The mental health landscape is continuously evolving, with novel treatment methods to help individuals deal with various conditions.
One such breakthrough has been the utilization of ketamine – a substance used to treat mental health issues that are difficult to overcome with traditional methods.
How Ketamine Affects The Brain
Ketamine is known to have a profound impact on glutamate, a neurotransmitter that is responsible for synaptic plasticity and neural communication. This property allows for a rapid and profound alteration in mood, perception, and cognition.
With a heightened awareness and the ability to connect seemingly disconnected parts of the brain, patients can arrive at profound insights that may take weeks or months with regular mood stabilizers or antidepressants.
What Can Ketamine Treat?
Clinical studies show that ketamine can treat a range of mental health conditions, even in patients who have shown resistance to conventional methods.
While research is relatively small, there’s enough evidence suggesting that ketamine has the potential to alter the therapeutic landscape and how we view certain illnesses.
Here are a few conditions that have been treated with ketamine along with links to clinical trials supporting these cases.
- PTSD – This is an area where ketamine has shown great promise
- Clinical Depression – Ketamine’s rapid effects can relieve symptoms after only a few sessions
- Addiction – While it’s still in the works, ketamine has proven effective in controlled settings
- Anxiety – The relaxing effect of this substance provides an immediate reduction in anxiety
- Eating Disorders – While relevant literature is limited, ketamine has shown promise in helping those suffering from eating disorders
- Caregiver Distress – Ketamine-assisted therapy offers caregivers a transformative approach to alleviating distress, fostering resilience, and promoting mental well-being.
- LGBTQ and Self-Identity – Ketamine-assisted therapy provides LGBTQ+ individuals a supportive space to explore and affirm their self-identity, fostering acceptance and emotional healing.
- Grief – Ketamine-assisted therapy offers a profound pathway to navigate grief, facilitating deeper emotional processing and fostering healing.
Types Of Ketamine Administration
Ketamine can be administered in four different ways.
- Intravenous: This is the most common method and involves the controlled infusion of ketamine through an intravenous tube and directly into the bloodstream.
- Sublingual: A ketamine-infused tablet or liquid is placed under the tongue, which dissolves and subsequently enters the bloodstream.
- Nasal Esketamine: This method uses a nasal spray containing esketamine, a derivative of ketamine, sprayed into the nostrils and absorbed through the nasal mucosa.
- Intramuscular Injection: Ketamine is directly injected into the thigh or buttocks and gradually absorbed into the bloodstream.
The speed of onset, duration, intensity of the experience, and potential side effects vary depending on the method.
The Rationale Behind Different Routes Of Ketamine Administration
While the same substance is administered in each situation, there are nuances that can alter the efficacy and results of the therapeutic process.
Let’s look at the different methods of administration, their pros and cons, and studies that show how they are being used.
The intravenous method involves ketamine being administered via controlled infusion directly into the patient’s bloodstream through a vein.
This method ensures that the substance bypasses the digestive system, leading to a quicker onset of effects compared to other methods.
- Rapid Onset: The key benefit of the IV method is the immediate onset, often noticeable minutes after the infusion begins. This swift response quickly alleviates depression and other severe symptoms.
- Precise Dosage: The dosage can be regulated and tailored according to the patient’s needs and responses, which can optimize the therapeutic outcome.
- Clinically Monitored: IV infusions involve a healthcare professional who monitors the patient’s vital signs and mental state closely and makes adjustments when needed.
- Established Efficacy: There are plenty of clinical trials substantiating the efficacy of IV ketamine in treating severe conditions like treatment-resistant depression and PTSD.
- Discomfort: The insertion process may be uncomfortable and even scary to patients with a fear of needles.
- Intense Effects: The rapid onset through IV administration and the dissociative effects can be overwhelming for some people.
- Medical Equipment: This method requires medical equipment for the infusion as well as monitoring the patient’s vital signs to make changes if needed. This can limit accessibility to regular sessions.
IV infusion continues to gain recognition as a viable form of treatment. And the rapid onset is a beacon of hope for those grappling with severe mental health conditions such as treatment-resistant depression.
Sublingual ketamine offers an alternative to the traditional intravenous approach, by combining convenience and rapidity of effects.
Here, patients place ketamine-infused tablets or liquids under their tongue and the medication is absorbed through the sublingual mucosa (mucous membrane) into the bloodstream.
- Quick Onset: While it’s not immediate, this method exhibits a faster onset of effects than oral ingestion. Combined with the ease of administration, it’s ideal for patients seeking quick relief.
- Reduced Discomfort: There are no needles or medical equipment involved, making this a more comfortable way to ingest ketamine.
- Home Administration: Studies show that sublingual ketamine can be administered at home in safe doses for a significant reduction in depressive symptoms. It is generally recommended that the administration of sublingual ketamine be supervised by a trained professional.
- Variability In Absorption: Factors like saliva production and mucosal health differ among individuals, which leads to varying levels of effectiveness among patients.
- Slower Onset: While it’s absorbed quickly, sublingual ketamine still takes longer to act than IV administration.
- Dissociative Effects: Like IV, sublingual ketamine can cause dissociation.
Clinical studies show that sublingual ketamine has the potential to significantly reduce symptoms of anxiety and depression.
While this treatment hasn’t been tested as extensively as IV, there is growing research to help us better understand how it works so we can discover its potential for therapy.
This approach utilizes a nasal spray to deliver esketamine such as Spravato, a derivative of ketamine. The difference isn’t just in the method of administration, but also in the substance being administered.
Esketamine is similar to ketamine, albeit with lesser dissociative effects. When the nasal spray is administered, esketamine is absorbed through the nasal mucosa and quickly enters the bloodstream.
- Ease of Use: It is non-invasive, reducing the discomfort associated with this form of treatment. Patients may even self-administer under medical supervision.
- Mitigated Dissociative Effects: Esketamine is formulated to reduce the intensity of dissociative experiences. This makes the effects more tolerable for patients.
- Frequency Of Treatment: The effects of nasal esketamine are short-lived and most patients require frequent sessions to maintain the therapeutic benefits.
- Variability In Response: Like sublingual ketamine, nasal administration shows variability in response depending on the absorption rates of different individuals.
- Requires Medical Supervision: Nasal esketamine is relatively newer than other forms of treatment. As such, it may still require the supervision of a medical professional.
While the efficacy of nasal esketamine in the long term requires further examination, studies show that it can alleviate symptoms of treatment-resistant depression.
This study even labeled esketamine as a breakthrough treatment for depression and its associated symptoms.
Research continues to prove that esketamine is effective in treating mental health conditions, with great promise that this treatment will be integrated into the therapeutic landscape.
Intramuscular administration involves injecting ketamine solution into a muscle, usually the thigh or buttocks.
This method capitalizes on the gradual absorption of ketamine through the muscle tissue, leading to a sustained release into the bloodstream over an extended period.
- Longer Duration: Unlike other forms, intramuscular injections have a longer-lasting effect and provide extended relief, reducing the number of treatments required.
- Greater Stability: The gradual release leads to a more sustained level of medication in the bloodstream, minimizing abrupt mood fluctuations.
- Reduced Dissociation: While dissociation occurs, it is often mild due to the gradual release of ketamine, making the experience more comfortable.
- Slower Onset: It takes longer to feel the effects of intramuscular ketamine as it must be absorbed from the muscle into the bloodstream.
- Injection Required: While it’s not as invasive as an IV, there is still an injection involved, which may cause anxiety in some patients.
- Professional Administration: Intramuscular injections are usually administered by healthcare professionals and require a clinical setting, or specialized training for outpatient administration.
While intramuscular injections take longer, the difference is only a few hours.
This study found that intramuscular ketamine caused a significant reduction in depressive symptoms of two individuals diagnosed as highly depressed with suicidal ideation.
The reduction in symptoms continued three days after the injection and dropped further when a second dose was administered.
Another study found that 0.25 mg/kg of intramuscular ketamine was as safe and effective as a higher dose of 0.5 mg/kg using the IV route. This proves that the IM method of administration is a powerful and promising method to reduce severe symptoms of depression without a full medical setup.
Comparison Of Different Ketamine Treatments
Here’s a table comparing the different ketamine administration routes depending on specific factors.
|IV Ketamine||Sublingual Ketamine||Nasal Esketamine||Intramuscular Ketamine|
|Effectiveness||High efficacy in severe cases of depression and other disorders.||Results may vary based on absorption by the patient’s body.||A notable efficacy in treating disorders. Yet, not as effective as other forms.||Extended duration of effects, showing potential for sustained relief.|
|Side Effects||Dissociation, dizziness, and nausea which subside quickly.||Potential for dissociative effects but more tolerable than IV.||Reduced dissociation due to esketamine formulation.||Least dissociative due to gradual release of medication.|
|Convenience||Must be conducted in a medical facility.||Can be self-administered.But the potential for variability can cause inconvenience.||Can be self-administered. However, the patient may need frequent sessions.||Requires a professional. But the effects last longer, which means fewer sessions.|
|Patient Satisfaction||High satisfaction due to rapid and profound results. There may be concerns about dissociation, but these are mitigated under a trained therapist.||Mixed satisfaction due to variable absorption rates.||Typically positive due to ease of administration and manageable side effects.||High satisfaction due to sustained effects. However, not ideal for patients who need immediate relief.|
Factors Affecting The Choice Of Ketamine Administration
While the aim of ketamine therapy is to achieve a desired outcome, the choice of administration will influence the result.
Here are a few factors to consider.
- Medical Condition: Depending on the nature and severity of the issue, the therapist may recommend a rapid relief measure (intravenous) or suggest the need for long-term stability (intramuscular).
- Patient Preference: Some patients may be uncomfortable with needles and opt for sublingual or nasal administration. Others may not want to experience intense dissociation and avoid the IV method.
- Frequency: For those looking to minimize clinical visits, the intramuscular method works best. However, some may require rapid relief and more frequent sessions, for which IV or nasal spray is a better option.
- Accessibility: Consideration of available medical facilities, trained professionals, and the ability to self-administer will influence the chosen method.
- Cost: The cost associated with each form of treatment and the medical facilities involved will affect the patient’s final decision.
Ultimately, the method of ketamine administration should be chosen through a discussion between the therapist and patient, after reviewing the patient’s medical history, preferences, and treatment goals.
This personalized approach is crucial to ensure that the chosen method aligns with the patient’s unique needs and maximizes the potential benefits of ketamine therapy.
Make An Informed Choice
Each approach carries its own set of benefits and drawbacks, catering to different preferences and therapeutic needs.
- Intravenous ketamine offers immediate relief in acute situations, leading to profound insights and high efficacy. But the possibility of an intense dissociative experience is higher.
- Sublingual ketamine offers a balance of convenience and efficacy. However, the outcome will vary depending on how effectively the substance is absorbed.
- Nasal esketamine is easy to use and the dissociative effects are minimized. But the lower intensity means that patients may require more sessions to achieve the desired outcome.
- Intramuscular ketamine provides extended relief for those seeking sustained effects. However, it takes longer for effects to kick in once the ketamine has been administered.
A patient must understand the different methods, the benefits, and the drawbacks so they can make an informed decision aligned with their unique circumstances.
Ketamine-Assisted Therapy in Los Angeles
The evolution of ketamine therapy signals a shift in the approach toward mental health.
The Psychedelic Collective aims to empower patients with the latest insights, equipping them to collaborate effectively in crafting personalized treatment plans.
Our evidence-based modalities focus on patient-centered care and prioritizing the physical, mental, and emotional safety of those who seek our help.
We urge you to explore the realm of ketamine-assisted therapy in Los Angeles as a potential avenue for relief. Call us today to learn more about your treatment options and craft a plan that suits you best.
With the help of ketamine, you can navigate your condition in a way that produces tangible results in a short time, helping you improve your overall quality of life.