I Didn’t Realize My Brain Would Be So Expensive

Sometimes, you don’t need to think about your brain. It just… runs. You wake up, remember your passwords (mostly), answer emails without crying (ideally), sleep at night instead of staring at the ceiling replaying a weird thing you said in 2016 (actually), and generally move through the day without feeling panicked, sluggish, or sad.

For some people, functioning at that baseline happens for free. But for others, there’s a steep price. Therapy, meds, and other treatments often aren’t covered by insurance. A 2023 study from Self Financial found that Americans are spending an average of $374.95 per month on direct mental health costs. Since treatment is usually not a “one and done” deal, it tends to be an ongoing expense.

An estimated 1 in 5 Americans lives with a mental illness, according to the National Institute of Mental Health, and this kind of care isn’t just for people with diagnoses. It’s also helpful for those navigating grief, heartbreak, burnout, and the kind of general life chaos that makes your brain feel like it has 47 tabs open and one of them is blasting music you cannot locate.

To get a full picture of the total cost of mental health care, we asked five women to tally a year’s worth of spending, with treatments running the gamut from traditional talk therapy to red light treatments and ketamine infusions.

The Traumatized Driver

Anne*, 36, works in HR, lives in Denver

• Exposure therapy: $167 per session, once a week.
• EMDR: $175 per session, once a week.
• Medication: Adderall and Lexapro, $15 per month (co-pay).
• Psychiatrist: $150 per session, once every three months.
• Spa: $150-$200 for a day pass, occasional.
• Yoga studio membership: $90 per month.
• Motor oil and car maintenance: About $80 every three months.

Annual total: $19,964

Anne used to be a confident driver until she spun out on a highway in 2014 and almost hit the divider at full speed. She white-knuckled it for years after that terrifying incident, but when the pandemic hit, she stopped driving for a year, eroding any remaining confidence. When she finally got back behind the wheel, panic attacks came along for the ride — even at 20 miles per hour.

Though she lives in a walkable part of Denver, her job is a 45-minute drive away, and she relied on Ubers that cost about $60 per ride.

“It wasn’t just inconvenient,” she says. “It was disrupting my life.”

Anne had tried talk therapy in high school but hadn’t found it helpful. As an adult, she wanted something more specialized, and in 2022, she found an exposure therapist. Every week, she would drive to his office, and then spend an hour on the road with him in the passenger seat. They started with side streets, then worked up to busier roads and highways.

“It was like Carpool Karaoke, with me in the driver’s seat,” she says.

Her insurance wouldn’t cover it. About a year in, she added eye movement desensitization and reprocessing (EMDR) to treat her diagnoses of complex post-traumatic stress disorder (CPTSD) and ADHD — not covered by insurance either. She did both therapies weekly for a year, spending about $1,000 per month. Her mother helped foot some of the bills, but ultimately, Anne dropped exposure therapy due to cost and burnout. “Not only was it draining, but it was expensive,” she says.

Today, she’s more comfortable behind the wheel, which she considers a big success. If I hadn’t done these therapies, I would be in a very different emotional place,” she says.

The PCOS Patient Whose Anxiety Turned Physical

Kelly*, 36, works in real estate, lives in New York’s Hudson Valley

• Acupuncture: $100 per session, once a week.
• Talk therapy: $15 per session, once a week (co-pay).
• Massage: $68 with tax and tip, every few months.
• Xanax: $5 co-pay, every four to six months.
• Supplements: $400 every three months for magnesium, prenatal vitamins, spearmint capsules, Myo-inisitol, probiotics, Acetylcysteine.
• Facials: $220, every six weeks.
• Oura ring: $350 for the ring, $6 per month for the subscription.
• Medical care: $200 (co-pay) per ER visit for three visits, plus about $2,000 for testing and physical therapy.
• Dog: $150 to $250 per month (food, walker, meds).
• Mira hormone testing: $90 every 30 days.

Annual total: $17,059

Kelly has polycystic ovarian syndrome (PCOS), a common hormonal disorder that can cause irregular periods, acne, excessive hair growth, and infertility. For years, she managed it with birth control, which kept her skin, hormones, and mental health in check. But last July, she stopped taking it, hoping to get pregnant with the help of a reproductive endocrinologist. The change in hormones, coupled with the stress of anticipating invasive fertility treatments with unpredictable outcomes like IVF, gave her such bad health anxiety that she ended up in the ER.

“My heart was racing, I was feeling pressure and tingling from my neck down to my fingers, I was having internal tremors,” the 36-year-old says. “I was like, my God, I have heart issues.”

Repeat EKGs and cardiologist visits revealed that the real culprit was stress. Kelly turned to additional resources: talk therapy, magnesium supplements, acupuncture, and an Oura ring to track her heart rate.

To address her intense muscle tightness, a symptom of anxiety, she did physical therapy for nearly three months and gets monthly deep-tissue massages. Since going off birth control has worsened her acne — another stressor — she visits a facialist every six weeks.

“It’s a very expensive time,” she says.

Kelly has managed to mitigate costs somewhat by adding her husband’s policy as a secondary insurance, which will help bring down the weekly costs of acupuncture from $100 to $10.

She’s also set a one-year time limit on fertility treatments, which makes it easier for her to face the financial and emotional tolls. Knowing this stage is temporary has helped ease her anxiety. “I’m comfortable that if it doesn’t happen, there are other ways to try to grow our family if we really want to,” she says.

The Ketamine Therapy Convert

Emily*, 33, works in entertainment marketing, lives in Los Angeles

• Ketamine therapy: $600 per session, has done three sessions.
• Talk therapy: $150 per session 1x week (80% reimbursed).
• Psychiatrist: In-network, covered.
• Medications: Wellbutrin, covered.
• Acupuncture: $15 per session, 12 sessions a year, covered.
• Peloton: $400 for a secondhand bike, $40 per month for the subscription.
• Classes: About $20 per month for workshops on somatic breathwork and yoga.
• Calm meditation app and phone distraction blocking app: $5 to $10 per month.
• Cannabis: $200 per year.

Annual total: $4,980

Emily*, 33, was diagnosed with depression as a teenager. For years, she’s treated it with talk therapy and antidepressants, but still struggled with big feelings about her career and relationship. Six months ago, she joked to her therapist, “I think I just want to do a bunch of drugs this year, and maybe something will change.”

“I meant doing a whole bunch of shrooms in Joshua Tree, but she told me she did ketamine therapy and it was really helpful for her,” she says.

Emily was intrigued. The therapy, which uses controlled doses of the anesthetic to create new, healthier neural pathways in the brain, has been shown to help people with treatment-resistant depression. During her first session, she was hooked up to an IV and monitored while she had visions of a black void with shapes and colors, an experience she describes as “sort of boring and scary.”

Although the treatment itself wasn’t exactly pleasant, the aftermath was transformative. It helped quiet her stressors, slow down her hyperactive brain, and navigate difficult conversations and feelings in a totally new way. She was even able to taper down and eventually go off Zoloft. In general, she says, she’s much, much happier.

“It was as if I had unplugged my brain and plugged it back in,” she says. “It’s been life-changing.”

The downside is the cost. Emily’s insurance covers the bulk of her mental health care, but not ketamine. At her clinic, one ketamine IV session is $600, with practitioners recommending at least four to six infusions over the course of two to three weeks, plus monthly maintenance as needed.

Though Emily had hoped that a single session would do the trick, she’s done three so far, and plans to do more. The clinic offers cheaper options, like intramuscular injections for $400 per session or under-the-tongue administration for less. She’s considering them for cost reasons, though she likes the precision of IV dosing.

“I could spend that money on a vacation, but the mental health benefits of that trip typically only last for a short while,” she says. In the long run, ketamine is more effective. “So it’s like, OK, I’ll send my brain to Mexico instead.”

The Yogi Who Fights Depression With Movement

Megan, 29, lives in Orange County, California, works as a bodywork and energy practitioner

• Somatic therapy: $120 to $150 per session (sliding scale), 10 sessions.
• Acupuncture: $150 for six sessions.
• Red light sauna suit: $100 (bought off a friend).
• ClassPass: $89 per month.
• Facials: $200 to $600, four per year.

Annual total: $5,568

Megan, 29, did talk therapy for years, including marriage counseling with her now-ex husband. It never quite clicked. “I would find myself in a state of rumination where I was constantly reliving things and not necessarily getting over them,” she says.

Two years ago, following her divorce, she felt worn down and depressed, and wanted help processing what had happened. “I wanted to move into the next phase of my life with a clear head and a clear heart,” she says.

As a bodywork and energy practitioner, Megan had long felt the connection between movement and her mental health. She decided to try somatic therapy, which uses body-focused techniques like breathwork, dance, and mindfulness to process trauma and emotions. (Preliminary studies suggest it’s pretty effective in PTSD patients.) Megan was hooked after her first Zoom session, which gave her the opportunity to move, gesture, and embrace her primal instincts.

“The physical exertion helps to cleanse and clear a lot of those lower vibrational energies and negative thought patterns or emotions,” she says. She logs off feeling lighter. In an ideal world, she would go every other week, but that would be $300 a month.

Somatic therapy isn’t Megan’s only mind-body treatment. She started acupuncture, and uses a ClassPass membership for spa treatments like red-light therapy and saunas, as well as boutique fitness classes. This doesn’t leave her with much financial wiggle room.

“Some months I have to choose dental care or eye care over therapy,” she says. “I’m trying to space it all out so it’s not too much all at once.”

The Woman Stuck In A Money Pit

Jaclyn, late 30s, New York City

• Talk therapy: $225 per session, every other week.
• Psychiatrist: $420, twice a year.
• Medications: Wellbutrin and Prozac, $30 to $35 a month.
• Cannabis edibles: $40, every two months.

Annual total: $7,350

Jaclyn started seeing a reproductive psychiatrist in 2019, before she began trying to conceive her now-toddler. The support was critical. “She reassured me that it's healthier to be medicated when you're pregnant than to be really depressed or anxious,” she says. (Research has shown that antidepressants are not linked to birth defects or long-term developmental issues, and that maternal anxiety can be passed on to a fetus in utero.)

She also leaned on mental health care practitioners during her pregnancy (which included preeclampsia), a traumatic birth experience, emergency C-section, a subsequent perinatal mood and anxiety disorder, and a child in the NICU.

“The mental health of a new mother, at least in my experience, isn't really taken into consideration,” she says. “We saw a social worker at the hospital maybe once or twice, but they weren’t there to address my trauma; they were there to help us navigate paying.”

She’s thought about switching to in-network practitioners, but they’re hard to find, and she’s already spent years building strong relationships with her current support system. At times, her monthly costs approach $1,000. Other resources, like couples counseling, or a sleep study to address her exhaustion, seem out of reach.

“On top of the cost of living in New York City, and the cost of raising a child, it’s so overwhelming I can’t even consider it,” she says.

Her care has been invaluable. “I don't know if I could function without it,” she says. But she also feels trapped. “I’m boxed into having to spend a lot of money. I'm so dependent.”

*Name has been changed for privacy.