WHICH METHOD OF KETAMINE DELIVERY IS MOST EFFECTIVE?

I frequently get asked “which method of ketamine delivery is the most effective?  Intravenous (IV), a shot into the muscle (IM) or nasal spray?”

Both intravenous (IV) and intramuscular (IM) ketamine and nasal spray have been sued to treat depression, although IV ketamine is generally considered the gold standard due to its faster onset and more consistent dosing.

IV ketamine is typically administered in a clinical setting and involves the slow infusion of ketamine into a vein over a period of 40 minutes to 2 hours.  This method has been shown to produce rapid and robust antidepressant effects, with many patients experiencing relief from depressive symptoms within hours to days of treatment.

IM ketamine, on the other hand, is typically administered as an injection into the muscle and may have a slower onset of action compared to IV ketamine.  It is also more difficult to control the blood levels and the length of treatment as each individual has differing absorption rates which leads to unpredictable bioavailability (amount of drug in the blood stream) and length of therapeutic blood levels.  However, IM ketamine can still produce antidepressant effects and may be more practical in some situations, such as in emergency medicine or in situations where IV access is not possible.

Ketamine given via nasal spray may be effective for some, but overall tends to have a much lower success rate, takes longer to work and the effects generally aren’t as long lasting.  It too must be administered and monitored in a physician’s office, so there is no additional convenience.  It generally costs more per dose and must be used more often than the other two delivery methods.  For these reasons, I use this very infrequently. 

Overall, both IV and IM ketamine have shown promising results in the treatment of depression, although IV ketamine is generally preferred due to its faster onset and more consistent dosing.  However, the choice of delivery method will depend on factors such as the severity of the depression, the patient’s medical history, and the preferences of the healthcare provider and patient.  It is important to note that ketamine treatment for depression should always be conducted under the supervision of a trained healthcare professional.  

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