Ketamine Administration and Dosing

How is ketamine administered, and how can it help you?

About one out of five adults in the U.S. will experience mental illness each year.⁽¹⁾ These disorders can have a serious impact, both here in the U.S. and abroad. Nearly 52.9 million Americans struggle with a mental health condition, while depression represents a leading global cause of disability. While research is ongoing, ketamine may offer a solution for some individuals.^(2,3)

Unfortunately, over half (54.7%) of people living with a mental health condition will not receive treatment or will be under-treated.⁽¹⁾ Those who do receive treatment may not experience successful results regarding symptom resolution. While standard therapies can help, they don’t work for everyone.⁽⁴⁾

As a result, researchers continue to look for new solutions. Medications such as ketamine may be the answer, especially when you have mental health conditions that don’t respond to other treatments.

Ketamine Treatments: What Are They?

Ketamine is an anesthetic drug that can cause sedation at higher doses (relaxation and calmness). It is often used to help people fall asleep during quick surgical procedures and may help to ease pain.⁽⁵⁾ However, new research shows that ketamine’s benefits may stretch even further.

How is Ketamine Used as a Mental Health Treatment?Some studies suggest that ketamine may help to treat depression quickly. While antidepressants may take weeks or months to impact symptoms, ketamine may relieve depression symptoms within one to 24 hours.^(6,7)

Ketamine treatments have also been shown to last for several weeks before depression symptoms return.⁽⁷⁾ Additionally, one study found that the participants with treatment-resistant depression (TRD) who used the nasal spray esketamine, a derivative of the medication ketamine, when combined with an oral antidepressant, had a significantly prolonged depression relapse time compared to those in the placebo group (antidepressant plus placebo nasal spray).⁽⁸⁾

Ketamine therapy may also treat post-traumatic stress disorder (PTSD), anxiety, obsessive-compulsive disorder (OCD), and substance use.⁽¹⁰⁾

How is Ketamine Administered?Ketamine comes in a few different forms. It can be given intravenously (through an IV, into your vein), intramuscularly (an injection into your muscles), as a sublingual lozenge (a tablet placed under the tongue), or as a troche (between your cheek and gums).⁽⁵⁾

One medication, esketamine (Spravato), is a different form of ketamine and is available as a nasal spray. This is the only type of ketamine approved by the U.S. Food and Drug Administration (FDA) for mental health conditions, more specifically for treatment-resistant depression in adults and depressive symptoms with major depressive disorder (MDD) accompanied by suicidal behavior or ideation, again, in adults. However, the other ketamine forms can be prescribed off-label (outside of the medication’s FDA-approved usage) by doctors if they think their patients could benefit.⁽¹⁰⁾

What to Expect During a Ketamine Appointment

IV ketamine, ketamine injections, and esketamine nasal sprays are administered in a clinic or doctor’s office. During an appointment, you receive medication from a healthcare provider trained to administer ketamine. You aren’t permitted to take them home.⁽¹⁰⁾

If you are going through ketamine therapy, you will work with a mental health provider before, during, or after taking the medication. This can occur in person in the provider’s office or at home through a telehealth appointment.⁽¹⁰⁾

If you are doing at-home treatment, ketamine lozenges or troches are typically delivered to your door and are (at least initially) taken while you connect with your treatment provider, counselor or licensed Ketamine-Assisted Psychotherapy (KAP) therapist over a tele-health appointment.

a ketamine therapist discussing ketamine dosage and administration

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How is a Dose of Ketamine Determined?Your dose of ketamine partially depends on your weight. Doses are often measured in milligrams per kilogram (mg/kg), meaning that you will receive a certain amount of ketamine for every kilogram you weigh. Medical providers use kilograms instead of pounds for accuracy when dispensing medication.

When using IV ketamine, you may experience dissociation or anesthesia at a dose of 1 – 1.5 mg/kg. Ketamine injections into your muscle may also produce these effects at 3 – 4 mg/kg. However, when used as a mental health treatment, doctors administer ketamine at lower doses so that you can stay awake.⁽⁴⁾

Some experts say you should receive a dose of between 0.1 and 0.4 mg/kg of the drug when given through an IV for off-label use.⁽⁴⁾ However, researchers have tested various doses in clinical studies. More research is needed to determine which doses work best for various conditions.⁽⁵⁾

Esketamine is between two and five times stronger than ketamine injections. Therefore, doctors will generally give you a lower esketamine dose to produce the same effects.⁽¹¹⁾

Ketamine Therapy SessionsTo further boost its ability to treat mental health conditions, ketamine is sometimes paired with talk therapy. Ketamine therapy can work in a couple of different ways. For example, a doctor may prescribe low doses of ketamine, and you may take the medication while talking through your thoughts and sensations with a therapist or guide.⁽⁵⁾

Alternatively, you may take higher doses of ketamine and focus inward on your thoughts. Therapists or other professionals also frequently guide this sort of practice. For example, the provider may help you plan out your goals and intentions or meet with you afterward to review your experience and help you process it.⁽⁵⁾

These therapy sessions may have many uses. They could help you better understand how your mind works, set clear and attainable goals, or be able to reflect more clearly on your life or specific events. Ketamine therapy may also help you think more positively, feel better about yourself, work through trauma, or boost creativity.⁽⁸⁾

Is Ketamine Administered Safely?No medication or drug is 100% safe—there is always a risk of side effects or health complications. However, providers who prescribe ketamine know how to do it with minimal risk.

Ketamine can be safely administered in a variety of ways. As we said earlier, you may receive ketamine from an intravenous (IV) drip, intramuscular injection (IM), or an oral lozenge or troche. For intravenous ketamine, you will receive a low-dose IV drip, with the dosage calculated based on your body weight. Intramuscular ketamine is administered directly to one of the large muscle groups, such as your upper thigh or buttocks. The dosage is calculated similarly to IV ketamine and is based on body weight. Both IV and IM ketamine must be administered by trained personnel in the safety of a medical provider’s office. Your provider will monitor you during your ketamine session and can adjust the dosage to make sure your experience is safe and comfortable.

Sublingual ketamine comes in the form of a lozenge with a predetermined dosage. It is not calculated based on body weight, as are the other methods. These methods are designed to ensure that you receive your ketamine treatment in the safest way possible.

Esketamine is a little different. It is delivered through a nasal spray and has strict safety requirements from the FDA. Esketamine must be administered in the presence of a medical provider and cannot be taken off premises. During the approval process for esketamine (Spravato), the FDA required the drug manufacturer to develop a Risk Evaluation and Mitigation Strategy (REMS). As part of this program, healthcare providers get extra education on prescribing ketamine safely. A REMS may also require you or your provider to take extra precautions when using a medication like ketamine.⁽¹²⁾

The REMS developed for esketamine requires medical offices to be certified before you can receive treatment there. It also says that healthcare providers must watch out for any side effects during and after treatment.⁽⁹⁾

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Ketamine Side Effects

Various forms of ketamine cause some of the same short-term side effects. They can alter your perception of colors and sounds, make it harder to focus, cause an out-of-body experience, make time feel like it’s speeding up or slowing down, or make you feel generally intoxicated or strange for the duration of the session.⁽¹³⁾

Ketamine has a range of side effects. Most commonly, it can trigger nausea or vomiting. It may also increase your blood pressure levels.⁽¹³⁾ Ketamine infusions may also cause dizziness, confusion, speaking problems, vision changes, tiredness, or dry mouth.^(14-15)

Several side effects have been identified for esketamine nasal spray. Typically ketamine side effects are short-lived, usually lasting for the duration of treatment. You may experience:⁽¹⁶⁾

Nausea
Vomiting
Diarrhea

Constipation
Frequent Urination
Bruning Sensation While Urinating

Increased Metallic Taste in Mouth
Nose or Throat Pain
Suicidal Thoughts (Rare)

Ketamine can affect your thinking for several hours after treatment, so it’s best to avoid driving or making big decisions on treatment days. If you are doing outpatient (in-office) treatments, you will also need to arrange transport to and from the provider’s office. Regardless, you’ll want to have had a full night’s sleep prior to treatment, and plan for another after treatment.⁽¹⁶⁾

Is Ketamine Treatment Professionally Monitored?

Whether or not you are monitored while taking ketamine depends on your treatment program.

When medical professionals give ketamine in a clinic, they watch out for issues before, during, and after treatment. You will need to stay in the clinic for a half hour or more after undergoing treatment to ensure there are no problems.⁽⁹⁾

You aren’t always directly monitored when you use ketamine tablets at home. Sometimes, you may communicate with a healthcare provider during the treatment. Other times, you may take ketamine on your own and talk to a provider later about your experience.⁽¹⁰⁾

Combining Ketamine With Other Medications

Ketamine shouldn’t be combined with certain medications. Some drug combinations may cause side effects to increase or can make some medications less effective. You may experience problems if you combine ketamine with drugs like:⁽¹⁶⁾

Amphetamines
Anti-seizure medications
Opioid medications

MAO inhibitors (medications used to treat depression and neurological conditions like panic disorder or Parkinson’s disease)
Medications to treat sleep disorders, including armodafinil (Nuvigil) or methylphenidate (Aptension)

To reduce your risk of drug interaction problems, make sure your doctor knows all the different medications, supplements, herbal products, and vitamins you are taking.

Is Ketamine Therapy a Good Choice for You?

When deciding whether you want to try ketamine, you should talk with your healthcare team, who can help you understand whether you have any health conditions that may cause problems while using this drug. A mental health provider, such as a psychiatrist or therapist, can help you explore how ketamine may improve conditions like depression.

If you have been struggling with your mental health and can’t find any good solutions, you may want to give ketamine a try. You can use our search tool to find a ketamine clinic near you.

Sources Cited

Where to Find
Ketamine TreatmentLocate outpatient ketamine clinics and at-home ketamine service providers in the U.S. that offer care for pain, depression, anxiety, PTSD, OCD, and addiction.

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