnant Women – (Es)ketamine may have potentially unwanted effects on the nursing child or the fetus. Data from the study published in Nature suggests that prenatal exposure to ketamine impairs the neuronal development of the prefrontal cortex. Women who are breastfeeding may consider "pump and dump" for method to allow (es)ketamine to metabolize and break down before breastfeeding can resume within 6-12 hours depending on the dose, route, or repeated doses.
- Untreated Cardiovascular Problem–Hypertension, especially if it’s untreated, is a contraindication to the use of (es)ketamine. The drug causes a rise in blood pressure. Individuals with a history of heart problem, therefore, may not be eligible to take this treatment.
- Untreated Hyperthyroidism – People with this condition should not take (es)ketamine. The drug increases the risk of tachycardia and hypertension.
- Patient's with psychiatric instability or certain mental health diagnosis are not considered for (es)ketamine treatment.
We understand that not everyone has access to medical insurance, and we believe that cost should not be a barrier to exploring your healing journey. Even without insurance, we can still conduct a thorough assessment to determine if you’re a good candidate for our integrative treatment options, including Ketamine-Assisted Psychotherapy and holistic approaches. If you choose to proceed with treatment, you can pay cash for the treatment or we can provide super bills that you can submit to your insurance company for possible reimbursement. Our team is dedicated to working with you to find the best path forward, ensuring that your mental health care is both accessible and compassionate.
Esketamine is FDA approved and thus covered by most insurance companies. It is important to know however that (es)ketamine is not considered first line treatment for depression even if the medication is FDA approved. Most insurance payors have some of the following specific requirements for coverage.
- Diagnosis of Major Depressive Disorder (MDD) - with or without suicidal ideation.
- Documented history of inadequate response to at least two different antidepressants at adequate doses and durations (typically 6-8 weeks each).
- For example, insurance A might require two different antidepressant medications each with a duration of at least 8 weeks, while insurance B may require failure of at least two antidepressants from two different classes.
- Some insurance companies may have additional requirements including diagnosis by a mental (not medical) health professional, baseline depression scale, or diagnosis with acute suicidal ideation, or severe/persistent, recurrent MDD, no history of SUD.
- Exclusion of contraindications such as uncontrolled hypertension, active psychosis, substance use disorder, or pregnancy.
- REMS certified clinic/setting to administer the medication.
- Note: There has been a recent change. Patients are NO LONGER required to concurrently be on antidepressants while undergoing Spravato treatments, although some insurance payors may still recommend it.
IV or IM ketamine is not FDA approved and is used off-label for rapid relief of depression symptoms and suicidality. What does that mean as far as insurance coverage?
- We can bill for the initial assessment and therapy (preparation and integration sessions), while you can pay for the medication session and monitoring.
- You can choose to pay out-of-pocket treatment for the medication session. The clinic provides you with a "superbill" with all the itemized expenses including CPT code such as 96365 for IV infusion, and you can submit to your insurance for reimbursement.
- Some employers partner with Enthea, a third-party benefits administrator, to offer coverage for (es)ketamine assisted therapy including IV and IM infusions, as a part of employee health benefits. Some examples of employers include Dr. Bronner and Plexis Healthcare Systems.
- Patients are encouraged to inquire from their insurance coverage and explore what is covered for the medication sessions so some of the medical expenses are covered.
- Paying out-of-pocket is always the last option but applies to patients who are eligible but do not have insurance or want to receive treatments regardless.
We want to remind you that the Food and Drug Administration (FDA) has approved esketamine (Spravato) for treatment resistant depression. But FDA hasn’t established the use of ketamine via IV or IM routes. It is currently used as “off-label” for treatment of depression and trauma-related work.
In addition FDA has not certified the appropriateness of the ketamine-assisted psychotherapy while administering (es)ketamine. Your awareness of this information is vital to understanding any liability related to your use of the medication. Your signed, informed consent signifies your knowledge of this situation.
Your decision to go through ketamine therapy, therefore, is 100 percent voluntary. We encourage you to ask us questions before saying yes to the treatment.
If you are eligible and will be undergoing our (es)ketamine therapy, you can be at ease knowing that we’ll keep your records confidential. A signed release form is required if you want to allow others, such as medical professionals, to access your files.
** Ketamine administration is a medical treatment and there is strict adherence to safety protocols. This treatment is only offered after a very thorough and detailed clinical evaluation.
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