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Condition · Bipolar Disorder

Ketamine therapy for bipolar depression in DC, Maryland & Virginia

Bipolar disorder causes unusual shifts in mood, energy and concentration that can derail daily life, and the depressive episodes often resist standard antidepressants. When you are in a depressive episode — NOT mania — ketamine may offer relief other treatments have not.

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A quiet corner for journaling and integration work
10+ yrsTreating patients in the DMV
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5Clinics across DC, MD & VA
1,000+Patients treated to date

Ketamine is not recommended during manic or hypomanic phases of bipolar disorder — it can be too intense and may worsen symptoms during those periods. Where it can help is during depressive episodes: research supports ketamine for treatment-resistant depression generally, and a growing body of evidence backs its careful use specifically for bipolar depression under close psychiatric supervision. At Avesta, bipolar depression is treated as part of a full diagnostic picture: we screen you, recommend a treatment path, and bring your mental health team into the conversation. 

You may recognise yourself here

If several of these describe your last few months, a consult is worth twenty minutes of your time.

  • A depressive episode that has lasted two weeks or more
  • Low energy and motivation that make daily tasks feel impossible
  • Sleeping far more or far less than usual during this episode
  • Loss of interest in things you used to enjoy
  • Feelings of hopelessness or worthlessness
  • Difficulty concentrating or making decisions
  • Depression that has not responded to standard antidepressants
  • Increased thoughts of suicide during depressive episodes

And you have already tried things

  • Mood stabilizers or antipsychotics without enough relief from depressive episodes
  • Antidepressants that either have not helped or raised concern about mood switching
  • Talk therapy that helps you cope but has not lifted the depression
  • Being told there is little left to try beyond what you are already on

That history matters — it is exactly what makes a different mechanism worth considering.

Why It Persists

Why bipolar disorder can stall and how ketamine works differently

Effective in the depressive phase, not the manic one

Ketamine can be too intense during hypomanic or manic episodes and may worsen symptoms during those periods. Its benefit is specific to the depressive phase of bipolar disorder, which is why timing and psychiatric coordination matter here more than with most conditions.

A different target than standard antidepressants

Ketamine acts on glutamate — the brain's main excitatory neurotransmitter — by blocking NMDA receptors and triggering a downstream cascade many people feel within weeks rather than months.

Where the evidence points

A 2021 international expert consensus paper concluded that given the high rate of treatment-resistant depression in people with bipolar disorder, along with preliminary evidence of safety and efficacy, ketamine is worth considering as an investigational treatment for bipolar depression.

A window where therapy lands differently

For several days after dosing, the brain is measurably more plastic. We aim to take advantage of this window by recommending treatment paired with integration coaching or ketamine-assisted psychotherapy if you don't have your own mental health provider. Our goal is to reinforce new habits instead of a temporary lift.

Our team monitors you throughout your session so that you can relax and feel safe.

How Avesta Treats It

Our treatment options

We do not sell one package to everyone. After screening, your clinician recommends the path with the strongest evidence for your history — and says so plainly when ketamine is not the answer.

Most common starting point

IV Ketamine Therapy

Used during depressive episodes only, in coordination with your psychiatrist and current mood stabilizer

  • 45–60 minute sessions, six over two to three weeks
  • Dose titrated to you, adjusted between sessions
  • Clinician and vitals monitoring throughout
  • Boosters scheduled only when your response calls for it
Treatment details →
Insurance pathway

Spravato (esketamine)

When treatment-resistant depression is the primary diagnosis and you need insurance coverage

  • The only FDA-approved esketamine treatment, for TRD
  • In-network with many plans
  • Delivered in our REMS-certified clinics
  • Two-hour monitored visit, twice weekly at first
Treatment details →

Ketamine-Assisted Psychotherapy

When long-standing patterns or trauma are tangled up with the depressive episodes

  • Licensed therapist in the room to provide trauma support
  • Structured preparation and integration sessions
  • Coordinated with your existing therapist
Treatment details →

Integration Coaching

Between and after sessions, to make the gains hold

  • Accompanied by a psychedelic- or ketamine-trained coach
  • Preparation for your first treatment
  • Sitting sessions during treatment for emotional support if wanted
  • Integration sessions after
Treatment details →

What To Expect

From first call to maintenance, step by step

  1. 01

    Free 30-minute consult

    A clinician reviews your diagnosis, medications and history, answers questions and tells you candidly whether ketamine is a reasonable next step. No referral needed, no cost, no obligation.

  2. 02

    Medical & psychiatric screening

    Blood pressure, cardiac and psychiatric history, current prescriptions and substance history are reviewed before anything is scheduled. Some people are safely declined at this stage — that is the point of it.

  3. 03

    Your first session

    You arrive with a ride home arranged. Dosing takes 45–60 minutes in a private room with a clinician present, followed by a short recovery period. Most people describe it as floaty and dreamlike, not frightening.

  4. 04

    The initial series

    Six to eight sessions over two to three weeks. Many patients notice a shift around the fifth or sixth session; your provider re-scores symptoms and adjusts dose along the way.

  5. 05

    Integration

    Coaching or KAP alongside the series, plus written updates to your therapist, psychiatrist or primary care provider so everyone is treating the same plan.

  6. 06

    Maintenance

    Boosters scheduled by response, not by package. If you are not responding, we say so and help you look at other options.

Free 30-Minute Consult

  • No cost, no referral needed
  • Benefits checked up front
  • A clinician on every call
Book my consult(301) 381-8381

Please do not include medical details in web forms. In a crisis, call 988.

Other Conditions We Treat

Dr. Ladan Eshkevari, PhD, CRNA, FAAN, founder of Avesta Ketamine and Wellness, with a patient
Who Sets Our Protocols

Dr. Ladan Eshkevari, PhD, CRNA, FAAN

Founder & Co-CEO · Georgetown University faculty

Dr. Eshkevari led a study with her Georgetown graduate students published in the Journal of Psychiatric Research, supporting ketamine therapy for people living with treatment-resistant depression. She sets the clinical protocols used at every Avesta clinic.

Read the published study (PDF)Watch her interview

Patient Reviews

What real patients say on Google

ExcellentBased on 225 reviews
Write a review
Amy GutierrezAugust 18, 2026BethesdaGoogle
I have had the pleasure of going to 3 locations- Bethesda, Tyson, and DC. Every experience has been phenomenal and the staff makes sure you are heard and happy. Both before the infusion and afterwards. They are all amazing and have the best bedside manners!
Wendy LaffermanSeptember 25, 2026ColumbiaGoogle
This was my first visit to Avesta for a Ketamine infusion for chronic migraine pain comorbid with mental health diagnosis.

Coming in with a lot of anxiety due to past experiences, I was greeted by Nyla who was kind, patient, and empathetic throughout my entire visit. She was there to answer any questions I had. The environment was quiet and peaceful; with a sign as a reminder.

My practitioner, Nate, was amazing. He was caring and intentional. Communicated every step of the process and eased all my fears; specifically getting the IV on the first stick!! Both checked in on me often throughout the infusion to ensure I was having the best possible experience.

I’m incredibly grateful that I found this place and am looking forward to my next visit!
Kate GowingAugust 2, 2026Norfolk/Virginia BeachGoogle
Great treatment, been coming to Avesta in DC for a while. Glad they finally opened closer to me.
Spencer AgostiniAugust 2, 2026TysonsGoogle
Avesta is the best ketamine clinic in Northern Virginia. I did my research and I'm so glad I decided to go with Avesta.
Matthew ConnorsSeptember 10, 2026Washington DCGoogle
Nice atmosphere, professional staff that are also warm and friendly. I won't go anywhere else.
Paul ThompsonJuly 3, 2026BethesdaGoogle
Meghan was well informed, polite, answered all of my questions clearly and in the context of our conversation she provided information she discerned to be important to me.
Toby KatesAugust 2, 2026ColumbiaGoogle
Excellent clinic for Spravato treatments, they are so friendly and welcoming.
Carole WilkinsFebruary 10, 2026TysonsGoogle
As always the experience was top notch. Nate and Gillian saw to it that my needs were met and questions answered. I always feel like I’m in the best hands when I’m there. These treatments are life savers for me.
Elsa AlaswadJuly 18, 2026Washington DCGoogle
This place is a haven for me. What makes it the most special are the people who work here, especially Abigail and Arielle. They make the whole experience feel safe and comfortable. Abigail is a wonderful and caring future physician who makes you feel right at home. She’s a joy to have around. Arielle is an expert at IV placement in addition to being an amazing healthcare provider with impeccable bedside manner. I love to see she’s the NP on because I know I’m gonna be in extremely capable hands. Avesta is my happy place. Thank you for making my life better.
D SMay 3, 2026BethesdaGoogle
Excellent service and facility.
Carolyn ErwinAugust 1, 2026ColumbiaGoogle
No complaints. Always feel better after my sessions!
B CJanuary 16, 2026TysonsGoogle
I love this place. It’s comfortable and the staff is so nice. Dion Gillian and Mimi are the best. I highly recommend them.

What The Care Looks Like

Setting your expectations

Weeks, not monthsTypical onset

If you are responsive to Ketamine, the effects can be felt around the 5th or 6th session. For responders, ketamine's effects can be measurable far faster than oral medications.

6-8 sessionsStandard initial series

Delivered over two to three weeks, then reassessed against your baseline scores.

Symptom scoringAt every visit

We send you mood surveys to track validated symptom scales so that you can recognize how far you've come, in addition to how your mood progresses.

Individual results vary. Ketamine is not FDA-approved for bipolar disorder and is used off-label, specifically for depressive episodes and under close coordination with your psychiatrist; it is not appropriate during manic or hypomanic phases. Spravato (esketamine) is FDA-approved only for treatment-resistant depression and for depressive symptoms in adults with MDD with acute suicidal ideation or behavior. Nothing here is a promise of outcome or a substitute for evaluation by a clinician.

Candidacy

You may be a candidate if…

Screening happens before anything is booked. Being told no is a legitimate outcome of a consult.

Likely a good fit

  • You are 18 or older with diagnosed bipolar disorder, currently in a depressive episode
  • Standard mood stabilizers or antidepressants have not relieved this episode
  • You have a psychiatrist or prescriber we can coordinate with
  • Your blood pressure and cardiac history are stable or well managed
  • You can arrange a ride home after each session

We would pause or refer out if

  • You are currently experiencing a manic or hypomanic episode
  • Uncontrolled high blood pressure, or recent heart attack or stroke
  • Active, untreated psychosis
  • Pregnancy or breastfeeding
  • Active, unmanaged substance use — we will help you sequence care first

Safety standards on every visit

  • Full medical and psychiatric history reviewed before your first visit
  • A clinician is present and vitals are monitored for every dose
  • Emergency protocols and medications on site at every clinic
  • LegitScript-certified practice, REMS-certified for Spravato
  • Written coordination with your therapist, psychiatrist and primary care team

Insurance & Cost

In plain terms, before you commit

We verify your benefits and give you an out-of-pocket estimate on your consult call.

Spravato

In-network with many commercial plans. We run your benefits and give you an out-of-pocket estimate before you commit to anything.

IV ketamine

Generally out-of-network. We provide superbills for reimbursement claims and HSA/FSA funds are usually eligible.

Veterans & military families

We work with Veterans Affairs Community Care to serve our military families directly.

First responders 

Ask during your consult call for discounted pricing for first responders, current military or veterans. 

Locations

Our Ketamine Clinics in Washington, DC, Maryland & Virginia

Every Avesta location is staffed by a licensed clinician for every session.

Washington, DC clinic
Washington, DC

1400 16th St NW, Suite 101

(202) 735-1183
Bethesda, Maryland clinic
Bethesda, Maryland

4833 Rugby Ave, #400

(301) 200-9333
Columbia, Maryland clinic
Columbia, Maryland

5840 Banneker Rd, Suite 270

(301) 381-8381
Tysons, Virginia clinic
Tysons, Virginia

8000 Towers Crescent Dr, Suite A150

(703) 646-6343
Norfolk / Virginia Beach, Virginia clinic
Norfolk / Virginia Beach, Virginia

6275 E. Virginia Beach Blvd, Suite 103

(301) 381-8381

FAQs

Common questions about bipolar disorder

Is ketamine safe if I have bipolar disorder?

Ketamine is not recommended during manic or hypomanic episodes, where it can be too intense and may worsen symptoms. Its benefit is specific to the depressive phase of bipolar disorder. We screen carefully for your current mood state and coordinate with your psychiatrist before recommending treatment.

Is ketamine FDA-approved for bipolar disorder?

No. Ketamine is used off-label for bipolar depression specifically, based on preliminary evidence and expert consensus. Spravato (esketamine) is FDA-approved specifically for treatment-resistant depression and for MDD with acute suicidal ideation or behavior. On your consult we explain exactly which route applies to your diagnosis and why.

How quickly might I feel a difference?

Ketamine acts far faster than oral antidepressants — some people notice a change within days. In a standard six-to-eight-session series, patients most often report a meaningful shift around the fifth or sixth session. Some do not respond, and we tell you rather than extending the series indefinitely.

Can I keep taking my mood stabilizer or other medications?

Yes — staying on your mood stabilizer is essential. Your clinician will review your full medication list, including mood stabilizers and antipsychotics, and coordinate any changes with your psychiatrist. We never adjust psychiatric medications without your prescriber’s involvement.

What does a session actually feel like?

Most people describe a floaty, dreamlike state with altered sense of time and body, lasting about the length of the dose. It is not painful and you remain able to communicate with the clinician in the room. Nausea and mild dizziness are the most common side effects and are treatable on the spot.

How much does it cost?

It depends on the route. Spravato is in-network with many plans; IV ketamine is typically out-of-network with superbills provided. We verify your benefits and quote your out-of-pocket cost before you schedule — no surprise billing.

Do I need a referral?

No. You can book a free consult directly. Because coordination with your psychiatrist is especially important for bipolar disorder, we will ask permission to loop them in before treatment begins.

Which clinic should I go to?

We have five: Washington DC, Bethesda, Columbia, Tysons and Norfolk/Virginia Beach. Not every clinic offers every treatment, so we match you to the nearest location that offers the route you need.