Ketamine treatment has emerged as a promising option for individuals suffering from treatment-resistant depression, anxiety, post-traumatic stress disorder, and certain chronic pain conditions. If you are considering ketamine therapy for yourself or a loved one, the following referral information will guide you through the process.

Who is an Ideal Candidate for Ketamine Treatment?

Patients Who May Benefit from This Therapy Include:

✔️ Individuals with a history of depression that has not improved after trying at least two different antidepressants from different medication classes
✔️ Patients diagnosed with moderate to severe Major Depressive Disorder (MDD)
✔️ Those experiencing chronic suicidal thoughts (without immediate intent or plan, and under clinical supervision)
✔️ Individuals living with Post-Traumatic Stress Disorder (PTSD)
✔️ Women with Postpartum Depression who are medically cleared for treatment
✔️ Patients undergoing an acute depressive episode or mental health crisis and in need of rapid relief

🧠 Ketamine therapy is often considered when traditional antidepressants have not been effective or have caused intolerable side effects.

Who Should Not Receive This Treatment

Contraindications to Treatment

This treatment may not be appropriate for individuals with the following:

❌ History of aneurysms or arteriovenous malformations

❌ Uncontrolled high blood pressure (hypertensive crisis risk)

❌ History of psychosis or active psychotic symptoms

❌ Current substance use disorder (especially involving ketamine or other dissociatives)

❌ Hypersensitivity or allergy to the active drug or its components

❌ Pregnancy or breastfeeding (unless explicitly approved by a healthcare provider)

❌ Severe liver impairment

❌ Unstable cardiovascular conditions (e.g., recent heart attack or stroke)

Referral Process

For Mental Health Providers, Therapists, and Non-Mental Health Providers:

To initiate a referral, please follow these steps:

1. Submit the Referral Form
   Complete and send the official referral form.

2. Submit the Most Recent Office Visit Note
   Attach documentation from the patient's most recent office visit.

3. Review and Contact Timeline
   Once all documentation is received and reviewed, the patient will be contacted within 2–5 business days.

Follow-Up After Referral

Successful ketamine treatment involves ongoing monitoring and coordination between the referring provider and the Revitalize. Regular updates on patient progress and any adverse effects help optimize care. Progress updates with be sent to referring provider during the treatment course.