For Treatment-Resistant Depression & Chronic Suicidality
Overview
Dr. Faryal Mallick is pleased to offer IV-Ketamine Assisted Psychodynamic Psychotherapy (IV-KAP) for individuals aged 18 and older with treatment-resistant unipolar or bipolar depression, severe and chronic suicidal thoughts, and other psychiatric indications where IV ketamine shows efficacy. This innovative treatment combines subtherapeutic doses of ketamine with psychodynamic psychotherapy to address complex mental health challenges.
Treatment Details
Cost: $850 per session; 10-session package available for $7500.
Insurance: This treatment is not covered by insurance and does not qualify for out-of-network benefits.
Initial Evaluation: The initial evaluation may be reimbursable by your insurance depending on your Out of Network benefits.
Treatment- refractory non-psychotic depression
Severe and chronic suicidal ideation
Other psychiatric indications with evidence of ketamine efficacy
General Inclusion Criteria
Large vessel aneurysms
Psychotic Symptoms
Insufficient cognitive ability
Active substance use disorder
Certain heart conditions, uncontrolled hypertension, or respiratory issues
Pregnant women or those who may become pregnant
General Exclusion Criteria
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An initial evaluation is required to assess psychiatric history and determine eligibility for IV-KAP. The evaluation lasts 90 minutes and costs $600. An initial evaluation does not guarantee that you will receive IV-Ketamine assisted psychotherapy, and Dr. Mallick may recommend and treat you with other modalities first. The treatment plan will be discussed in detail.
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Follow-Up Appointment: After the initial evaluation and completion of labs, you will be scheduled for a 50-minute follow-up in two weeks to review lab results and finalize IV ketamine-assisted psychotherapy appointments.
Therapeutic Preparation: We will establish therapeutic goals and education on the ketamine experience and its integration into ongoing therapy will be provided.
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Treatment Schedule:
Treatment Day Schedule: Each ketamine treatment will take approximately 3-4 hours.
Arrive an hour before receiving ketamine for vital sign assessments and IV line initiation.
Mood and mental state assessments will be repeated periodically during treatment.
Ketamine infusion will be administered over 40 minutes at an appropriate dose of 0.4-0.5 mg per kilogram, followed by a 20-30 minute recovery period with continuous professional supervision.
Treatment will be concluded with a 50 minute psychotherapy session with Dr. Mallick.
Vitals will be reassessed before discharge to ensure patient safety.
Frequency: Ketamine infusions should be repeated no less than 3 days apart and not more frequently than twice a week for 3 weeks. After 3 weeks, reduce the frequency of infusion to once a week. This schedule will be individualized based on the patient’s response, tolerability, and preference/availability. A total of 10 treatments are recommended for the first block of treatment. A total of 4-8 treatments are recommended for any subsequent blocks for relapse. However, this will be tailored to each individual patient, and your treatment sessions may not be exactly in this format.
Post-Treatment Recommendations: You will require someone to drive you back from the appointment. It is recommended to journal after the appointment. Avoid heavy lifting or operating machinery for up to 24 hours after the session.
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Ketamine is FDA-approved as a general anesthetic but is used off-label for depression and suicidality. Patients will give verbal and written consent for treatment. Side effects will be monitored closely. However, these are minimal due to the lower dosages used as compared to anesthesia.
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Possible side effects include: anxiety, hallucinations, dissociation, derealization, depersonalization, changes in heart rate or blood pressure.
You are probably excited about getting relief for your treatment resistant depression or major depressive disorder, getting your first ketamine infusion or any medical procedure can be scary. The night before ketamine infusion is an important part of your treatment. Here are a few tips and tricks to improve outcomes with ketamine infusions.
Preparing for Ketamine Infusion
1- Get a Good Night Rest:
You will have to sit for 40 minutes to 1.5 hours during your treatment. This is much easier to do if you are not overtired or stressed. Getting a good night’s sleep can help you relax during your treatment session.
2- Don’t Eat or Drink:
You shouldn’t eat or drink anything six hours before your treatment session is scheduled to begin. The treatment may cause you to vomit and feel nauseated, which is why you shouldn’t have food and drinks sitting in your stomach during the treatment.
3- Get a Ride:
You will want someone to drive you to and from your treatment. You shouldn’t drive for the remainder of the day, so be sure to arrange a ride to and from your treatment session.
4- Prepare your Mind:
Don’t watch anything too sad or violent before your appointment. Your mindset is important to your treatment. It’s important to be calm and relaxed the night before your treatment. Meditation is a great way to calm your mind and you can find many free options on YouTube or on your mobile app. You can listen to calming music. Others prepare mantras for ketamine or "intentions" they can mentally repeat while in treatment.
5- Dress Comfortably:
Since you have to remain seated during your treatment, you will want to wear comfortable clothing that isn’t binding or restrictive. Wear clothing you can feel relaxed in. Wear short sleeves for your infusion appointment.
What to Bring
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Do you tend to get hot quickly? Wear short sleeves and shorts and bring a handheld fan. Do you tend to get cold easily? Feel free to layer on your clothing or bring a blanket or two with you. Got cold feet? Bring spa socks and foot balm to keep your feet warm and moisturized.
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Some people like to keep their eyes open in a dark room. Others like the feeling of an eye mask, which allows them to relax deeply during the treatment process. We provide self-heating lavender eye masks for you to use during your appointment.
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A journal and a pen will allow you to write down your thoughts and experiences.
After your Ketamine Infusion:
Preparing for ketamine infusions should include a transportation plan or a support person you trust who can pick-you up and drive you home after your session. Patients are not allowed to drive a vehicle or operate heavy machinery on the day of their treatment. A restful night's sleep is recommended before resuming regular activities like working or driving.
We encourage patients to journal their thoughts and feelings while in our recovery to share with their therapist or with Dr. Mallick.
Side Effects of Ketamine Infusion:
Ketamine treatment can cause high blood pressure, nausea and vomiting, perceptual disturbances (time appearing to speed up or slow down; colors, textures, and noises that seem especially stimulating; blurry vision), and dissociation (sometimes called out-of-body experiences). Some patients experience a strong urge to urinate after treatment. These side effects are temporary and go away within a few hours after treatment. Preparing for ketamine infusion therapy appropriately can reduce some of the negative side effects that can come from treatment. Please also know that our staff is medically trained to keep you safe throughout the entire procedure.
For more information
If you have questions about IV-KAP or wish to discuss your treatment options, please contact Dr. Faryal Mallick via email at info@faryalmallickmd.com or call her office at 813-461-7797.
Disclaimer: This webpage is for informational purposes only and is not intended as medical advice. Please consult a healthcare provider for a professional diagnosis and treatment plan.