Ketamine Therapy

No. SPRAVATO® is esketamine, an FDA-approved intranasal medication billed through insurance under a REMS (Risk Evaluation and Mitigation Strategy) program, restricted to treatment-resistant depression and depression with acute suicidal ideation. What Dr. Mike Mah offers is compounded intranasal ketamine, an off-label use of a different (though related) molecule, cash-pay, appropriate for a broader range of psychiatric indications, and available without insurance prior authorization. Both are legitimate. If SPRAVATO is the right treatment for you, Dr. Mike Mah will tell you. Many psychiatrists in West Los Angeles offer SPRAVATO.

Intravenous ketamine is the most-studied route. Intranasal ketamine has grown in use because it is less invasive, does not require IV access or an anesthesiologist, and can be dosed more flexibly across sessions. Both routes can be effective. Intranasal is appropriate for most patients seeking outpatient ketamine care. Some patients ultimately do better with IV, and Dr. Mike Mah will refer you to a trusted IV clinic if that is the case.

For ketamine sessions specifically, no. Ketamine treatment is cash-pay. The office does not provide CPT-coded superbills for ketamine, because there is no clean code for compounded intranasal ketamine and Dr. Mike Mah will not use codes designed for other medications. A paid receipt for HSA or FSA reimbursement is provided. For general psychiatric care with insurance, patients can be seen at Century City Psychiatry, Dr. Mike Mah's insurance-based group practice.

No. A designated adult is required to accompany you at discharge. That person can drive you, or can ride with you in a rideshare, but you will not travel home alone. You cannot drive, cycle, or operate machinery until at least the morning after treatment. Please arrange this in advance.

Standard induction is two sessions per week for four weeks (eight sessions), followed by weekly consolidation sessions for about four more weeks, then maintenance every two to four weeks based on your response. A once-weekly induction schedule is also available for patients who can't do twice-weekly: a slower response trajectory, but a legitimate alternative with good evidence behind it.

Ketamine works faster than any traditional antidepressant. Some patients notice a shift within 24 hours of the first session. Most responders show clear improvement within three to four weeks.

We reassess at session eight (around week four). If you're responding, we move to the consolidation and maintenance phases. If you're not, we talk honestly about stopping and discuss alternatives such as SPRAVATO, TMS, ECT, or medication adjustments. We'd rather stop than keep charging for a treatment that isn't working for you.

Almost always, yes. Standard antidepressants (SSRIs, SNRIs, atypicals), mood stabilizers, antipsychotics, and stimulants are all compatible with ketamine. A few specifics worth flagging at your intake:

• MAOIs require an individualized risk-benefit discussion before proceeding.
• Lamotrigine: continue as usual, no interaction.
• Regular benzodiazepines may blunt ketamine's antidepressant effect, and we may hold them on session mornings.
• Cannabis and alcohol: hold for 24 hours before each session.

Bring your full medication and supplement list to your intake visit so we can review everything together.

The psychiatric nurse practitioner will guide a brief mindfulness practice at the start of each session and check in with you afterward, but does not provide psychotherapy during the ketamine experience itself. Patients are strongly encouraged to work with a psychotherapist for preparation and integration around treatment. If you already have a therapist, they are welcome to join in-office or via Zoom during your session with a signed release. If you do not, the office can help connect you with community therapists trained in ketamine-assisted work.

Yes, in most cases. Bipolar depression is a legitimate indication for ketamine treatment, provided you are stable on a mood stabilizer and under the care of a treating psychiatrist. Current mania or a mixed episode is an exclusion. The evaluation covers this carefully.

It depends. An active substance use disorder, particularly involving ketamine, dissociatives, opioids, or stimulants, is a contraindication. A history of substance use in stable recovery, with appropriate support, is often compatible with ketamine treatment. This is a case-by-case conversation with Dr. Mike Mah.

Common and usually short-lived: dissociation (feeling disconnected from your body or surroundings), transient increases in blood pressure and heart rate, nausea, dizziness, and drowsiness. Less common: prolonged perceptual changes, unpleasant emotional experiences, transient cognitive effects. Uncommon but serious: manic activation in vulnerable patients, worsening of psychiatric symptoms, urinary or bladder symptoms with repeated use, and rare cardiovascular events. Full details are reviewed in informed consent, which you receive before you consent to treatment.

The FDA issued a warning in October 2023 about compounded ketamine, primarily focused on at-home and telemedicine-only ketamine where no clinician is present to monitor for adverse outcomes. That warning is a real concern, and it is the reason this program does not send any ketamine home with patients, does not offer telehealth ketamine, and requires every dose to be administered under continuous in-room PMHNP supervision in the office.

No. The practice does not offer an after-hours or on-call phone service. For medical emergencies, call 911 or go to UCLA Ronald Reagan Medical Center. For mental-health crises after hours, call or text 988. For non-urgent questions, contact the office during business hours.