Everything you need to know about physician-led ketamine therapy, from eligibility and pricing to safety and aftercare.
Often, yes, and we would rather say so here than after you have paid. Ketamine is appropriate for treatment-resistant presentations, and treatment-resistant means adequate trials that failed: a therapeutic dose sustained six to eight weeks, not a course abandoned at week three because nothing had happened yet. If you have not had that, or have not had protocol-driven therapy such as CBT, EMDR or ERP, those are cheaper and better-evidenced steps. Untreated sleep apnea, thyroid disease and nightly alcohol use also keep depression in place regardless of what is prescribed.
Uncontrolled hypertension or significant cardiovascular disease, active psychosis or schizophrenia, untreated bipolar mania, active substance use disorder including alcohol, pregnancy or breastfeeding, being under 18, active suicidal planning, or being unable to arrange a sober support person. Being physically outside Florida, New Jersey, or California at appointment time also rules us out. These are assessed before payment, and if you are declined you receive a full refund along with guidance on what to do instead.
Possibly, and it is worth checking before paying privately. Spravato is esketamine, is FDA-approved for treatment-resistant depression, and is covered by many insurance plans, though it requires in-clinic administration with a two-hour monitored observation period. If you are enrolled with the VA, ask your mental health team about ketamine and esketamine, since some facilities provide both. We do not bill insurance or the VA, so if either covers you, that is the cheaper route and there is no clinical reason to prefer us.
Roughly a third of patients in the trials did not respond, so this is a real possibility rather than a disclaimer. We measure with the same instruments at intake and through the course, so response is tracked rather than remembered. If there has been no meaningful change after an adequate series, the right answer is to stop and reconsider, not to keep selling you sessions. We will tell you that directly.
Not in this form. Ketamine is FDA-approved as an anesthetic, and prescribing it for depression, anxiety or PTSD is off-label. Off-label prescribing is ordinary, legal medical practice and covers a large share of psychiatric prescribing generally, but it is not the same as approval and you should know which you are getting. Esketamine, sold as Spravato, is the FDA-approved option for treatment-resistant depression.
The accepted account is that ketamine blocks NMDA receptors preferentially on inhibitory interneurons, producing a downstream glutamate surge that activates AMPA receptors, engages mTOR signaling and increases synapse formation in prefrontal regions. Two honest caveats: other NMDA antagonists have not reliably reproduced the antidepressant effect, and the metabolite hydroxynorketamine appears active in animal models without NMDA blockade. The clinical effect is better established than the explanation for it.
Treatment-resistant depression has the largest and most replicated evidence base. PTSD is next, and unusually the trials were run in PTSD patients rather than extrapolated from depression research. Bipolar depression has add-on evidence and requires an established mood stabilizer. Anxiety, OCD and chronic pain have real but thinner support, each with specific caveats. Burnout without depression has none, and we do not treat it.
Genuinely unknown. Some studies find dissociation intensity correlates with response and others do not, and the metabolite research suggests the two may be separable. We dose for tolerability rather than intensity, because there is no good evidence that a harder session produces a better outcome.
Start with the free eligibility assessment and the screening instruments, which are scored in your browser before any payment. If you look like a candidate, select a consultation package and complete the health questionnaire and consent forms in the patient portal. Your video consultation with Dr. Ben Soffer, DO, is a real clinical evaluation including a full medication review, not a formality that approves everyone.
After your questionnaire and consent forms are complete, book directly in the patient portal from the available slots, including extended windows at 12:30 PM and 5:00 PM. You can reschedule anytime through the portal.
Your physician sends the prescription electronically to one of our partner compounding pharmacies, who contact you directly about payment and shipping. Medication typically arrives within a week.
You receive a full refund. You also get specific guidance on what would be more appropriate, whether that is an infusion clinic, a psychiatrist, addressing blood pressure first, or a treatment you have not adequately tried. A refusal without a next step is not much use to anyone.
Have a light meal two to three hours before and then stop; water is fine. This is the single biggest lever on nausea, which is the most common unwanted effect. Avoid sedatives and alcohol for 24 hours. Prepare a quiet room with dim lighting, an eye mask and music if you use them. Arrange your support person to be present before you take anything. Have a blood pressure cuff or pulse oximeter available if recommended. Clear at least four hours.
Yes, and it is not waivable. A sober adult must be present for the full session. They do not need to be in the room but must be nearby, awake and not intoxicated. You will be impaired, judgment included, and in a home setting that person is the main safety mechanism. If you cannot arrange one, we cannot treat you, and any provider who lets patients dose alone has removed the only monitoring the model had.
Every medication is reviewed individually at the consultation rather than by category. Some change dosing, some change timing, and a few rule out treatment. Benzodiazepines may blunt response, opioids share respiratory-depressant effects, stimulants are held on session days for additive cardiovascular reasons, and MAOIs need specific evaluation. Continue essential medications with minimal water unless told otherwise, and never stop anything on your own to prepare.
Place the tablet under your tongue or in your cheek and keep it there for at least ten minutes. Do not swallow it; swallowing substantially reduces the effect and is the most common first-session mistake. Have a cup ready to spit out residue. Lie down with your eye mask once it is in.
Onset is gradual over ten to twenty minutes. Common elements are floating or weightlessness, visual patterning with eyes closed, emotional distance from things that normally feel urgent, intensified experience of music, and distorted time perception. The peak typically arrives 40 to 60 minutes after dosing and lasts 30 to 60 minutes. It is frequently interesting rather than pleasant, and it is not reliably euphoric.
Stay out of all water. No bathtubs, hot tubs or pools, because drowning is the realistic risk and this is the most important line on the page. Remain lying down through peak effects. No driving for the rest of the day, and wait until the next day. Your support person stays present. Keep at least four hours free of responsibilities.
A minority of sessions are, particularly first ones and particularly for patients with trauma histories. Loss of control is the usual difficulty rather than any specific content. The effects are time-limited and will resolve. Use the in-app help for grounding, and your support person can assist. Afterward, tell us, because a difficult session is a reason to adjust dose or approach rather than something to push through into the next one.
KetAI provides check-ins, grounding exercises and music through the session, tracks the timeline, prompts vitals checks at key points, and can alert your support person or our team. It is a support tool, not a monitor and not a substitute for the person in your house.
Nausea, dizziness, headache, dissociation, and transient increases in heart rate and blood pressure. Most are mild and resolve within a few hours. Nausea is the most common and responds substantially to proper fasting. Serious respiratory effects are uncommon and need immediate medical attention.
Ketamine-induced uropathy is real and can be severe, including irreversible damage in the worst cases. It is documented overwhelmingly in heavy, frequent recreational use at exposures far beyond a supervised course. The honest caveat is that long-term data on therapeutic dosing is limited, so we ask about urinary symptoms at every follow-up. Report urgency, frequency or pain immediately; new urinary symptoms pause treatment pending evaluation.
There is recognized misuse potential, and having medication in your house is a genuine complication that clinic models do not have. It is managed with limited quantities, defined intervals, documented sessions, and declining patients with active substance use disorders. If you find yourself wanting to use it outside sessions, raise it rather than managing it privately. Anyone telling you at-home ketamine carries no dependence risk is not being straight with you.
Immediately for difficulty breathing, chest pain, seizure activity, or loss of consciousness. For emotional distress during a session, use the in-app help, which alerts your support person and our team. Do not wait to see whether something serious resolves on its own.
Rest and hydrate for at least an hour. No driving for the rest of the day, no alcohol, nothing safety-critical. Expect to be tired that evening and plan nothing demanding. If a mood response comes, it is often noticed the following morning rather than the same day.
The synaptogenesis account implies the two to three days after a session are when new patterns consolidate most readily. What you do in that window influences what sticks, which is the neurobiological reason therapy alongside ketamine outperforms ketamine alone. Patients who dose without using the window generally need ongoing maintenance to hold their gains. Integration is a clinical step, not an upsell.
Typically one to three months at minimum, extending to six months or longer for severe presentations, with most patients completing six to twelve sessions. Maintenance intervals are stretched as far as symptoms allow rather than kept short by default. If an adequate series produces no response, the course ends rather than continuing indefinitely.
Not required, strongly encouraged, and for PTSD close to essential. Ketamine reduces symptom load; trauma-focused therapy is what changes how a memory is stored. We ask what therapy you are engaged in because the answer genuinely changes what to expect.
Plans start at $349/month for a 1-month protocol covering two 30-minute physician visits. The most popular 3-month package is $650 and covers six visits. That covers physician consultation, evaluation, prescription and care team support. Medication is billed separately by the partner pharmacy at approximately $6 to $9 per dose, typically $90 to $150 per month. There are no hidden fees and your total is set out upfront.
No. Insurance does not cover ketamine treatment for mental health conditions and we do not bill it. We accept all major credit and debit cards, and HSA or FSA funds may be eligible; check with your plan administrator. If insurance coverage is your binding constraint, look into Spravato before paying privately for anything.
Once your prescription is approved it goes to one of our partner compounding pharmacies: CDRX Pharmacy (561-826-0711), Town & Country Compounding (201-447-2020), SoWal Pharmacy (850-828-6337), or Bay Life Pharmacy II (833-247-2299). They contact you directly about payment and shipping. Medication ships via USPS or FedEx in discreet packaging, typically arriving in 2 to 3 business days.
Florida, New Jersey, and California only. What matters is the state you are physically in during the appointment, not where you live or where your insurance is registered. This catches out commuters, so if you work across a state line, schedule for a time you are physically in Florida, New Jersey, or California.
No. This is a telehealth practice and all consultations are private, HIPAA-secure, non-recorded video calls. If being seen in person matters to you, a local clinic is the right choice and it is not a preference we would talk you out of.
Email Dr. Soffer at drben@tovanihealth.com or call 561-468-6981. Toll-free: 866-450-1425. Florida patients: 561-468-6981. New Jersey patients: 908-450-4944. For urgent clinical questions within 72 hours of a session, you get a response within 12 hours.