Ketamine for Bipolar Depression
in Baltimore
When the depressive phase won't lift — and standard treatments haven't been enough
Ketamine for bipolar depression Baltimore costs $499.99 per session ($375 for Vitality Circle members) and is off-label IV ketamine infusion therapy for the depressive phase of bipolar disorder only — the phase that is often more frequent, longer-lasting, and more disabling than mania, yet harder to treat responsibly. It is delivered as anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD, a Johns Hopkins anesthesiologist, with a Certified Registered Nurse Anesthetist (CRNA) on-site. Every evaluation reviews your current mood stabilizer regimen, assesses manic switch risk, and confirms the Bipolar I vs II distinction; unstable or recent mania is an exclusion, and ketamine is never a replacement for your mood stabilizer. Ketamine is self-pay, with an itemized superbill you can file with your insurance for possible out-of-network reimbursement. Not everyone is a candidate — you'll be told clearly after evaluation.
"The team is extremely professional, compassionate and knowledgeable — they take the time to explain the process thoroughly and care about your well-being throughout." — Google review, Vita Nova patient
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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Bipolar Depression — The Harder Half of the Illness
Bipolar disorder is often described in terms of mania, but for most people living with it, the depressive phase causes the greatest cumulative suffering. Bipolar depression is more frequent, longer-lasting, and more strongly associated with disability and suicide risk than the manic phase — yet it is remarkably difficult to treat. Standard antidepressants often fail in bipolar depression, and worse, can trigger a switch into mania or accelerate mood cycling. This is why bipolar depression demands a fundamentally different, more careful treatment approach than unipolar depression — and why ketamine is evaluated here with more caution than for any other mood condition.
The depressive phase — persistent low mood, anhedonia, fatigue, cognitive slowing, hopelessness, and elevated suicide risk. This is the phase ketamine is evaluated to address, always alongside mood-stabilizing treatment. The depressive burden of bipolar disorder accounts for the majority of time spent unwell in both Bipolar I and Bipolar II.
The elevated phase — mania or hypomania — is not treated by ketamine. In fact, the primary concern is that any antidepressant-like treatment could trigger a switch into this phase. Mania is managed by your mental health provider through mood stabilizers and antipsychotics, which must remain in place throughout any ketamine evaluation.
Manic Switch Risk — Addressed Directly
The single most important clinical question in ketamine for bipolar depression is the risk of triggering a manic or hypomanic episode — the "switch." This concern shapes the entire evaluation, and it is why bipolar depression cannot be treated like unipolar depression.
The concern: Antidepressant treatments can push a bipolar patient from depression into mania or hypomania, or accelerate the frequency of mood episodes (cycling). This risk is why standard antidepressants are used cautiously — or avoided — in bipolar depression.
- The reassuring data: Controlled studies of IV ketamine for bipolar depression — including the landmark trials by Diazgranados (2010) and Zarate (2012) — reported low rates of treatment-emergent mania when ketamine was given as an add-on to mood stabilizers. Switch rates were comparable to placebo in these controlled settings.
- The essential condition: That reassuring evidence applies specifically to patients maintained on adequate mood stabilizer coverage. This is precisely why Vita Nova requires that a mood stabilizer regimen — lithium, valproate, lamotrigine, or an atypical antipsychotic — be in place before ketamine is considered.
- Individual risk still varies. Bipolar I with a history of frequent or severe manic switches carries different risk than Bipolar II. Your specific history directly shapes whether ketamine is appropriate — and how conservatively it would be dosed and monitored.
- Monitoring is built in. Every patient is monitored for early signs of mood elevation throughout the treatment course. Any indication of a switch prompts immediate reassessment and coordination with your mental health provider.
Bipolar I vs Bipolar II — Why the Distinction Matters
Your specific bipolar diagnosis is not a technicality — it fundamentally shapes the risk-benefit evaluation for ketamine. The two presentations carry different switch risks and require different levels of caution.
Defined by at least one full manic episode. Because Bipolar I involves a demonstrated capacity for full mania, the risk and consequences of a treatment-emergent switch are greater. Ketamine evaluation for Bipolar I depression is approached with heightened caution — particularly for patients with a history of antidepressant-induced switches or rapid cycling. Robust mood stabilizer coverage is essential, and dosing is more conservative.
Defined by hypomanic episodes (not full mania) plus major depressive episodes. Bipolar II depression is frequently the dominant, most disabling feature and is where much of the ketamine evidence base is concentrated. Switch risk to hypomania still exists and is evaluated, but the ceiling of that risk differs from Bipolar I. Mood stabilizer coverage remains required.
If you are unsure whether you have Bipolar I or II, that is something the evaluation will clarify with you and your mental health provider. What matters is that ketamine is never offered for bipolar depression without an accurate diagnosis, a clear picture of your switch history, and confirmation of current mood-stabilizing coverage.
The Mechanism & The Evidence
Ketamine's rapid antidepressant action works through a mechanism entirely different from standard antidepressants — which is central to why it may help in bipolar depression where monoamine antidepressants often fail.
The controlled evidence for IV ketamine in bipolar depression is meaningful but smaller than for unipolar treatment-resistant depression. Effects are often robust but can be temporary, which is why a maintenance approach is discussed individually. Ketamine is not a cure, not a mood stabilizer, and not a replacement for your existing regimen — it is an add-on evaluated to address the depressive phase.
The Care Pathway & Pricing
Ketamine for bipolar depression is off-label and delivered as a short induction series alongside your existing mood stabilizer coverage — not as a replacement for it. Each session is delivered as anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD, a Johns Hopkins faculty physician, with individualized dosing and continuous monitoring — the price reflects physician-level, monitored care, and the Complete Series adds 3 complimentary hydration IVs. Here is what the pathway and pricing look like.
- Comprehensive evaluation — diagnosis confirmation, mood stabilizer review, switch history, current mood state
- Coordination with your mental health provider regarding your mood stabilizer regimen
- Induction series of IV ketamine infusions, individually dosed and conservatively titrated
- Continuous monitoring for mood elevation throughout the treatment course
- $499.99/session non-member · $375/session Vitality Circle member
- An established mood stabilizer regimen (lithium, valproate, lamotrigine, or atypical antipsychotic)
- An accurate Bipolar I vs II diagnosis
- A clear picture of your manic/hypomanic switch history
- Ongoing relationship with a mental health provider for mood stabilizer management
- Currently in the depressive phase — not manic, hypomanic, or mixed
| Treatment | Non-Member | Vitality Circle Member | Saving |
|---|---|---|---|
| Ketamine Infusion — per session Off-Label | $499.99 | $375 | $124.99/session |
| Complete Series — 6 infusions +3 complimentary hydration IVs | $2,849.94 | $2,250 | $599.94 |
Self-pay, with a superbill. Vita Nova is self-pay for ketamine. We provide an itemized superbill you can file with your insurance. HSA and FSA accepted; Community Heroes discounts available. Sessions determined individually. Pricing August 2026 — subject to change. Full pricing guide →
Complementary Treatments Alongside Care
Bipolar disorder is associated with mitochondrial dysfunction, oxidative stress, and nutritional deficiencies that can worsen depressive symptoms. The following wellness services address these physiological factors — none is a treatment for bipolar disorder, and all should be coordinated with your mental health provider.
Emerging research links bipolar disorder to mitochondrial dysfunction. NAD+ is central to cellular energy metabolism, and IV NAD+ supports mitochondrial function — a rational complement to the physiological exhaustion of the bipolar depressive phase.
Members: 25% off all dosesMagnesium modulates NMDA receptor sensitivity and has been studied for mood stabilization. Deficiency is common and associated with mood dysregulation and poor sleep. IM delivery bypasses the poor absorption of oral magnesium.
✅ Included for Vitality Circle members (2 shots/month)B vitamins — particularly B12 and folate — are cofactors in neurotransmitter synthesis and mood regulation. Deficiency is associated with poorer response to mood treatment. IM delivery provides the full spectrum at therapeutic bioavailability.
✅ Included for Vitality Circle members (2 shots/month)Oxidative stress is elevated in bipolar disorder. Glutathione is the body's primary antioxidant, and levels are often reduced in mood disorders. IM glutathione supports antioxidant capacity — complementing the cellular support of NAD+ therapy.
✅ Included for Vitality Circle members (2 shots/month)Clinical note: These wellness services are not treatments for bipolar disorder and are not a substitute for mood stabilizers or mental health care. They address general physiological factors and should always be coordinated with your treating mental health provider.
Bipolar Depression & Ketamine — Questions Answered
Common questions from patients and families evaluating ketamine therapy for bipolar depression in Baltimore.
The Depressive Phase
Deserves Careful Options
When the lows have taken too much and standard treatments haven't been enough, ketamine may be evaluated — carefully, as an add-on to your mood stabilizer regimen, with manic switch risk assessed directly. All care anesthesiologist-led, under the medical direction of Dr. Brijen Joshi MD. Self-pay with an itemized superbill.
Canonical URL: https://vitanovawellnessclinic.com/ketamine-bipolar-depression-baltimore/ · Last reviewed August 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 →
