What is Ketamine?

Alternative Telemedicine Treatment for Anxiety, Depression, PTSD, & Substance Abuse

Ketamine is an alternative treatment for anxiety, depression, PTSD, and substance use. Unlike SSRI’s and other more widely used antidepressants, Ketamine acts quickly. It works on a brain pathway called NMDA. This action is associated with a rapid cessation of looping negative thoughts, as well as decreasing the “Heaviness”/Sadness felt with severe depression. Even more importantly, it can bring about a rapid decline in suicidal feelings. Other research has shown that Ketamine actually causes brain cells to grow many new connections. Patients often report a feeling of their mind being “reset” or “rebooted”. A recent study followed patients treated regularly with the same dose of Ketamine for four years. The Ketamine Effect did not fade with time, and no significant side effects were reported. 

Ketamine is especially helpful for Treatment Resistant Depression. The majority of our patients that respond positively to Ketamine have suffered for greater than 10 years and did not get better with multiple other medications. Another recent study showed that although minimally helpful for mild depression, Ketamine is remarkably helpful for those with severe symptoms of depression, and even more so in those with a history of past trauma or childhood trauma.

Other studies have shown that patients with a family history of Alcohol Use Disorder are much more likely to respond to ketamine.

Ketamine is helpful with the depression associated with Bipolar Disorder. It is safest when combined with a mood stabilizer. It is possible for Ketamine to induce mania.

Learn More About Ketamine

We participate in the Ketamine International Journal Club and Conference. The following is a link to their youtube channel. There are many in depth presentations related to the most recent Ketamine research.

Relieving Anxiety

When taken on a twice weekly basis Ketamine is helpful with Anxiety Symptoms.

Ketamine by itself is helpful with the symptoms of Post Traumatic Stress Disorder (PTSD). Current research has revealed that Ketamine Assisted Talk Therapy KATT, the use of Ketamine during a talk therapy session, can help people make progress that could not previously be attained. Ketamine assisted  talk therapy will soon become one of the gold standards of treatment for PTSD. our practice can provide KATT by Telemedicine upon request. We can also provide the medication for Ketamine Assisted Psychotherapy (KAP) with a psychotherapist of your choice. Please have your psychotherapist contact us.

Ketamine can also be very helpful for recovery from substance use disorders. It is the only medication that helps treat cravings for all of the following substances: alcohol, opiates, cocaine, marijuana. Some patients have also used Ketamine to assist in their recovery from Kratom addiction.

Ketamine can cause sedation at the time of use. It should only be taken while sitting or lying down in bed. It should be used the first time with someone sitting with you. It should not be used in combination with any other medication‘s that are sedating or any other substances that are sedating. Ketamine should not be taken in the bath, in a sauna, in a hot tub, in a sensory deprivation tank, or in any other situation that would be dangerous if sedated. It can be deadly in combination with alcohol intoxication. It can be deadly if used by an alcoholic that has not gone through detoxification treatment. It can elevate the blood pressure and pulse as much as moderate exercise does. 

This would not be safe in people with uncontrolled high blood pressure or at high risk for heart attack, stroke, aneurysm, or other cardiovascular disease. It would not be safe for people with diseases involving increased pressure of the fluid in the eyes or increased pressure of the fluid around the brain. Immediately after the use of Ketamine, it is not safe to drive or perform any type of activity that could be hazardous. Financial and other important decisions should not be made under the influence of Ketamine or in the hours after use. The aforementioned activities should be avoided until the next day after treatment. Any patient experiencing significant side effects from treatment should seek immediate medical attention. There is a chance that Ketamine could cause unexpected symptoms that would require an emergency room visit. There is a chance that Ketamine could cause anxiety symptoms. There is a chance that Ketamine could cause psychosis.

Frequently Asked Questions

The most common side effects while using ketamine are sedation, confusion, nausea, headache, dizziness, discoordination, and insomnia.

Get in a comfortable, semi-reclined position. It is helpful to wear an eye mask to avoid distraction and looking around the room. We recommend wearing earphones while playing soothing ambient or spa-like music without lyrics. Place the waxy square troche or oral dissolving tablet between your cheek and gum or underneath your tongue. The medicine is absorbed by the tissue that lines your mouth. You want to hold the saliva that builds up as long as possible before swelling it for maximum absorption of the Ketamine. Greatest effect is found to be after holding the saliva for 45 minutes to an hour before swelling. If this becomes difficult, allow a very small amount to be stalled and continue to hold the rest.

Also helpful for absorption is to swish every minute or two as you would in a dentist’s chair. The troches should dissolve in about 10 to 15 minutes. After about 20 minutes you may notice numbness or tingling in your face and a feeling of relaxation. You may feel weightless or as if floating. You may feel like you can see your thought process from a different perspective. You may have very light feelings of disassociation or have colored visual effects when closing your eyes. These feelings will slowly dissipate over 60 to 90 minutes and you should feel normal again. After a treatment you should not work or drive, do anything that could be hazardous, or make any financial decisions until the next day. Please contact us immediately for any problems related to treatment.

Ketamine can be sedating. Afterwords some people feel washed out. Some people have a mild headache. Some people have difficulty sleeping immediately afterwards. It seems best to use it towards the end of the day.


This is a prescription medication with new found antidepressant and anxiolytic properties. If you have a positive response, and take a therapeutic dose on a regular basis, it can help with Depression, Anxiety, PTSD, and Substance Use Disorders. As a side effect, some patients have a feeling of dissociation at the time of treatment that lasts 60-90 minutes. The most recent research has shown that dissociation has nothing to do with the treatment effect. Dissociation is not required for successful treatment. The longer that a patient takes Ketamine, the more this side effect decreases and will even go away completely, but it will continue to have robust treatment effect.

Dissociation is a feeling of leaving your body. When Ketamine is used as an anesthetic for surgery, it causes the mind to completely separate from all body input. The dose of Ketamine used in our treatment protocol is very low compared to surgery and most people do not dissociate. Most people feel a relaxed floating sensation and see their thoughts from a different perspective.

The price for a month’s worth of ketamine troches can range from $50-$120 depending on the part of the country you live in. 

Google “compounding pharmacy near me”
Call each pharmacy on the list to ask them if they will make a ketamine troches and request a price for a quantity of 10.


You should only use 1/2 of a troche for your first treatment session. You should have someone that you trust to sit with you for the first two treatment sessions to answer questions that you may have about odd sensations or unusual thoughts. A common feeling is the sensation that nothing is real anymore. In this situation it is always good to have a friend nearby, so that you may ask, “Are things still real?” They can provide you with reassurance that things are still real and that you are using a medicine to help with depression. This kind of reassurance from another living human being helps prevent feelings of anxiety.

Some people feel better the next morning. Patients often express ”I woke up and felt like doing things“ or “I woke up and felt like some of the weight of the world had fallen off of my shoulders“. Most people notice an improvement in their mood after three or four treatments. Some people that respond positively in the long run, don’t feel any improvement for the first three or four treatments. But most patients can tell whether the medicine is going to help or not within the first 30 days. 

Sometimes increasing the dose is helpful, but this is only necessary for a percentage of patients. We will follow your improvement with standardized scales of anxiety. We will follow your improvement with standardize scales of anxiety, depression, suicidality and PTSD.  This will provide objective information to monitor and guide your treatment. It is very important that you fill out these surveys before each telemedicine visit.

You should keep any controlled substance in a secured area of your home or in a lock box.

You will need to have a face-to-face telemedicine visit with us every 30 days. Ketamine is a controlled substance and requires regular visits to monitor for side effects, compliance with treatment, appropriate use, and to discourage diversion of medication.  Diversion is sharing or selling your medicine to another person.   The diversion of a controlled substance is a crime and grounds for immediate dismissal from our practice without refund. Diversion of medication will be reported to the appropriate authorities. 

Ketamine is not a miracle cure. Ketamine can be an incredibly important part of starting the process of recovery and successfully managing your depression anxiety PTSD or substance use disorder. We cannot stress enough the importance of adding cognitive behavioral therapy to your treatment plan while your mood is improving. We highly recommend the free app for your phone called WOEBOT. It is an artificial intelligence cognitive behavioral therapist. It will check in with you once daily to see how you are feeling. Based on what you talk to it about it will do cognitive behavioral teaching with you. We have used it in the past and we think it is very helpful. Of course meeting with a therapist by telemedicine or in real life would be helpful as well.   Meditation yoga exercise healthy eating and stress relieving activities are all an important part of a comprehensive plan for the treatment of anxiety depression PTSD and substance use disorders. Behavioral activation is also an important part of getting better. Behavioral activation is planning an activity once a week that you would enjoy participating in and then doing it no matter how you feel. The idea is that your actions can influence your thoughts and feelings. Helping others is also an important part of getting better. It would be very important for you to participate in a support group for depression anxiety PTSD or substance use disorder. Ultimately it would be good for you to contemplate the great existential question. What is your purpose in life? What would you like to do with your life? What can you do to take steps and set goals to live the life that you would want to.     Research has shown that people that feel like they know their purpose in life have a lower incidence of anxiety and depression symptoms.

A permanent type of bladder pain and irritation has been seen in some patients using ketamine in high doses on a daily basis for people abusing Ketamine in high doses on a daily basis. This is not been noticed in people being treated with the doses commonly used for depression. Smith Ketamine Services only treats with a low dose of ketamine once every three days. It would be highly unlikely that you would encounter this problem, but of course it is still possible. If you notice any signs of bladder irritation stop using medicine immediately and contact us.  


Research has shown that dissociation is not necessary for successful treatment, and we practice evidence based medicine. Our point of view is that of scientists and  medical doctors.

We fully understand that there is a community of people that have strong feelings about Ketamine’s ability to induce a dissociative state, and their opinion that this state brings about spiritual and psychic healing. We have no argument with this community. We love and enjoy speaking with members of this community. We respect their point of view. We do not invalidate anyone’s experience,


This goes beyond the boundaries of our practice of medicine. We are held to certain standards by state and federal authorities for our medical and drug prescribing licenses. If we violate those standards, our licenses can be rightfully revoked.


People seeking Ketamine without a valid diagnosis will not be tolerated. Persistent seeking of an experience from a substance is a potential pathway to addiction. Persistently asking for a substance without a valid diagnosis is called Drug Seeking Behavior. Drug Seeking Behavior will be reported to the appropriate authorities.


Sharing a controlled substance with another person is called diversion. Diversion is grounds for dismissal from our medical practice. Diversion is a crime. Diversion will be reported to the appropriate authorities.

As a general rule, No. It is best for any controlled substance to be secured, preferably in a lock box or safe.


Upon request we will offer a discount to Veterans. Please send us appropriate documentation.

As a general rule, No.

We currently only treat mental health conditions with Ketamine. We do not practice pain management. Patients requiring Ketamine for pain control should be seen by a doctor that specializes in pain management.

Ready to Schedule Your Appointment?

Start scheduling your appointment today! 

Ready to Schedule Your Appointment?

Start scheduling your appointment today!