Therapeutic Ketamine Preparation & Integration
Ketamine is a dissociative anesthetic that has been used for years as a sedative in medical settings, and can also be legally used as an off-label treatment for certain mental health conditions. In research studies, ketamine has been shown to be helpful for people with severe and persistent depression, anxiety, PTSD, chronic pain, and OCD, among other conditions. While I am not licensed to prescribe ketamine, I partner with trusted medical professionals who are licensed prescribers, and would be happy to provide referrals upon request.
Routes of Administration
Administration is typically done intravenously via infusion, but it can also involve intramuscular, intranasal, or sublingual administration (i.e. lozenges or troches). The main differences between the various routes of administration have to do with bioavailability, or the ability of the medication to be absorbed and used by the body, as well as the amount of time it takes the medication to enter the bloodstream and thereby reach it's peak effect. Another important distinction is where the medication is administered; intravenous, intramuscular, and intranasal doses should always be administered in a clinical setting, as they tend to have stronger dissociative effects that require the patient to be monitored by a medical professional for potential adverse reactions. Sublingual or oral administration can be prescribed for at-home use as determined by the clinical judgment of the provider, but please note that this varies by state since every state has different laws regarding the prescription and dosing of ketamine outside of clinical settings.
-
During an IV infusion, patients absorb the highest levels of the medication—typically 100%—since it is administered directly into the bloodstream. The ketamine is provided at a steady rate over a continuous timeframe, usually 45 to 60 minutes, but this can vary depending on your therapeutic goals as well as your weight, response, and potential side effects experienced during treatment. One of the greatest benefits of IV infusions is that your doctor can easily adjust your dosage and rate of administration and this will have an immediate effect. It is typically recommended to begin with six infusions roughly once per week, but this depends on each individual's case and can be tailored as needed. Ketamine IV infusions therefore allow for much more flexibility in terms of dosage and timing during treatment, as well as frequency and spacing of sessions between treatments.
-
Ketamine can also be administered intramuscularly, for example through injection in the arm. Around 93% of the medication is absorbed and it usually takes around 5 minutes for the medication to reach its peak effect, so it is also fast-acting. However, there is less control over the dosage and sometimes treatment requires multiple injections in a single session, which can be a downside for some people. Intramuscular injections follow a similar cadence of sessions as IV infusions, but this can also be tailored to each individual's preference and response to the treatment.
-
There are two types of intranasal treatments that are offered as nasal sprays: racemic and esketamine (e.g. Spravato), which comes in different strengths. The bioavailability of these treatments are estimated to be around 40-50%, but this can vary considerably both within and across treatment sessions. As such, more frequent treatments are needed to have the same effects as IV or intramuscular treatments, and the peak effect typically takes around 15 minutes.
-
Sublingual lozenges, troches, or rapid dissolve tablets are another common method of administration for ketamine. These tend to have even lower bioavailability at 25-40%, and usually take longer for peak effect to be reached, i.e. 15-30 minutes. These methods, along with the nasal sprays, are often used to prolong the therapeutic effects of the IV and intramuscular injections or to extend the time period in between these sessions. Since they tend to have a gentler onset, they can be less destabilizing and may be desirable to those who want a less intense therapeutic experience. However, the effects can again vary considerably depending on the individual, and some people find that the sublingual doses produce an unpleasant taste or feelings of nausea, dizziness, or drowsiness, which can be a downside for many. In addition, it is more difficult to dose accurately with these methods and to titrate the experience in the moment like one can with IV infusions.
An essential component of ketamine treatment includes preparation for and integration following your medicine sessions. I work closely with your care team to develop an individualized treatment plan that takes into account appropriate dosage, frequency, route of administration, treatment goals or intentions, and outcomes monitoring so that you can get the most from your dosing sessions. I provide support throughout every stage of your ketamine journey, and have found that continuing to meet regularly for integration following the dosing sessions optimizes the efficacy of the medicine and results in longer-term benefits. Learn more about integration here.