Practice Statement

Dr. Cohen’s practice offers comprehensive treatment for mood and anxiety disorders. In addition to psychopharmacology and psychotherapy, Dr. Cohen’s office offers Transcranial Magnetic Stimulation (TMS), a medication-free alternative treatment for depression and other disorders; Ketamine, a cutting-edge psycho-pharmacological approach to depression; and pharmaco-genetic testing to help guide the approach to medication. 

Ketamine Therapy in Columbus Circle NYC

Ketamine is a cutting-edge psychiatric treatment being used to target severe medication and treatment resistant depression. Ketamine has been widely used as an anesthetic for minor procedures since the 1960s.  In many countries, it is used by first aid response workers when dealing with minor trauma.  The safety of Ketamine is such that it is used as outpatient anesthetic by non-physicians.  The dose used to treat depression is about one quarter (1/4) of anesthetic dose.

While it has not yet been formally approved by the FDA, there are now many studies that demonstrate that Ketamine infusions for depression may be an effective and rapid treatment option. Benefits may occur after only one treatment, though typically an initial course of several treatments are required for a more robust response.

Our Ketamine infusions take place at our convenient midtown New York City location in a private room with state-of-the-art medical equipment under the supervision of Dr. Cohen. Each infusion takes about one hour and is administered intravenously.

The American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments has issued a consensus statement that “ketamine may be beneficial to some patients with mood disorders,” and encouraging doctors to weigh benefits and risks of this therapy with potential patients based on available data.

An estimated 17.3 million U.S. adults experienced at least one major depressive episode in 2017. Many individuals suffering from depression receive treatment and begin to feel better. For some people, symptoms seem to resist treatment and stick around even after trying many different antidepressant medications and treatment methods.

As a mental health clinic specializing in the treatment of mood and anxiety disorders, Principium Psychiatry has experience serving patients with a range of disorders and symptoms, including treatment-resistant depression. At Principium, we believe people deserve access to any care that could provide relief from depression and other mental health disorders. That’s why we’re dedicated to providing cutting-edge treatments like ketamine infusion therapy in addition to traditional psychopharmacology and psychotherapy.

Located across from Carnegie Hall in the heart of New York City, we offer ketamine therapy for patients with severe, treatment-resistant depression and other mood disorders. Our goal is always to treat our patients with the utmost respect and compassion and find the most effective treatment options for each individual’s needs. Learn more about ketamine therapy in NYC and feel free to reach out to us with any questions you may have.

A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders

For more information about Ketamine infusions for treatment-resistant depression, visit the Ketamine Advocacy Network.

What Is Ketamine Infusion Therapy?

Ketamine infusion therapy is an innovative treatment method that involves using small doses of the anesthetic ketamine as an antidepressant. In ketamine therapy, the drug is delivered directly into the bloodstream through an IV. This allows the drug to have maximum effect.

Ketamine is thought to relieve symptoms of depression by binding with glutamate receptors in the brain. Glutamate is a neurotransmitter that is dysfunctional in patients with depression. By activating the neurotransmitter receptors and pathways, ketamine has been found in animal studies to promote the regrowth of neurons damaged by prolonged exposure to stress, potentially leading to remission of depression in the long-term.

Although ketamine as an anesthetic holds U.S. Food and Drug Administration (FDA) approval, it is considered an off-label treatment when used for depression and other mental health disorders. This means ketamine is not yet FDA-approved specifically for the treatment of depression. Psychiatrists and physicians have permission to prescribe off-label medications at their discretion based on available evidence and the potential benefits to the patient. The American Psychiatric Association released a consensus statement on the use of IV ketamine to treat major depressive disorder. At Principium Psychiatry, we are one of few clinics in NYC able to provide innovative treatments like ketamine therapy. Our clinic is affiliated with New York Presbyterian Hospital, Weill Cornell Medicine and Columbia University, where our medical director Dr. Cohen is Clinical Assistant Professor.

Who Can Benefit From Ketamine Therapy?

Because ketamine therapy is still under medical and scientific investigation, this type of treatment is typically recommended for adults with severe, treatment-resistant depression who have tried other medications and seen little result. You may also benefit from ketamine psychiatry if you have had side effects from antidepressants that have made continued treatment impossible. At Principium Psychiatry, we have also seen ketamine therapy assist patients with varying levels of anxiety in addition to depression. Ketamine has been used successfully to treat bipolar depression, PTSD, OCD, and pain.

Ketamine infusion therapy is one of the fastest-acting treatments for depression. As a result, it can serve as a life-saving option for patients suffering from suicidal thoughts who need relief from symptoms as quickly as possible.

We welcome both local and international patients at our ketamine clinic in NYC. Our experienced and caring psychiatrists will work to understand your symptoms and determine whether ketamine could work for you. We’ll then create an individualized treatment plan tailored to your unique situation, whether that plan involves ketamine infusion, Transcranial Magnetic Stimulation (TMS), medication, psychotherapy, or another option.

What Can You Expect When Starting Ketamine Therapy for Depression?

When you come to Principium Psychiatry for ketamine therapy in NYC, we’ll do everything we can to make you feel comfortable and relaxed at every appointment. In most cases, we’ll provide six ketamine infusions, given 2-3 times per week over 2-3 weeks. Depending on your unique needs, you may receive additional infusions after this initial treatment period.

At a typical ketamine therapy appointment, you’ll have both a registered nurse and a psychiatrist or psychiatric nurse practitioner in your private room with you the whole time. Once the IV is inserted, treatment usually takes around an hour. You’ll stay awake during treatment, and you’ll have the option to listen to music or chat with the supervising staff. Our unique ketamine protocol was developed by our medical director Dr. Cohen.

Some patients start to experience relief from symptoms soon after the first treatment, although you may have several treatments before you notice a substantial effect.

Insurance typically does not cover ketamine infusion therapy. However, we will provide a detailed invoice you can give to your insurance company to receive reimbursement for aspects of treatment that are covered, such as IV placement and saline solution.

Does Ketamine Have to Be Given Through IV?

In addition to IV, there are ketamine nasal sprays available for patients in NYC. Although IV infusions are the gold standard of ketamine therapy given the large clinical trials proving their efficacy, intra-nasal ketamine is now available in an FDA approved formulation, Spravato. Only specially licensed clinics are able to provide Spravato therapy. At Principium, we are proud to offer Spravato treatment to our patients. Please visit our Spravato page to learn more about this exciting form of ketamine therapy.

If you have any questions or concerns about the infusion therapy process, we would be happy to discuss them with you.

What Are the Benefits and Risks of Ketamine Therapy?

For many patients with treatment-resistant depression, the benefits of ketamine therapy are numerous. Ketamine therapy for depression is typically fast-acting, effective and safe. The dose of ketamine required is much lower than when used for anesthetic purposes, and it can quiet suicidal thoughts and help you start feeling better quickly.

Compared to antidepressant medications, ketamine comes with few side-effects. Ketamine can affect blood pressure and heart rate, which is why we monitor these metrics during treatment. Long-term risks in those who abuse ketamine at high doses include urinary symptoms, substance use disorders and cognitive impairment. As a result, the American Psychiatric Association has advised doctors to consider the advantages and risks for individual patients based on available data.

At Principium Psychiatry, our team members will work with you to understand your medical history and identify potential risks before recommending ketamine therapy.

KETAMINE FAQS

How was ketamine for depression discovered?

In recent years, there has been a surge of information on the uses of ketamine for the treatment of depression. Ketamine is an anesthetic which has been on the market since the 1960s. Ketamine was introduced into clinical practice as an anesthetic that reliably brought about sedation for surgical purposes with little effect on respiration or the circulatory system. The name “ketamine” derives from two of the molecules found in ketamine’s molecular structure: a ketone and an amine.

 

It was first suggested in 2000 that ketamine may have antidepressant effects in humans. The suggestion was based on animal studies of depression showing that a neurotransmitter called glutamate was dysfunctional in depression. Other studies showed that NMDA, a drug that binds to glutamate receptors, relieved depression in humans. This led to the “glutamate hypothesis” about the origins of depression. Ketamine was known to bind to glutamate receptors.

 

A number of clinical trials support the use of ketamine for depression. These randomized, controlled clinical trials, have compared Ketamine to a placebo. Studies have shown that even one infusion of Ketamine is superior to placebo and achieves clinically meaningful reductions in depression rating scores. Other studies have shown that serial treatments with Ketamine (i.e. more than one infusion) can increase the response rate to the treatment. On the basis of this evidence, the American Psychiatric Association released a consensus statement on the use of Ketamine to treat depression: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2605202

Is Ketamine for depression FDA approved?

Ketamine treatment for depression is an off-label treatment. This means that although Ketamine is an FDA approved drug for anesthesia, and has passed the FDA’s rigorous safety testing process for this purpose, the FDA has not approved the use of ketamine for depression. Physicians, however, are authorized to prescribe a medicine to treat other conditions based on clinical judgment and professional evidence.

 

The website of the FDA (https://www.fda.gov/ForPatients/Other/OffLabel/default.htm) explains off-label medication use:

“From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient. You may be asking yourself why your healthcare provider would want to prescribe a drug to treat a disease or medical condition that the drug is not approved for.  One reason is that there might not be an approved drug to treat your disease or medical condition.  Another is that you may have tried all approved treatments without seeing any benefits.  In situations like these, you and your healthcare provider may talk about using an approved drug for an unapproved use to treat your disease or medical condition.”

 

Of note, Ketamine is given in smaller doses for the treatment of depression than are typically used in anesthesia.

What is the success rate?

Studies show that approximately 3 out of 4 patients will have a positive response to ketamine treatment for depression.

How do I make an appointment?

Simply call our office at 212-335-0236. Alternatively, you can book an appointment online at ZocDoc: https://www.zocdoc.com/doctor/ziv-cohen-md-40226. You do not need a referral from a psychiatrist, since Principium Psychiatry is psychiatrist led by our medical director, Ziv Cohen, MD, a Fellow of the American Psychiatric Association. Dr. Cohen will do a comprehensive assessment and provide you with a diagnosis and recommendations, including whether you are appropriate for Ketamine treatment.

What are the side effects?

Ketamine is given in small doses for the treatment of depression. As such, a typical side effect is mild sedation. Some patients complain of mild nausea, which is easily treated with anti-anxiety medication. Some patients have mild elevations or reductions in blood pressure. Dr. Cohen will discuss with you side effects in detail during your consultation.

How many treatments do I need?

The typical treatment course involves 6 infusions, which are given 2 to 3 times per week (for a period of 2-3 weeks). In some cases, further infusions are given during the initial course.

Is the treatment done in a hospital or private office?

At Principium Psychiatry, we offer Ketamine infusions in our private, comfortably appointed office located off Columbus Circle and Central Park South in the heart of New York City. We are located directly across the street from Carnegie Hall.

What happens during an infusion?

During the infusion, a multidisciplinary team will be present, including a registered nurse and a psychiatrist or psychiatric nurse practitioner. Your blood pressure, heart rate, and blood oxygen levels will be measured continuously during the infusion. The team will be closely monitoring you. You will be free to engage in conversation, close your eyes and relax, or listen to calming music. You will not fall asleep during the treatment.

Can I resume normal activities after a Ketamine infusion?

Ketamine is rapidly metabolized. Within ten to fifteen minutes after the infusion you will feel substantially more alert. Patients generally report that a full recovery to normal activities takes about 1 hour. There is some individual variation in responses to ketamine.

What happens after I finish my treatment course?

After you finish your initial course of 6 or more infusions, you and the treatment team will make a plan for follow up care. Some patients will return for further infusions on an as needed basis (typically several months or more after the initial course), while other patients with particularly severe symptoms will be placed on a regular maintenance treatment schedule (typically monthly infusions).

Is Ketamine safe for me if I am taking antidepressants?

Yes, Ketamine is safe to administer with most medications.

Is Ketamine addictive?

No, administered at small doses in a medical setting, there is no evidence that Ketamine is addictive. In contrast, those who abuse ketamine recreationally do so at very high doses to induce psycho-active affects.

If I have already had TMS or ECT without benefit, could Ketamine still help me?

Yes, clinical experience supports that Ketamine can be effective for patients with treatment resistant depression, including those who have already tried ECT and TMS without benefit.

I am considering TMS in addition to Ketamine. Which do you recommend?

At Principium Psychiatry, we offer both TMS and Ketamine treatment.

We offer a detailed comparison of the two treatments in our blog: https://www.principiumpsychiatry.com/ketamine-vs-tms-which-treatment-is-best-for-me/. You will also find additional useful information about ketamine and TMS on our blog.

Are there medical conditions which prevent me from receiving ketamine for depression?

In general, ketamine is safe for patients with a variety of health conditions. If there is a concern about your cardiovascular health, we may refer you for a check up to make sure you are able to receive ketamine treatments.

Is IV Ketamine effective for anxiety?

While still in preliminary studies, there has been scientific evidence showing that IV infusions of ketamine can be effective in treating generalized anxiety disorder and social anxiety disorder. Our team at Principium Psychiatry has treated many patients who, in addition to having depression, also have varying degrees of anxiety. Throughout their infusion protocols, we have found that not only do their depressive symptoms improve, but so does their anxiety.

Why do you use an IV infusion for Ketamine treatments?

Some patients ask, “Why does it have to be IV? I don’t like needles!”

IV is the best route for your brain to receive ketamine because of something called bioavailability. In addition, it is also more effective, more precise, and safer for you.

 

Receiving a medication intravenously is the only way to have 100% bioavailability. Let’s take a look at the different bioavailability percentages based on what route you receive ketamine:

Intravenous: 100%
Intranasal: 25-50%
Sublingual (under the tongue): 30%
Orally (by mouth): 16-24%

When we give ketamine intravenously, we know exactly where your entire dose is going: straight to your brain. The same cannot be said for other forms of ketamine.

IV ketamine is by far the safest and most effective approach in using ketamine to treat depression. You are in a comfortable setting with healthcare providers with you the whole time, the potential for side effects is low, and you are certain that the dose you receive is the dose that is going to your brain, maximizing the benefits of this cutting-edge treatment.

Why Choose Principium Psychiatry for Ketamine Therapy in NYC?

Our multidisciplinary team includes experienced psychiatrists, psychologists, nurses and psychiatric nurse practitioners who come to us from a range of respected institutions, including Cornell University, Columbia University, Binghamton University and Yale University. All of our team members work hard to make patients feel welcome and heard.

We’re committed to finding effective treatment options for every patient, no matter how mild, severe or treatment-resistant their symptoms may be. Our comfortable and conveniently located midtown office sees patients between 9 a.m. and 8 p.m. Monday-Friday, and on weekends by special appointment.

Schedule an Appointment

Getting treatment is the best way to move forward from depression and find relief from symptoms. Even if you’ve tried other treatments in the past, ketamine therapy can offer help. If you’re ready to take the next step toward feeling better, please view our availability online or call 212-335-0236 to schedule an appointment with Principium Psychiatry today.

MEET OUR DOCTORS

Dr. Ziv E. Cohen is a Weill Cornell-affiliated and board-certified psychiatrist with extensive experience treating mood disorders, trauma, PTSD, and a variety of other disorders.  His experience lies with individuals across the lifecycle, including adolescents and adults. Dr. Cohen is also Clinical Assistant Professor of Psychiatry at Weill Cornell Medical College of Cornell University, and on the medical staff of New York Presbyterian Hospital, both in New York City.

Dr. Irina Kogan is a board certified psychiatrist with a thorough knowledge of psychopharmacology across the full spectrum of psychiatric disorders. She is expert in the treatment of mood, anxiety, and attentional disorders. In addition, she completed addiction psychiatry training at Mount Sinai Beth Israel Medical Center, where she gained expertise in the treatment of co-occurring substance use disorders.

Sarah Delaney is a Yale-trained psychiatric nurse practitioner. In New York State, psychiatric nurse practitioners are fully licensed psychopharmacologists. She is a skilled practitioner and is on staff at the Columbia University outpatient psychiatric department. In her private practice, she treats a variety of conditions with the most current and comprehensive regimens. Ms. Delaney received her undergraduate and master’s degrees at Yale University. Ms. Delaney works with children, adolescents, and adults to address a wide range of social, emotional, and behavioral issues.

Avi Adri is a board certified Psychiatric Nurse Practitioner, with training and experience in treating clients using a holistic approach. Avi graduated at the top of his class from Stony Brook University with a specialization in the psychiatric care of at risk youth. He is currently on staff at the Psychiatric Department of NYP-Columbia University Medical Center. With over seven years of clinical experience Avi brings a humanitarian ideology of both mind and body with a deep dedication to comprehensive personalized care for all individuals.

Ashley Strongwater is a Physician Assistant with extensive experience as a Psychiatric PA. She completed a BS in neuroscience at the University of Michigan and her physician assistant training at Mercy College in New York. Ashley’s passion for neuroscience led her to pursue psychiatry as her speciality. Ashley is a skilled psychopharmacologist, using the best regimens to control symptoms of depression, anxiety, bipolar disorder, ADHD, and other conditions.