Montana consistently ranks among the top five states in the nation for suicide rate, a statistic that reflects a mental health crisis made sharper by geographic isolation, limited specialty psychiatric access, and a cultural norm of self-reliance that can make seeking help feel like weakness. Treatment-resistant depression — depression that persists despite adequate medication trials — sits at the center of this crisis, and it is exactly the population Cassidy Boyer, CRNA, built Mend the Mind to serve. IV ketamine therapy is the cornerstone of Cassidy’s clinical practice, and the evaluation process she applies before recommending it says as much about her clinical philosophy as the treatment itself does.
The Clinical Case for IV Ketamine
IV ketamine for depression is an off-label application of an FDA-approved anesthetic medication. The psychiatric use of ketamine is not FDA-approved, and Cassidy is direct about this with every patient who walks through the door of Mend the Mind. Off-label use is not inherently problematic — it is legally and ethically appropriate when supported by clinical evidence and administered with informed consent — but the distinction matters, and patients deserve to know what they are being offered. The body of research supporting IV ketamine for treatment-resistant depression is substantial: multiple randomized controlled trials, including landmark work from the National Institute of Mental Health, have demonstrated rapid and significant reductions in depressive symptoms following ketamine infusions in patients who had not responded to prior antidepressants.
What Cassidy Evaluates Before Recommending IV Ketamine
What Cassidy evaluates before recommending IV ketamine begins with the treatment history. She reviews every medication the patient has tried — not just the name, but the dose, the duration, and the reason for discontinuation. This matters because “treatment resistance” can mean very different things: a patient who tried sertraline at 50mg for three weeks before stopping due to side effects has a different clinical profile than one who completed adequate trials of three different antidepressants at therapeutic doses for adequate durations. Cassidy’s evaluation is designed to determine whether a patient has actually experienced treatment failure or whether there are prior medication trials that are worth reconsidering before moving to an advanced intervention. Honest clinical assessment sometimes means redirecting a patient toward optimizing a prior treatment rather than immediately advancing to ketamine.
For patients who have genuinely experienced adequate prior treatment trials without adequate response, Cassidy then turns to the risk-benefit analysis specific to ketamine. This includes a review of cardiovascular health — ketamine transiently elevates heart rate and blood pressure, which requires medical screening — psychiatric history including any personal or family history of psychosis, current substance use patterns, and the patient’s support structure. Mend the Mind is an outpatient clinic in Livingston, and Cassidy ensures that every patient who receives IV ketamine has adequate support available during and after the treatment period. This is not bureaucratic caution — it is the basic clinical responsibility of a provider working with a dissociative agent in an outpatient setting. If you are wondering whether you may be a candidate, our guide on Am I a Candidate for Ketamine Therapy? is a helpful starting point.
What the IV Ketamine Experience at Mend the Mind Looks Like
The IV ketamine experience at Mend the Mind typically involves a series of four to six infusions over two to three weeks for the initial treatment course. Each infusion session lasts approximately 45 to 60 minutes, with a monitoring period after the infusion has ended. Cassidy is present throughout and monitors vital signs, subjective experience, and tolerance to the medication continuously. The dissociative state induced by ketamine varies across patients and across sessions — some find it expansive and introspective, others find it disorienting or unpleasant. Cassidy’s presence provides both medical monitoring and a steady clinical anchor for whatever the experience brings.
Addressing the Real Barriers: Cost and Stigma in Montana
One barrier to ketamine treatment in Livingston and across Montana that Cassidy consistently encounters is cost. Mend the Mind is an out-of-network provider, and most commercial insurance plans do not cover IV ketamine for depression. Cassidy provides superbills after each session for patients to submit to their insurance carriers, and some patients do receive partial reimbursement — but the out-of-pocket cost of a ketamine series is a real barrier for many people in a state with significant economic diversity. Cassidy addresses this directly in every financial conversation: she will not oversell the likelihood of insurance reimbursement, and she encourages patients to have a clear-eyed picture of the financial commitment before beginning. She also discusses maintenance strategies — including ketamine troches as a lower-cost option for sustained benefit between IV series — because she understands that affordability is part of sustainability. Results vary by individual.
A second barrier is the cultural hesitancy in Montana communities around seeking advanced psychiatric treatment. Depression carries significant stigma in rural Western culture, and the idea of a treatment that involves a dissociative drug compound can trigger additional resistance from patients who are already ambivalent about seeking psychiatric care. Cassidy approaches this with the direct, non-judgmental communication style that defines her practice. She explains the pharmacology plainly, answers every question with clinical honesty, and does not ask patients to believe ketamine will help them — she asks them to consider the evidence and the evaluation process and make an informed decision. That approach — transparency over salesmanship — is the foundation of everything Mend the Mind does.
FAQ
What does “treatment resistant” mean, and do I qualify for IV ketamine?
Treatment-resistant depression is generally defined as inadequate response to at least two antidepressant medications of appropriate dose and duration. Cassidy reviews each patient’s full treatment history to determine whether prior trials meet this standard. Some patients who present as treatment-resistant have had inadequate prior trials and may benefit from optimizing those medications first — Cassidy will be honest with you about her assessment.
What is the IV ketamine experience like at Mend the Mind?
Patients receive an IV infusion over approximately 45 to 60 minutes while resting in a clinical setting with Cassidy present. Most patients experience dissociation — an altered perceptual state with variable content — during the infusion. This resolves fully after the infusion ends. Cassidy prepares every patient in advance for what to expect and remains present throughout for both monitoring and support.
How many sessions do I need to start feeling better?
Most patients receive four to six infusions over two to three weeks as the initial treatment course. Some patients notice meaningful changes after the first two infusions; others require the full series. Cassidy monitors response across sessions and adjusts the approach accordingly. Maintenance infusions or troches may be recommended after the initial series based on your individual response.
Is Mend the Mind the right fit if I live in a remote part of Montana?
Cassidy works with patients across the Livingston area and broader Montana region. The ketamine infusion sessions themselves must be conducted in person. For evaluation, follow-up, and integration support, Cassidy incorporates telehealth where appropriate for patients with distance constraints. Contact our office to discuss logistics for your specific location.
Does Cassidy coordinate with my existing psychiatrist or prescriber?
Yes. Cassidy communicates with existing prescribers when a patient has an active psychiatric care relationship and the patient consents to that communication. She views coordination with your care team as part of responsible clinical practice, not as an optional nicety.
Key Takeaways
- IV ketamine for depression is an off-label use of an FDA-approved medication, supported by robust clinical research showing rapid antidepressant effects.
- Cassidy Boyer’s evaluation process reviews the full prior medication history, cardiovascular health, psychiatric history, substance use, and support structure before recommending IV ketamine.
- A typical initial treatment course involves four to six infusions over two to three weeks, with Cassidy present throughout each session.
- Mend the Mind is an out-of-network provider; superbills are provided after each session for potential insurance reimbursement.
- Results vary by individual; Cassidy’s honest, thorough evaluation process ensures patients only receive IV ketamine when it is clinically appropriate.
Conclusion
IV ketamine for treatment-resistant depression is not a treatment to pursue casually, and it is not a treatment to dismiss out of hand. At Mend the Mind in Livingston, Cassidy Boyer, CRNA, brings clinical rigor, honest communication, and a genuine commitment to patients who have not been adequately served by conventional psychiatry to every evaluation she conducts. If you are in Montana and your depression has not responded to prior treatment, we encourage you to reach out and explore whether IV ketamine is the right next step for you. Schedule a consultation with our Livingston office today.
References
National Institute of Mental Health. Ketamine for Treatment-Resistant Depression. https://www.nimh.nih.gov/health/topics/depression
American Journal of Psychiatry. Rapid antidepressant effects of ketamine. https://ajp.psychiatryonline.org/
Montana Department of Public Health and Human Services. Suicide Prevention. https://dphhs.mt.gov/suicideprevention
National Alliance on Mental Illness. Treatment-Resistant Depression. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Treatment-Resistant-Depression
About Cassidy Boyer, CRNA
Cassidy Boyer, CRNA, is the lead clinician at Mend The Mind in Livingston, MT, offering IV ketamine therapy and ketamine troches for adults with treatment-resistant depression, anxiety, PTSD, OCD, bipolar disorder, suicidal ideation, and chronic pain conditions including fibromyalgia, neuropathic pain, and restless legs syndrome. Boyer’s evaluation process is built on honest, detailed clinical assessment — reviewing each patient’s full prior treatment history, including medications tried, doses, duration, and response, before making any recommendation. As an out-of-network provider using the Osmind care management platform, Mend The Mind provides patients with superbills for potential insurance reimbursement after each session, combining rigorous clinical standards with direct, transparent communication about what ketamine therapy is and who it is actually appropriate for.
Medical Disclaimer
This content is provided by Mend the Mind for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. IV ketamine for depression is an off-label use of an approved medication. Only a qualified medical provider can determine whether ketamine therapy is appropriate for your specific situation. Results vary by individual, and no outcomes are guaranteed. Please discuss all treatment options with your provider before making any decisions about your care.