Frequently Asked
Questions

Most antidepressants (SSRIs, SNRIs, MAOIs) work by adjusting serotonin, norepinephrine, or dopamine — a process that takes weeks to months to produce results. Ketamine works through an entirely different mechanism: it blocks NMDA receptors, causing a surge in glutamate that rapidly promotes the growth of new synaptic connections. This is why many patients who have not responded to 2, 4, or even 8 prior antidepressant trials see meaningful relief from ketamine. It's not a "better antidepressant" — it's a fundamentally different approach to the same problem.

Prescriptions are written monthly and include 15 sessions — typically used at a rate of 3–4 sessions per week. Your clinician sets the schedule based on your condition, response, and goals. Some patients notice meaningful improvement within the first 1–2 weeks; others respond more gradually over the first month. We reassess your response each month before renewing your prescription. Some patients continue monthly for several months; others taper down or discontinue once a stable improvement is reached. We'll guide every decision collaboratively.

Generally, good candidates are adults who have a diagnosis of treatment-resistant depression, anxiety, PTSD, OCD, chronic pain, or bipolar II depression and who have not achieved adequate relief from at least one or two prior treatments. You should be medically stable without uncontrolled hypertension, active psychosis, or certain other contraindications. The best way to find out is through our free consultation — we'll give you an honest, individualized assessment. We don't take patients who aren't genuine candidates.

When used at clinical doses under medical guidance, ketamine has a very low addiction risk. The doses used in therapy are significantly lower than those associated with recreational misuse. Our protocols are infrequent (not daily), carefully dosed, and tightly monitored — each prescription is tracked and refills require clinician approval. That said, ketamine does have abuse potential in recreational contexts, which is why we conduct thorough substance use screening during evaluation and maintain an ongoing clinical relationship throughout your treatment. We will discuss any concerns openly and honestly.

The most common side effects are temporary and resolve within about an hour of your session: nausea, dizziness, mild dissociation, and transient increases in heart rate and blood pressure. Fasting beforehand and staying well-hydrated help reduce nausea. In rare cases of long-term heavy use (not applicable to our clinical protocols), urinary tract issues have been reported. Our comprehensive pre-treatment screening is designed to minimize risks, and your clinician reviews your response after each session. We'll walk through the full informed consent document with you before treatment begins so you understand every possible effect.

Many medications are compatible with ketamine therapy. Our physician will conduct a thorough medication review during your telehealth evaluation. Some medications may require timing adjustments (for example, certain benzodiazepines can blunt ketamine's effects if taken close to a session). A few medications — particularly some MAOIs — may be contraindicated. We'll give you clear, specific guidance based on your exact medication list. Please have a complete list of all medications, supplements, and over-the-counter drugs ready to share at your evaluation.

Having a trusted support person with you during every session is one of the most important safety measures for at-home treatment — they can offer reassurance and reach out on your behalf if something feels wrong. Sublingual ketamine's effects are relatively mild and wear off on their own within an hour; there is no IV to pause, but because the dose is lower than IV protocols, overwhelming experiences are uncommon. We prepare you thoroughly before your first session and provide grounding techniques.

Yes — Couch Spaceship is a referral service and is cash-pay only. There are two separate costs: a $350 doctor fee paid directly to the independent physician who evaluates you and writes your prescription, and a medication cost around $120 paid to the compounding pharmacy that fills it (the exact amount may vary depending on which pharmacy is used). No insurance billing, no prior authorizations, no coverage denials. We accept all major credit cards and HSA/FSA cards for the doctor fee.

Yes — HSA and FSA funds can generally be used for physician-prescribed ketamine therapy. We accept HSA and FSA cards directly and provide itemized receipts for your records. We recommend confirming with your HSA/FSA administrator if you have any questions about your specific plan's coverage rules.

We strongly recommend — and for your first several sessions, require — that a trusted adult be present with you at home during each session. Since the treatment is at-home, there's no commute to worry about, but you should not drive, operate machinery, or be alone until you feel fully grounded (typically within 1–2 hours of completing a session). Having a support person present isn't just a safety measure — research suggests that a calm, trusted presence enhances the therapeutic experience.

Most patients feel fully back to normal the morning after a session. Some experience mild fatigue or grogginess for up to 24 hours. We generally recommend taking the rest of the treatment day off. For the following day, most people return to work and normal activities without issue — though we advise against high-stakes tasks (important presentations, demanding travel) on the day immediately following your first session until you know how your body responds.

No referral is required to start the process. You can contact us directly and we'll conduct our own medical evaluation.

Response duration varies considerably between individuals. Some patients experience sustained remission for 3–6 months or longer after a full 6-session course. Others maintain benefits with periodic booster sessions. Research suggests that integration practices — therapy, mindfulness, lifestyle changes — during the post-treatment window significantly extend the duration of benefit.

Integration refers to the intentional process of reflecting on and applying insights from your ketamine sessions to your daily life. The neuroplasticity that ketamine promotes creates a temporary "window of growth" — new neural pathways form more easily. Integration practices (journaling, therapy, mindfulness, meaningful conversations) help anchor those changes in lasting ways. Research consistently shows that patients who actively integrate their ketamine experiences maintain benefits longer than those who simply undergo infusions without any follow-up work.

Not everyone responds to ketamine, and we believe in being honest about that. Clinical studies show roughly 60–70% of treatment-resistant patients experience meaningful improvement — which means 30–40% may not see the benefit they hoped for. If you're in that group, we won't push more treatment. We'll review the full picture, discuss whether any protocol modifications might improve your response, and help connect you with other evidence-based options. Our commitment to you goes beyond selling a service.