I have been training in the use of ketamine since early 2021, both experientially and through structured lectures spanning medical safety and implementation to ketamine-assisted psychotherapy (known as KAP). While I do not practice KAP directly with my patients, it is important to understand what it offers and how it can be implemented, with some believing it is integral to ketamine’s benefits. My own explorations with ketamine have been my greatest teacher and I highly encourage anyone seeking ketamine therapy to choose practitioners and administrators that have experienced it themselves; you would be surprised at the number of providers that have not experienced what it is they are providing and I believe this does a disservice to patients and to this therapy. With first-hand experience and careful observation from patients undergoing treatment, I have curated a ketamine experience elevated from other places, from needle type and placement, to eye mask choice, to medication dosing. Patients that have had ketamine experiences elsewhere always cite their experience with me to be superior.
Many clinics administer ketamine via intramuscular (IM) injection or oral lozenge (also called a troche), largely for logistical ease in comparison to intravenous (IV) administration, delivered through the vein. For a variety of reasons I am partial to IV ketamine and this is what I choose to offer in my practice; I find it has a more gentle onset, longer duration of experience, is more quickly cleared by the body (observational, not studied), and that patients retain the memory of the experience better. It also provides patients a sense of comfort and control knowing the administration of the medicine can be stopped at any time (to date, I have had no patients ask for this). I will speak more about the different routes of administration in a future writing.
One of the difficulties mainstream medicine has with ketamine is that there is no standard dosing when used for therapeutic reasons – the amount needed to achieve psychotropic effect is not dependent on gender, weight, age, or overall body size, and a lack of standardization is a bane to the conventional medical paradigm. That being said, there is a range to work within in ketamine therapy and a skilled ketamine provider will assess an individualized starting dose for each patient and increase as appropriate. There are “ketamine clinics” across the country that let most anyone walk in and receive ketamine after a brief interview, with every person receiving the same, fixed dose. While I believe those patients can still achieve therapeutic benefit, I imagine it could be much greater if overseen by a practitioner or clinic that is attuned to the dosing nuances of this therapy.
In my practice, I personally administer all ketamine IVs and check in with patients at certain points in the treatment, adjusting dose as indicated to curate the most beneficial experience for them. I also sit in on sessions when requested. Patients are otherwise equipped with a button that alerts me if they need assistance. Music plays a large role in the ketamine experience and a specially curated playlist is offered along with a high-quality eye mask to limit external distractions. Patients drip anywhere from 45-55 minutes and then provided an hour to recover and contemplate their experience post-treatment. Before leaving, we have a debriefing period and patients are sent off with things to consider over the next 24 hours, which research suggests is an important time for ketamine’s neuroplastic effects. Patients may receive as many as 8 sessions within a 4-week period, but sessions are otherwise spread out over a period of 1-2 months or less frequently depending on patient need and response.