Understanding the Medical Screening Process for Ketamine Therapy

A common misconception about ketamine therapy is that patients move directly from a phone call to an infusion chair. At Thrive Center for Health in Grand Rapids, no ketamine treatment begins without two distinct clearance steps — a psychiatric evaluation and a medical evaluation — each serving a specific clinical purpose. This process exists to protect patients, personalize treatment, and ensure that every infusion we administer is appropriate for the individual receiving it.

Why Screening Matters for Ketamine Therapy

Ketamine is a powerful medication with a well-established safety profile at therapeutic doses. Research from the NIH confirms that side effects from a single antidepressant dose of intravenous ketamine are mild and brief in clinical settings — but that safety profile is contingent on proper screening and monitoring (NIH, n.d.). The mild side effect profile documented in research applies to patients who have been appropriately evaluated, not to patients receiving ketamine without clinical oversight.

Ketamine is not appropriate for everyone. Certain psychiatric histories — including active psychosis, untreated mania, and some substance use patterns — require careful evaluation before ketamine is considered. Certain medical conditions and medications interact with ketamine in ways that require assessment and sometimes adjustment before treatment begins. The screening process exists specifically to identify these factors, address them where possible, and confirm that the patient presenting for treatment is a clinically appropriate candidate.

Beyond candidacy determination, screening serves a second function: it produces the clinical baseline our team uses to monitor your response across the course of treatment. Without a documented starting point — an accurate picture of your current psychiatric state, medication regimen, and medical history — we cannot meaningfully track whether treatment is working, identify early warning signs, or make informed adjustments to your protocol. The screening process is not a bureaucratic step before the real treatment begins. It is the foundation on which effective ketamine treatment in Grand Rapids is built.

Step One: Psychiatric Clearance

The first step in our intake process is a psychiatric evaluation with one of our Psychiatric Mental Health Nurse Practitioners. This appointment, which typically runs about 45 minutes, is an in-depth clinical conversation — not a checklist.

Our providers use this session to understand the full arc of your mental health history: the diagnoses you have received, the treatments you have tried, how long you have been managing your current condition, and what adequate response to treatment would look like for you. For patients presenting with treatment-resistant depression, anxiety, PTSD, OCD, bipolar disorder, or suicidal ideation, this history is particularly important. The clinical definition of treatment-resistant depression, for example, requires that a patient has not responded adequately to at least two antidepressant medications at appropriate doses for appropriate durations — and confirming that threshold is part of what the psychiatric evaluation establishes (Murrough et al., 2013).

Our providers also use the psychiatric clearance to screen for conditions that could affect candidacy or require protocol adjustments. This includes screening for bipolar spectrum features, which can make standard antidepressants less effective and require specific considerations in a ketamine protocol, as well as assessing for any history of psychosis or substance use that would need to be factored into the treatment plan. Every question asked during this evaluation has a clinical purpose, and our providers will explain the reasoning behind their assessment if you ask.

The psychiatric clearance costs $250 without accepted insurance. For patients with accepted insurance — including Cigna, BCBS, Priority Health, Aetna, McLaren, Molina, TriCare, Michigan Medicaid, and Michigan Medicare — the office visit is billed to insurance with a $40 deposit required at scheduling. You are responsible for what insurance does not cover. Visit our comprehensive health insurance page for a full breakdown of accepted plans.

Step Two: Medical Clearance

Following psychiatric clearance, patients complete a medical evaluation. This step assesses the physical health factors relevant to ketamine administration: cardiovascular status, current medications and potential interactions, any medical conditions that could affect how ketamine is metabolized or tolerated, and confirmation that the patient’s overall health supports the planned treatment protocol.

Medical clearances at our clinic are conducted by our board-certified Family Nurse Practitioner Kelsey, who handles all medical clearances and infusion administration. The medical clearance is not a general physical exam — it is a targeted evaluation designed to confirm that the patient is medically appropriate for the specific ketamine protocol being planned. For chronic pain patients, who receive higher-dose infusions than mood disorder patients, this evaluation is particularly thorough given the additional physiological demands of the pain protocol.

The medical clearance costs $150 without accepted insurance. As with the psychiatric clearance, office visit components are billed to insurance for patients with accepted coverage, with the $40 scheduling deposit required.

What Happens After Clearance

Once both clearance steps are complete, our team has a full clinical picture: your psychiatric history, your medical baseline, your current medications, and a confirmed assessment of your candidacy for the planned treatment protocol. At that point, we build your individualized treatment plan — the number of infusions in your initial series, the dose, the scheduling framework, and any specific considerations that apply to your situation.

For mood disorder patients, the standard initial series consists of 6–10 infusions. For chronic pain patients, the protocol involves 4–6 infusions at a higher per-session dose. Both protocols include a post-treatment follow-up appointment, and maintenance infusions are available on a weekly or monthly basis as needed following the initial series. You can review our pricing page for a full breakdown of infusion costs and package options.

The clearance process also establishes the relationship between you and your provider — a clinical relationship that continues across the full course of treatment. Our providers monitor your response closely across sessions, adjust your dose as needed, and remain available to address questions or concerns that arise during the treatment period. That continuity begins at the clearance step, not at the first infusion.

Addressing Fear of the Screening Process

We hear regularly from patients who have delayed seeking care because they are afraid of what a psychiatric evaluation involves. Some worry about being judged for the severity of their symptoms, or about disclosures being used in ways that feel outside their control. Others have had previous clinical experiences where their history was minimized or dismissed, and they approach a new evaluation with understandable wariness.

Our providers approach the psychiatric clearance as a collaborative conversation, not a gatekeeping exercise. The goal is to understand your situation accurately enough to determine whether ketamine therapy is appropriate and, if so, how to structure it for your best possible outcome. Bringing your full history — including treatments that did not work, symptoms you have been reluctant to disclose elsewhere, and honest concerns about the process — is exactly what makes the evaluation useful. That information does not disqualify you from treatment; in most cases, it helps us understand how to approach it.

Research on how ketamine interacts with brain chemistry helps explain why individualized screening matters so much. If you’re curious about the neuroscience behind this treatment, our post on how ketamine affects the brain offers a helpful overview.

The second barrier for many patients is cost. The combined cost of both clearance steps is $400 without insurance — $250 for the psychiatric evaluation and $150 for the medical evaluation. For patients with accepted insurance, these costs are billed to insurance with the $40 deposit required at scheduling, and you pay the remainder of what insurance does not cover. If you are uncertain about whether your plan covers these appointments, contact us before scheduling. We will verify your coverage and walk through the numbers before you commit.

Frequently Asked Questions

How long does the screening process take before I can start infusions? The psych clearance and medical clearance are typically scheduled as separate appointments. The psychiatric evaluation runs about 45 minutes. Scheduling depends on availability, but our team works to move through the clearance process efficiently. Contact us directly to discuss current wait times and scheduling options.

What if I don’t pass the screening? Screening is an assessment of clinical fit, not a pass-or-fail judgment. If the evaluation reveals factors that make standard ketamine therapy inappropriate for your current situation, our providers will explain what those factors are and what they would need to look like before ketamine could be reconsidered. In some cases, adjustments to existing medications or treatment of a comorbid condition may make candidacy possible over time. Our team will discuss your options clearly.

Do I need to stop my current medications before the screening? No. Bring a complete list of your current medications — including dosages — to both clearance appointments. Medication review is part of the evaluation process. Any adjustments that may be needed before infusions begin will be discussed with you during or after the clearance appointments, not assumed in advance.

Will my primary care provider or therapist be contacted? Not without your consent. If coordinating with outside providers would benefit your treatment plan, our team will discuss that with you and ask for your authorization. Collaborative care is something we support, but it is initiated with your knowledge and agreement.

What does the $40 deposit cover? The $40 deposit is required at scheduling for patients with accepted insurance and is applied toward the cost of the appointment. It is not an additional fee — it is part of the payment structure for insured patients. Contact our front desk for details specific to your coverage.

Key Takeaways

• Ketamine therapy at Thrive Center for Health requires two clearance steps before any infusion begins — a psychiatric evaluation and a medical evaluation — each serving a distinct clinical purpose.
• The psychiatric clearance establishes your full mental health history, confirms clinical candidacy, and screens for conditions that could affect the treatment protocol; the medical clearance assesses physical health factors and medication interactions.
• The combined cost of both clearance steps is $400 without accepted insurance; for patients with accepted plans, office visit components are billed to insurance with a $40 deposit required at scheduling.
• The screening process is a collaborative clinical conversation, not a gatekeeping exercise — bringing your full history, including prior treatment failures and symptoms you have been reluctant to disclose, makes the evaluation more useful.
• Results vary by individual, and the clearance process exists in part to identify which patients are most likely to benefit from ketamine therapy and to build treatment plans calibrated to each patient’s specific clinical picture.

Ketamine therapy works best when it is built on an accurate clinical foundation — and that foundation is what the screening process creates. At Thrive Center for Health in Grand Rapids, the clearance appointments are where we learn what we need to know to treat you well. If you are ready to begin that process, call us at 616-730-8069 or schedule a consultation online. Results vary by individual, and the evaluation is the right place to bring every question you have before treatment begins.

References

National Institutes of Health. (n.d.). Side effects mild, brief for single antidepressant dose of intravenous ketamine. https://www.nih.gov/news-events/news-releases/side-effects-mild-brief-single-antidepressant-dose-intravenous-ketamine

Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., Iqbal, S., Pillemer, S., Foulkes, A., Shah, A., Mathew, S. J., & Charney, D. S. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: A two-site randomized controlled trial. American Journal of Psychiatry, 170(10), 1134–1142. https://pubmed.ncbi.nlm.nih.gov/23982301/

Medical Disclaimer

The information in this blog is provided for educational purposes only and does not constitute medical advice. Ketamine therapy should only be pursued under the supervision of a licensed medical provider familiar with your full psychiatric and medical history. Individual results vary — not every patient will be an appropriate candidate for ketamine therapy, and no specific outcome can be guaranteed. Discuss all treatment options with a qualified healthcare provider before making decisions about your care. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.