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Be Very Cautious of At-Home Ketamine “Therapy”

On March 4th, 2019, the FDA approved ketamine for the treatment of depression. Since then, ketamine and other psychedelics have gained more recognition as powerful and therapeutic tools for the treatment of mental disorders. These novel medicines work by completely different mechanisms than traditional antidepressants such as Prozac and have a high rate of efficacy along with a low-risk profile. With many patients failing to response to current treatment modalities, we couldn’t agree more that ketamine and other psychedelic are much needed given the fact that mental disorders are on the rise, especially in adolescence and the elderly.

At-home ketamine therapy has become a real thing, with patients being able to order ketamine online and have it delivered to their doorstep. Today, we are going to discuss our take on this approach to ketamine therapy and suggest that you be more cautious on what we believe is something too good to be true. We do appreciate patients having more access to different forms of therapy, including ketamine, although at-home ketamine use has a potential dark side that needs to be discussed and become more apparent to public who are putting their trust into this powerful medicine.

How does at-home ketamine “therapy” work?

The process of getting ketamine delivered to your home typically begins with an online search and choosing from a growing number of companies who offer this service. This may involve a consultation with a clinician, but other times that does not appear to be the case. Some companies will “prescribe” a regiment on how and when to take ORAL forms of ketamine. The proper guidance, however, appears to be less formal, with sometimes that including an automated app checking in on you. Some of these apps have patients choose between a smiley or frowny face button on their phone with the hope that they get feedback on what to do next. It is our opinion that some companies are doing a better job than others, however, this clearly appears to be more of a money-making business model rather than a means to provide effective, safe, a properly guided mental health care.

IV and oral at-home ketamine “therapy” are not the same

At Innerbloom ketamine therapy we offer intravenous ketamine for two reasons: safety and efficacy. As previously mentioned, there are various forms of ketamine, however, IV ketamine is the superior route of administration for various reasons. Let’s do a side-by-side comparison between IV ketamine and at-home oral ketamine.

IV ketamine

  • Most studied and supported form of ketamine in the scientific community
  • 100% bioavailable
  • Predictable dose and experience
  • Ability to stop an infusion
  • Precision: ability to titrate and find exact “goldilocks” dose with the most therapeutic potential
  • Ability to treat potential side effects (i.e., nausea) with ease given established IV access
  • Treatment in a monitored setting by physician or qualified healthcare provider

Oral at-home ketamine

  • Oral ketamine had been found to be a potentially less effective form of ketamine with a delayed onset of anti-depressant effects
  • 20-25% bioavailable (meaning most of the ketamine does not reach the bloodstream and has no effect)
  • Less predictable experience (i.e., dose is depended on rate of absorption and other patient specific factors)
  • No ability to stop or take back dose, rather patient must wait for effects to “run its course” and wear off
  • Less guidance on proper use and dose that is specific to each patient
  • Potential for abuse with often marginal oversight on when and how to properly use
  • Potential harm to self and others – patients may have an adverse reaction and may put them and others at risk if for example they choose to drive to hospital or seek help when they are unsupervised, unmonitored, and often simply alone

Potential benefits of oral ketamine

Oral ketamine on initial appearance seems like an attractive option and could make ketamine an accessible, affordable, and helpful option in certain context – for example, when a patient needs an immediate response to an acute issue such as suicidal ideation. However, it is important to recognize its limitations as noted in this 2019 research, “Literature on oral ketamine is thin and that there are many areas that need more investigation, especially matters related to pharmacokinetics, physiologic effects, abuse potential and strategies to mitigate illicit use, and adverse effects and efficacy relative to other routes of administration. Until studies of a sufficiently high quality become available, the use of oral ketamine to treat depression must be considered experimental.”

Final thoughts

The literature supports that ketamine is a safe, rapid, and effective intervention option for the treatment of various mental disorders such as depression. The use of ketamine including its various forms along with other powerful psychedelics are here to stay, with their use becoming more common every day. We love the fact that the public is gaining access to this transformative form of therapy for mental health, and while we appreciate that some are doing it for the right reasons, we fear others are not.

The business of at-home ketamine delivery undoubtably is very lucrative and that raises some red flags for us. We hope that you take extra precautions with something that may be too good to be true. Sure, it sounds great to use ketamine in the comfort of your home, but is that somewhere that will be most effective and safe? What happens when things go wrong? Who is there for you when the experience becomes challenging? Where is the guidance of a properly trained professional to get the most out of the ketamine therapeutic potential?

These are just some of the few questions we encourage you to ask yourself when considering at-home ketamine use. At Innerbloom Ketamine Therapy, we recognize and appreciate the importance of the entire ketamine therapy experience, and we strive to curate an environment with the most potential comfort, safety, and efficacy.

Tags: anxiety, best ketamine clinic, depression, fibromyalgia, generalized anxiety disorder, integration, ketamine, ketamine assisted psychotherapy, ketamine infusion, mental health, psychedelics, PTSD, san luis obispo

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