I’ve been treating patients with ketamine for the better part of the last decade. It has only been until recently that a growing number of people have gained a familiarity with ketamine as a powerful therapeutic in the treatment of depression, post-traumatic stress disorder, and anxiety.
By far, the most recognizable delivery system for ketamine therapy is outpatient intravenous or “IV” delivery. It’s completely understandable why so many conflate ketamine therapy specifically with the IV protocol as brick-and-mortar ketamine clinics have been popping up all over the country and have largely been featured in popular media spotlights on ketamine (New York Times, Vice, Fox, NPR, the list goes on).
When I started providing iv therapy to my patients, there were all but a few dozen clinics spread across the U.S. and predominantly serving large metro areas. Many patients justified the expense of flying in for their treatments from other parts of the country due to the efficacy of the therapy. Fast forward to today and these large metro cities often house several competing infusion clinics. Better yet, less populous and more rural areas are increasingly gaining access to this life-saving mental health and chronic pain treatment.
But what many still don’t realize is that there are a variety of delivery systems and protocols for therapeutic ketamine that each have their own benefits and drawbacks. One of the questions I get asked the most is “which treatment method is right for me?”. Ultimately, this is a question for both you and your primary care physician but I will attempt to outline a framework regarding the current menu of low-dose ketamine administered in a clinical setting by a licensed physician. Equipping yourself with the knowledge of ketamine delivery models can go a long way in ensuring that you wind up setting yourself up for the most successful treatment plan possible.
Easily the most popular and well known ketamine treatment option is intravenous or iv therapy. This delivery system involves the administration of one or more infusions of ketamine combined with lidocaine and/or magnesium into the bloodstream via a needle or catheter. A key advantage of infusion therapy is that the ketamine can be administered precisely over the course of the treatment. Patients travel to outpatient ketamine iv clinics for treatment, spend anywhere from 45 minutes to several hours (depending on what is being treated) in a treatment room with a nurse practitioner who administers the infusion, and at the conclusion of treatment, the patient must arrange for transportation as they are unable to operate a vehicle post treatment.
Who is it for?
With a properly vetted protocol, IV treatment centers tend to celebrate excellent success rates in the treatment of neuropathic pain conditions such as Fibromyalgia and Complex Regional Pain Syndrome (CRPS). Generally, patients who are treating debilitating chronic pain seek out ketamine infusion clinics because pain treatment protocols require extended durations for the infusion itself (up to four hours). Because IV treatments are so titrated and highly controlled, they are ideal for the low & slow approach to ketamine therapy. Infusion clinics treat mental health conditions with similarly strong success rates however the high price tag along with difficulties getting full or partial insurance coverage are the largest barriers to prospective patients undergoing ketamine treatments.
How much does it cost?
Ketamine infusion clinics, on average, cost patients anywhere from $375 to $800 per treatment. The stabilization period of treatment requires 4-6 sessions within the first week or so of treatment, which costs patients anywhere from $1,875 to $4,000 in the first month of therapy. From that point on, the majority of patients return for treatment on a more infrequent basis (once a month, every other month, etc).
Intramuscular (IM) administration is a single dose of Ketamine given to an arm or leg muscle via a needle injection. Unlike the infusion delivery system, intramuscular injections are not titrated and thus don’t allow for continuous control, measurement, and monitoring. There is an overall lower expected amount of absorption of the ketamine into the bloodstream which potentially results in diminishing results in regard to mental health or chronic pain relief. Intramuscular ketamine therapy requires a shorter clinic visit than intravenous ketamine at approximately 30-45 minutes. IM treatments are however more cost-friendly to prospective patients and as such, some ketamine clinics offer both intravenous and intramuscular delivery options.
Who is it for?
Intramuscular ketamine therapy can be a good option for those suffering from relatively mild to moderate symptoms of mental health or neuropathic pain conditions. Furthermore, the lower price point may attract individuals who are more averse to alternative treatment options.
How much does it cost?
On average, intramuscular ketamine infusions are anywhere from 30-40% less expensive than intravenous therapy. The provider is able to save costs on personnel, additional medications, and monitoring that is customary to the IV therapy setting.
Ketamine nasal sprays have existed for some time; however this particular delivery method gained national attention upon the 2018 FDA approval of Spravato, a nasal spray that utilizes a variation of ketamine, produced by Janssen Pharmaceuticals (a Johnson & Johnson company). Ketamine nasal sprays are widely regarded as the least efficient delivery system due to fluctuations between each individual spray and differences in intranasal absorption rates.
Who is it for?
At this time, esketamine-based nasal sprays are only prescribed for the treatment of Treatment-Resistant Depression and Major Depressive Disorder. If you suffer from PTSD, chronic pain, suicidal ideation, or other personality disorders, you are not likely to be a strong candidate for the FDA-approved ketamine nasal spray. Furthermore, Spraato patients are not permitted to self-administer the nasal spray and must be treated at a certified clinic while remaining monitored after they have dosed.
How much does it cost?
In terms of raw cost, Spravato is the most expensive of any of the available ketamine-based delivery systems. Select private insurance carriers may assist with a portion of the cost of being prescribed Spravato however coverage is largely dependent on the type of insurance and details of the plan.
Oral ketamine, also known as ketamine sublingual tablets, involves the intake of oral ketamine medication. Typically, the ketamine tablet is dissolved under the tongue and any dissociation takes effect 6-10 minutes after the ketamine is initially taken. Generally, oral ketamine is prescribed online via a telehealth system and meant to be taken at home but oral ketamine may also be administered in a monitored outpatient setting, as well. Ketamine sublingual tablets have an excellent safety record and have high rates of absorption into the body.
Who is it for?
While not as precise as infusion therapy, oral ketamine tablets are an effective option when combined with an evidence-based protocol. Factors such as accessibility, low side effect profile, and the ability to self-administer from the comfort of home under the supervision of remote monitoring are poised to make oral tablets one of the preferred delivery systems or ketamine therapy.
How much does it cost?
On average, sublingual tablets of ketamine are the most affordable options, beating out intravenous, intramuscular, and intranasal options. Because this is still a growing market, it’s difficult to pinpoint pricing.
Here at Tripsitter Clinic, our monthly subscription plans are 60% more affordable than ketamine infusion therapy. One of the main reasons we started Tripsitter Clinic is to provide accrssibility to those who have been priced out of their path to getting well. We believe achieving your breakthrough shouldn’t bankrupt you, cause strain on your family, or be put off any longer than it needs to.
TripSitter Clinic is transforming lives. Get started today.
I Was Paralyzed by Severe Depression. Then Came Ketamine
Zoe Boyer, New York Times
https://www.nytimes.com/2021/05/30/opinion/ketamine-treatment-depression.html
How Ketamine Infusions Saved My Life
Jacki A., Vice Motherboard
https://www.vice.com/en/article/d7yvgk/how-ketamine-infusions-saved-my-life
How ketamine is revolutionizing the way we treat depression
Keith Ablow, Fox News
https://www.foxnews.com/health/how-ketamine-is-revolutionizing-the-way-we-treat-depression
Ketamine May Relieve Depression By Repairing Damaged Brain Circuits
Jon Hamilton, NPR
https://www.npr.org/sections/health-shots/2019/04/11/712295937/ketamine-may-relieve-depression-by-repairing-damaged-brain-circuits
Dr. Huber is a mental health professional of over 20 years, as well as a clinical forensic psychologist. He regularly provides analysis to national and local media and has appeared on over three hundred radio shows (NBC Radio, CBS, Fox News Radio) and thirty national television programs (ABC, NBC, Spectrum News). In addition, Dr. Huber is also the host of “Mainstream Mental Health Radio” a nationwide broadcast delivering interviews with today’s top mental health professionals.
