Choosing Ketamine Treatment That’s Right For You

Ketamine treatment and ketamine assisted therapy are exploding around the nation, especially as ongoing research into the therapeutic effects of ketamine continues to show its value in helping to treat mental health issues and mood disorders. And, as an increasing number of people undergo ketamine treatment, we’re hearing more and more anecdotal accounts of how effective ketamine is in helping people experience relief and a more expansive relationship to themselves and the world around them.

If you’re struggling with depression, anxiety, PTSD, substance use disorder or another ailment, you may be considering ketamine treatment and wondering what type of model and approach would be best for you. 

As a therapist who has been offering ketamine assisted therapy for four years now—long before infusion clinics began popping up across the country and ketamine therapy became more well known—I’ve been asked by both clients and colleagues about best practices when it comes to ketamine and the different models of treatment available. The answers I give them, and will provide here, come from both personal and professional experience with ketamine as a ketamine clinician and a ketamine client, as well as from extensive training and research.

Ketamine treatment can be expensive, and it’s important to explore options while navigating the expanding market of ketamine treatments and choosing the one that best supports your needs and therapeutic goals. 

It’s important to note that each person responds to ketamine differently and, in my experience, there is a lot of gray area when it comes to the outcomes of ketamine. Simply using ketamine, for instance through an infusion clinic, can yield results, but without therapeutic support, integration and implementation, you may not experience long-term effects.

If someone is making ironclad guarantees about ketamine treatment, steer clear. While ketamine treatment has a high rate of efficacy (notably ketamine treatment for depression), the results of just receiving the medicine without integration and implementation are typically short-lived (a couple of days to a couple of months).

Ketamine is a tool, not a panacea or a silver bullet, which is why integration and therapeutic support is an important adjunct for long-term healing. 

Types of Ketamine Treatment

When it comes to treatment, there are three primary models of treatment—medical, psycholytic and psychedelic—currently operating with various delivery methods.

The Medical Model

The first model, I refer to as the “medical model.” The standard delivery methods for the medical model are IV infusion and IM (intermuscular) injections. Ketamine clinics use IV drips to slowly administer ketamine over the course of 45 minutes to 1 hour and/or IM injections of ketamine once or twice over the course of a treatment session. The goal of these clinics is to minimize the side effects of ketamine and this method of delivery depends solely on the outcomes generated by the drug itself. Patients are typically shown to a room where they may have a medical professional monitoring blood pressure and pulse throughout the session.

A question that I’ve been often asked is how important it is to have a medical staff available during an infusion or other ketamine treatments, such as with a trained therapist in their office. Having a medical professional present can be reassuring and could be helpful in the case of a medical emergency, however, when used legally in medical and therapeutic settings, ketamine is well proven to be a very safe drug.

I have a colleague who also practices ketamine assisted therapy and has seen over 1000 ketamine clients—never with an emergency. I also recently spoke with another clinician who has seen hundreds of clients for ketamine therapy and also has never had an emergency. And, in my own practice, there has never been an emergency. Given the proven safety of ketamine, there is rarely a medical emergency. And, if there were to be, whether in a clinic or in a setting with a trained ketamine assisted therapist, the protocol, either way, would be to call 911, as there would likely be no onsite significant medical care available in either type of location.

Psycholitic Ketamine Therapy

Psyholiyic ketamine therapy refers to the process by which low doses of ketamine are used in a therapeutic context to bring up and/or soften the intensity of emotions associated with experiences that may have caused depression, anxiety, PTSD and other types of distress. The drug can provide a cushion of sorts, allowing for difficult emotions to be more easily tolerated and then processed and healed. Within this model clients rarely reach a completely dissociated state. Rather, they often report a wavy experience in which they drift in and out of normal consciousness and the dissociated states associated with ketamine. This can allow clients to be more lucid and active in the therapeutic work.

The Psychedelic Model

The psychedelic model can bring one through the process of “ego death,” which is thought by many to be a primary function of healing. People may experience a complete departure from normal consciousness and reality for as long as two hours, during which clients may or may not be communicating with a therapist. In this model, which delivery is generally done through IM injections or sublingual ketamine, a therapist may be just holding space for the client who may be undergoing an internalized experience. Although there may be opportunities to actively support the client in important ways.

In the psycholytic and psychedelic models, the medication—and even any side effects—are often a powerful contributor to sustaining the effects of the experience. In my experience, both the psycholytic and psychedelic ketamine treatment routes have potential for short-term relief and offer an increased opportunity for long-term benefits. We truly do not know exactly what dosage will provide the best return on your investment, which is why it’s important to work with a trained therapist or administrator who understands and feels comfortable working with a range of dosage and symptoms.

Types of Ketamine Delivery Methods

All delivery methods have a high potential for efficacy, at least in the short-term, and all have a good chance of providing positive outcomes.

IV Ketamine

Used solely in the medical model, the IV method delivers ketamine slowly over a span of 45 minutes to 1 hour, with the goal of limiting or removing side effects. This method offers excellent bioavailability, but I highly suggest that you don’t get caught up on bioavailability as the various delivery method doses will be adjusted accordingly to ensure that you receive maximum benefit. The primary con of this type of administration is having a needle in your arm for at least 45 minutes, restricting any ability for mobility and movement that may come up during a session or when needing to go to the bathroom. This method is still the most common (although the trend is changing) and most researched, but I consider it the least desirable given the overuse of the medical model and restrictive nature of IV.

IM Ketamine

Used in both the medical model and increasingly while working with a therapist in a private, intimate setting, the intramuscular injection has a more sudden and robust onset, generally occurring within minutes of injection. Some people claim this fast uptake creates the opportunity for a hard reset and report a psychedelic experience. The sudden onset can be overwhelming for some, however, and really good for others. Depending on the model used and your particular needs, a second shot may be administered midway through a session as a boost to prolong the experience.

If you don’t like needles, then the above two methods may not be right for you.

Sublingual Ketamine

Sublingual ketamine is delivered through a rapid dissolve tablet or a slow dissolve troche. This method is often better for people who may not be able to handle the sudden onset of the IM and/or have an aversion to needles. With this method, the ketamine takes about 15-20 minutes to set in and often comes on gently, although you can still easily reach the big experience and the ego death/reset possible with IM. I recommend using the rapid dissolve tablet over the troches, in order to get the medicine in at a more rapid pace.

Intranasal Ketamine

This is generally Spravato or a pharmacy formulated alternative. Intranasal ketamine is often used for people with severe trauma and/or those who can only manage a very small amount at a time as it can be administered in very low doses. Although the dose may be low, this method produces a rapid onset and administering it properly can be difficult at times. It can be prescribed for ongoing use; however, this method would be the easiest to abuse so people with a history of drug or alcohol abuse may want to be wary.

Subcutaneous Ketamine

Subcutaneous ketamine is administered above the muscle, in the fat below the skin and slows the uptake of the ketamine.

All of these delivery methods can be administered in a therapeutic environment, with the exception of IV, which has more requirements and must be administered in a medical specific environment.

All of these methods work best on an extended protocol and with the support of a therapist.

Spravato can be used for nine weeks or longer, depending on the recommendation and approval of a licensed prescriber.

The other methods typically entail six sessions occurring within three weeks to begin with. Maintenance sessions can be provided if and as needed.

Understanding How Ketamine And Ketamine Treatment Works

Ketamine has been shown to stave off suicidal thoughts and bring relief to feelings associated with chronic depression, trauma, chronic anxiety and physical pain. Those results can last a few days to a few months. Ketamine can also help patients become “unstuck,” and support them in working through mental health issues that have not been addressed or not yet fully resolved. We are not exactly sure what the mechanism is that facilitates these experiences, but it might have something to do with a “dulling down” of the big emotional responses that can keep patients from getting through blocks, as well as helping to express mental/emotional pain in a way that supports healing and provides access into deeper insight.

One thing is clear from my experience as both a clinician and a client and reports from others who have come to me from other types of ketamine facilities, such as clinics. The ketamine experience often provokes strong responses before, during and after treatment. Just as I, as a therapist, am not qualified to administer medical treatment, medical professionals are not usually trained or prepared to support and add depth and dimension to ketamine sessions. Nurses at clinics, for instance, may not be trained in ketamine and/or understand trauma and other mental health issues, as well as the symptoms associated with patients’ ketamine experiences. And, unfortunately, I have heard reports of staff being insensitive to a client’s experience at IV and IM clinics.

While people have successful experiences with the medical model and infusion clinics, finding  a therapist to work with, in my opinion, is your best bet.

Ketamine Assisted Therapy

If you’re working with a ketamine assisted therapist through a private practice, such as mine in Denver, CO, the method of delivery is sublingual ketamine, which is administered orally, or IM injections—both safely and easily administered in a therapeutic setting. In this type of safe and more familiar and comfortable setting, therapists hold space for their clients, closely monitoring them while they undergo the ketamine treatment, and are available to offer psychological support to help navigate challenging experiences, should they arise, prior, during or following the treatment.

Drawing from my extensive personal and professional background with ketamine, having a trained and experienced ketamine assisted therapist with you before, during and after the treatment for preparation and integration, and as a possible source for continued care, can be very important.

And, here’s why:

Ketamine can bring up all kinds of emotional and physical experiences and there is no way to tell what your experience will be until you have the experience. Trained professionals can offer a general idea of what to expect, but we can’t say with any certainty what you may experience.

Choosing Your Ketamine Location/Clinician

Whether you’re working with a private practice ketamine therapist or decide to go to an infusion clinic, when choosing your location and type of model, it’s important to consider:

Is there a therapist available before, during and after sessions end? How many preparation sessions will you  have with a therapist prior to your ketamine therapy? How many afterward?

Is the therapist trained in the kind of work/modalities that may be helpful in supporting your particular needs, history and therapy/healing goals?

Does the therapist(s) have experience with ketamine themselves?

What model are they using?

I firmly believe that it is important to know how much professional experience a clinician has and how much personal experience they have with ketamine. Keep in mind this is a relatively young industry. If a clinician has a couple of years of clinical experience with ketamine, that’s pretty good. Certainly, there are therapists who have far more, although they are generally harder to find.

It’s also advisable to consider how many sessions they have undergone themselves. While I do not believe people have to have direct experience to be effective, I do believe, especially with psychedelics in general, a clinician who has a decent amount of personal experience can be far more effective in helping you prior to, during and following your ketamine treatments.

Furthermore, there are specific therapeutic models that have been shown to be most supportive and effective when used in conjunction with ketamine, some of which include Hakomi, Internal Family Systems, Sensorimotor Psychotherapy and Somatic Experiencing. Clicnican trained in these therapeutic approaches seem to be the best equipped to understand and aid in a client’s ketamine or other type of psychedelic and/or non-ordinary states experience.

In closing, it’s important to note again that while ketamine treatment can be incredibly helpful for many people, it is not a panacea, nor is it a cheat code to bypass self-inquiry. Whether using ketamine or engaging in other therapeutic, healing modalities, attention to self-inquiry and self-awareness is important to sustain relief and experience long-term health and healing.

Click through for more information on ketamine assisted therapy and my coaching and counseling practice in Denver, CO.