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Home / Choosing a Clinic

How to choose a ketamine clinic

Because most ketamine treatment is off-label, no federal standard defines a good ketamine clinic. Spravato® is the exception: it can only be given in REMS-certified settings. For everything else, you have to judge. These seven markers do most of the work.

By: ZSKFL ManagementPublished: Last updated: Editorial policy

The seven markers of a strong program

1

A real medical evaluation before any treatment is scheduled

If you can book an infusion before anyone reviews your psychiatric history, medications, and cardiovascular health, walk away. Strong programs turn some paying customers away. That is what the evaluation is for.

2

Appropriate clinical leadership

Look for psychiatric expertise in the loop (for mental-health treatment) and someone present who is trained to handle a medical emergency during dosing. Ask directly: who evaluates me, who is present during treatment, and what emergency training do they have?

3

Monitoring that matches the drug

Blood pressure checks before and after dosing, breathing and oxygen monitoring, emergency equipment and protocols, a required observation period (at least two hours for Spravato®), and a no-driving rule that matches the drug label (see the driving rules). Missing any of these is a red flag.

4

Measured outcomes and stopping rules

Response should be tracked with standardized scales (PHQ-9, MADRS, or similar), and the program should tell you in advance what "not responding" looks like and when they'd recommend stopping. A clinic with no stopping rule has an incentive problem.

5

Integration with your ongoing care

Strong programs want to coordinate with your psychiatrist or therapist and will send records with your consent. Be wary of a clinic that presents itself as a replacement for your psychiatrist or therapist.

6

Straight talk about evidence and money

They should volunteer that a meaningful fraction of patients don't respond, explain maintenance costs before you start, offer Spravato® (or a referral) when insurance coverage matters, and put refund terms in writing. Compare what they claim to treat against our evidence rankings.

7

No pressure tactics

Countdown discounts, "spots filling fast," pressure to prepay large packages at the first visit. These are retail tactics applied to vulnerable people, and a medical program has no need for them.

Finding programs to compare

This site does not list or rank clinics. To build a short list, start with these free tools, then check each program against the seven markers above.

  • For Spravato®, the manufacturer’s Find a Center tool lists REMS-certified treatment centers by location. The drugmaker runs it, so treat it as a starting list and ask any center you call how it bills your insurance.
  • For mental health treatment in general, FindTreatment.gov, from the federal Substance Abuse and Mental Health Services Administration, is a confidential and anonymous locator for mental health and substance use treatment facilities.
  • If you would rather talk to someone, SAMHSA’s National Helpline gives free, confidential referrals for mental health and substance use treatment, 24/7.

Questions to ask on the first call

  1. Who conducts the medical and psychiatric evaluation, and what could disqualify me?
  2. Who is physically present during treatment, and what happens in an emergency?
  3. How do you measure whether treatment is working? When would you tell me to stop?
  4. Do you offer Spravato® and handle prior authorization?
  5. What does the full first month cost, including everything? What does year one cost for a responder?
  6. Will you coordinate with my current psychiatrist or therapist?
  7. What is your refund policy, in writing, if I stop mid-package?

Questions a family member can ask the clinic

If you are helping someone choose a clinic, you can ask questions too. Ask them with the patient present or with the patient's consent. Clinics handle these things differently, and the answers tell you how this one works.

  1. With the patient's consent, can I attend the evaluation?
  2. Can I be listed as the emergency contact?
  3. How will you measure whether treatment is working, and when will you reassess?
  4. What is your stopping rule? At what point would you recommend stopping?
  5. How long should I plan to wait at the clinic on treatment days?
  6. What changes in mood or behavior should we report to you, and how?
  7. Who do we call after hours? What counts as an emergency, and when should we call 911?

If you will be the one driving, our guide to what the day looks like for the driver walks through it.

Checking a specific clinic? Take the seven first-call questions above with you. To check a clinician's license, our East Coast guide links each state's license lookup. If something on this page isn't clear, and we'll reply with general information.

At a glance

  • The first three markers are about safety: who evaluates you, who is in the room, and what is monitored.
  • Measured outcomes and a stopping rule protect your money as much as your health.
  • Pressure to prepay, reluctance to coordinate with your psychiatrist, or vague refund terms are reasons to keep looking.
  • A clinic that misses any of the first three markers is a safety risk, whatever it charges.

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