Frequently Asked Questions

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Please email us directly at michelle@mindfulhealingpsychiatry.com or you may have your current provider fax a referral to 509-494-8422

I'm currently in-network with Regence, Premera, and First Choice Health. I'm an out of network provider for all other insurance companies.  

At this time, ketamine treatments are not covered by insurance, so the full cost is out-of-pocket.  I will submit your initial psychiatric evaluation appointment directly to insurance for those covered by Regence, Premera, and First Choice Health. For all other insurance providers, you may request a super bill, which you can submit to your insurance company for reimbursement.  

Ketamine is a psychoactive drug classified as a dissociative anesthetic.  It's used in a variety of medical situations because of its safety.  Ketamine has been used off-label in sub-anesthetic doses to treat chronic pain, depression and other mental health issues for over 20 years. Ketamine is now used off-label in conjunction with psychotherapy to treat depression, anxiety, suicidality, and other psychological conditions. 

Ketamine was introduced into clinical practice in the 1960s and has traditionally been used in higher doses as an anesthetic (for surgery) with children and adults. Initially recognized for its anesthetic properties, ketamine has garnered attention in recent years for its potential therapeutic effects on mental health conditions, particularly treatment-resistant depression (TRD), post-traumatic stress disorder (PTSD), and anxiety disorders.  

Ketamine is believed to have a unique mechanism of action. Unlike the majority of psychotropic medications available in the United States, ketamine has been found to primarily target glutamate receptors, more specifically, N-methyl-D-aspartate (NMDA) receptors. Glutamate is an excitatory neurotransmitter associated with numerous neurological functions including memory and learning; glutamate also moderates anxiety and adrenaline release as well as aspects of sleep. Ketamine antagonizes or blocks glutamate receptor transmission. 

Ketamine and its role in neuroplasticity can assist the individual to gain more clarity about themselves and their life. For many, ketamine has been found to provide rapid, sometimes immediate relief of major depressive symptoms, including suicidal ideation; however, the degree and length of symptom relief is variable from patient to patient with some requiring few doses and others needing maintenance administration to experience ongoing symptom relief and remission. 

• Moderate to severe depression
• Adults experiencing acute suicidality
• Individuals diagnosed with bipolar disorder (with managed mood stabilization)
• PTSD 
• Complex Trauma
• Treatment-resistant depression
• Insomnia or disrupted sleep related to trauma
• Anxiety related to a terminal diagnosis
• Bipolar depression

 Your first session will be a "dose finding" session, as people respond differently to the medicine. We offer Ketamine using intramuscular (IM) administration given in the arm. Ten to twelve minutes after your first dose, you may choose to take an additional dose to deepen and lengthen your session. Based on your experience, we'll collaborate to adjust the dosage as needed in following sessions.  

For those of you with a fear of injections or hypodermic needles, there is the option of switching to sublingual ketamine troches (lozenges that dissolve under the tongue). Please discuss this option with your provider. 

Ketamine-assisted psychotherapy (KAP) is a therapeutic approach that combines the administration of ketamine, a dissociative anesthetic, with psychotherapeutic techniques to facilitate emotional processing and healing.  

"KAP is not a magic bullet, the client’s ongoing personal work (e.g. lifestyle changes & ongoing integration therapy) is integral in the effectiveness of KAP and the duration of experienced improvements"

Research supports multiple ketamine infusions are needed to minimize depression symptoms and maintain antidepressant effects. We recommend pursuing the 6 series infusion to start, followed by boosters as needed. A single ketamine infusion can be effective within hours of the infusion to reduce depression symptoms for up to 80% of patients. 

1) Medical/Psychiatric Intake: After an initial consultation to determine whether KAP is likely to be a good fit for your treatment goals, you'll complete a medical/psychiatric intake with our provider, Michelle Brantingham, ARNP, PMHNP-BC. Michelle will determine whether there are any medical contraindications or areas of concern before prescribing your ketamine. 

This 60 to 90-minute session includes: 

• an evaluation of your current concerns, needs, and goals; 
• a medical history and physical exam (if possible); 
• a review of your medical/psychiatric history; 
• a review of current or past psychological/psychiatric history and treatment; 

Based on the findings in this session, our treating provider may also recommend additional diagnostic testing, including, but not limited to: blood and/or urine laboratory tests, EKGs, or other tests.

 2) Preparation Session:  Next, we'll work on preparing the patient for the experience.  This begins with inviting the client to share their background and begin to create a roadmap of where the client would like to explore. During the preparation phase, we explore intentions for doing this work and setting goals and looking at expectations. Another important part of preparation involves educating the patient about ketamine and psychedelic therapy. We'll discuss the variety of experiences you may have during the ketamine sessions and ways to navigate them. Overall, preparation is about creating a comfortable and safe environment for the patient. 

3) Medicine Sessions: You'll arrive at our clinic for the actual ketamine session. The patient is given a low dose of ketamine through intramuscular injection by the provider. It takes place in a calm; comfortable environment designed to promote relaxation and minimize distractions. During the experience, the patient may experience a range of sensations, altered perception of time and space, and travel to a distant place. The experiences in terms of content are limitless and vary from person to person. We believe that whatever comes up in the experience is meant to be looked at with curiosity. Throughout the session, the provider is present to provide emotional support, guidance, and therapeutic interventions. During the height of the medicine experience patients are typically not interacting with the therapist, they are encouraged to ‘be in’ the experience. Once the medicine begins to wear off (40 min to 1hr) the patient is then able to begin interacting with the therapist. This can be an interesting part of the therapy as clients begin to process their experiences and make connections about certain intentions. The provider may suggest ongoing practices such as journaling, mindfulness exercises, or additional psychotherapy sessions to help integrate the insights and changes facilitated by the ketamine experience.

You should arrange to take the rest of the day off from work or other responsibilities or stressors. When possible, it's helpful to keep the following day gentle as well. Integration begins as the ketamine effects wear off, so having time for reflection and self-care will help you make the most of your experience.

"Our priority is to create a safe and therapeutic space for patients, the right environment and support can make all the difference" 

During your KAP treatment, if your medications require adjustment we will collaborate with your current provider and prescribe the medications if needed (with the exception of scheduled medications such as benzodiazepines or psychostimulants). After the initial 1 or 2-week KAP treatment sessions you will resume working with your current psychiatric provider; you may find that occasional maintenance KAP treatments are helpful for continued symptom remission.

We strongly encourage all of our clients to continue therapy whether they are engaged in counseling prior to KAP or not; integration (therapy) throughout and post-KAP is a critical part of this treatment modality. Additionally, ketamine continues to promote neuronal (brain cell) synaptic branching or neuroplasticity post-treatment, and therapy is strongly encouraged to maximize these new synaptic connections. Remember there is no magic bullet, the combination of medication, including ketamine, with continued self-exploration increases the likelihood of long-term symptom reduction and relief. 

• Previous severe allergic reaction or adverse effect to Ketamine. 
• Untreated/poorly managed hypertension or a history of heart disease
• Current or history of mania/hypomania, psychosis/hallucinations, or active substance abuse. 
• Untreated/poorly managed hyperthyroidism
• History of significant bladder disease (cystitis, chronic UTIs)
• History of stroke
• History of aneurism
• Pregnancy/Breastfeeding
• History of increased intracranial pressure 

Ketamine is known to interact unfavorably with a very small number of medications. Your medication history will be closely assessed to determine your eligibility for KAP. Certain medications need to be temporarily stopped. 

Common side effects may include a temporary increase in blood pressure and pulse rate, nausea, blurred vision, reduced balance/coordination. These generally resolve as the drug's effect wears off-- usually from two to four hours after administration. 

 Though you will be able to leave the clinic between 2-2.5 hours after your scheduled KAP start time; you will not be permitted to drive post-KAP sessions. Transportation to and from the clinic on days you are undergoing KAP will need to be arranged in advance. You will be able to safely and legally drive the day following your KAP sessions and resume your normal activities. You will not be allowed to use a taxi, Uber, or Lyft etc. 

Currently, KAP is not covered by insurance plans. 

We accept payment via debit card, credit card, and cash.