Unlocking The Full Potential Of Ketamine Therapy: Choosing The Best Way to Administer Ketamine

What is the Best Way to Administer Ketamine?

Ketamine therapy is now recognized as a promising alternative in mental health treatment. Recent research is showing that ketamine may be beneficial for many patients with symptoms of depression, anxiety, PTSD, and other anxiety disorders.

Ketamine clinics are rapidly opening in many cities across the nation and many patients are interested in knowing more. Patients want to know if ketamine is right for them, and many may not know that they have a few options to choose from. This will depend on their budget and the urgency of addressing their mental state.

One of the first decisions to make is how ketamine should be administered. There are 4 common routes of administration, and we’ll talk about those options here in order of most effective and considering a common dosage of 0.5mg/kg. 

1. Intravenous ketamine infusions.

Ketamine infusion therapy is also known as intravenous ketamine.

In this type of therapy, a ketamine infusion is administered into the arm through an IVcatheterso that ketamine is slowly titrated into the bloodstream over a period of about 40-50minutes. In this way, a precise dose of ketamine can be continuously administered throughout the session.

Administering Ketamine by Intravenous Infusion: How It Works and What to Expect

Patients receive the ketamine IV as they are laying down comfortably. They are usually given an eye mask and headphones, through which a curated playlist of meditative music plays. Patients are monitored for any signs of distress or changes in heart rate or blood pressure. Within an hour, a patient will start to come out of the ketamine experience and will remain resting in their chair until they feel ready to go home and continue their day, usually with a more positive mood. This method has been the most studied and is considered the gold standard for ketamine administration. Intravenous ketamine is the most common way ketamine is administered for two reasons.

IV Ketamine is Fast-Acting

With direct access to the bloodstream and the circulatory system, intravenous ketamine starts to act on the body and brain immediately. People tend to start feeling better and showing improvements in mood soon after the treatment has been administered.

One of the earliest studies to show how quickly ketamine worked as an antidepressant found that patients reported an improvement in depression symptoms within a few hours of IV infusion therapy. In another small study, suicidal patients who showed up at the emergency room were offered intravenous ketamine or a placebo. They found that 88% of the ketamine patients showed a significant decrease by 90 minutes, which became a full remission within 4 hours.

With repeated sessions, these antidepressant effects can be sustained over a period of a few weeks, and much more in some cases, which is why most treatment plans start with a series of 6 dosing sessions.

IV Ketamine Offers Precise Dosing

The dose of ketamine is critical to maintain both patient safety and to get a positive therapeutic outcome. The most common dose is a low dose of 0.5mg/kg during a 40-50 minute infusion.

By doing intravenous ketamine infusions, patients receive 100% of the prescribed dose, whereas the other methods described below receive less. With other methods, the body metabolizes the substance differently, which increases variability between experiences. This variability in dosage absorption is known as bioavailability.

Intravenous ketamine offers the clinician the most control over the experience. In the rare case that a patient is having an adverse event, the infusion can be immediately stopped. This crucial safety measure, along with the evidence-based methodology makes intravenous ketamine infusions the safest and most effective form of ketamine treatment.


2. Intramuscular Injection

Intramuscular injection involves ketamine administration directly into muscle tissue using a syringe. This method is done in much the same way as vaccines into the shoulder are given and has a similar absorption rate to IV, at about 93%. This method may be a little more painful, making it less common than the other options. One advantage, though, is that it bypasses the gastrointestinal system, making it much less likely for patients to experience nausea.

Research Proves the Benefits of Intramuscular Injection for Mental Health

One comparative study verified that intramuscular ketamine was as safe and effective as IV ketamine administration and could also produce similar results by substantially reducing symptoms of depression within a few hours.

In a series of case studies, 98% (39/40) of patients reported an improvement in their symptoms of depression. The series also found similar response rates to intravenous ketamine.

The cost is much less than ketamine infusion therapy, at about $250 - $700 per intramuscular injection.

3. Ketamine Nasal Spray

Spravato: What is Ketamine Nasal Spray Therapy and How Does It Work?

An alternative ketamine administration is a nasal spray. In 2019, the FDA approved esketamine (a ketamine derivative, also known as Spravato) for treatment-resistant depression, establishing ketamine as an effective and safe medicine for psychiatric conditions. The approval came with a “breakthrough therapy” designation that was based on several studies showing that esketamine was as effective in alleviating depression as common dose IV ketamine.

The spray is self-administered at a clinic (not at home) and offers a precise dose of ketamine through each nostril. Patients are then monitored and supported during the next 2 hours until they feel ready to go home.

Nasal spray is Convenient and Non-Invasive

Patients or clinicians might prefer nasal spray to IV treatment because of convenience. In much the same way as IV, nasal spray offers precise control over dosing, but without the discomfort of needle pricks. Nasal spray cost is about $800 per spray, but many variables contribute to the out-of-pocket expense, or about $4,700 for the first month of treatments. Spravato may be covered by insurance carriers, but the amount of coverage will depend on the individual’s health plan.

Even though the amount of ketamine that is absorbed by the body is less than IV (8% - 45% vs 100%), it has still been proven to show similar safety, tolerability, and antidepressant effects as common dose IV ketamine.

4. Under the Tongue: Lozenges or Troches

What Are Troches?

Ketamine can also be administered as a sublingual lozenge that sits under your tongue, also known as troches. Troches dissolve slowly (~10 minutes) into the highly vascularized tissues under the tongue, which is then absorbed into the bloodstream.

Rather than taking troches as full treatment doses, these are usually used as maintenance doses that can be used on particularly bad days, or to get people by until their next therapy appointment. In this way, sublingual ketamine is most often used as troches for depression or troches for pain.

The amount of ketamine that is absorbed in this way is much lower than the other methods, at about 17% - 29%. Yet, patients still benefit greatly from troches.

One study showed that sublingual ketamine, even at a very low dose, resulted in sustained improvement in 77% of patients with depression. The researchers pointed out that the only side effects experienced by patients were mild and transient light-headedness.

Advantages of Ketamine Troches: A Convenient and Effective Alternative

Many people choose to take troches over a full intravenous dose because of the cost. A month’s supply of troches is $70 - $100 while a single IV ketamine treatment can cost anywhere between $400 - $2000, depending on the location of the clinic.

Another advantage is that risks are much lower with lower doses, so these can be easily taken at home and at the patient’s discretion.

Lastly, unlike the other routes of administration, troches are easily accessed and can be taken at home. This offers much more ease than clinics that may be too far for some patients. However, the at home model is the most controversial as the patient has access to multiple ketamine troches and there is minimal or no clinical oversight.

Clinicians and researchers feel that troches still show much promise for various ketamine therapeutic applications, such as depression maintenance treatment and pain management.

 

5. What disorders can ketamine treat?

Ketamine infusion therapy is being used most often for depression, since many studies have shown how beneficial it can be in a short period of time for many patients. Studies have shown that ketamine works just as well for both treatment-resistant depression and anxiety.

Many clinics advertise ketamine infusion for depression or ketamine infusion for pain, but research is also showing promise for the treatment of many other mental health conditions:

  • Suicidal Ideation

  • PTSD

  • Bipolar Disorder

  • OCD

  • ADHD

  • Alcohol Use Disorder

More research is underway with many clinical trials that are actively recruiting new participants. Some studies are investigating ketamine for cancer patients, chronic headaches, Parkinson’s disease, and brain injury patients. It will be exciting to see what these new studies discover.

Ketamine Side Effects

Even though the routes of administration differ, ketamine acts on the same receptors in the brain, making the side effects mostly similar across each method.

Studies have documented a variety of ketamine therapy side effects, but there are several that are most common:

  • feeling strange, weird, or bizarre

  • feeling spacey

  • feeling woozy/loopy

  • dissociation (we see this as a positive and very therapeutic side effect)

  • floating

  • visual distortions

  • difficulty speaking

  • numbness

Other ketamine therapy side effects may include nausea, headache, dizziness, confusion, and elevated blood pressure.

Even though these may seem unusual, all ketamine therapy side effects are transient. Researchers note that none of the above side effects last more than 4 hours. Since ketamine is quickly metabolized through the body, patients are usually ready to leave the clinic and get back to their regular routines within two hours of starting their ketamine therapy session.

6. Ketamine Infusion Therapy at Ketamine Lounge

At Ketamine Lounge, we follow the gold standard research recommendations and deliver ketamine through IV infusion. However, we believe in higher dosages to actually induce dissociation (>0.75mg/kg). To learn more please read our blog “If you’re not dissociating during ketamine therapy, you are only getting half the therapeutic benefit.”

We offer ketamine infusion therapy as a treatment option for patients seeking relief from mental health conditions such as depression, anxiety, and PTSD.

Here at Ketamine Lounge, we take a holistic approach to mental health treatment and prioritize providing a comfortable and relaxing environment and tailoring treatment plans to each patient’s unique needs.

If you’d like to speak to someone about our personalized treatment plans or our innovative approaches, please send us a message or call (305) 604-9595.

If you connected with the above write-up, are curious, and need some guidance, psychedelic medicines such as Ketamine can really support this process of healing, self-discovery, and purpose. Click below to find out more.


Author: Alexa Julianne

Alexa Julianne works at MAPS to support MDMA-assisted therapy for the treatment of PTSD. With a professional background as a clinical lab scientist, she also has a comprehensive understanding of the many recent and ongoing clinical trials investigating the medical use of all psychedelics. As a writer, she provides research-based educational articles about the therapeutic potential of psychedelics. She is an advocate of psychedelic-assisted therapy for mental health, wellness, and healing and continues to support the advancement of psychedelic clinical research.

Alexa Julianne

Author: Alexa Julianne

Alexa works at MAPS to support MDMA-assisted therapy for the treatment of PTSD. With a professional background as a clinical lab scientist, she also has a comprehensive understanding of the many recent and ongoing clinical trials investigating the medical use of all psychedelics. As a writer, she provides research-based educational articles about the therapeutic potential of psychedelics. She is an advocate of psychedelic-assisted therapy for mental health, wellness, and healing and continues to support the advancement of psychedelic clinical research.

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