Many people are aware that in the last several decades, there has been a tremendous resurgence of medical research into the therapeutic potential of ketamine for patients with chronic depression and/or anxiety. Patients may be unclear as to what their options are for ketamine treatment, and we would like to outline and clarify the most common types of ketamine treatment here.
Some of the most common routes include IV (intravenous), IM (intramuscular), and Oral (typically a lozenge or rapidly dissolving tablet). Each of these different dosing strategies has benefits and drawbacks, and there is no one-size-fits-all approach to ketamine treatment.
Throughout the United States, there has been an explosion over the past decade of ketamine treatment being used in outpatient clinics for the treatment of treatment-resistant depression, generalized anxiety, and chronic pain.
These ketamine clinics often offer a particular treatment protocol that has been shown in several studies to rapidly benefit patients who are in deep chronic depression, have acute suicidal ideation, and are suffering from chronic pain without adequate relief.
This treatment series consists of a “loading dose” of ketamine with two infusions per week for three weeks. This loading series helps to jumpstart and augment synaptogenesis in the brain, which is the process by which neurons grow, connect, and communicate with each other. Ketamine works on well over a dozen receptor sites and neurotransmitters in the body, and its mechanism of action is still not entirely well understood due to its wide array of effects.
After the loading series is complete (6 treatments in all), booster IV sessions are typically recommended to maintain the benefits of treatment. Boosters are recommended on an individual basis based on a patient’s response to treatment but typically start with the first booster 2 weeks after the last session in the loading series, then anywhere between 2 weeks to 3 months later depending on how well the benefits are maintained.
IV ketamine treatment is typically structured in an outpatient clinic setting with little or no “talk therapy” component, although many clinics are beginning to create a “set and setting” that will facilitate the psychotherapeutic healing potential of ketamine along with its biomedical benefits.
The duration of the IV treatment itself is typically 40-75 minutes but the entire appointment time may be 90-min to 2 hours to give the patient adequate time to settle in, get treatment and rest before going home.
During IV treatment, a patient will have a vital signs monitor recording oxygen levels, heart rate, and blood pressure throughout treatment, but most clinics provide a very comfortable setting that doesn’t feel too “medical”.
In addition to the biologic effects of Ketamine listed above, Ketamine Assisted Psychotherapy or KAP is also focused on the healing benefits to the psyche (mind) and soma (body) that ketamine journeys can provide for patients. Like MDMA and other psychedelic medicines, ketamine at certain doses may induce a full psychedelic-altered state of consciousness that allows patients to better access their emotions, memories, visions, and body sensations than they can in “normal waking” consciousness.
KAP is typically provided in-office by a counselor, therapist, or another healthcare provider with sufficient training to be able to guide patients through the process of preparation, ketamine journey, and integration to facilitate healing and transformation.
Common themes that patients are interested in working on with ketamine-assisted psychotherapy include health concerns such as chronic depression, anxiety, and PTSD. Patients also come in looking to discover life purpose, resolve trauma in the body, heal feelings of disconnection, or search for spiritual fulfillment and transcendent experiences. Others find relief near the end of life from anxiety or heal from existential fear
Ketamine Assisted Psychotherapy sessions are typically between 2-3 hours in length and the ketamine itself is most commonly administered as an oral “lozenge”, rapidly dissolving tablet, or intramuscular injection. Patients can take lower doses of ketamine as a “psycholytic” dose, meaning they are less likely to be in a full psychedelic journey but feel more open and available to deep psychotherapy discussions and their own emotions. At higher doses, a full psychedelic journey may be experienced with alterations in body sensations, visualizations, or perceptions of time and space to name a few. These journeys are accompanied by relaxing music that is chosen to facilitate healing experiences and release from the body and emotions.
Ketamine journeys are followed up by a process of integration, which involves “unpacking” the material that came up during the journey state and helps to create meaningful change in everyday life. Integration helps to reinforce the new connections and insights that arise during journey states and provides a clear plan to help patients move forward from the new lens or shifts in perspective they experience with ketamine.
Things to consider for patients who are seeking ketamine treatment include:
What are the ultimate goals of treatment for you at this time? Exploring and releasing trauma? Symptom relief from anxiety/depression/suicidal ideation? Support for existential fears or fear of death and dying? Exploring an altered state of consciousness for personal and/or spiritual growth?
Knowing what your specific goals for treatment are will help guide your healthcare provider or therapist in determining which treatment option might be the best for you at this time. You can also start with one type of ketamine treatment and “fine tune” the process over time for what your body needs.
Other considerations for patients looking at ketamine treatment include the time commitment, financial investment, and psychic or emotional “space” for being able to truly benefit and integrate what comes up during these treatment sessions.
Can be sub-psychedelic or full psychedelic journey depending on treatment goals, level of comfort the patient has in an altered state of consciousness, ability/desire of the provider to hold space for psychedelic work (some IV clinics are more clinical, some are more psychedelic in orientation)
The highest level of bioavailability of the medicine at 98%, most medical monitoring during treatment for safety, highest quality of medical research done on this loading series for the treatment of acute suicidal ideation, treatment-resistant depression, and anxiety.
infusion rate can be adjusted or stopped as needed during the session.
Expense, higher level of “medical monitoring” during treatment, may not include psychotherapeutic engagement during the treatment or reach doses that achieve a psychedelic affect.
More likely to be a full psychedelic journey. This can feel very intense for patients as the onset of action is rapid and the peak of the experience happens quickly. IM ketamine can be used at a very low dose to support a psychotherapy session or at higher doses to induce a full psychedelic journey state. Generally a little less predictable in terms of the level of intensity of the experience and duration of the experience. This variability relates to how the body metabolizes ketamine which is very individual.
High bioavailability, approximately 93%. The patient may not be hooked up to any medical equipment during treatment. Can help patients who don’t tolerate oral ketamine (meaning they have side effects like nausea).
Rapid onset can be very intense for patients leading to higher levels of anxiety or difficulty integrating the experience.
Helpful “bell curve” experience where a patient has time during the initial part to feel themselves moving into the altered state, time at the peak, and then a softer landing afterward. Dosing can be variable to induce a mellow psycholytic experience or higher to provide a full psychedelic journey.
Onset of action is slower which can mean a “softer” take-off and landing with oral ketamine than intramuscular Ketamine. Good for those with needle phobia. Can be performed by therapist in a non-medical setting.
Tends to have more side effects including nausea, dizziness, and headache due to the slower metabolism. Some patients don’t like the taste of the medicine.