Do you offer ketamine or ketamine-assisted psychotherapy (KAP)? What are visits like?

We offer ketamine and always provide it along with psychotherapy at the same time; while other clinics might have you hooked up to an IV in a treatment room being monitored by video, here the doctor is with you the entire time, and offering psychotherapy before, during, and after the ketamine injection. We provide ketamine as an intramuscular injection to the shoulder muscle, which takes effect within a few minutes, and is strongest for 20-30 minutes. During this time, people are instructed to go inwards, and provided with blindfolds and music to facilitate the experience. Afterwards, we process the experience and can utilize this special window of time when one’s mind is working differently to make connections, build insight, and facilitate positive change. It is thought that ketamine helps catalyze psychotherapy, and so it is particularly useful to add psychotherapy into the treatment program.

What is ketamine, and what is it used for?

Ketamine is an FDA-approved anesthetic medication used to put people under for surgery that more recently has been found to be helpful for a variety of mental health disorders. It is used “off label” for such reasons, since it hasn’t been formally approved by the FDA for these indications. Mental health issues that ketamine is known to help includes depression, suicidal thinking, major depressive disorder (MDD), bipolar disorder, post-traumatic stress disorder (PTSD), and substance use disorders (like alcohol use disorder, opioid use disorder, cannabis use disorder). Evidence of lesser quality exists for other conditions like obsessive compulsive disorder and eating disorders (anorexia, bulimia, binge eating disorder).

How is ketamine different from Spravato (esketamine nasal spray)?

In the last few years a derivative of ketamine, called esketamine, has been approved by the FDA for depression and suicidality, but there seem to be a few things that limit its effectiveness. In the United States, esketamine is only available as a nasal spray formulation and only via a branded medication called Spravato. The parent compound ketamine is generic so the cost of a dose of medication itself is a few dollars, but because Spravato is a new and branded medication, the wholesale price is $600-900 dollars per dose. Additionally, Spravato is restricted to specific dosages and uses by an FDA required monitoring program (the REMS program), so dosages cannot exceed 84mg (3 units). It is also important to remember this is a nasal spray, and so it is absorbed slower and more poorly than injectable generic ketamine. Use of generic ketamine is not restricted like with Spravato, so dosages can be adjusted higher, often times yielding better outcomes. Studies comparing the two suggest that injectable ketamine works better than nasally administered esketamine. Both are offered as in-office medications, but some clinics compound ketamine for take-home use. Please browse to my page on ketamine / esketamine for much more information on this treatment option.

Do you accept insurance?

We do not contract with any insurance carriers. This allows us to spend more time and direct more attention to you and your care, rather than to meeting insurance company requirements. If you have coverage for out-of-network providers, which is typically offered by PPO type insurance plans, you can likely receive some reimbursement for your visit by submitting superbills to them. See the payment page for more details. 

How much does it cost? What are your fees?

Check out the payment page for more details on pricing, our fee schedule, and sample estimates for various services including ketamine-assisted psychotherapy (KAP), medication management, and combined medication management with psychotherapy.

How long are your visits? How often should I expect to come in?

New patient intake visits are booked for a duration of 1 hour. Subsequent visits range from 1/2 hour (medication management only) to 1 hour (combined psychotherapy / medication management).  Ketamine treatments are scheduled for 90 minutes, and esketamine nasal treatments (Spravato) are 2.5 hours. Unlike most busy physician offices, delays are infrequent and appointments typically start at the scheduled time.  Frequency of visits vary greatly, from up to weekly for those in psychodynamic psychotherapy to every other month for those who are doing well on a stable dose of medication.  

What should I do before my first appointment? What should I bring?

Feel free to bring any recent lab results or hospital discharge summaries, as well as any current medications, ideally in their original bottles, with you to your first appointment. Before, make sure to fill out and submit the new patient intake and ketamine informed consent forms, available on the forms page.

Where are you located?  Where can I park?

The office is located at 4519 Admiralty Way, Suite 202, in the Marina Del Rey neighborhood of Los Angeles, with a view of the water, and directly across from Yvonne Burke Park.  There is free and ample parking in the private lot surrounding the building.  The building is entirely wheelchair accessible.

Is what I say confidential?

Mental health treatment is personal and private, and we strive to maintain that.  Everything discussed in the doctor-patient relationship is held in the strictest confidentiality.  We are legally and ethically obligated to uphold this, other than when we have your explicit permission, such as for us to speak with your insurance provider to facilitate reimbursement/billing for your visit.  Only in situations of imminent danger can we legally breach confidentiality, such as in individuals who credibly pose an immediate danger to themselves or others; in such cases we may assist in arranging a hospitalization.

Are you available for telehealth visits? How about home visits?

Yes, we are able to do initial evaluations and preparatory visits via telehealth, but any injections like ketamine of course require an in-person visit.

We are able to facilitate home visits (for example, for at-home injected ketamine) but please note there are significant additional fees associated with this option so individuals are encouraged to consider in-office visits. Please contact the office for further details.

Notice to consumers:

Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322 www.mbc.ca.gov

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. https://openpaymentsdata.cms.gov