*The FDA has not approved intravenous ketamine or NAD+ for the treatment of any psychiatric or pain condition. These articles reference off-label use. Like all medical treatments, the discussed therapies carry risks and benefits. Speak with a doctor at Clarus Health to learn if these therapies may be right for you.
Ketamine therapy can be a powerful treatment for depression, anxiety, PTSD, and chronic pain. Unfortunately, this has led to an explosion of Ketamine therapies that may cut corners at the risk of harming patients physically and psychologically in unsupervised settings. Learn the risks and benefits of at-home Ketamine therapies compared to the gold standard of IV Ketamine Therapy.
At Home Ketamine Therapy Uses Oral Ketamine
At-home Ketamine is typically taken orally as a sublingual lozenge, also called a troches (pronounced "trokee"). Sublingual Ketamine is easier and cheaper than other forms of Ketamine. However, there are several critical drawbacks to oral (and intranasal) Ketamine compared to IV Ketamine, including:
- Less precise dosing
- Less reliable effects
- Less controlled setting
- Risks of addiction
- Lack of medical and psychological supervision
- Risk of frightening experiences and long term fear of healing psychedelic experiences
Oral Ketamine can be easier to administer but has significant drawbacks that reduce its effectiveness
Oral Ketamine's Bioavailability is the Lowest
Bioavailability refers to how much of the medication is absorbed into your body. IV Ketamine's bioavailability is 100%, meaning 100% of the Ketamine reaches your bloodstream. Oral (sublingual) Ketamine's bioavailability ranges from 10-30% because 50% of Ketamine is metabolized by the liver (if not absorbed sublingually). This means that sublingual Ketamine cannot be dosed as precisely as IV Ketamine because the absorption into the body is not as consistent as IV Ketamine's. Less reliable dosing of Ketamine means that the healing experience cannot be reproduced as reliability.
This is one of the main factors contributing to IV Ketamine's highly effective number-needed-to-treat (NNT) of 2 compared to 6 for other forms of Ketamine (a lower NNT is better).
Sublingual Ketamine Cannot be Titrated Reliably
When Ketamine is dosed, a specific number of milligrams are given to the patient. At-home Ketamine therapy usually involves mailing troches to the patient, and each troche is a fixed number of milligrams. If a patient needs a dose adjustment, it can be difficult to make dose adjustments.
IV Ketamine is unique because it is dosed instantaneously. If a patient suffering with treatment resistant depression needs 10% more, it can be given immediately. If 50% more Ketamine is required, the dose can also be instantaneously adjusted. Therefore, IV Ketamine has a virtually limitless number of potential dosing strategy that allows your doctor to select the right dosing strategy for you.
IV Ketamine is dosed instantaneously compared to having to wait days or weeks for sublingual dose adjustments
Feedback Dosing Adjustments Takes Time with Oral Ketamine
If a patient tells their doctor they need a different dose based on their Ketamine experience, it may take days or weeks for a new dose to be mailed to the patient. In IV Ketamine Infusions, patients tell their doctor immediately during the session if the experience requires a dose adjustment. This leads to significantly faster feedback loops for optimal dosing and healing effect.
Set and Setting Are Critical to Ketamine's Healing Effects
The mindset you have before entering your Ketamine journey has a significant impact on what happens to your brain, mind, and body during the Ketamine experience.
Receiving IV Ketamine in a compassionate and responsible healing center allows for a controlled environment.
When your doctor is physically present with you during your Ketamine experience, they can also orient your mindset. The proper mindset before, during, and after the experience can make a significant difference in how effective the Ketamine is in healing depression and other conditions.
The Harms of Ketamine Experiences at Home
When patients come to me after trying oral Ketamine at home, they often have one of the following experiences:
- Non-healing experience: they are still suffering from depression, anxiety, etc.
- Frightening, or "bad trip" leading to an unpleasant experience
You can see that these ineffective tests of Ketamine therapy can result for any of the reasons above. Unfortunately, patients can be afraid to pursue highly effective IV Ketamine Infusion Therapy after experiences like this. This can lead to long-term harm if depression, PTSD, or anxiety remain untreated or undertreated.
The Benefits of At Home Ketamine
Understanding these limitations of oral Ketamine is important so it can be used safely and appropriately. For example, we advocate for responsible oral Ketamine use in patients who have had positive experiences with IV Ketamine and are ready to transition to a more sustainable treatment plan.
While this sounds like an attractive option, we also caution against replacing traditional antidepressants with oral ketamine.
The goal of Ketamine therapy is to uncover our healing potential, not add more medications or side effects. A personalized IV Ketamine treatment plan should help you reduce the need for extra medications, whether traditional SSRIs or ongoing oral Ketamine.
Start your Ketamine Journey to Uncover Your Healing Potential
Contact Clarus Health for a free consultation to learn if IV Ketamine therapy can help you uncover your innate healing capacity and possibly reduce the need for other medications.
Anthony Kaveh MD
Dr. Kaveh is a Stanford and Harvard-trained anesthesiologist and integrative medicine specialist. He has over 800,000 followers on social media and has guided hundreds of patients throughout transformative healing experiences. He is an authority on Ketamine, NAD, and SGB therapies. He is a registered continuing education lecturer in the Bay Area.
