Ketamine for Mental Health: In-Clinic vs. At-Home

Ketamine for Mental Health: In-Clinic vs. At-Home

By KCLA | December 20th, 2022 |

At-home ketamine therapy is an appealing option for people with depression and anxiety. This telemedicine model costs less than in-clinic infusions, it’s convenient, and can be effective for some people with moderate symptoms. Yet the choice between at-home sublingual ketamine lozenges and in-clinic IV ketamine therapy is not as simple as this basic comparison suggests. All types of ketamine can deliver powerful antidepressant benefits, but the delivery method, dosage, set and setting, and presence of a knowledgeable professional can make all the difference between a safe, effective experience and a failed, dangerous pursuit. 

Here we compare in-clinic IV ketamine therapy to at-home, sublingual ketamine telehealth, covering methods, research, benefits, uses, and risks so patients can make the best decisions

Bioavailability, Dosage & Effects

IV Ketamine therapy and at-home ketamine are entirely different treatment models, from the therapeutic experience and bioavailability to dosages and effects. These distinctions can dramatically alter patient outcomes. 

IV ketamine therapy

Over the last 20 years, mounting clinical research has revealed IV ketamine is incredibly effective at combatting PTSD, treatment-resistant depression, anxiety, and suicidality–often within hours of the first session. This gold standard model works by infusing around 0.5 mg/kg directly into the bloodstream.  

IV ketamine is 100% bioavailable, so every last drop of the medicine travels directly to the brain and begins working in seconds. Over the course of an hour, patients experience a mix of euphoric, psychedelic, and dissociative effects as the medicine builds new neural pathways and quiets the obsessive monkey mind. 

Ketamine lozenges (troches)

Sublingual ketamine lozenges, also called ketamine troches, usually take the form of rapidly dissolving tablets. These medicated lozenges are about 30% bioavailable, meaning the brain gets slightly less than a third of the total dose while the body digests, excretes, and otherwise wastes about 70%. Because of the bioavailability issue, proper lozenge dosing can be a challenge. In fact, a meta-analysis showed that oral ketamine tablets ranging from .5 mg/kg to 7 mg/kg were no more effective than placebos at treating depression. To overcome this issue, at-home ketamine providers have drastically increased standard dosages to four to eight times higher than the equivalent IV quantity in an attempt to replicate the experience. 

What the Research Says

SSRIs don’t work for 20 to 40% of people with major depression. Yet a single sub-anesthetic dose of IV ketamine can induce immediate and lasting relief for treatment-resistant patients.  IV ketamine can also target opioid and alcohol addiction, OCD, and bipolar depression. In contrast, at-home oral ketamine therapy is a relatively new model with no high-quality clinical trials to prove it can rival IV ketamine’s success. Still, recent studies indicate oral ketamine can be safe and effective for anxiety and depression under certain conditions. Let’s explore. 

IV Ketamine Research Findings

1. IV Ketamine works instantly and continues improving symptoms over multiple sessions

Even when SSRIs work, patients must wait four to twelve weeks before they feel any relief. In contrast, several studies show IV ketamine can significantly improve depression and anxiety within one hour and provide even more profound, lasting results after three to six sessions. This hospital-based open-label study of depressed patients found similar results. Twenty of twenty-five patients completed the program and experienced significant relief after one hour of the first infusion. Notably, patients continued reporting significant improvement in the severity of anxiety symptoms one month after the sixth treatment. 

2. IV Ketamine rapidly resolves suicidal ideation

IV ketamine focusing on patients with suicidal ideation has shown similarly remarkable success. For example, one trial found nearly 70% of participants experienced total symptom alleviation after six treatments. Another study found that 50% of people with suicidal thoughts no longer had them after six infusions within 21 days.

3. Repeated IV ketamine infusions can resolve bipolar depression

IV ketamine can also help people overcome treatment-resistant depression. One preliminary study found 15.8% achieved remission after the first infusion. After the sixth infusion, 63,2% reported remission. Another study that administered six ketamine intravenous infusions to people with bipolar disorder found that 50.5% achieved remission. 

IV ketamine research and our patient data show this administration route helps people find rapid relief from the most debilitating mental health problems. Additionally, patients can experience sustained benefits with a multi-infusion protocol. Accompanying psychotherapy may also be key to sustaining long-term remission. Our care team always encourages patients to continue talk therapy with their established providers as an essential after-care protocol. 

At-home Therapy Research Findings

1, Mindbloom analysis finds at-home, sublingual ketamine safe and effective for depression and anxiety

Mindbloom, one of the largest at-home ketamine providers, recently spearheaded a study that analyzed 2,848 of its own patients with moderate to severe depression. The study only reported results from 1274 of those patients. All received remote, sublingual, rapidly dissolving ketamine tablets for depression and anxiety symptoms. Doses were about 5 mg/kg, a relatively high dose compared to most sublingual protocols. 

After four weeks, 11.4% did not respond to the treatment, meaning they saw no clinically significant changes. However, 62.8 % reported a 50 % or greater improvement in depression symptoms, and nearly a third achieved remission. Additionally, less than 5% reported adverse effects throughout the four sessions. 

The results are undoubtedly impressive, but the study only included data from about half of the initial 2,848  patient population, leaving unanswered questions about the people who did not complete the mental-health questionnaires. Additionally, the study did not monitor patients’ long-term progress post-treatment. 

2. Nue Life study also finds sublingual ketamine safe and effective for depression and anxiety

In a similar ketamine telehealth study published this September, Nue Life Health (formerly My Ketamine Home) analyzed 1101 of its own patients engaging in the at-home program for anxiety and depression. After three doses of sublingual ketamine, 47.6% of patients reported a significant decrease in depression and anxiety scores. Interestingly, compared to three, those who completed six doses of 300 mg to 450 mg tablets experienced the most significant benefits.

Like the Mindbloom study, Nue Life presented data from a fraction of eligible candidates, so it’s unclear whether the results are comprehensive with such a large exclusion list. 

At-home ketamine therapy studies offer promising results for people with mild to severe depression symptoms. However, these studies are limited in scope (focusing on anxiety and depression only), and Mindbloom and Nue Life’s financial incentives could compromise the results. 

Risks and Benefits

Ketamine can make depression and anxiety dissipate under the right conditions, dosages, and treatment protocols. However, it can also cause significant anxiety, confusion, imbalance, difficulty speaking, flashbacks, increased heart rate, and insomnia. Proper support and the right mindset and setting are essential to minimize these risks and maximize success. 

In-clinic IV Ketamine research and benefits

IV ketamine offers unique benefits with very few risks as long as clinics adhere to best practices. At Ketamine Clinics of Los Angeles, our patients receive fresh blankets, pillows, an eye mask, and noise-canceling headphones, listening to relaxing music as they sink into a comfortable chair in a private room. This soothing environment is essential to help patients settle into a healing mindset. 

Throughout the process, registered nurses, psychiatric nurse practitioners, and physician assistants monitor patients’ blood pressure, oxygen, pulse, and EKG to ensure safety and comfort. Nurses can also help patients manage challenging emotions, memories, and feelings that occasionally arise throughout this experience. 

If the experience becomes too overwhelming, practitioners can adjust the infusion with a push of a button, relieving the patient almost immediately. Fortunately, these issues are rare because high-dose IV ketamine infusions are precisely what most patients need to achieve clinically significant improvements with lasting results. In fact, research shows that psychedelic-level ketamine doses dissolve egoic defensiveness and evoke transpersonal experiences that help patients transcend self-limiting beliefs and respond better to post-treatment psychotherapy. 

High-dose ketamine also evokes dissociation or the mental state of detaching from one’s sense of self. Researchers have observed that greater levels of dissociation predict stronger and more durable antidepressant effects. However, not everyone dissociates from a 0.5mg/kg IV infusion. Some patients need a customized protocol. Fortunately, IV ketamine care teams can fine-tune the experience by up-titrating the dose in real-time. Higher doses may cause temporary loss of balance, nausea, difficulty speaking, and brain fog, but these effects are normal and short-lived.

In-clinic IV ketamine therapy’s unique benefits make it incredibly effective for patients with severe treatment-resistant conditions ranging from depression to suicidality, bipolar depression, and PTSD.

At home, sublingual ketamine therapy research and benefits

Telemedicine ketamine can also be safe and effective, but this at-home option comes with considerable risks and challenges. For example, home can be the perfect setting rife with solace, privacy, and spiritual nick-nacks. But for many people, home is chaotic and messy at best. At worst, home is a source of toxic relationships and traumatic memories. People who live in tumultuous environments will not benefit from at-home treatments. In fact, they’re more likely to suffer adverse events like flashbacks, anxiety, paranoia, and increased heart rate.

To make matters worse, at-home ketamine patients are virtually alone. Ketamine providers often mail patients blood pressure monitors, masks, and anti-nausea medications. But they don’t send nurses or therapists to guide the patients through challenging situations. Vulnerable at-home patients are at risk of becoming further traumatized by these experiences. Just imagine the dog making a mess, the kid needing you, someone knocking at the door, or any other number of interruptions that you are not in a position to manage while under the influence. 

At home patients taking sublingual ketamine tablets or lozenges also have no control over the experience once the tablet absorbs into the bloodstream. If the patient is panicking and wants to end the treatment, they must suffer through the duration. Conversely, if the patient doesn’t respond to the medication at all, they have no recourse to increase the dose and must pay for a wasted session. Non-response to ketamine is a relatively common phenomenon, and one of the only resolutions is to up-titrate to effect, an option only IV clinicians can provide.

Still, sublingual ketamine lozenges for home use are increasingly popular for a few reasons. At-home sessions generally cost around $250, making them more accessible for a broad range of budgets. Additionally, at-home providers do their best to find effective dosages that mimic IV ketamine’s psychedelic and dissociative impact while minimizing risks by preparing patients for what to expect. They are also easier to acquire as the screening process is less stringent; unfortunately this also means the quality of the care is also less.

At-home ketamine can be effective, but it has significant limitations. which is why providers like Field Trip don’t advise severely depressed people to utilize their telemedicine program. Only patients with mild to moderate symptoms, ideal home environments, and thorough preparation should consider this option, and even then, the research shows it is not equivalent to IV infusions.. 

Bottom Line

Ketamine is one of the fastest-acting antidepressant medications available today in any form. It’s also more effective than traditional SSRIs for the most common mental health conditions. Still, successful ketamine treatment depends on precise dosing, mindset and setting, symptom severity, and professional support. In-clinic IV ketamine therapy delivers unmatched care in all key areas, which is why our team operates in-clinic only. Patients considering ketamine therapy at home must weigh the risks and benefits and consult with trained professionals to guide them toward the best healing protocol.