Oral ketamine (ketamine assisted psychotherapy) vs IV ketamine?

Been struggling from depression for about 6 years now. Have tried prozac, zoloft, and benzos. ready to try something new that actually helps.

Has anyone tried both oral ketamine with therapy and IV ketamine? I’ve heard that IV ketamine can be a pretty intense onset

any help would be greatly appreciated

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Hi there! I’ve tried oral ketamine (lozenges) and infusions with no therapy. The California West Coast model leans towards ketamine assisted psychotherapy, which I would love to try but it isn’t as available on the East Coast. Apparently the psychotherapy while doing lozenges is effective, so if you have the chance I definitely recommend trying!

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ohh got it! how did you like ketamine lozenges vs IV?

Hi!

I have a similar story, countless antidepressants and benzos with not really any significant improvement for about 7 years. I was able to get in a clinical trial for IV ketamine, and continued a few infusions after at a private clinic. Since my last infusion a couple months ago ( I had a total of 6 ) I’ve been trying maintenance therapy with oral troches/lozenges that I take twice a week. I believe they’re helping, but I’m not feeling the profound effects like I did from the infusions, but I am functioning and able to enjoy things again. I’m also in psychotherapy twice a week and was doing some CBT groups prior to the pandemic. I found going to therapy has been key to maintaining the gains I get from ketamine; I haven’t done ketamine specific therapy, I’ve just continued with the therapist I’ve been seeing for the past year.
The IV infusions I found were a positive experience, I had a little nausea but it was manageable and was able to work through things and see things from a different point of view during the infusions. I was terrified before my first one, but even though it was a bit intense, it wasn’t scary and I felt very safe. Also, the clinics will monitor you and I know mine offered to have someone stay with you during the infusion or you could bring your own guest (pre-covid). With the oral dosing, I’ve had more nausea and a few times it has gotten a little too intense, but I’m able to ride it out and tell myself the feeling won’t last… but the next morning I always feel so much better and lighter again. The oral ketamine is significantly cheaper, the biggest downside for me is more nausea (which probably differs from person to person) and they taste absolutely terrible ha.
This is long winded, but I hope it helps a bit!

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That’s so helpful, thanks SaraTaylor!!! Sounds like both are good options to try and see what works best

I take quick-dissolve tablets, which are supposed to be more like infusions, in terms of the experience and the treatment course, as I understand it. I had 4 treatments, 1 per week. I am now on a next course of 4, 1 every 2 weeks. I take mine at home, though I have video calls with the clinician. I also see my regular therapist weekly.

I started feeling pretty great after my 3rd treatment and am now weaning off my SSRIs after 25+ years. I even skipped a month between my first 4 and second 4 treatments due to covid and relocating out of NYC. Really feeling amazing.

I do take an anti-nausea pill before treatment, and they also gave me a blood pressure cuff for monitoring. I’ve not had any problems thus far.

Much less expensive than infusions!

Are “quick dissolve tablets” different than lozenges or troques?

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hmm I’ve never heard of troques. I’m not sure about lozenges but lozenges also dissolve in the mouth. Maybe “quick dissolve tablets” are faster? Maybe someone who knows more can chime in

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My understanding is that they are different. They dissolve in about 10 mins and take you right into your “trip.” They are used like an infusion - so once every x weeks - and seem to be much higher doses than lozenges/troches?

Hey! I recently got prescribed oral ketamine after doing about 2 years of IV infusions. I get these for chronic neuropathic pain called CRPS, but also have treatment-resistant/very severe depression. Ketamine has absolutely changed and improved my life.

You are right that IV ketamine can be very psychedelic - but the protocol for pain treatment is different than that for depression - it’s a much higher dose - 600mg/4 hours. I’ve had one bad experience, out of ~20 infusions, and the benefits outweighed the bad side effects. So you may have a psychedelic experience during the infusion, but I believe the depression is treated with a lower dose over a shorter period.

I’ve only been taking the oral for 2 days - (20mg capsules 2x daily) but I feel a very noticeable improvement in my depression. It’s wonderful honestly. Everyone is different, and I don’t know whether the brain builds a tolerance to ketamine (if so, I have a higher tolerance for sure) but I’m not finding the at-home prescription to be psychedelic at all. I’m just very slightly light-headed and grateful to have some relief from the constant pain (physical and mental).

I hope this helps, I’m happy to answer questions if you have any. Good luck to you!!

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@surfsup, I think you’ll find this link helpful. It discusses ROA (route of administration) of ketamine, and why that is so important. Some useful info here: http://www.ketamineadvocacynetwork.org/route-of-administration/

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Does your doctor work with patients outside DC? If not, did you find a doctor that will work with you after your relocation?

IV seems to be the gold standard, but it costs a LOT of gold. I would take a silver or a bronze standard if they costs less, but I cannot find anyone to work with me who is interested in making LESS money than they would with IV.

Assuming this is Mindbloom? Great to hear about the SSRI! I’ve been weaning the last year now, went from highest dose to lowest dose and it’s been hell but now that I’ve stabilized worth it. Looking to give ketamine a shot to feel more like I’m making progress so I can get off this last 25mg.

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Yeah, using MindBloom. They are licensed in both New York, where I normally live, and Florida, where I am now. I have heard of a few other competitors coming out now, so I think we will see a lot more home oral Ketamine use during and post Covid. It’s all still so new…

What state are you in?

Let me also suggest Reddit - look up the TherapeuticKetamine subreddit. Tons of info there, and very detailed.

Maryland.