Who are the clinicians?
Dr. Jeremy Shugar is the owner and practicing clinician at PASTmed, providing safe and supported in-home ketamine treatments in NYC. Read more about Dr. Shugar and his qualifications here.
What’s included in the PASTmed service?
PASTmed’s practice philosophy appreciates the bi-directional effects the mind and body have on each other. Treatment plans include one or more doses of ketamine delivered intramuscularly or intra-nasally within the comfort of your own home within a KAP inspired model. This practice integrates osteopathy prior to medication administration to promote optimal physiologic function, quiet the nervous system, and bring awareness for later focus to any ‘somatic dysfunction’ that may be functional in ongoing physical symptoms.
Everyone’s KAP experience will be designed specifically for their unique needs. The number of treatments, the method of administration, and the timeline for healing will vary from person to person, which is why oversight by an experienced and available doctor is critical. As a small practice, PASTmed designs and delivers convenient and customized in-home KAP in the NYC area without ever stepping foot into a clinic.
How are ketamine, psychotherapy, and osteopathy related?
These healing methods integrate into a holistic treatment plan that targets mental and physical health. Ketamine is often used for its rapid antidepressant effects, especially in treatment-resistant cases. This creates a window of reduced symptoms where patients may be more receptive to psychotherapy. In this way, ketamine enhances the psychotherapeutic process by facilitating deeper emotional processing and cognitive reevaluation. Osteopathy focuses on the physical manipulation of the body’s structure to support overall health, complementing ketamine-assisted psychotherapy by addressing the physical aspects of mental health disorders such as tension and pain from chronic stress and depression. Together, these modalities can provide a comprehensive and synergistic approach that addresses the interconnectedness of mind and body, offering multiple pathways for your healing and recovery.
Can ketamine treat depression, anxiety, and PTSD?
Yes, ketamine can help manage various mental health conditions including depression, anxiety, PTSD, chronic pain, and other persistent neuropathic challenges. It can be especially effective in treatment-resistant cases where traditional medication has failed to yield results. In combination with psychotherapy and osteopathy, ketamine is a powerful healing medicine for mind and body.
What is ketamine?
Ketamine is a safe and legal medication that can help treat challenging conditions like PTSD, anxiety, and depression. It’s been used safely for 50+ years in medical settings, initially as an anesthetic and recently as a psychotherapeutic medicine. It can take the form of liquid, spray, or lozenge and it’s prescribed off-label. It inhibits NMDA receptors and stimulates AMPA receptors in the brain, which can enhance mood-regulating neural circuits and encourage neuroplasticity. Ketamine triggers immediate mood-enhancing and antidepressant effects that can last for weeks.
What are the benefits of ketamine?
Ketamine works faster than other medications. It produces neurobiological effects in your brain that allow you to safely explore new perspectives in an alternate state of being. It helps your brain make new synaptic connections, forming healthier thought patterns.
It’s a safe, accessible, rapid, and impactful healing tool for people suffering from chronic trauma, depression, and neuropathic pain. Ketamine can be a valuable tool in preventing suicide due to its fast-acting nature.
Ketamine is also more predictable than psilocybin, LSD, or Ayahuasca. Studies out of Yale, Mt. Sinai, and other top universities found that ketamine was more effective than traditional antidepressant medication for some patients.
Is ketamine legal?
Yes, ketamine is completely legal. In fact, it’s considered one of the most powerful breakthroughs in psychiatry due to its fast-acting and predictable antidepressant effects—especially for people who don’t respond to traditional antidepressant medication. Ketamine is listed on the World Health Organization’s Essential Medicines list since 1985.
Is ketamine therapy FDA-approved?
Ketamine can be legally prescribed and administered by licensed physicians. While it is approved by the FDA as an anesthetic, it is not approved as a treatment for depression. About 30% of all medications are “off-label,” including many cancer drugs. This means they are used in applications different from their intended purpose, according to the FDA. Off-label ketamine has been used safely and legally in private medical practices for almost a decade. Pharmaceutical companies have not invested in the required trials to get FDA approval, and it’s unlikely they will do so. The drug will remain off-patent so no company can own the revenue.
Do you treat patients under 18 years of age?
This practice would consider the use of ketamine for individuals less than 18 years of age as part of an interdisciplinary decision with the prospective patient’s psychiatrist and/or primary care physician.
What form of ketamine administration do you offer?
This practice offers intramuscular intramuscular (IM) and intranasal administration of ketamine. Each method has differing bioavailabilities, benefits, and drawbacks. Intramuscular injections are favored by this practice because they are less invasive than IVs while still offering high bioavailability. At this time, oral lozenges and sublingual administration are not available through PASTmed. Read more about different methods of ketamine administration here.
ABOUT
FAQ:
EXPERIENCE
FAQ:
How do I prepare for my ketamine experience?
Choose the place in your room where you’d like to receive treatment. It should be somewhere comfortable where you can lie back for 60 minutes.
Invite a friend or caretaker to sit with you, if desired. Gather the comfort items you’d like with you, such as a blanket, socks, eye mask, headphones, etc.
You can eat and drink normally, although some administration methods require that you do not consume any food within one hour of your appointment.
What is the ketamine therapy experience like?
Before the in-home treatment begins, you’ll discuss the experience with Dr. Shugar, set intentions and optimize your comfort: lighting, temperature, and music will be adjusted to your liking and blankets and eyeshades will be available. Following a brief ceremony, you will lie back in a comfortable position and receive the dose-controlled medicine via the method previously selected by you and your clinician (either intranasally or intramuscularly).
As the medicine progresses, you may experience physical and emotional changes like lightness, dreaminess, and calm. You might feel separate from your body, noticing alternate sensory textures and imagery. Your motor and verbal abilities may slow down while the medicine works. Most significantly, routine perceptions of oneself and realty are disrupted, opening a potential space for re-appraisal and growth. The experience is mostly internal, and Dr. Shugar will remain with you throughout to offer support and hold space.
It’s different for every person and it’s different every time. Dr. Shugar will carefully monitor you and provide support in case of any unpleasant side effects.
After about 40-60 minutes, you may feel fully alert again if slightly disoriented. You will acclimate yourself as you regain awareness of the space around you. You may feel like the spiritual insights you’ve gained are obvious, even if they’re difficult to articulate. Dr. Shugar will take notes to aid in your integration.
Once Dr. Shugar confirms that you are feeling safe and answers any lingering questions, he will pack up and depart your home, leaving you with printed follow-up instructions.
How long does it take?
The average session is about 1.5 to 2 hours, although the actual ketamine experience may last between 45 and 60 minutes. The sessions ends with quiet integration time before “discharge.”
The effectiveness of the ketamine may be immediate. Some patients may need around four sessions to notice durable improvement.
Will I be asleep?
No, you will be fully awake for your ketamine experience with each administration method offered by PASTmed. There is no loss of consciousness in ketamine therapy.
Is it painful?
Ketamine is not a painful treatment. If you are receiving an intramuscular administration, the doctor will use a tiny needle to deliver the medicine. This part is brief and hurts no more than a small prick. It is not uncommon to feel slight pressure when medicine is injected. The actual experience of the medicine is pleasurable to most patients.
Is it safe to get ketamine therapy at home?
Yes, ketamine has been safely administered for 50+ years and it’s safe and easy to receive ketamine therapy at home. There are various methods of administration, and all include strict medical protocols to ensure your health and safety in a home setting.
Can I go to work and drive the next day?
Although most people feel very clear after a ketamine session, we recommend that you plan to avoid driving, operating equipment, or signing documents after treatment. You can go to work the next day.
What is integration?
Integration can help you transform your insights from a ketamine experience into long-lasting growth and healing. At PASTmed, integration sessions may include psychotherapy and osteopathy to help your mind and body digest your experience at a deeper level. You may review the memories and thoughts that emerged during your treatment, and you may prepare for subsequent doses.
OTHER FACTORS
FAQ:
How does starting ketamine treatment at PASTmed work?
The first step is to reach out for a consultation with Dr. Shugar, either via text, call, or email. This is a preliminary screening and it’s completely free.
If you decide to proceed with treatment, you will schedule an evaluation to go over your medical history and goals for treatment. This carries a fee. You will fill out intake forms ahead of your appointment, and then participate in an in-person evaluation with Dr. Shugar. In this session, you’ll review your medical history and collaborate on a treatment plan.
Next, you’ll book your first in-home treatment appointment and receive instructions on how to prepare for ketamine therapy.
Do I need a referral from a psychiatrist?
No, you do not need a referral although we welcome referrals from mental health care providers. Start with a free initial phone consultation to determine if you’re a good candidate for ketamine therapy.
What if I already have a therapist?
Excellent! This practice encourage—and in most cases requires—that all patients follow up with a mental health provider, keeping them appraised of their sessions and to maintain their scheduled therapy appointments to help with integration. If a prospective patient does not have a therapist, Dr. Shugar would be happy to provide a referral.
Who should not be treated with ketamine?
People taking Benzodiazepines should discuss their medication regime with the doctor. These medications can block ketamine efficacy. Some antipsychotics or anti-seizure medications should also be avoided. People with hypertension, personality disorders, heart conditions, and pregnant/nursing people may not be eligible.
Is addiction a concern with ketamine therapy?
There is no evidence that ketamine therapy in appropriate doses will lead to addiction or dependence. In fact, the opposite is true—research shows that ketamine can help people overcome addiction. If you have a history of substance abuse, you can still access ketamine but you should disclose this during your assessment.
What are the side effects from the treatments offered?
Side effects are quite minimal and they tend to abate after an hour or two. You may experience slightly elevated blood pressure, mild sleepiness, and light nausea. If you have hypertension or if you’re prone to motion sickness, discuss it with the doctor in your intake. Some people feel temporary anxiety, which can partially be managed with a comforting home environment including music and eye shades. There are no delayed “flashbacks.” Please tell your doctor if you experience additional side effects.
Can I take my medications while having these experiences?
Some medications should be avoided or adjusted prior to your session, either because they interfere with how well ketamine works, or because of an additive effect. If you are on Lamotrigine (Lamictal) or Benzodiazepines (Valium, Ativan, Xanax, Lorazepam, Klonopin), Memantine, clozapine, haloperidol or risperidone, additional coordination with your prescriber may be necessary. Never abruptly discontinue or adjust your medications unless under the supervision of your prescribing physician. It is critical that you disclose any and all medications as part of your intake assessment.
Are there any medical conditions that exclude me from treatment?
Some medical or psychiatric conditions may exclude you from treatment, or require follow up with your primary care doctor or specialist for optimization and clearance. Conditions that may limit eligibility include uncontrolled hypertension, hyperthyroidism, heart conditions, bladder disease, schizophrenia or personality disorders. Additionally, pregnant or nursing moms should not use ketamine.
How do I know if ketamine treatment is right for me?
If you’re experiencing depression, chronic pain, PTSD, anxiety, or exhaustion, then in-home ketamine treatment in NYC might help you. Ketamine is an especially useful medicine for people who have not found relief through conventional medication or therapy. Ketamine for chronic pain, ketamine for PTSD, and ketamine for depression are all common applications of this healing tool.
Call to schedule an intake assessment and discuss a personalized care plan based on your health history, symptoms, and goals.
LOGISTICS
FAQ:
Where are your services available?
PASTmed is a NYC-based house call service that provides care for patients who live in Manhattan, Brooklyn, Queens, Bronx, and Staten Island. Services are also available outside of NYC, however a travel fee may apply. For patients who prefer not to receive treatment at their own home, it’s possible to provide an office call (such as a therapist’s office for therapy) or house call to a friend or relative’s home.
What is the cost of treatment?
Dr. Shugar is committed to making this important work accessible to those who are most likely to benefit. Unfortunately, many people who could benefit from certain treatments are often unable to because they cannot afford the full fees, becoming ineligible due to financial limitations. Recognizing this as a significant barrier, Dr. Shugar addresses the issue by offering an ethical and flexible sliding scale. For reference, an in office ketamine session alone without psychotherapeutic support, guidance, integration or somatic work is seldom less than $500. Standard fees in this practice should reflect the convenience, amount of time and care Dr. Shugar provides to each individual as a house call service. Some may say that is double or triple to a typical practice model. However, because so many people who seek this work are also unable to afford what many may consider the “usual and customary fee”, Dr. Shugar has chosen to abandon these obsolete pricing structures to ensure that no eligible patient is turned away due to financial constraints.
For prospective patients that benefit from a livable income, minimal debt, other assets, etc, we ask that they pay full fees as follows:
$500.00 - Initial Intake/eligibility determination which includes a comprehensive intake, history and physical/osteopathic exam, assessment and recommendations.
$1500.00 - Single in-home Ketamine Assisted Psychotherapy (KAP) Session (~3 hrs)
$2000.00 - Single in-home integrated Osteopathic / KAP session (~4 hrs)
Multi-session and couple discounts are available.
Are there any financial assistance programs or sliding scale fees for patients? Do you offer military or first responder discounts?
Yes. If you struggle with a history of trauma and you are financially unable to pay the full fee, reach out and ask about sliding scale fees.
This practice aims to be flexible. We want to ensure that populations who face additional trauma and economic marginalization (veterans, first responders, and more) can access this valuable healing medicine.
If you benefit from a livable income, minimal debt, and other assets, we ask that you pay the full fee.
Is it covered by insurance?
Insurance, including Medicare and Medicaid, does not cover ketamine treatments. Depending on your policy, parts of your visit may be eligible for some reimbursement. Integrative sessions with OMT (osteopathic manipulative treatment) are considered a billable medical procedure and is covered by some insurance plans.
Do you accept HSA/FSA cards?
Major cards that accept HSA/FSA are accepted. This practice accepts major credit cards including Visa, Mastercard, American Express, and Discover.
What are the payment options—and is financing available?
This practice accepts cash, check, major credit cards.
What is your cancellation and reschedule policy?
To respect the time of both our clients and the demands of a small practice, we kindly ask that you provide at least 72 hours’ notice if you need to cancel or reschedule your appointment. Cancellations or rescheduling requests made less than 72 hours before your scheduled appointment will result in a $500 fee.
We understand that unforeseen circumstances can arise. If you are unable to provide the required notice due to an emergency or other significant issue, please contact our practice as soon as possible to discuss your situation. We are committed to understanding and flexibility where warranted.
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