Start by Separating the Two Problems

The most common reason ADHD care stalls is that two different problems get treated as one. Inattention, distractibility and executive dysfunction are the ADHD. Low mood, anhedonia, dread and rumination are a separate diagnosis sitting on top of it. Stimulants treat the first and do essentially nothing for the second, which is why a patient can be optimally dosed on lisdexamfetamine and still feel that nothing is worth doing. Ketamine is a candidate for the second problem only.

• ADHD symptoms: sustained attention, task initiation, working memory, time perception
• Mood symptoms: anhedonia, hopelessness, early-morning waking, psychomotor slowing
• A stimulant that works on focus but not on mood is behaving exactly as expected
• Treating the mood disorder often makes existing ADHD strategies workable again
• If the mood symptoms are new since a stimulant change, that is a dose conversation first

Screening Before Any Prescribing Decision

Tovani does not treat a self-described diagnosis. Before a physician considers ketamine for an ADHD patient, we establish what is actually present and how severe it is, using validated instruments rather than impression. That matters more here than in most presentations, because ADHD, bipolar disorder and treatment-resistant depression overlap heavily in how patients describe them, and the treatment implications diverge sharply.

• ASRS to characterize the ADHD symptoms themselves
• PHQ-9 for depression severity and change over time
• GAD-7 where anxiety is the more prominent complaint
• MDQ screening for bipolarity, which changes the plan substantially
• Every instrument is scored in your browser before anyone asks you to pay

The Stimulant Question, Answered Precisely

Ketamine and stimulants act on unrelated systems, so the concern is not a pharmacokinetic interaction. The concern is same-day physiology. Both raise blood pressure and heart rate, and a dissociative session on top of an active stimulant dose is a worse experience with no added benefit. The practical answer is timing rather than discontinuation, coordinated with whoever prescribes your stimulant.

• Stimulants are held on session days, not stopped between sessions
• Your ADHD prescriber stays your ADHD prescriber; we coordinate, we do not take over
• Baseline blood pressure is reviewed before approval, not after
• Uncontrolled hypertension is a contraindication regardless of ADHD status
• Every medication you take is checked individually, including supplements

Who This Is Actually For

The candidacy criteria are narrower than most sites imply, and saying so is more useful than a broad invitation. Ketamine earns its place when the mood disorder is established, has resisted adequate treatment, and is doing more damage than the attention symptoms.

• Adults 18 and over with a stable ADHD diagnosis and treatment plan
• A co-occurring depressive or anxiety disorder documented on screening
• At least one adequate antidepressant trial at a therapeutic dose and duration
• No stimulant dose change in the past 30 days, so the picture is interpretable
• No active substance use disorder, psychosis, or untreated bipolar mania
• A sober support person available for the duration of each session

What Treatment Looks Like Here

Tovani runs a physician-led model with the same doctor across your course of care rather than a rotating panel, and booking windows that extend past the usual clinic day. For adults managing ADHD around work, that scheduling flexibility is often the difference between finishing a treatment course and abandoning it.

• Eligibility screening online, scored immediately, no payment required
• Video consultation with Dr. Ben Soffer, DO, who reviews the full medication list
• Extended booking windows including 12:30 PM and 5:00 PM appointments
• Sublingual medication shipped to your home, no clinic travel
• Guided sessions with structured check-ins and documented follow-up