Ketamine for Co-Occurring
Depression & Chronic Pain in Baltimore
When your mental health provider says they can't treat your pain — and your pain specialist says they can't treat your depression
Can ketamine help if I have both depression and chronic pain in Baltimore?
Vita Nova offers physician-led ketamine for co-occurring depression and chronic pain in Canton, Baltimore. Mental-health infusions are $499.99 per session ($375 for members) and chronic-pain infusions are $1,499.99 ($1,125 for members) — one off-label IV treatment that uses a single shared mechanism, NMDA receptor blockade, to address both conditions: the central sensitization that amplifies chronic pain and the synaptic dysfunction underlying depression, PTSD, and anxiety. It is built for the patient whose mood condition and pain feed each other — depression amplifies pain through descending facilitation pathways, and chronic pain drives depression through inflammatory and sleep-disruption pathways. Ketamine interrupts both through one glutamatergic mechanism, not two separate treatments. Every infusion is anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD, a Johns Hopkins anesthesiologist — not a nurse-only or spa protocol. Care is self-pay with an itemized superbill; a six-infusion Complete Series ($2,849.94; $2,250 for members) adds 3 complimentary hydration IVs. Protocol and pricing are set individually by your primary burden and clinical evaluation. Overview: ketamine therapy in Baltimore.
Founder & Medical Director, Vita Nova · Johns Hopkins Faculty Physician · Assistant Professor, Anesthesiology & Critical Care Medicine · Chief, Thoracic Anesthesia, Johns Hopkins Hospital · Board-Certified Anesthesiologist
Mon–Fri: 1PM–8PM · Sat: 10AM–2PM
513 Bayview Blvd, Canton, Baltimore MD 21224
(443) 563-1059
Tell Us About Your Situation
Answer a few quick questions — our clinical team reaches out within 1 business day to discuss whether ketamine therapy may be right for you.
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When You Have Both — And Neither Provider Treats the Whole Picture
A significant proportion of patients with chronic pain have co-occurring depression, PTSD, or anxiety. A significant proportion of patients with depression that hasn't responded to standard treatment have chronic pain that standard mental health care does not address. The two clinical systems — mental health care and pain medicine — are largely separate, and most providers treat only one side of the equation. The result is patients who are treated for their depression while their pain is ignored, or treated for their pain while their depression goes untreated, and who find that treating only one side rarely produces meaningful relief for either.
The reason both conditions persist when only one is treated is that they are not independent — they are bidirectional, self-reinforcing, and share a common neurobiological substrate in NMDA receptor dysregulation. Understanding this bidirectional amplification cycle is the first step to understanding why ketamine — which targets the NMDA system — is uniquely positioned for this population.
The Shared NMDA Substrate — Why Ketamine Bridges Both
NMDA receptors are central to both chronic pain and mood disorder pathophysiology — which is why ketamine, as an NMDA antagonist, is uniquely positioned for patients with both. This is not coincidence — it reflects a fundamental commonality in the neurobiology of pain and mood that conventional treatment systems ignore by treating them separately.
NMDA Receptor Dysregulation — The Shared Substrate
Both chronic pain and mood disorders involve pathological NMDA receptor activity — in different circuits but through the same fundamental mechanism. Ketamine's blockade addresses both.
- NMDA receptor upregulation → excessive glutamate activity → synaptic pruning in prefrontal and limbic circuits
- Loss of dendritic spines in mood-regulating circuits → reduced capacity for emotional regulation and reward
- NMDA-mediated fear memory reconsolidation maintains PTSD intrusions and hyperarousal
- Ketamine blockade → BDNF release → synaptogenesis → restored mood circuit function
- NMDA receptor upregulation in spinal cord and brain → central sensitization → pain amplification
- Wind-up phenomenon — repeated pain signals progressively amplified through NMDA-mediated LTP
- Allodynia and hyperalgesia both NMDA-mediated
- Ketamine blockade → interrupts central sensitization → resets spinal and supraspinal pain processing
References: Woolf CJ, Salter MW (2000). Neuronal plasticity: increasing the gain in pain. Science 288(5472):1765-9. PubMed · Duman RS, Aghajanian GK (2012). Synaptic dysfunction in depression: potential therapeutic targets. Science 338(6103):68-72. PubMed · Zhou Y et al. (2021). Plasma inflammatory cytokines and treatment-resistant depression with comorbid pain: improvement by ketamine. J Neuroinflammation 18(1):200. PubMed · Bushnell MC, Ceko M, Low LA (2013). Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci 14(7):502-11. PubMed
Common Co-Occurring Presentations Evaluated at Vita Nova
The following are the most common combinations of mental health and chronic pain conditions seen at Vita Nova among patients seeking evaluation for ketamine. Each combination shares the NMDA substrate that makes ketamine mechanistically relevant to both dimensions simultaneously.
Fibromyalgia is a central sensitization syndrome — its widespread pain, fatigue, and cognitive fog are NMDA-mediated. Depression co-occurs in up to 60% of fibromyalgia patients and is frequently hard to treat. Ketamine's dual mechanism is particularly well-aligned to this combination — addressing both the synaptic dysfunction of depression and the central sensitization of fibromyalgia through the shared NMDA substrate.
Veterans and first responders with combat or duty-related injuries frequently present with co-occurring PTSD and chronic pain from traumatic injury — musculoskeletal, neuropathic, or post-surgical. The PTSD hyperarousal amplifies pain perception through shared neurological pathways. Treating only the pain ignores the PTSD amplification; treating only the PTSD leaves the chronic pain unaddressed. Ketamine's fear memory and central sensitization mechanisms address both simultaneously. Community Heroes discounts apply.
Chronic migraine and anxiety disorders co-occur at rates significantly above the general population — both involve NMDA-mediated hyperexcitability in overlapping neural circuits. Anxiety lowers the migraine threshold through cortical hyperexcitability and elevated stress reactivity. Chronic migraine produces anticipatory anxiety and avoidance that feeds the anxiety disorder. Ketamine's glutamatergic normalization may reduce both the neurological hyperexcitability driving migraine and the NMDA-mediated fear circuit dysregulation of anxiety.
Neuropathic pain — including diabetic neuropathy, CRPS, post-herpetic neuralgia, and chemotherapy-induced neuropathy — is among the most treatment-refractory pain conditions, and depression co-occurs in a substantial proportion of affected patients. Both neuropathic pain and hard-to-treat depression involve NMDA receptor upregulation and glutamatergic dysregulation. Ketamine's NMDA blockade is the most mechanistically direct approach to neuropathic pain available, while its synaptogenic mechanism simultaneously addresses the co-occurring depression.
Chronic back and spine pain has rates of comorbid depression approaching 40%. The depression removes the motivation for physical rehabilitation, worsens pain catastrophizing, and activates descending pain facilitation that amplifies the chronic pain signal. The central sensitization component that magnifies and perpetuates the pain, and the co-occurring depression that prevents recovery, are both amenable to NMDA-targeted treatment.
Inflammatory pain conditions — including rheumatoid arthritis, lupus, and psoriatic arthritis — are associated with elevated inflammatory cytokines that cross the blood-brain barrier and activate neuroinflammatory pathways that worsen depression and mood instability. Bipolar depression with inflammatory pain presents unique complexity — mood stabilizer review and manic switch risk assessment are part of the evaluation, alongside the pain protocol discussion.
Mental Health vs. Chronic Pain Protocols — And How Co-Occurring Patients Are Evaluated
The standard ketamine protocols for mental health and chronic pain differ in dose, duration, and number of sessions. For patients with both conditions, the appropriate protocol is the most important clinical decision made during the evaluation.
| Parameter | Mental Health Protocol | Chronic Pain Protocol | Co-Occurring — Determined at Evaluation |
|---|---|---|---|
| Typical dose | ~0.5 mg/kg IV | Higher — provider determined | Individual · Primary burden guides |
| Infusion duration | ~40 minutes | Longer — 90–180 min or multi-day | Individual · Both options available |
| Induction series | 4–6 sessions over 2–3 weeks | Series design varies by condition | Designed for your specific combination |
| Price / session (non-member) | $499.99 | $1,499.99 | Based on protocol at evaluation |
| Price / session (Vitality Circle member) | $375 | $1,125 | Member pricing applies to both |
| Payment | Self-pay · Superbill provided | Self-pay · Superbill provided | Superbill you can file with your insurance |
Paying for treatment: Vita Nova is self-pay for ketamine. We provide an itemized superbill you can file with your insurance. HSA/FSA cards are accepted for every session, and Community Heroes discounts apply. A six-infusion Complete Series is $2,849.94 ($2,250 for members) and includes 3 complimentary hydration IVs; the four-infusion Relief Series for pain is $5,699.96 ($4,500 for members) and includes 4 complimentary hydration IVs. Treating the mood component often reduces pain severity as well — by improving descending pain modulation and lowering the neuroinflammatory load that worsens both conditions. View self-pay pricing →
Evidence Supporting Ketamine Across Both Dimensions
The evidence base for ketamine in co-occurring mental health and chronic pain draws from both the robust depression and PTSD treatment literature and the growing chronic pain evidence base. The same NMDA mechanism appears across both bodies of research.
Complementary Treatments for Mental Health & Pain Together
Several wellness services at Vita Nova are particularly well-suited to patients with co-occurring mental health and chronic pain — addressing physiological factors that worsen both conditions simultaneously.
Magnesium is a natural NMDA receptor modulator — directly relevant to ketamine's mechanism in both pain and mood circuits. Magnesium deficiency is common in both chronic pain and depression, and its deficiency increases NMDA receptor sensitivity, worsening both central sensitization and mood circuit excitability.
Members: Included (2 shots/month)Iron-deficiency anemia drives the fatigue, low mood, and reduced pain tolerance that worsen both depression and chronic pain — and it is common in menstruating women and people living with chronic illness. When bloodwork confirms deficiency, IV iron restores stores faster than the oral supplements many patients tolerate poorly.
Members: 25% offNAD+ supports mitochondrial energy production in both neural and peripheral tissues — depleted by chronic pain states and long-term depression. Neurological restoration at the cellular level supports the synaptic plasticity that ketamine initiates. Particularly relevant for patients with fibromyalgia and neuropathic pain.
Members: 25% off all dosesHigh-dose IV Vitamin C has anti-inflammatory properties relevant to inflammatory pain conditions — addressing elevated inflammatory cytokine load that both worsens pain and crosses the blood-brain barrier to drive neuroinflammation implicated in mood disorders.
Members: 25% offB12 deficiency contributes to both neuropathic pain (through impaired myelin synthesis and nerve conduction) and mood disorders (through depletion of mood neurotransmitter synthesis cofactors). For patients with co-occurring neuropathic pain and depression, addressing B12 status simultaneously supports both.
Members: Included (2 shots/month)Clinical note: These wellness services are not treatments for any mental health condition or chronic pain condition. Always discuss supplemental therapy with your treating providers before beginning.
Special Pricing for Those Who Serve
Veterans and first responders present with co-occurring PTSD and chronic pain at rates far exceeding the general population. The Community Heroes program recognizes that cost should not compound the burden these patients already carry.
Co-Occurring Mental Health & Pain — Questions Answered
Real questions from patients with both a mental health condition and chronic pain evaluating ketamine and IV therapy at Vita Nova in Baltimore.
One Clinic Treats
The Whole Picture —
When your mental health provider says they can't treat your pain and your pain specialist says they can't treat your depression — Vita Nova's NMDA mechanism addresses both simultaneously. Protocol and pricing determined individually. Self-pay with an itemized superbill you can file with your insurance. Community Heroes discounts available.
Canonical URL: https://vitanovawellnessclinic.com/ketamine-mental-health-pain-baltimore/ · Last reviewed August 26, 2026
Medically reviewed by Dr. Brijen L. Joshi MD — Assistant Professor of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine · Chief of Thoracic Anesthesia, Johns Hopkins Hospital · Medical Director, Vita Nova Ketamine & Wellness Clinic. · View full team →
