Ketamine Dosing in Mental Health Can Get Confusing!
When doing your own research related to ketamine, you may see all types of dosing regimens. Today’s post is aimed to help separate clinical evidence from anecdotal hype. Ketamine dosing in mental health differs significantly from other areas of medicine, but researchers are gathering more and more evidence for its effectiveness in mental health!
What Is Ketamine?
Scientists originally developed ketamine as an anesthetic during the Vietnam war era. You can find detailed posts about its mechanism of action in previous posts. Over time, more and more research began to recognize ketamine’s role in mental health. Researchers discovered that ketamine dosing in mental health was much more beneficial at lower doses, especially when infused over longer periods of time.
Table of Contents
- How is ketamine dosing in mental health different?
- Why does the route of administration matter?
- What ketamine dosing does InnerVision Psychiatry recommend?
How is Ketamine Dosing in Mental Health Different?
Anesthesia vs Mental Health
The doses of ketamine used in mental health differs greatly from ketamine dosing in anesthesia. First, ketamine is dosed at much higher doses in anesthesia. Depending on the procedure and patient involved, common doses range from 2-4mg/kg. To put that into perspective, the average adult male in the US weighs ~90kg (or ~200lbs in freedom units).
This means the doses range from 180mg to 360mg of ketamine. On top of that, when used for anesthetic purposes, ketamine is often “pushed” or given over a very short period of time (<2 minutes). Doses of this size allows for rapid onset of action or “induction” of anesthesia.
In contrast, ketamine dosing for mental health is much lower. The largest amount of clinical evidence is for using 0.5mg/kg of IV ketamine, infused over 40 minutes. Researchers at Yale University first published this groundbreaking evidence in 2000. This effort was lead by Dr. John Krystal and is still ongoing to this day, 24 years later.
Does the Dose Matter?
This is a complex question. For many clinics across the country, dosing does not matter. However, our psychiatry-based clinic values ketamine dosing in mental health. We aim to follow the evidence rather than the hype.
The largest amount of clinical evidence supports using 0.5mg/kg IV ketamine infused over 40 minutes. In some cases, increasing the dose can be appropriate, but this decision is made on an individualized basis. If you respond well to treatment, evidence does not suggest that increasing the dose improves the treatment’s effectiveness.
On the other hand, if treatment at 0.5mg/kg has not been effective, there is a case to be made that increasing the dose has clinical utility. Even if increased, ketamine dosing in mental health dose to approach the dosing used in anesthesia. When used in mental health, ketamine is infused much slower than its use in anesthesia.
Does the Route of Administration Matter?
Intravenous vs Intramuscular vs Oral Ketamine Dosing
This is a very important question with a very simple answer: Yes! Ketamine dosing in mental health greatly varies based on which formulation is being used. This all comes down to what is know as bioavailability.
Bioavailability in this context is how much ketamine is absorbed into your blood steam and that be used by your brain before it is metabolized. Ketamine given IV 100% bioavailable, thus a lower dose can be used. When given IM (intramuscularly), ketamine is ~93% bioavailable. But when ketamine given orally, estimates range from ~8-30% (on average) depending on the study. This is because your body metabolizes a lot of the oral ketamine before your brain can use it.
So what does all that mean? Well, it means that if you go to a clinic that uses oral ketamine, you’re likely to see much higher doses. We have seen reports that online clinics are sending take home doses of oral ketamine upwards of 1500mg per dose. In our opinion, this is dangerous and we do not recommend it.
What Dose Does InnerVision Psychiatry Recommend?
Follow the Evidence!
Our goal at InnerVision Psychiatry is to follow the research! Ketamine dosing at mental health is not regulated by any governing body. We strive to do our best to help those in the community who are struggling with treatment resistant depression, PTSD and anxiety. In our opinion, the best way is also the safest way.
This is why we only prescribe IV ketamine. Our clinic does not offer any other formulations of ketamine as we feel there is too much variability with dosing, and too little evidence to support other formulations.
We recommend starting ketamine dosing in mental health with 0.5mg/kg infused over 40 minutes. We also recommend an induction series of 6 treatments to start. The reasons for this are the same: clinical evidence! We believe that this protocol has the longest running track record of proven efficacy and longevity.
If you or a loved one in Tampa is struggling, please give us a call at (813) 428-5420 and let us help you Rewrite Your Story!
Frequently Asked Questions
The doses used in ketamine for anesthesia vs ketamine in mental health vary greatly. Ketamine given for anesthetic use is administered much quicker (<2 min) and at a much higher dose (2-4mg/kg). Ketamine dosing in mental health is infused slower (40 minutes) and at lower doses 0.5mg/kg.
Yes, each route has its own pros and cons. The main limitation of oral ketamine and IM ketamine is that there is a lower bioavailability than IV ketamine. This make it more difficult to determine the best dose for you.
The largest amount of clinical evidence for ketamine dosing in mental health involves a weight-based approach. This calculation is 0.5mg/kg. The infusion length is 40 minutes. For a 90kg adult patient, the dose would be 45mg infused over 40 minutes.
No, we do not offer oral ketamine as we feel the risks greatly outweigh any potential benefits. In addition, given the highly variable bioavailability of oral ketamine (~8-30% on average), correct dosing becomes nearly impossible to accurately establish.
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