What To Expect: These are the Most Common Types of Ketamine Treatments

What To Expect: These are the Most Common Types of Ketamine Treatments

Ketamine treatment is gaining traction in the medical world, but in reality, ketamine is an unusual drug. On one hand, it has muscle-relaxing and anesthetic effects. But in high doses, ketamine takes the user completely away from their body, knocking them out completely. Dislocated shoulders and knees can be put back into their sockets. Doctors can perform surgery on children. 

This painkilling effect is why ketamine is classified as dissociative anesthetic. Yet some people also classify ketamine as a psychedelic, because it can also have considerable psychedelic effects at certain dosages. 

Ketamine creates a subjective feeling of detachment from the body and a person’s surroundings. As well as its primary effect of dissociation, ketamine can create other qualitative effects:

Interested in Ketamine Therapy? Find Ketamine Clinics Near You

An Overview of the Most Common Types of Ketamine Treatment

Ketamine Infusion ClinicInfusions are administered intravenously in a clinic under the supervision of a healthcare provider.Immediate effects, precise dosing, professional monitoring, option for co-therapy with a psychologist/psychiatrist.
Ketamine Nasal SprayEsketamine (Spravato) is a prescription nasal spray used along with an oral antidepressant, under medical supervision.Easy to administer, less invasive than IV, used in conjunction with an oral antidepressant, supervised use.
Oral KetamineKetamine can be prescribed in pill or lozenge form, usually taken under the supervision of a healthcare provider.Easier administration than IV or nasal spray, less invasive, can be administered at home under supervision, may be combined with psychotherapy.
Ketamine-Assisted Psychotherapy (KAP)Therapist-guided sessions where ketamine is used to enhance the therapeutic process. Usually combined with infusions or oral ketamine.Enhanced therapeutic outcomes, individualized care, beneficial for treatment-resistant conditions.
Telehealth Ketamine TherapySome providers may offer ketamine treatment in the form of a lozenge or nasal spray over telehealth. This requires close coordination with a healthcare provider.Allows treatment from the comfort of home, beneficial for those with mobility issues or a lack of nearby facilities, still requires supervision.

What Patients are Saying about their Ketamine Treatments:

What they like about their experience: 
1. Rapid Relief: Many patients have reported experiencing rapid relief from depressive symptoms after undergoing ketamine therapy. This is particularly notable for individuals who have tried other treatments without success. The quick onset of relief can be life-changing for some.

2. Professional Setting: Receiving ketamine therapy in a clinic means the treatment is administered under medical supervision. This gives many patients peace of mind, knowing that professionals monitor their vital signs and overall well-being during the session.

3. Holistic Approach: Some ketamine clinics offer additional therapeutic support, such as psychotherapy or counseling, alongside the treatment. This comprehensive approach can enhance the overall therapeutic experience, allowing patients to integrate their experiences more effectively.

What they don’t like about their experience: 
1. Cost: One of the most common concerns is the cost of ketamine therapy. Insurance often doesn’t cover it, making the treatment inaccessible for many individuals due to high out-of-pocket expenses.

2. Temporary Effects: While many experience rapid relief, the duration of the benefits can be temporary, requiring repeated treatments to maintain the effects. This can be both time-consuming and expensive.

3. Potential Side Effects: Some patients report experiencing side effects during or after the therapy, including nausea, increased blood pressure, disorientation, or unsettling hallucinations. While these effects are generally temporary and can be managed, they can be off-putting for some individuals.

– Have you received ketamine treatment? Leave a review below
A ketamine clinic waiting room by Plus by APN.

What a Ketamine Treatment in a Clinic is Like

The Space

Ketamine treatments typically take place in offices that look like a dentist or doctor’s. Usually there’s a comfortable recliner, pictures on the wall, and medical equipment to inject the ketamine. There’s a sound system and/or headphones and eyeshades. (The environment matters somewhat; a comfortable space puts the patient at ease. But the physical surroundings during a high-dose ketamine treatment matter less than with other psychedelics, like mushrooms or LSD. On those drugs, the setting becomes amplified and more vivid. On ketamine, it’s the opposite; people are disconnected from the surroundings. It’s literally difficult to look at the room or move around it.)

The Intake

A nurse, doctor or physicians assistant will typically ask about the patient’s physical health to make sure they’re healthy enough for ketamine. Clinics may exclude people with certain maladies, like really high blood pressure or certain medications. People using ketamine for depression, bipolar, or any other mental health issue will likely talk to a therapist to make sure ketamine is right for them.

The Injection

In a clinic, medical professionals, like a nurse or an EMT, insert a needle in the shoulder or an IV in the arm. It hurts as much as a shot.

The Come Up

In most cases, ketamine’s effects come on fast. People feel themselves losing contact with the room, as if their senses have been covered in a blanket. They feel like they’re falling, like the recliner tipped backward and the ground opened up. They feel like they’ve lost contact with their body; they might not feel the chair under them or the person next to them holding their hand; it’s hard to move arms and legs, and difficult to speak. For people with chronic pain, this disconnection from their bodies is a blessing; the pain feels a mile away.

READ NEXT: What Does Ketamine Feel Like?

The Experience

A high dose of ketamine produces different effects for different people. Some say it’s total darkness. They say ketamine puts them in a black hole without shape or form, like being buried in a ten foot hole, or else in a dark room with slate-gray walls, like the inside of a mausoleum. Their ego dies; meaning, it’s hard to recall where they are, who they are or even if they’re alive. The sensation of dying can be terribly frightening and uncomfortable, like being stuck in a deep freezer you can’t get off of. Other people welcome the feeling of disappearing; they say a ketamine hole feels euphoric; they like losing control; they feel held and safe in the darkness. Their ongoing narrative of their life, which can often be negative, ends. They feel peace.

On the other hand, some people don’t feel blackness. They say ketamine puts them in a world full of shapes, colors, and images, like a kaleidoscope, people watch scenes from their lives play out in front of them; they feel they’re connecting to lost relatives or something larger than themselves. Patients replay traumas or past joys; people wail, sing, shake or cry. People often come out saying they feel changed as a human being.

The Come Down

In any case, the effects wear off relatively fast. Unlike other psychedelics, which go on for hours, the peak of ketamine is only about 45 minutes or an hour. About two hours after the injection people feel more or less normal, though they may feel wobbly.

The Afterglow

In the days after a ketamine treatment, it’s common to feel lighter. Problems may seem farther away or less weighty. People clean our their closets or drop relationships that aren’t serving them. Other people say they feel no change at all.

READ NEXT: Psychedelics Won’t Fix You. Here’s What They Will Do

RELATED: Do Dosages of Psychedelics Differ for Anxiety, Depression, Pain and PTSD?

Ketamine’s Effects at the Various Dose Ranges

Lower Dosages

Lower dosages create effects often described as wavy or weird. You may feel somewhat stimulated or drowsy, and with a light body high. You may experience slight perceptual changes, including objects looking ‘high definition’ and sounds heard as strange. The normal patterns of thought can slow down, and forming sentences and processing information can be difficult. 

Medium Dosages

At a medium dosage, stereotypical psychedelic effects may come on: colors will be noticeably enhanced and vivid, walls and objects can move. You may feel drowsy, as well as a numbness across your body and slurring in your speech. You may feel some nausea, too, as well as higher heart rate and blood pressure. 

Higher Dosages

At a higher dose, you may experience more numbness and difficulty communicating. You will probably find it difficult to move and co-ordinate your body, which is why having a trip sitter or medical professional is so helpful. Higher doses of ketamine may cause more powerful psychedelic-style effects, including feelings of traveling to ‘other dimensions’ and complex visual imagery. Higher doses may also produce the ‘k-hole’ experience, in which the user is immobilized and their usual sense of self is loosened or erased. It is called a ‘k-hole’ because users may feel so detached from their surroundings that they appear to be at the receded end of a tunnel. There may be a feeling of ego dissolution or mystical interconnectedness, but also panic, anxiety and overwhelm, including the possibility of trauma.
Ketamine has shown increasing promise for treating psychiatric conditions like depression. 

BECOME A PSYCHEDELIC THERAPIST: Psychedelic-Assisted Therapy Certifications and Training

What a Low-Dose Ketamine Troche or Lozenge Experience is Like

Often, ketamine is used in lower doses. The medicine comes in the form of a lozenge or a small tablet called a troche. Or, sometimes, as a liquid you swish around your mouth.

At these lower doses, the effect is different. The patient isn’t disassociated from their bodes, down in a hole. On a troche or lozenge, the world is shifted slightly. The world slows down, including thoughts, as if someone’s train of thought is plowing through cubes of Jell-O. The world can look more digital or pixelated. Inhibitions can lower, facilitating talk about difficult or important things. On lower doses, therapists can talk to patient and do therapy. People can process emotions in a way that feels safer, calmer, and less threatening. This is called psycholytic–the psyche is loosened.

RELATED: What Are The Biggest Misconceptions About Ketamine Therapy?

Please remember that while ketamine shows promise in treating conditions like depression, it should only be used under the guidance of a healthcare professional. It can have serious side effects and is not appropriate for everyone. This is an emerging field of study, and more research is needed to fully understand the benefits and potential risks.

The waiting room in Ketamine Clinics Los Angeles.

Here are the four main ways that ketamine treatments are administered as well as their typical dosages:

Interested in visiting a ketamine clinic? These are the four options of treatment you have. For a deeper dive into dosages, check out our breakdown of ketamine dosages.

1. Intranasal (Spravato/Esketamine)

Dosage: 28-84 mg per treatment session
How it Works: Typically administered twice a week for the first four weeks. Then once a week to once every two weeks thereafter.
Overview: Spravato must be delivered intranasally in a controlled medical setting while supervised by a healthcare professional. Patients must remain in the clinic for two hours after dosing to ensure aftercare. 

The bottles come only in 56 or 84 mg concentrations, which can make it hard to personalize treatment.

2. Oral Ketamine (Both Lozenges and Troches as well as Liquid)

Lozenges/Troches: In this method, the patient sucks on a pill until the ketamine dissolves in the mouth. Typically used in telehealth experiences.
Dosages: The dosage for ketamine lozenges can vary widely depending on the indication and patient response, but often ranges from 50-200 mg per administration.

Liquid form of Ketamine: The patient swishes the liquid around their mouth, allowing it to be absorbed by the pores on the insides of their cheeks.
Dosages: Doses are often done based on the patient’s weight. And typically range from 0.25 to 2 mg/kg, or about 12 mg to 300 mg.

3. Intravenous (IV) Infusion

How it Works: A doctor, nurse or EMT starts an IV in the patient, usually on the forearm, and injects ketamine using a special machine.
Dosages: for depression vary based on the individual and the indication for use. Treatments are typically administered over typically 4-6 sessions

Some patients may prefer IV ketamine because all of it is available to be absorbed and metabolized in the body (100 percent bioavailability). And the quantity of ketamine can be altered depending on the patients’ preferences.

4. Intramuscular (IM)

How it Works: A medical professional injects liquid ketamine into a patient’s muscle, usually the shoulder.
Dosage: Dosing vary, typically ranging from 0.2 to 0.5 mg/kg, with higher doses used in some cases.

For IM ketamine, 93 percent of the drug is available to be absorbed. This means that the precise amount of ketamine entering the body’s circulation isn’t known with certainty. 

A ketamine clinic in Irvine, California.
Photo by Reynier Carl on Unsplash

Photo by Priscilla Du Preez on Unsplash

A Hudson Mind ketamine treatment center in the New York City area.

Jonathann Kuo, MD, counsels a patient at Hudson Mind.

How to Find Ketamine Clinic Near You

To check your options, you can scan a list of clinics near you here.

Ed Prideaux

Ed Prideaux

View all posts by Ed Prideaux

Ed is a journalist, writer and MSc Psychology student who has been focusing on harm reduction and critical research around psychedelic drugs, and helped to grow a nonprofit called the Perception Restoration Foundation. He's worked for the influential alternative media firm Rebel Wisdom, and has freelanced for a range of international publications.

Abid Nazeer

This post was medically approved by Abid Nazeer

Dr. Nazeer is the Founder and President of APS Ketamine/Advanced Psychiatric Solutions, which he established in 2016 as the first psychiatric outpatient ketamine clinic in Illinois. He is board certified in Psychiatry as well as Addiction Medicine. He completed his psychiatry residency at Louisiana State University Health Sciences in Shreveport where he held the role of Chief Resident. Dr. Nazeer is providing medical oversight to the growth plan of Wesana Clinics, with the model of comprehensive psychiatry clinics specialized ketamine and psychedelic therapies, integrated brain health and wellness centers, and technology utilization of Wesana Solutions remote patient monitoring product.

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