Types of Ketamine for Therapeutic Use

Written by Admin Strange DM on August 18, 2023. Posted in Depression, Grief, Ketamine Assisted Therapy, Ketamine Lozenges, LGBTQ. No Comments on Types of Ketamine for Therapeutic Use

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.

IV Ketamine

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.

Benefits

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.

Drawbacks

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

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.

Benefits

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.

Drawbacks

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.

Nasal Esketamine

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.

Benefits

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.

Drawbacks

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 Injection

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.

Benefits

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.

Drawbacks

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.

Overview of the different types of ketamine for therapeutic purposes

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.

Additional Reading

The Promise of Ketamine-Assisted Therapy in Addressing Mental Health Concerns within the LGBTQ Community

Written by Admin Strange DM on July 22, 2023. Posted in Ketamine Assisted Therapy, LGBTQ, Mental Health. No Comments on The Promise of Ketamine-Assisted Therapy in Addressing Mental Health Concerns within the LGBTQ Community

Over the past two decades, there has been an increase in public and scientific awareness of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, and Asexual (LGBTQIA+) lives and issues.

This heightened awareness can be attributed to sociocultural shifts in understanding sexual and gender identities.

While everyone has a sexual orientation and gender identity, people who identify as LGBTQIA+ often face higher mental health risks.

Why is that?

And what makes ketamine-assisted therapy (KAT) an effective tool for the LGTBQ community?

The State of Mental Health in the LGBTQ Community

Prevalence of different mental health disorders within the LGBTQIA+ community

Numerous studies conducted in the United States and internationally have found that LGBTQ youth report higher rates of symptoms of psychological distress compared to heterosexual and cisgender youth.

These include

Emotional distress
Symptoms of mood and anxiety disorders
Substance abuse and dependence
Self-harm
Suicidal ideation and behavior

Of course, mental health patterns not only vary across sexual and gender identities. They also extend to racial and ethnic backgrounds, cultural influences, and social class identities.

From “pathology” to the unique stressors contributing to mental health challenges

Historically, the understanding of homosexuality and same-sex attraction has evolved within the field of psychology.

Prior to the 1970s, homosexuality was pathologized and listed as a “sociopathic personality disturbance.”

However, shifting attitudes and pioneering studies led to the removal of homosexuality as a mental disorder in 1973.

Over the past five decades, the focus has moved away from perceiving homosexuality as inherently linked to poor mental health. Instead, researchers have turned their attention to understanding the social factors that influence the mental well-being of the LGBTQ community.

We are currently seeing similar debates about gender identity diagnoses that still remain in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The minority stress theory

According to Dr. Alex Belser, a psychedelic researcher at Yale University who studies psychedelic use among LGBTQ people, “Young gay people are taking their own lives because of the sort of stress, pressure, bullying, and rejection they received in their families, religious communities, schools, and broader political experience in the world.”

This fits with Dr. Illan Meyer’s minority stress theory, which suggests that sexual minorities face unique, chronic stressors related to their stigmatized identities, including victimization, prejudice, and discrimination. Combined with everyday or universal stressors, these distinct stressors can greatly impact the mental health and well-being of LGBTQ individuals.

Meyer further identifies three stress processes, progressing from external factors to internal conflicts:

Objective or external stressors (such as discrimination or prejudice)
Expectations of victimization or rejection and the vigilance related to these expectations
The internalization of negative social attitudes (often referred to as internalized homophobia)

Current Mental Health Treatment Landscape for LGBTQ Individuals

The mental health treatment landscape for the LGBTQ community presents a series of hurdles, making access to appropriate care a complex journey.

Limitations of current therapeutic approaches

Traditional therapeutic modalities to treat mental health concerns often do not fully address the unique experiences and needs of LGBTQ individuals.

These approaches usually operate within a heteronormative framework, which can overlook or minimize the impact of societal prejudice, discrimination, and minority stress experienced by LGBTQ individuals.

Existing therapeutic interventions

Realizing people from the LGBTQ community have specific needs that tend to go unmet in traditional therapeutic approaches, clinicians have set out to create programs that work better.

These modalities validate rather than pathologize queer identities. They are, therefore, called ‘affirmative treatments’.

Below are some examples of LGBTQ-affirmative mental health treatments:

LGBTQ-affirmative cognitive behavioral therapy (CBT). This can include several types of interventions, including EQuIP and AFFIRM. EQuIP (Empowering Queer Identities in Psychotherapy) specifically addresses someone’s reactions to stressors while AFFIRM focuses on reducing depression and promoting healthy coping through collaborative group therapy.
Support groups specifically designed for people from the LGTBQIA+ community. These offer a safe haven where people can share their struggles and triumphs.
Online affirmative counseling platforms. These provide convenient and accessible mental health services that break down geographical barriers.
Ketamine-assisted psychotherapy

While therapeutic interventions exist, the path is often hindered by numerous challenges.

Barriers to accessing mental health care

Accessing mental health care that meets the unique needs of LGBTQ individuals can be challenging due to multiple barriers.

Here are three significant ones:

There is a shortage of culturally competent providers who have the necessary knowledge and understanding of LGBTQ identities and experiences. This limits the availability of professionals who can provide affirming and inclusive care.
Financial constraints and lack of insurance coverage can make mental health services unaffordable or inaccessible.
The fear of experiencing discrimination or bias from healthcare providers or staff can deter LGBTQ individuals from seeking help. Past negative experiences or the anticipation of encountering stigma can create a reluctance to engage with mental health services.

These obstacles can lead to a large gap in care for those who need it.

Ketamine-Assisted Therapy for LGBTQ Mental Health

As mentioned at the start of this article, KAT could be an effective tool for addressing mental health concerns within the LGBTQ community.

But how can KAT help LGBTQ individuals? And what are the theoretical underpinnings?

Let’s take a closer look.

The theoretical underpinnings: How can KAT help the LGBTQIA+ community?

According to Belser, psychedelics offer a powerful avenue to explore and even reconstruct gender and sexual identities.

Research on KAT suggests that it helps individuals by facilitating neuroplasticity, enhancing emotional processing, and reducing symptoms of depression and anxiety.

Far from the harmful LSD-conversion therapies used in the 60s, KAT doesn’t aim to undo LGTBQ people of their identity but rather help them embrace who they really are.

To quote Belser: “If a person has been fighting their sexual identity, the neuroplastic window of opportunity is a critical period for them to shift to a new way of understanding themselves and relating to other people in their lives. That can be incredibly relieving and quite liberating.”

Integration of KAT within a holistic treatment approach for LGBTQ mental health

To maximize the benefits of KAT, integration within a holistic treatment approach is key.

This involves combining KAT with other evidence-based therapies, support networks, and community resources. Creating comprehensive treatment plans that address the multifaceted needs of LGBTQ individuals leads to more effective and inclusive care.

Find out if you are a good candidate for KAT.

In addition, we need advocacy for policy changes and improved mental health resources.

This includes raising awareness about the unique mental health challenges faced by LGBTQ individuals and advocating for increased funding and support for LGBTQ-affirming mental health services.

Conclusion

Mental health concerns within the LGBTQ community require special attention due to the unique challenges and experiences faced by these individuals.

For this, inclusive and affirming therapeutic approaches are needed.

Due to its antidepressant qualities and neuroplasticity-enhancing nature, Ketamine-Assisted Therapy (KAT) holds promise as a potential solution to address mental health concerns within the LGBTQ community. To maximize the benefits, integration within a holistic treatment approach as well as further advocacy for policy changes are key.

Join Psychedelica Collective’s LGBTQ+ Ketamine Therapeutic Group in Los Angeles today! It’s an inclusive and confidential space where you can safely explore your mental health concerns while building connections with like-minded individuals. Let ketamine-assisted therapy help you dive deeper into self-discovery, empathy, and holistic well-being. Contact us today and start your journey toward healing.

References

Why does the LGBTQIA+ community suffer from poor mental health at higher rates? (https://healthcare.utah.edu/healthfeed/2021/07/why-does-lgbtqia-community-suffer-poor-mental-health-higher-rates)
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual review of clinical psychology, 12, 465-487. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887282/)
Psychedelics are for queer folks, too (https://www.vice.com/en/article/8xwz95/lgbtq-psychedelic-therapy-trauma-depression-anxiety)
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of health and social behavior, 38-56. (https://pubmed.ncbi.nlm.nih.gov/7738327/)
National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26383. (https://nap.nationalacademies.org/read/26383/chapter/6#51)
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674. (https://pubmed.ncbi.nlm.nih.gov/12956539/)
Pachankis, J. E., Harkness, A., Jackson, S., & Safren, S. A. (2022). Transdiagnostic LGBTQ-affirmative cognitive-behavioral therapy: Therapist guide. Oxford University Press. (https://doi.org/10.1093/med-psych/9780197643303.003.0001)
Project EQuIP: Empowering Queer Identities in Psychotherapy (EQuIP) (https://classic.clinicaltrials.gov/ct2/show/NCT03721276)
Project Youth AFFIRM (https://www.projectyouthaffirm.org)
Drozdz, S. J., Goel, A., McGarr, M. W., Katz, J., Ritvo, P., Mattina, G. F., … & Ladha, K. S. (2022). Ketamine assisted psychotherapy: a systematic narrative review of the literature. Journal of Pain Research, 1691-1706. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9207256/)