Ketamine Therapy: IV vs Injection vs Lozenge

Ketamine therapy is a new treatment tool that mental health clients and therapists are moving towards as it is showing successful outcomes in treating depression/anxiety/trauma and other mental health issues. I’m going to address the question today about the different types of administration based on my own experience as a therapist and someone who has used these different medicine administering techniques myself.

I often get calls from clients who are interested in doing ketamine treatment and are wanting to know if I offer IV infusions. The answer is no, mainly just lozenges.

Because ketamine is a drug that requires a medical doctor to prescribe, the roots of the field began in medical offices where doctors and nurses were using IV or injections with needles to administer the medicine.

Since ketamine is now also available to be compounded into a lozenge form and prescribed by a doctor to the client through a pharmacy, clients no longer need to go into a medical offices or work in person with medical staff in order to receive the medicine. Instead, they have the option of working with a psychotherapist with the lozenge form of the medication and doing the therapy work that is necessary to heal from past traumas, depression, anxiety, etc.

From my experience, the higher doses that can be given with the injection or IV- is only really necessary when a client is in a severe enough mental health crisis that they are not able to do any psychological processing in therapy and therefore just getting them into a “brain re-set” is the only option (hence sending them far out into an unconscious state.)

With high doses of injections or infusions, a person doesn’t usually have access to their words, and can’t comprehend or hold any type of conversation because they are so dissociated/sedated. While this can be an effective way of getting the medicine to the brain to give it the anti depressant effects, it doesn’t allow for any therapy processing that can get to the root of the depression/anxiety/trauma, and do the most healing. Clients also often do not remember their session which can take away from the long term effects.

On the other hand, ketamine in the lozenge form gives the person all of the anti depressant effects that IV/injections do, and because its not too high of a dose, it can lower a persons ego defenses which allows the person to access feelings and emotions that need to be processed from past traumas, and act as an empathogen- opening a person to feelings of love, gratitude, compassion, and forgiveness.

The lozenge form of administration allows a client and therapist to work with all the benefits of the medicine (psychedelic, dissociation, bypassing the default mode network to rewire neural pathways) and more so, it allows the client and therapist to actually do therapy during the medicine treatment. The therapist can guide the client towards the areas of healing that were discussed in prep sessions and create healing opportunities for those past traumas/negative beliefs.

The anti depressant effects of the medicine are then paired with deeply meaningful healing opportunities that come from the therapy relationship and the intention set by therapist and the client. The client and the therapist are in connection throughout the session so that the therapist can write down what the client is saying, so that the client has a transcript to refer to and to continue to work with in therapy or on their own.

The only time that I refer a client to have an injection is if they physically cannot tolerate the taste of the lozenge or get sick from it, or if they have too high a tolerance for lozenges and would need to take more than 5 to get the needed effects, or if the risk of suicidality is very high and the person is in a high crisis situation and does not have any psychological bandwidth for doing psychological processing. All of these occurrences are very rare.

Another benefit of using lozenges with a therapist is that when it’s appropriate a client can do a ketamine session in their own home without having to go to an office and commute back home after a medicine session. The person is on zoom with the therapist the whole time and they don’t need to move after the session-they are already home. Lastly, I know that for myself I don’t often feel the same level of comfort in a medical facility that I do in a therapist’s office. Having comfy blankets, couches, and a soft environment that is common for therapy offices is the type of environment where my brain and body feel most at ease and comfortable and therefore most likely to open up and heal.

Sometimes there are not therapists available to offer the lozenge ketamine treatment and a medical facility is a great alternate option. I have heard wonderful things about doctors and nurses who have been incredibly kind and supportive sitting for clients using IV in the medical office.

Please reach out with any questions, I love helping folks understand this field, it is a true passion of mine.