Ketamine’s first FDA-approved use was as a dissociative anesthetic and is used for this purpose in medical and surgical procedures. Ketamine is a special medicine in this class as it does not suppress respiratory rate and is a generally safe tool for anesthesia. It has also been used for years for its rapid acting analgesic (pain reducing) effects from battlefields to emergency care. To achieve the dissociation and sedation required, doctors needed a direct and effective way to provide and regulate larger amounts of ketamine to the patients. This is where IV and IM injections of ketamine began. At anesthetic levels, patients often come back from an experience with little to no recollection of what happened while they were sedated. During an invasive procedure this is the preferred outcome. However, when working with mental illnesses, some level of subjective or conscious experience may be preferable, particularly when ketamine’s psychedelic medicinal effects are desired. IV/IM administration allows dosing of the medicine at amounts that can produce full dissociation and sedation.
There is scientific evidence supporting the mental health benefits of dissociation, and more research is being conducted. These are typically the longest sessions, ranging anywhere from 1-3 hours, and are the most expensive, with individual sessions running around $800-1200+USD, with psychotherapy afterward as an available option.
Tablets or troches (pronounced “tro-keys”) are compounded tablets from a pharmacy that are absorbed into the brain/bloodstream sublingually, or held in the mouth. Dosing can vary from 10-200 milligrams (mg) per tablet on average, depending on the compounding pharmacy and the order from the clinician. Tablets are the method allowing for a greater flexibility in treatment based on the client’s response to the medication. Tablets also provide an identical delivery mechanism as IV/IM, but without the risk of infections or introducing harmful agents into the bloodstream. A secondary benefit is there is a ceiling, an upper limit, to how much medicine an individual can absorb sublingually, making it nearly impossible to take larger doses than necessary.
Intravenous (IV) infusions or Intramuscular (IM) ketamine injections have similar effects. The difference is that IV is typically infused into a vein with a bag that drips the substance in while IM is injected directly into the arm with a needle.
Ketamine nasal sprays are a synthesized mist stored in a spray bottle that is applied according to the delivery timeline outlined by the clinician. This is the latest delivery method to gain FDA approval with the introduction of Spravato. The bioavailability and desired effect (sub dissociative, sub psychedelic, anesthetic) of each delivery method, which is the proportion of the compound that enters the body’s circulation, is what determines the typical dosing ranges. You can apply the highest doses/ with infusions, a mid-range with sublingual tablets/torche and the lowest doses with nasal sprays.
It’s important to distinguish the two ways in which ketamine treatments provide therapeutic value, as this will help you make a decision as to which one is right for you, and when.
There are the neurobiological effects and benefits when receiving ketamine. Through these effects, we would expect a general improvement in overall mood, an increase in brain-derived neurotrophic factor (BDNF), and bolstering of neurons that have been worn down over time by the body's physiological response to things like anxiety and depression. The biological effects are dose-dependent, and happen regardless of an individual's subjective experience with the medicine.
There are also subjective or phenomenological healing effects that ketamine can provide at medium/high doses. These effects include novel ways of thinking, disconnection from thoughts or emotions, dilation of time or space, out-of-body experiences, and more. These experiences vary between each individual and each treatment, but can be essential catalysts for deep transformation when treating mental health conditions such as depression or anxiety with ketamine. The subjective effects have a ‘sweet spot.’ They need a certain dosage to surface, and can be overtaken by the dissociative or sedative effects at higher doses. This ideal range for the subjective or phenomenological effects of ketamine is an important point to consider when looking at methods of treatment, and the results you want to achieve. An experienced clinician can help you make the right choice in this regard.
As off label treatments for ketamine are increasingly researched, ketamine’s subjective and psychedelic effects should be considered.
When looking at long-term, enduring benefits and personal transformation, ketamine’s psychedelic effects play an important role.
Individuals in treatments have the potential to experience more classically ‘psychedelic’ experiences: novel ways of thinking or feeling, immersion in new experiences, time or space dilation, out-of-body experiences, hallucinations, and visual imagery.
Not to be discounted, these experiences and insights can provide the scaffolding for long-lasting changes especially if properly integrated back into their lives.
If you want a compliment of biological benefits and subjective, experiential insights:
Dr. Eric Cerre is a Naturopathic Medical Physician focusing on male enhancement, erectile dysfunction, Peyronie's Disease, male hormone replacement as well as treatment of acute and chronic pain condition with PRP and Exosomes. Practicing medicine for over 34 years, Dr. Cerre has treated thousands of patients and is one of the first providers of the P-Sot and 0-Shot in Arizona. He is also a Shockwave provider. Dr. Cerre only uses the highest quality, FDA- approved medical devices such as the Magellan, TruPRP Machine and kits, to treat these conditions.
Our number one priority is in providing relief for our patients and our payment structure is designed to support our philosophy.
We have largely structured our services for the patient who is seeking pain relief and resolution without strict limitations and boundaries imposed by insurance plans.
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