Treatment Protocol

Treatment Protocol

1. Information Gathering

Please complete our two quick online forms:

  1. Our New Patient Clinical History form, and
  2. Our Medical Records Release form, so that we can obtain the needed information from your other providers. (Note, we do not need a referral, but we do require a documented mental health diagnosis from a mental health professional.)
  3. In addition, if you are interested in treatment for your chronic pain, please fill out our Chronic Pain History form  as well.

2. Finances

We require payment of our $390 Initial Consultation fee when scheduling the appointment. The consult fee covers our reviewing your history, talking with your mental and other healthcare providers, and our Telemedicine or In-person consultation with you. We also require payment in advance prior to each infusion appointment (each infusion is $690).  These deposits are required to hold your appointment with us.

This may seem expensive at first glance, if so, we strongly encourage you to read our “Mission Statement – Why Choose Us?” page on the website. We do not take insurance, Medicare, or Medicaid. Our fees are payable by cash, credit card, certified check, or CareCredit at the time of scheduling. Deposits are fully refundable until 48 hours before your appointment. For more details see our Financial & Appointment policy.

3. Initial Consultation

All of our patients start off with an Initial Consultation visit prior to their first infusion. This can be done by Telemedicine video-chat, or face to face in-person. During this visit, we will review your medical and mental health history, answer your questions, discuss ketamine infusion therapy, and explain what to expect in more detail. In addition, we may order and/or obtain relevant laboratory tests at this visit, as well. We request that you help us to obtain these results as soon as possible. Certain conditions, such as low vitamin D levels, anemia, low testosterone, etc. can contribute to or even be the primary cause of depression and anxiety.

We strive to maximize the probability of helping you overcome your depression, utilizing the most current clinical research, our medical judgement, and your individual medical history. If we feel you are an appropriate candidate for ketamine infusion therapy, and you want to proceed, we will then schedule your initial infusion series. At the same time, we reserve the right to refuse treatment based on our clinical impression.

4. Therapeutic Ketamine Infusions

Ketamine Infusion Therapy is relatively new in the treatment of mood disorders, and is still an evolving science. To maximize our patients’ outcomes, we stay current with ongoing research, attend conferences, discuss our protocols with our colleagues in the Ketamine Therapy field, and most importantly, LISTEN TO OUR PATIENTS’ FEEDBACK.

Our current protocol is to administer an initial series of six infusions over a two to three week span. (We will work with you if you cannot strictly adhere to this schedule, but it is best to try to begin your treatments as closely to this timetable as possible.) Research has shown that starting off with the series of six infusions results in a much longer lasting symptom reduction.

Overall, over 80% of our patients experience a significant reduction in their depressive symptoms. Some patients have an only mild-to-moderate improvement after the initial series of six infusions; in these patients we have found that extending the initial series to 8, 10, or even 12 infusions results in a greater overall improvement.

American Journal of Psychiatry March 2019

This is consistent with recent research published in the American Journal of Psychiatry, which was the first study to specifically assess IV ketamine infusion protocols for treatment-resistant depression. Indeed, some clinics now recommend an initial series of 12 infusions for every new patient.

However, our current protocol is to customize the number of initial infusions for each patient, based on their response. Again, we firmly believe in the importance of individualized patient care.

The reduction in depressive symptoms after the Initial Series of six infusions lasts for about 5 weeks on average, with a range of 3 weeks to two months for most people. After the initial series, only subsequent single maintenance or “booster” infusions are typically necessary to maintain your improvement. These booster infusions are needed anywhere from 3 weeks to 6 months, depending on the patient. Once we determine your optimal interval time, for most patients the frequency stays constant, eg every 3 weeks for patient A, and for patient B it could be September 1, then December 1, then March 1.

5. Ongoing Psychotherapy

Before we begin your Ketamine infusions, we will encourage you to continue, or resume, some form of ongoing ‘talk therapy’ with an appropriate mental healthcare provider, such as a psychotherapist or psychiatrist. As the ketamine stimulates the growth of depression-stunted neural tissue and synapses in the brain, many patients attain new breakthroughs in therapy during this window of opportunity. It has also been demonstrated that ongoing cognitive behavioral therapy can decrease the frequency with which booster infusions are needed (Wilkinson et al, cited below).  In select patients, “Ketamine-Assisted Psychotherapy” (or KAP, discussed in more detail here) can be even more transformative.

6. The importance of an overall holistic treatment plan

Ketamine is a powerful and paradigm shifting tool. Indeed, we regard it as the most effective antidepressant yet! However, it is NOT a one-time cure. It it is ideally utilized in concert with the other essential elements of an overall holistic treatment plan such as counseling, exercise, good nutrition, adequate sleep, meditation, journaling, etc. Ketamine enables the motivation, energy, and positive attitude to allow one to fully participate in these activities. Your active participation in a comprehensive, holistic treatment plan (in addition to psychotherapy) also impacts the need for and frequency of booster infusions.

7. Day of treatment Instructions

On the day of your infusion, we recommend that you not eat anything for at least 6 hours prior to your appointment, to minimize the risk of nausea and vomiting. You may drink clear liquids (water, broth, juice, black coffee, tea etc) in moderate amounts for up to two hours ahead, to avoid dehydration. You should take all of your usual morning medications, with a few sips of water, the day of your infusion (however, if your usual meds include lamotrignine (Lamictal) or benzodiazepines, discuss this with us ahead of time).

On your day of your treatment at Boulder Mind Care a responsible friend or family member is required to drive you to and from the clinic. Wear comfortable clothing. Please complete the four forms under the “Established Patients” section of the Forms page on our website (here). For your first infusion, you MUST bring a Government-issued Photo ID.

We recommend you bring noise cancelling headphones, as well as a playlist of soothing, instrumental music for your infusion. In addition, most patients find that sleep eye-shades are helpful in maintaining a deep state of relaxation during the infusion. Another comfort measure many patients prefer is to bring a comfortable blanket, especially the weighted or ‘furry/fuzzy’ textured types, as well.

Prior to your arrival to the clinic, please submit the online forms mentioned above, to assist us in assessing your progress. Upon arrival, you will be seated in a comfortable reclining chair. After a quick consultation with Dr. Grindle, a small IV will be placed in your hand, arm or leg. During the infusion, we will closely monitor your vital signs and mental state. If you brought a companion, they may stay quietly in the room with you if you like, although this is not required. Infusions for depression last for approximately 1 hour, and most patients recover from the infusion within 20-30 minutes. Infusions for chronic pain last for 2 to 4 hours, and most patients recover and are ready to go home within an hour. For more details see “What is the experience like?” in the FAQ section. Expect to be at our facility for a total of 1 ½ to 2 hours for mood disorder infusions.

After your infusion, we encourage you to rest the remainder of the day. Most patients feel mildly sedated for several hours afterwards. You should not drive a car, operate heavy machinery, or make any important legal decisions for 24 hours after your infusion.

8. Osmind and Measurement-Based Care

Along with the usual methods of communication, we utilize Osmind’s sophisticated monitoring program app to follow your response and progress after each infusion, along with brief patient surveys. Such Measurement-Based Care (MBC) enhances Ketamine therapy’s effectiveness and efficiency, and improves patient satisfaction, outcomes, as well as adherence to the treatment plan. Osmind also helps you to easily and quickly submit superbills for possible out-of network insurance reimbursement of our fees. The Osmind app also helps you journal how you are feeling, keep track of medications taken, and has an online support community forum that can be very helpful. For details see our Osmind page here.

1. Wilkinson et al “Cognitive behavior therapy may sustain antidepressant effects of intravenous ketamine in treatment-resistant depression.”