If you’ve been looking into ketamine treatment, or are currently familiar with the space, you might have noticed there are several different methods of receiving the medicine: ketamine infusions (intramuscular or intravenous), tablets (or “troches”), or nasal spray.
What isn’t as immediately evident is what the differences are, what the benefits may be, and why you would choose one over the other. Below is a brief history of ketamine treatment, three common methods of administering ketamine, and how each fits into the best course of therapeutic treatment.
A Brief History of Ketamine’s Medical Use
Ketamine’s first FDA-approved use was as a dissociative anesthetic and is used for this purpose in medical and surgical procedures. Ketamine is a special medicine in this class as it does not suppress respiratory rate and is a generally safe tool for anesthesia. It has also been used for years for its rapid acting analgesic (pain reducing) effects from battlefields to emergency care.
To achieve the dissociation and sedation required, doctors needed a direct and effective way to provide and regulate larger amounts of ketamine to the patients. This is where IV and IM injections of ketamine began.
At anesthetic levels, patients often come back from an experience with little to no recollection of what happened while they were sedated. During an invasive procedure this is the preferred outcome. However, when working with mental illnesses, some level of subjective or conscious experience may be preferable, particularly when ketamine’s psychedelic medicinal effects are desired.
IV/IM administration allows dosing of the medicine at amounts that can produce full dissociation and sedation. There is scientific evidence supporting the mental health benefits of dissociation, and more research is being conducted. These are typically the longest sessions, ranging anywhere from 1-3 hours, and are the most expensive, with individual sessions running around $800-1200+USD, with psychotherapy afterward as an available option.
Methods of Administering Ketamine
Ketamine infusions and injections aren’t the only method of delivery used in mental health treatments. Here’s a quick overview of the different methods one can expect when working with ketamine.
Sublingual Tablets or Troches
Tablets or troches (pronounced “tro-keys”) are compounded tablets from a pharmacy that are absorbed into the brain/bloodstream sublingually, or held in the mouth. Dosing can vary from 10-200 milligrams (mg) per tablet on average, depending on the compounding pharmacy and the order from the clinician.
Tablets are the method utilized by Mindbloom clinicians, allowing for a greater flexibility in treatment based on the client’s response to the medication. Tablets also provide an identical delivery mechanism as IV/IM, but without the risk of infections or introducing harmful agents into the bloodstream — contributing to an increased safety profile.
A secondary benefit is there is a ceiling, an upper limit, to how much medicine an individual can absorb sublingually, making it nearly impossible to take larger doses than necessary.
IV Infusion or IM Injection
Intravenous (IV) infusions or Intramuscular (IM) ketamine injections have similar effects. The difference is that IV is typically infused into a vein with a bag that drips the substance in while IM is injected directly into the arm with a needle (similar to a flu shot).
Ketamine nasal sprays are a synthesized mist stored in a spray bottle that is applied according to the delivery timeline outlined by the clinician. This is the latest delivery method to gain FDA approval with the introduction of Spravato.
The bioavailability and desired effect (sub dissociative, sub psychedelic, anesthetic) of each delivery method, which is the proportion of the compound that enters the body’s circulation, is what determines the typical dosing ranges. You can apply the highest doses (several thousand milligrams) with infusions, a mid-range with sublingual tablets (around 1000-1500mgs) and the lowest doses with nasal sprays (<100mg.)
Determining Which Method is Right for Your Ketamine Treatment
It’s important to distinguish the two ways in which ketamine treatments provide therapeutic value, as this will help you make a decision as to which one is right for you, and when.
The Biological Effects of Ketamine
There are the neurobiological effects and benefits when receiving ketamine. Through these effects, we would expect a general improvement in overall mood, an increase in brain-derived neurotrophic factor (BDNF), and bolstering of neurons that have been worn down over time by the body's physiological response to things like anxiety and depression.
The biological effects are dose-dependent, and happen regardless of an individual's subjective experience with the medicine.
Learn more about the neuroscience of ketamine here.
The Subjective Effects of Ketamine
There are also subjective or phenomenological healing effects that ketamine can provide at medium/high doses. These effects include novel ways of thinking, disconnection from thoughts or emotions, dilation of time or space, out-of-body experiences, and more. These experiences vary between each individual and each treatment, but can be essential catalysts for deep transformation when treating mental health conditions such as depression or anxiety with ketamine.
The subjective effects have a ‘sweet spot.’ They need a certain dosage to surface, and can be overtaken by the dissociative or sedative effects at higher doses.
This ideal range for the subjective or phenomenological effects of ketamine is an important point to consider when looking at methods of treatment, and the results you want to achieve. An experienced clinician can help you make the right choice in this regard.
Ketamine’s Role as a Psychedelic Therapy Catalyst
As off-label treatments for ketamine are increasingly researched, ketamine’s subjective and psychedelic effects should be considered.
When looking at long-term, enduring benefits and personal transformation, ketamine’s psychedelic effects play an important role.
Individuals in treatments have the potential to experience more classically ‘psychedelic’ experiences: novel ways of thinking or feeling, immersion in new experiences, time or space dilation, out-of-body experiences, hallucinations, and visual imagery.
Not to be discounted, these experiences and insights can provide the scaffolding for long-lasting changes, especially if properly integrated back into their lives.
Which Ketamine Treatment Method is Right for Me?
If you’re considering overall cost of treatment:
- Infusions: Each infusion session can range from $400 to $1000-plus, often sold in 4-6 session packs.
- Nasal Spray: Monthly nasal spray use can cost $4000-5000 based on recommended dosages. There are some insurance coverage options here to help manage costs.
- Sublingual Tablets: Depending on the recommended dosage, these can run from $500-1500 per month. Mindbloom offers four initial sessions using this method for only $1000.
Subjective or Psychedelic Benefits
If you want a compliment of biological benefits and subjective, experiential insights:
- Infusions: Have the potential to provide a higher degree of dissociation as dissociation is dose dependent and higher doses can be provided via IV or IM.
- Nasal Spray: Little to no dissociation.
- Sublingual Tablets: Has the potential to produce mild to moderate levels of dissociation which is generally supportive of a deep meditative state or a trance-like state which can include some psychedelic properties.
When speaking with your clinician or provider, you can use this information to help determine the best method for your unique circumstances.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety