Ketamine is a synthetic pharmaceutical compound, classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. It was developed in 1963, FDA approved in 1970, and adopted by many hospitals and medical offices because of its rapid onset, proven safety, and short duration of action.

Ketamine is most commonly used in surgical settings, including pediatric surgery, due to its excellent safety profile, particularly around breathing/airway management. It has has also been utilized successfully in managing acute and chronic pain conditions due to its analgesic properties.

In the last two decades, ketamine has been increasingly clinically applied at subanesthetic doses as an off-label treatment for various chronic treatment-resistant mental health conditions, such as depression, alcoholism, substance dependencies, post-traumatic stress disorder, obsessive compulsive disorder, and other psychiatric diagnoses.

Ketamine is classified as a dissociative anesthetic, where “dissociation” means a sense of disconnection between mind and body, and from one’s ordinary reality and usual sense of self.

The present understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system. (This is a different pathway than that of other psychiatric drugs such as the SSRIs, SNRIs, lamotrigine, antipsychotics, benzodiazepines, etc.)

In depression, the spindly receptors on neurons that facilitate signal transmission may recede, and the amygdala and hippocampus (both which help govern mood) may shrink. Animal research has shown that ketamine can stimulate neural growth within days (and sometimes hours). One hypothesis is that there is similar action in humans. 

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Another hypothesis is that ketamine affords a reprieve from habitual patterns of thought that underlie mood and behavior, thereby creating an opportunity for learning new and healthier patterns of thought. There is no current consensus on mode of action, and other mechanisms may be found central to ketamine’s effects.

The administration of ketamine may be most effective when paired with psychotherapy tailored to the experience of the medicine. Our program prepares you for your ketamine sessions, encourages you to explore your mind while within the ketamine space, and assist you in integrating your experiences afterwards. 

This program emphasizes the potential for change, and such change is best facilitated within a structured, supportive psychotherapeutic environment with providers who are aware of your issues, hopes, desires, and struggles.  

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Ketamine has the potential to create a non-ordinary state of consciousness, facilitating a profound transpersonal or mystical peak experience. These sorts of peak experiences have been shown to expand one’s sense of self and understanding of existence, and may enable you to access your own healing wisdom. Your providers serve as guides, and assist in processing the experience and its impact on your everyday life. 

Ketamine’s altered state can create conditions of relational and psychological openness, and thus we believe that trust in your providers enables the deepest work possible. Psychotherapy sessions are meant to build that sense of connection and trust between you and your treatment team.

Please note that ketamine assisted psychotherapy is not a standalone treatment, and is best applied as part of a comprehensive recovery or wellness plan. You can discuss your intentions with your mental health provider to determine if a ketamine treatment may be indicated for you, and if they are interested in collaboratively referring you to our services. 

We use a range of dosing and route of administration (ROA) strategies to tailor a personalized approach for each client.  In our practice, ketamine is administered by either:

• Sublingual (oral) dissolving tablets, a lower-dose strategy which may allow for psychotherapy during the treatment, and an easier experience for those who are hesitant about injections

• Intramuscular injection (IM), given in the shoulder, which delivers a highly bioavailable amount of medicine and a rapid onset; IM can provide the same dose used in sublingual administration, or a higher dose that creates a more dissociative experience.

The ketamine experience is characterized by the relaxation of ordinary concerns and usual mindset, all while maintaining conscious awareness. This tends to lead to a disruption of negative feelings and preoccupations. Some ketamine providers feel that this interruption–and the exploration of other possible states of consciousness–can lead to significant shifts in overall well-being.

At lower doses, you will most likely experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience empathogenic (similar to MDMA) effects in this dose range. This state may also enhance participation in psychotherapy, as defenses are relaxed, yet communication with others is still possible.

Higher doses are more likely to produce psychedelic, dissociative states that are largely internal journeys away from the external world. Body sensations are greatly diminished.  Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological and (and possibly spiritual) growth, and promoting a positive change in outlook and character that we refer to as a transformative response.

Sensory effects of ketamine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, and changes in visual, tactile and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar sounds may not be recognizable, and an ordinary sense of time may morph into time dilation. Some have compared the experience to vivid or lucid dreaming, giving access to unconscious themes just as dreamwork can.

Adults age 18 and over who suffer from depression and have not had success with traditional treatments for depression are eligible for ketamine treatment. Our comprehensive evaluation will include a medical history to ensure ketamine is safe for you, as well as an in-depth psychosocial assessment to support a healthy integration of your ketamine experiences.

You are required to be under the care of a primary care physician to evaluate your overall health, and in particular your respiratory and cardiovascular status.  You are also required to be under the care of a mental health provider who refers you to our service and will continue your care after your ketamine treatment.

Some medical and psychiatric conditions need to be addressed before you can safely take ketamine.  These conditions include hallucinations, untreated mania, unstable angina (chest pain/heart disease), uncontrolled high blood pressure, uncontrolled hyperthyroidism, increased intracranial pressure, evidence of liver disease, or a previously demonstrated allergy to ketamine. 

Pregnant women and nursing mothers are not eligible because of undetermined potential effects on the fetus or nursing child.

Those with a history of cystitis or other bladder issues may need to be cleared by urological consultation, due to the rare but potentially significant adverse effect of cystitis. 

Those with a primary psychotic or dissociative disorder or who are currently in a manic or mixed episode are not eligible for treatment with ketamine. 

Please consult your treating clinician if you are taking anxiety medications such as benzodiazepines, pregabalin, or gabapentin as they may blunt the antidepressant effects of ketamine. Opiates cannot be taken concurrently with ketamine therapy.

Ketamine is distinguished from other psychotropic medications by its rapid onset, often producing relief in as soon as a few hours. The literature indicates a 70% initial response rate to ketamine, as well as a remission rate (resolution of symptoms) for people with treatment-resistant depression of 40-50%. 

Durable improvement generally occurs with more than one administration, and is most robust when part of an overall treatment program. 

Although a course of ketamine treatment typically provides only a few months of benefit, repeated treatments have been shown to have a cumulative effect, prolonging mood improvements, and current research is focused on how to sustain these benefits with an optimal dosing schedule and integration of psychotherapy. 

Ketamine treatment can result in a number of benefits, and there are now many studies demonstrating its efficacy; however, it is still a relatively new and experimental psychiatric intervention, and there are no guarantees of your outcome.  It may not permanently relieve your condition.

Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any other medication, there are also some potential risks and side effects to be informed of and consider.

The most common physical side effect is a short-term spike in blood pressure, pulse, or heart rate, which may be a risk to those with heart disease.

Other possible transient side effects are drowsiness and sedation, blurred vision, dizziness or lightheadedness, impaired balance and coordination, slurred speech, nausea, and headache, which tend to resolve within a few hours. (Nausea and risk of vomiting is greatly reduced by having an empty stomach and by limiting motion.)

Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction or cystitis in individuals abusing the drug.  These adverse effects are much less likely in medically supervised ketamine treatment populations, but might include more frequent, painful, or difficult urination. Please inform your providers immediately if you notice any of these side effects.

In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying psychological problems in people with severe personality disorders and dissociative disorders.

The administration of ketamine for mental health concerns is currently not covered by insurance companies, as this is still considered an off-label use. We are aware that this may be a significant out-of-pocket investment for you. 

Dr. Scharf will provide you with a visit receipt (including procedure and diagnosis codes). This visit receipt may be eligible for submission for out-of-network reimbursement with your insurance company. Please check with your insurance company regarding your out-of-network benefits. 

Dr. Scharf does not contract with insurance companies or Medicare/Medicaid for her services; therefore, you will not be able to submit a claim to Medicare or Medicare’s supplemental insurance. 

1. Complete our KAP contact form to receive Dr. Scharf’s Ketamine Practice Policies and Ketamine Information and Informed Consent documents. 
2. If you have questions, Dr. Scharf is happy to answer them either by email or 
3. Set up a brief initial free consultation call (10-15minutes) to discuss details and ask any questions you might have about the process.