Maybe you’ve tried two antidepressants. You have a psychiatrist you trust and a routine that sort of works, but your mood still hasn’t lifted the way you hoped. If you’re looking into ketamine for treatment-resistant depression in Aventura, there’s probably a worry under the curiosity: does trying it mean giving all of that up?
Usually, it doesn’t: for most people, IV ketamine (ketamine given slowly through a vein) is added to the care they already have. Treatment-resistant depression is depression that hasn’t eased enough after at least two medicines.
Do I have to stop my antidepressant to try ketamine for treatment-resistant depression?
In most cases, you can keep taking your antidepressant. In 2021, a group of experts writing in the American Journal of Psychiatry expected ketamine to be added to the medicines people already take rather than replace them. Many studies gave ketamine together with common antidepressants.
Guidelines point the same way. The depression guideline used by the Department of Veterans Affairs and the Department of Defense suggests ketamine or esketamine as an add-on after several medicines haven’t worked. Needing more than one try is common. In a large federally funded study, only about one-third of people felt well again on their first antidepressant. If you’re still mapping your choices, see your options beyond antidepressants.
Esketamine (Spravato) is an FDA-approved nasal spray from the same medicine family. Its prescribing information allows it for treatment-resistant depression on its own or with an oral antidepressant. It carries a boxed warning, the FDA’s most serious label alert, and is given only in approved clinics under a federal safety program called REMS. Our framework to compare IV ketamine and Spravato covers the differences.
Which medicines matter when starting ketamine?
Before your first infusion, the team reviews your medical history and every medicine you take, and talks through any changes with you. Research points to a few medicines worth mentioning:
- Benzodiazepines (calming medicines such as lorazepam or clonazepam). The 2021 expert group noted they may weaken or slow ketamine’s effect, though the evidence is small and mixed. In a 2023 study of benzodiazepine use, taking a benzodiazepine didn’t take away ketamine’s benefit overall, though people on higher doses improved less on the first day.
- MAOIs and stimulants. MAOIs are an older type of antidepressant, and stimulants include many ADHD medicines. Ketamine can briefly raise blood pressure, and the esketamine prescribing information notes these medicines may raise it too. Your heart rate and blood pressure are watched throughout every infusion, and the dose can be adjusted or stopped at any time if you feel uncomfortable.
- Lamotrigine (a mood stabilizer). Whether it affects ketamine’s results is not known, but mention it so your team knows everything you take.
Any change to a medicine is your prescriber’s decision, made together with you. Please don’t stop or adjust anything on your own.
What should I bring to my first consultation?
Your medication list and the antidepressants you’ve tried matter most. If you can, bring:
- Your current medicines, with doses
- The antidepressants you’ve tried, and roughly how long you took each
- Recent clinic notes or questionnaire scores, such as a PHQ-9 (a short depression questionnaire)
- Contact details for your psychiatrist, primary-care doctor and therapist
- Your consent, if you’re comfortable, for us to share updates with them
It’s fine if something is missing. Testing before treatment can include blood and urine tests, a blood pressure check and an EKG (a quick heart rhythm test).
How does Nushama work with your psychiatrist and therapist in North Miami-Dade?
With your permission, our team works alongside your psychiatrist and therapist and keeps them updated. A U.S. public health task force found strong evidence that collaborative care, where your clinicians share one plan, helps people with depression feel better. In a 2015 study, when doctors used a short symptom questionnaire at each visit to guide medicine decisions, people were more likely to feel better than with standard care.
If you already see a psychiatrist, primary-care doctor or therapist in Miami-Dade or Broward, IV ketamine adds to that care. If you don’t, Nushama can help with a referral. Integration support is included. Licensed therapists and integration coaches help you make sense of what came up in a session and carry it into daily life, alongside your own therapy.
The Aventura clinical team includes Steven Radowitz, MD, co-founder and chief medical officer; Mark Braunstein, DO, senior psychiatrist; Cynthia Soderberg, BSN-RN, clinic and nurse director; and Tiffany Herrera, RN.
What happens after the first series?
After the first series, your team checks how you’ve responded and decides with you whether to add occasional follow-up infusions, called maintenance sessions. An initial series is usually six infusions, on a schedule your team sets with you, and the same expert group recommends that check-in after four to six infusions. In one small study, 59% of people improved substantially after six infusions over two weeks, with symptoms cut by half or more. Their gains held steady during weekly follow-up infusions.
Benefits can fade without ongoing care, which is why the experts recommend a plan for care after the series. Your psychiatrist, antidepressant and therapist keep supporting you between sessions.
Why do members in Aventura choose this approach?
Members can add IV ketamine close to home. Nushama’s medical team has overseen more than 21,000 ketamine infusions. Our Aventura center is at 2999 NE 191st St, Suite 200, at the corner of Biscayne Blvd and NE 191st St, easily reached from the William Lehman Causeway.
Private treatment rooms with reclining chairs, ambient lighting and curated music help members settle in. Our guide shows what a visit looks like.
Consultations, preparation and integration are available in Spanish; our Spanish-language Aventura page has details.
FAQ
How do I find out what my plan covers?
For Spravato, our team handles the insurance approval and verifies your benefits before your first session, and it is often covered. IV ketamine is typically paid out of pocket, and Nushama offers financing options and discount programs. Benefits vary by plan.
Is IV ketamine right for everyone?
It isn’t a fit for everyone. Some conditions, such as uncontrolled high blood pressure, certain heart conditions or active psychosis or mania, may mean ketamine isn’t a good option. A medical check and a conversation with your own clinicians help decide.
What if I’m having thoughts of suicide?
Please reach out now rather than waiting for a consultation. Call or text 988, the Suicide & Crisis Lifeline, or contact 211 Miami, available 24/7 in English, Spanish and Haitian Creole. If you’re in immediate danger, go to the nearest emergency room.
How do I take the next step?
Bring your medication list and your questions about how IV ketamine could fit alongside your current plan. Request a consultation with our Aventura care team, in English or Spanish.
