Ketamine-assisted therapy has gained attention as an innovative treatment for various mental health conditions, including depression, anxiety, PTSD, eating disorders, and chronic pain. With several delivery methods available, understanding the differences can help you choose the best approach for your needs. There are three common approaches to ketamine-assisted therapy:
- IV ketamine clinics
- Low-dose talk therapy (oral administration with lozenge or troche)
- Intramuscular (IM) injections with a therapist in the room
IV Ketamine Clinic Overview
Intravenous (IV) ketamine therapy involves administering ketamine directly into the bloodstream via an IV drip. This method is typically provided in specialized clinics with medical supervision. You will generally find these types of practices referred to as “Ketamine Clinics,” “Ketamine Therapy,” or “IV Ketamine Clinics.” Typically, this approach is more medicalized, with a primary focus on delivering the biochemical benefits of ketamine efficiently, and little if any attention is given to the potential psychedelic experience of the participant. Dose ranges typically start at 0.5 mg/kg level established in research and can increase depending on the participant’s response.
Pros:
- Rapid Onset: IV delivery ensures rapid onset of effects, often within minutes, making it ideal for clients needing immediate relief.
- Consistent absorption: By the nature of IV administration, absorption is 100%
- Precise Dosage Control: Medical professionals can carefully monitor and adjust the dosage in real-time.
- Medical Supervision: Clients are closely monitored throughout the treatment, ensuring safety and quick response to adverse reactions.
Cons:
- Medicalized Environment: Some clients may be less comfortable in a sterile and clinical setting. Usually, participants are left alone during the experience with remote medical monitoring or are medically checked occasionally by a medical staff. IV administration requires being connected to an IV bag and medical monitoring equipment throughout the process.
- No Psychedelic Best Practice Employed: IV clinics focus on delivering the biochemical benefits of ketamine and minimize or overlook the potential transformational psychedelic experience that can accompany ketamine administration. The psychedelic effects of ketamine can be powerful. Without preparation and therapeutic support, these experiences can be overwhelming for participants. This is especially true for participants who may have a trauma history or other complex mental health considerations.
- Time-Consuming: Each session typically lasts several hours, including preparation and recovery time.
- Cost: IV ketamine therapy can be expensive due to the need for medical staff and equipment.
Ideal For:
- People without trauma histories, who are comfortable being unaccompanied during the ketamine experience, or who have a close friend or family member who could provide support during the experience (if allowed by the clinic).
- People who are experiencing chronic pain without complex mental health conditions.
- People with treatment-resistant depression who feel comfortable with the approach described above. Individuals with medical complexities needing precise dosing and constant medical monitoring.
Ketamine-Assisted Talk Therapy (Low-Dose Oral Administration) Overview
Low-dose ketamine lozenges or troches are taken orally and used in conjunction with talk therapy. The therapy session begins as the ketamine takes effect, typically within 20-30 minutes. These sessions are generally two hours long. Often, ketamine-assisted therapists utilize tools such as EMDR or other talk therapy techniques during the session to help clients work through difficult material.
Pros:
- Comfortable Setting: Sessions can be conducted in a more relaxed, therapeutic environment, often resembling traditional therapy settings.
- Integration with Talk Therapy: Combining ketamine’s effects and therapeutic dialogue can enhance insights and emotional breakthroughs.
- Gentler experience: Low-dose ketamine can have a relaxing effect, often leaving participants feeling safe and calm. Feeling less defended and more open can help participants dig in and work in therapy.
- Cost-Effective: Lozenges or troches are generally less expensive than IV treatments, as they don’t usually require on-site medical staff during administration.
Cons:
- Slower Onset: Effects take longer to manifest compared to IV or IM methods.
- Variable Absorption: Oral administration can result in less predictable absorption and effects. Dosage can be challenging to determine, and absorption can vary widely between visits.
- No Research Support for Low Dose: The research on ketamine’s efficacy for treatment-resistant depression was completed with dosages of 0.5 mg/kg or more. Substantially lower dosages are typically used in ketamine-assisted talk therapy. Emerging research is investigating this approach, and anecdotal reports indicate it may be helpful for moving through difficult material more easily. That said, the biochemical benefits of low-dose ketamine are yet to be determined.
- Not Psychedelic: generally, low-dose ketamine elicits a trance-like calm state of mind but is not commonly reported to elicit psychedelic effects (maybe a pro depending on client preferences).
- Limited Medical Supervision: Compared to IV therapy, less immediate medical oversight is typically available (maybe a pro, depending on your perspective).
Ideal For: Clients looking for a gentler approach combining medication with psychotherapy. Individuals who prefer a less invasive method with a slower onset of effects. Participants who are looking to move through difficult material in therapy more easily. Participants whose primary presenting concern is trauma-related rather than treatment-resistant depression.
Intramuscular (IM) Ketamine Injections with Therapist in the Room Overview
IM ketamine therapy involves injecting ketamine directly into the muscle, administered by a healthcare professional, with a therapist present to support the client during the session. Generally, dosage ranges start at 0.5 mg/kg, as established in research, and go up from there depending on the participant’s preference, reported experience, and medical stability. These are generally 2-hour sessions.
Pros:
- Rapid Onset: Effects are felt quickly, usually within 5-10 minutes.
- Psychedelic Experience: IM injections can lead to profound and immersive therapeutic experiences, often eliciting a psychedelic experience.
- Therapeutic Support: Having a therapist present ensures emotional support and guidance throughout the session. Therapists provide preparatory and integration sessions as well, ensuring the participant is fully supported before, during, and after each experience.
- Consistent Absorption: IM administration absorption is approximately 95% and is consistent across individuals.
- Comfortable Setting: Sessions can be conducted in a more relaxed, therapeutic environment, often resembling traditional therapy settings.
- Less Medicalized: During the experience, there is no need to be connected to an IV pole or other medical equipment. Once the injection has been given, the participant is free to move as needed and find a comfortable position.
- Focus on Psychedelic Best Practices: Ketamine-assisted therapists focus on establishing a good set and setting, preparing clients well for the experience, and helping them learn to navigate the psychedelic effects of ketamine. Integration therapy helps insights gained in the experience to make a lasting personal impact.
Cons:
- Intensity: The experience can be intense for some individuals; therapeutic support may help mitigate this factor.
- Accessibility: Requires a healthcare professional for administration, which may limit availability.
- Cost: Similar to IV therapy, IM injections can be costly due to the need for medical staffing.
Ideal For:
- Clients seeking profound, transformative experiences with immediate onset.
- Individuals who benefit from having a therapist present to navigate the therapeutic process.
- Individuals with trauma histories, treatment-resistant depression, or other complex mental health conditions such as eating disorders who would benefit from therapeutic guidance during the experience. Individuals interested in experiencing the psychedelic properties of ketamine.
Final Thoughts
Each approach to ketamine-assisted therapy offers unique benefits and considerations. IV ketamine therapy provides rapid and precise relief under medical supervision, making it suitable for chronic pain and medically complex cases. Low-dose lozenge or troche talk therapy integrates medication with psychotherapy in a comfortable setting, ideal for those without treatment-resistant depression seeking a gentler approach. Intramuscular injections offer rapid and profound experiences with therapeutic support appropriate for people with complex mental health conditions and catering to those looking for deep, transformative sessions. Understanding these differences can help individuals and healthcare providers choose the most appropriate method for their therapeutic goals.
About the Author
Erin Jacklin, PsyD, LCP
Dr. Erin Jacklin, CEO and founder of The Catalyst Center is passionate about psychedelic assisted therapy, assessing and celebrating neurodiversity, and depth supervision. A longtime meditator and keen observer of human patterns of behavior, Erin blends a calm centered presence with her deep knowledge base. She is not currenting taking new weekly therapy clients, but remains available for supervision, assessment, psychedelic assisted therapy, and business consulting.
Interested in Learning More?
If you are interested in connecting with support, our specialized team is here to help. You are not alone. Call 720-675-7123 or contact us below.
