Ketamine Infusion Therapy Information For Providers

This page is a work in progress, and we’re actively adding more detailed information to better support providers. Additional resources will be available in the coming weeks, so please check back for updates!

At Lighthouse Infusions, we specialize in providing IV ketamine infusion therapy (KIT) — an innovative treatment supported by a growing body of clinical evidence. KIT offers a powerful option for patients with treatment-resistant mental health conditions, including major depressive disorder, PTSD, OCD, bipolar-II, and a variety of anxiety disorders. With efficacy rates exceeding 70%, ketamine has transformed the landscape of mental health care, especially in cases where traditional modalities fail to provide adequate relief from symptoms. Additionally, due to its unique mechanism of action, ketamine has demonstrated remarkable effectiveness in managing chronic neuropathic pain disorders such as fibromyalgia.

This page provides a comprehensive overview of ketamine infusion therapy, designed to educate providers on this cutting-edge treatment modality. Our goal is to provide essential information that can help you identify patients who may benefit from ketamine infusion therapy. You’ll also learn about our rigorous safety protocols, patient-centered care approach, and how we can collaborate with referring providers to ensure optimal patient outcomes.

Provider Referrals

We’ve placed our referral tools at the top of this page to make it easy to refer patients without needing to scroll through the whole page. However, we invite you to explore this page, as it’s packed with useful clinical resources and answers to common questions about IV ketamine infusion therapy.

If you have any questions, please call us directly (8:00am⁠–⁠5:30pm, 7 days a week ): 425‑835‑2363

Documentation

We strive to make referring patients as simple as possible. While we don’t require a referral, we will need documentation of the patient’s diagnoses. Being a treatment center, we don’t offer diagnostic services, so before patients can begin treatment, we will need documentation that they have been diagnosed with one or more of the conditions that we treat. To expedite your patient’s intake process, we ask that you do one of the following:

  • Online Form: Complete our quick and secure online form. This form integrates directly into our electronic health record system, allowing us to process referrals promptly. It also avoids the hassle of printing and signing.

  • Fillable PDF Form: Providers who prefer a more traditional approach can download and complete our fillable PDF form. It should only take about 2 minutes to complete, and you can fill out most of the information on the computer before printing and signing. Providers can give the completed form directly to the patient, fax it to us, or send it to us as an email attachment (our email is HIPAA-compliant): info@LHinfusions.com

  • Health Records: We can also accept health records that show the patient’s relevant ICD-10 diagnosis codes. Records can either be faxed or emailed as an attachment (our email is HIPAA-compliant: info@LHinfusions.com)

Eligibility and Contraindications

Providers should avoid referring patients with primary contraindications, including a history of psychosis, mania, seizure disorders, or stroke/brain bleeds. Aside from these clear contraindications, we welcome all referrals. During the intake call, our skilled anesthesia provider, Liana, will use her extensive clinical expertise to determine if ketamine infusion therapy is appropriate and likely to be both safe and effective for each patient. Even patients with complex medical histories or significant comorbidities may still be appropriate candidates, but this will be determined individually.

Next Steps

Once we receive the referral and patient contact information (phone number and email), we typically reach out to the patient within 24 hours — often the same day. Our initial outreach is usually by phone, enabling us to personally answer any preliminary questions and ensure the patient understands the treatment process before scheduling their intake call. If we’re unable to reach the patient by phone, we’ll promptly follow up by email.

Responsive Team

We pride ourselves on our exceptional responsiveness, personalized approach, and accessibility. We can usually schedule patients for their intake call within a couple days, though we are often able to get them if not the same day. Once the patient has completed the intake process (completed intake call, filled out our intake forms online, and we have documentation of their diagnoses on file), most patients can begin their loading doses within a few days.

As a small clinic, we personally manage each referral and prioritize individual patient needs. Unlike larger facilities, we provide a higher level of care, ensuring an advanced practice provider is present in the room throughout each infusion. Patients and referring providers alike appreciate our thoughtful, hands-on approach and attention to detail.

If you have questions or wish to discuss a potential referral, please feel free to call us at 425‑835‑2363 or send us an email info@LHinfusions.com. For additional contact options and information, please visit our contact page.

What is Ketamine Infusion Therapy?

Ketamine infusion therapy (KIT) involves the controlled administration of precise, sub-anesthetic doses of ketamine through intravenous infusion, leveraging its unique pharmacological properties to achieve therapeutic effects. With its rapid onset of action and ability to target pathways often unresponsive to conventional treatments, KIT offers a groundbreaking approach to addressing treatment-resistant mental health and chronic pain conditions. Administered in a closely monitored clinical setting, this innovative therapy combines safety with transformative outcomes for eligible patients.

At Lighthouse Infusions & Seattle Ketamine, we utilize ketamine infusion therapy to treat patients suffering from the following conditions:

  • Depression
  • Anxiety
  • PTSD
  • OCD
  • Bipolar-II Disorder
  • Suicidal Ideation
  • Fibromyalgia

Development and FDA Approval

Ketamine, first synthesized in the 1960s, was approved by the FDA in 1970 for use as an anesthetic. Initially developed as a safer alternative to phencyclidine (PCP), ketamine demonstrated a superior safety profile due to its dissociative anesthetic properties and short duration of action. Its rapid onset, minimal respiratory depression, and favorable hemodynamic effects made it a widely used anesthetic in surgical and emergency medicine settings. Ketamine remains on the World Health Organization’s List of Essential Medicines due to its critical role in healthcare globally.

Discovery of Mental Health Benefits

The discovery of ketamine’s rapid-acting antidepressant effects revolutionized the field of mental health. In the early 2000s, studies revealed that sub-anesthetic doses of ketamine produced profound and sustained reductions in depressive symptoms, particularly in treatment-resistant populations. Subsequent research demonstrated its efficacy in reducing suicidal ideation, sometimes within hours of administration — a paradigm shift compared to traditional antidepressants, which may take weeks to become effective. Ketamine’s ability to modulate the glutamatergic system and enhance neuroplasticity provides a novel mechanism of action distinct from serotonergic and noradrenergic pathways targeted by conventional treatments.

Pharmacology of Ketamine

Ketamine acts primarily as a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist. By inhibiting NMDA receptors, ketamine reduces excitatory glutamate activity, which is implicated in neurotoxicity and the pathophysiology of depression. This mechanism promotes synaptogenesis and enhances neuroplasticity, facilitating the brain’s ability to form new connections and adapt to healthier patterns of thought. Additionally, ketamine’s modulation of the glutamate system is thought to restore functional connectivity in key brain regions involved in mood regulation, including the prefrontal cortex and hippocampus.

Ketamine also exerts secondary effects on opioid, monoaminergic, and inflammatory pathways, which may contribute to its analgesic and mood-regulating properties. Its pharmacokinetic profile includes rapid absorption and distribution, with a half-life of approximately 2–3 hours and metabolism primarily in the liver via the cytochrome P450 system. These properties, combined with its dissociative effects at therapeutic doses, make ketamine uniquely suited for controlled, short-term interventions in mental health and pain management.

Clinical Use vs. Recreational Abuse

While ketamine has been mischaracterized by its association with recreational use as a “club drug”, the controlled administration of ketamine in clinical settings is fundamentally distinct. In a medical context, ketamine is administered under strict monitoring by trained professionals, with doses tailored to achieve therapeutic effects while minimizing risks. This controlled approach contrasts starkly with recreational use, which involves unregulated dosing and is often associated with adverse outcomes. Clinically, ketamine’s benefits far outweigh its risks when administered appropriately, supported by its excellent safety profile.

Clinical Advantages of Ketamine Infusion Therapy

Rapid Symptom Relief

Ketamine infusion therapy offers a unique advantage in its ability to provide symptom relief significantly faster than traditional pharmacological treatments. While most patients begin to experience noticeable improvements after their third or fourth infusion — typically by the second week of treatment — some report relief as early as the first infusion. For others, symptom reduction may require completion of the full six-infusion series, typically administered over 3–4 weeks, but this timeline remains considerably shorter than the time often required to assess the efficacy of conventional antidepressants.

Traditional medications such as SSRIs and SNRIs often take 6–8 weeks to demonstrate clinical effectiveness, leaving patients in prolonged states of distress during the initial trial period. Ketamine’s faster onset provides a critical alternative, particularly for individuals with severe symptoms or those in acute crisis. This rapid response, combined with ketamine’s novel mechanism of action, positions it as a transformative option for patients seeking timely relief from treatment-resistant conditions.

Outstanding Efficacy for Treatment-Resistant Conditions

Ketamine infusion therapy (KIT) has demonstrated exceptional efficacy in addressing conditions that have not responded to conventional treatments. Clinical trials have shown response rates exceeding 70% in populations with treatment-resistant depression, PTSD, OCD, and other refractory mental health conditions. This level of efficacy represents a paradigm shift in the management of these disorders, offering hope to patients who have tried multiple treatments without success, or may have even exhausted traditional options.

What sets ketamine apart is its ability to directly target the dysregulated glutamatergic system, which plays a critical role in the neurobiology of mood disorders. Unlike serotonergic or noradrenergic treatments, ketamine’s NMDA receptor antagonism promotes neuroplasticity and synaptic restoration in brain regions critical to emotional regulation, such as the prefrontal cortex and hippocampus. This mechanism not only addresses symptoms but also supports long-term improvements in brain function.

KIT’s success extends beyond mood disorders, with compelling evidence supporting its use in patients with chronic pain conditions such as fibromyalgia, where central sensitization and neuroinflammation are key contributors. By targeting these underlying mechanisms, ketamine provides meaningful relief in cases where other therapies have failed to achieve significant results.

IV Administration in Ketamine Therapy: Why It Matters

Intravenous (IV) administration is widely regarded as the gold standard for ketamine therapy due to its precision, safety, and efficacy. By delivering ketamine directly into the bloodstream, IV administration achieves 100% bioavailability, ensuring predictable plasma concentrations and allowing for meticulous control over dosing. This level of precision is critical in therapeutic settings, where even slight variations in dosage can influence clinical outcomes.

In contrast, other delivery methods — such as oral (PO), intramuscular (IM), or intranasal (IN) administration — are associated with significant variability in absorption, leading to inconsistent therapeutic outcomes and a higher potential for side effects. Oral administration of ketamine has a bioavailability of approximately 16–29% due to extensive first-pass metabolism in the liver, resulting in unpredictable plasma levels and reduced efficacy. Intramuscular administration offers improved bioavailability of around 75–93%, but it follows a less controlled pharmacokinetic curve and is associated with lower overall efficacy compared to IV infusion. Intranasal delivery has a bioavailability of roughly 45–50%, but its absorption rates are highly variable, further limiting its reliability in clinical settings. In contrast, IV administration achieves 100% bioavailability, ensuring precise plasma concentrations and consistent therapeutic effects.

IV administration provides a level of control, flexibility, and safety unmatched by other delivery methods. Because the ketamine is delivered at a steady rate over 40 minutes, the infusion can be adjusted in real time to optimize efficacy and manage side effects. This precise, linear delivery allows for consistent plasma concentrations and a predictable therapeutic response. IV access further enhances safety by enabling the immediate administration of adjunctive medications to manage side effects or stabilize patient vitals, while continuous vital sign monitoring ensures that any physiological changes are promptly identified and addressed.

While serious complications with ketamine therapy are rare, a critical advantage of IV administration is the ability to terminate the infusion immediately in response to adverse events. Unlike oral, intramuscular, or intranasal routes, which cannot be reversed once administered, IV infusions facilitate the immediate cessation of delivery, resulting in a correspondingly rapid decrease in plasma concentrations due to its short half-life and distribution kinetics. This rapid clearance minimizes the duration of adverse effects, reduces the likelihood of complications progressing to more serious outcomes, and lowers the overall risk of morbidity. This capability is essential for mitigating risks, particularly in patients who may have undiagnosed or emerging conditions that have yet to make a presentation.

The unparalleled precision, flexibility, and control of IV administration make it the preferred method for delivering ketamine therapy in clinical settings. By ensuring consistent therapeutic outcomes while minimizing risks, IV administration remains the most effective and safest approach to ketamine therapy.

Neuroplasticity and Long-Term Benefits

One of the most groundbreaking aspects of ketamine infusion therapy is its ability to enhance neuroplasticity — the brain’s capacity to form and reorganize synaptic connections. Unlike traditional treatments that primarily modulate neurotransmitter levels, ketamine directly targets the glutamatergic system, facilitating synaptogenesis and restoring functional connectivity in key brain regions such as the prefrontal cortex and hippocampus. These regions are critical for emotional regulation, decision-making, and memory, and their dysfunction is often implicated in treatment-resistant mental health conditions.

Ketamine induces a transient period of heightened neuroplasticity immediately following administration, creating a unique therapeutic window that can be leveraged to achieve breakthroughs in psychotherapy. Research indicates that ketamine promotes dendritic spinogenesis within hours of administration, with these structural changes supporting increased neural connectivity during the first 24 to 48 hours post-infusion. During this acute phase, the brain is more adaptable, allowing patients to process and integrate new insights or behavioral strategies more effectively. By combining ketamine therapy with psychotherapy, providers can maximize the impact of both treatments, fostering deeper and more sustained improvements in mental health.

Moreover, ketamine’s effects extend beyond mood regulation. In conditions such as fibromyalgia and other chronic pain syndromes, ketamine’s modulation of the central nervous system reduces hyperexcitability and central sensitization, offering both immediate symptom relief and longer-lasting functional improvements.

This dual impact on both symptoms and underlying neural mechanisms underscores ketamine’s role as a transformative treatment for patients with complex and refractory conditions, making it a cornerstone of innovative mental health and pain management strategies.

Contraindications

History of Psychosis

While individuals with a history of transient psychotic episodes related to acute medical conditions, substance use, or certain medications may still be eligible for ketamine therapy, ketamine therapy is strongly contraindicated for patients with a history of psychosis or schizophrenia. Ketamine’s dissociative and perceptual effects can significantly worsen symptoms such as hallucinations, delusions, or paranoia, leading to potential destabilization of thought processes, increased disconnection from reality, or exacerbation of pre-existing psychiatric symptoms. These risks can compromise the patient’s safety and overall mental health, making ketamine therapy unsuitable for this population. The intake call will provide an opportunity to thoroughly review all relevant factors and determine if ketamine therapy is appropriate and safe for the patient.

History of Mania

Patients with a history of mild hypomanic episodes or Bipolar-II disorder are likely eligible for treatment, depending on their overall medical history. However, patients currently experiencing mania or with a history of severe manic episodes are strongly contraindicated for ketamine therapy. For individuals with conditions such as Bipolar-I disorder, where mania is a primary feature, ketamine therapy poses significant risks of worsening symptoms or triggering dangerous episodes. All of these factors will be carefully evaluated during the intake call to ensure patient safety.

Seizure Disorders

While ketamine lowers the seizure threshold, this is generally not a concern for most individuals who already have a high threshold. Likewise, individuals who have experienced a seizure in the past due to medication reactions, acute medical conditions, or other transient factors are likely still candidates for treatment, as these events don’t necessarily reflect a lower baseline seizure threshold. However, for patients with known seizure disorders, ketamine poses a significant risk of triggering seizures and is considered a strong contraindication. This heightened risk is attributed to ketamine’s influence on glutamate signaling and its role in increasing cortical excitability in susceptible individuals. All of these factors will be carefully evaluated during the intake call to assess the patient’s eligibility and minimize any risks.

History of Stroke or Brain Bleeds

Although ketamine is generally safe for most patients, it can elevate both intracranial pressure and blood pressure. These effects pose significant risks for individuals with cerebrovascular conditions such as ischemic or hemorrhagic stroke, cerebral aneurysms, or intracranial hypertension, as they may exacerbate vascular instability, increase the likelihood of re-bleeding, or worsen pre-existing neurological deficits. Eligibility will be determined during the intake call, but patients with these conditions are generally not candidates for treatment.

Uncontrolled Hypertension

Although ketamine can cause a temporary increase in blood pressure, this is generally safe for most individuals. Likewise, patients with controlled hypertension who are effectively managing their condition with medication are typically eligible for treatment. However, uncontrolled hypertension poses significant risks, including an increased likelihood of cardiovascular events such as stroke, heart attack, or other complications during treatment. Patients with uncontrolled hypertension will need to stabilize their blood pressure before becoming eligible for IV ketamine infusion therapy. Eligibility will be determined during the intake call, taking individual health factors into account.

Severe Cardiovascular Disease

While patients with mild to moderate cardiovascular conditions might be eligible for treatment, those suffering from high-risk cardiovascular conditions, such as a recent heart attack or advanced heart failure, may be unable to safely undergo IV ketamine infusion therapy due to its potential effects on the cardiovascular system. These conditions require thorough consideration to ensure treatment is only pursued when it is safe and appropriate for the patient. Eligibility will be determined during the intake call, focusing on the patient’s cardiac health, stability, and overall medical profile.

Severe Liver Dysfunction

Ketamine is typically metabolized efficiently by the liver and is safe for most patients. Not all liver conditions preclude patients from being considered for treatment; however, severe liver dysfunction, such as advanced cirrhosis or acute liver failure, can significantly impair the metabolism of ketamine, potentially leading to prolonged drug effects, increased toxicity, or other complications during treatment. As such, patients with severe liver dysfunction are generally not candidates for ketamine therapy. Eligibility will be determined during the intake call, taking into account the patient’s liver function, medical history, and overall health.

Severe Kidney Disease

While IV ketamine infusion therapy is generally safe, patients with severe kidney disease may have difficulty processing and excreting ketamine metabolites, potentially increasing the risk of complications. Kidney disease does not automatically exclude patients from treatment, but it may require careful evaluation to manage potential risks. Eligibility for treatment will be determined during the intake call, considering the patient’s overall kidney function and other relevant factors.

Unstable Medical Conditions

Conditions such as severe infections, uncontrolled diabetes, or other unstable illnesses can complicate treatment and increase the risks associated with ketamine infusions. Eligibility for treatment will be determined during the intake call, taking into account the nature and severity of the condition.

Pre-existing Bladder Conditions

Most patients do not experience any bladder-related issues with IV ketamine infusion therapy. However, individuals with pre-existing bladder sensitivity may be at higher risk of irritation or discomfort. Bladder conditions are not necessarily a strict contraindication, as we have protocols to mitigate potential risks. Eligibility will be evaluated individually during the intake call with Liana.

Known Allergy to Ketamine

While allergies to ketamine are exceedingly rare, patients with a documented allergy are not eligible for treatment due to the risk of severe allergic reactions, including anaphylaxis.

Active Substance Abuse

While IV ketamine infusion therapy is generally considered safe for those who engage in moderate recreational substance use, or for patients with a history of substance abuse or addiction, those currently engaging in heavy substance abuse may not respond predictably to treatment and may face a heightened risk of adverse reactions. The context and degree of substance use will be considered during the intake call.

Pregnancy

Ketamine crosses the placenta and its effects on fetal development are not fully understood. As such, patients who are pregnant or planning on becoming pregnant should wait to begin treatment.

A Note on Breastfeeding:

Research has consistently demonstrated that the concentration of ketamine and its metabolites in breast milk is minimal and transient, posing negligible risk to nursing infants. Additionally, oral bioavailability (PO absorption) of ketamine is extremely low, further limiting any potential systemic exposure for the breastfeeding infant. Combined with its rapid clearance and short half-life, these pharmacokinetic factors contribute to ketamine’s favorable safety profile for lactating patients.

The 100% bioavailability achieved through intravenous (IV) administration enables the use of significantly lower doses compared to other routes. This reduces plasma concentrations in the lactating individual and minimizes the transfer of ketamine or its metabolites into breast milk. As a result, any potential exposure for the infant is extremely limited, while therapeutic efficacy for the patient is maintained. This pharmacological advantage further supports the safety of IV ketamine infusion therapy for individuals who are breastfeeding when administered in a controlled clinical setting.

Guidelines from professional organizations further affirm the safety of breastfeeding following medical procedures, including the use of anesthetic agents like ketamine. The American Society of Anesthesiologists (ASA) states, “It is generally safe to resume breastfeeding as soon as the mother is awake, alert, and able to sit up after anesthesia.” This aligns with broader evidence that anesthetic agents, including ketamine, are excreted into breast milk in only trace amounts that are extremely unlikely to harm the nursing infant. Consequently, there is no need to “pump and dump” following ketamine infusion therapy. Instead, individuals can safely resume breastfeeding as soon as they feel physically capable. These recommendations underscore the commitment to balancing effective care for the patient with the safety and well-being of the infant.

Medication Interactions

We strongly encourage patients to schedule an intake call before making any changes to their medications, especially if they are considering tapering. In some cases, patients may not be appropriate candidates for IV ketamine infusion therapy due to other factors, and tapering off existing medications — particularly those that are stabilizing — may carry unnecessary risks. Intake calls provide an opportunity to review the full clinical picture and determine if any medication adjustments are warranted in the context of ketamine therapy.

Lamotrigine

Lamotrigine has been associated with a reduction in ketamine’s therapeutic efficacy, likely due to its glutamate-suppressing properties. Because ketamine’s mechanism of action involves modulating glutamatergic signaling, concurrent use of lamotrigine may blunt both subjective and clinical responses. In our experience, patients undergoing ketamine therapy while taking lamotrigine typically show little to no meaningful reduction in symptoms; when a response does occur, it is usually minimal and short-lived.

For this reason, we do not recommend tapering lamotrigine until the patient has completed an intake call and we have determined that IV ketamine infusion therapy is otherwise clinically appropriate. Should they decide to proceed with treatment, the patient would then need to work with their prescribing provider to safely taper off lamotrigine prior to starting ketamine infusions.

High-Dose Gabapentin or Pregabalin

High doses of gabapentin or pregabalin can interfere with the clinical benefits of ketamine. More specifically, these medications may interfere with the neurobiological processes such as NMDA receptor modulation and downstream neuroplasticity that underlie ketamine’s therapeutic effects. In our experience, patients taking high-dose gabapentinoids often show a diminished response to treatment, and when a response does occur, it tends to be short-lived. That said, patients should not adjust their medication until after completing an intake call. If deemed a good candidate and they choose to move forward, they would then work with their prescribing provider to taper to a lower dose before starting ketamine infusions.

Benzodiazepines

Benzodiazepines can interfere with ketamine’s therapeutic activity by dampening central nervous system excitability and blunting the dissociative and neuroplastic effects that are integral to ketamine’s mechanism of action. This attenuation likely occurs through enhanced GABAergic signaling, which may counteract ketamine’s NMDA receptor antagonism and downstream activation of glutamate-mediated pathways involved in mood regulation and synaptic remodeling.

In our experience, patients who take benzodiazepines on a limited, as-needed basis (typically no more than two or three times a week), can often begin ketamine infusions without delay. However, patients who use benzodiazepines daily, particularly at moderate to high doses, may experience a significantly reduced response to treatment. In such cases, a taper may be required prior to starting therapy to improve the likelihood of meaningful clinical benefits. Additionally, long-acting benzodiazepines (e.g., clonazepam, diazepam) may take longer to clear from the system and could require a longer washout period, depending on the dosage and duration of use.

To prevent unnecessary changes to existing treatment plans, patients should not alter their regimen prior to completing an intake call. If approved for treatment and they choose to proceed, they would then work with their prescribing provider to safely taper down.

Other Medications

During the intake call, Liana reviews each patient’s current medications and will flag any concerns or potential interactions as needed. Fortunately, with the exception of those discussed above, most medications are compatible with IV ketamine infusion therapy and do not require any changes prior to starting treatment. This includes SSRIs and many other commonly prescribed psychiatric medications, most of which can be safely continued throughout the course of treatment.

In some cases, we may recommend adjusting the timing of certain medications in order to reduce side effects or improve treatment response, but we always advise patients to consult with their prescribing provider if any adjustment would conflict with their current medication instructions.

As a skilled anesthesia provider, Liana has extensive experience taking thorough patient histories to quickly identify any safety concerns or issues that might interfere with the efficacy of treatment. While a full analysis of pharmacological interactions is beyond the scope of this page, each patient’s medication regimen will be carefully evaluated to identify any contraindications or modifications needed for safe and effective treatment.

Contact Us

This page is a work in progress, and we’re actively adding more detailed information to better support providers. Additional resources will be available in the coming weeks.

If you have questions, please don’t hesitate to give us a call: 425‑835‑2363

We are open 8:00 AM until 5:30 PM, 7 days a week

If you prefer, you can also send us an email: info@lhinfusions.com

As always, you can find all our contact info on the contact page