Ketamine is certainly quite the buzzword lately, and with how many studies and different ketamine-based treatment options have been released over the last few years, it’s really no surprise. One way of using Ketamine, that was initially met with a lot of skepticism, has been growing in popularity over the last few months. Especially now that some new data was published, highlighting the safety and effectiveness of using Ketamine this way. The method in question? At-home ketamine therapy, administered at the patient’s residence in the form of a sublingual tablet, and with no direct supervision. So, how exactly does it work?
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What is Ketamine?
Ketamine (chemical formula: C13H16ClNO) is a dissociative anesthetic that is used both recreationally and therapeutically. Ketamine has been approved for use as an anesthetic since 1970, after it was discovered by Parke-David Pharmaceutical company in 1962. For decades, it was one of the most commonly used veterinary anesthetics and is still used regularly, especially by farm vets.
Although it only has FDA approval as an anesthetic, it can be easily accessed for a variety of different uses. It won’t always be covered by insurance, but doctors in the US can prescribe any medication they see fit for “off-label uses”. For example, both prescription and OTC drugs can be used off-label, and some common ones include Ibuprofen, Warfarin, Aspirin, Trazodone, and many others. Ketamine is no different, and nowadays, it’s used frequently in the mental health sector as an enhancement to regular talk-therapy sessions; a longshot from its established use as a pain reliever and anesthetic.
Now, it’s important to keep in mind a few different names you will see when looking for ketamine treatments. First, you have just plain “Ketamine”, which, once again, is approved for as an anesthetic but frequently used for off-label purposes. Then, you have “Esketamine” – which is an isomer of ketamine, technically known as “S-ketamine”, Esketamine is the brand name. Esketamine was approved by the FDA in 2019 to treat depression and suicidal ideation. There is also “Arketamine” (R-ketamine), another isomer, which has not yet received FDA approval yet probably will relatively soon.
To quickly clarify all these different Ketamines. R-ketamine and S-ketamine make up both halves of standard (or racemic) Ketamine. S(+)-ketamine (Esketamine) functions as the S-enantiomer of ketamine, whereas (R)-(−)-ketamine (Arketamine) functions as the R-enantiomer of standard Ketamine.
In medicinal or therapeutic settings, Ketamine is administered in a variety of ways including sublingual tablets, nasal sprays, and IV/IM infusions. When used recreationally, it typically comes as a white powder that is snorted. As a dissociative drug, it can distort the senses, make things feel like they’re moving slower, cause heavy body highs, and minor hallucinations may occur.
My only experience with Ketamine was over a decade ago, but I remember it relatively well (all things considered). For me, once it kicked in, everything slowed way down. At one point during my high, I was leaning against the speaker in the back seat of my friend’s car when we were sitting at the beach. The song ‘Time’ by Pink Floyd was playing and I remember feeling the vibrations from the music entering my ear and slowly traveling through the rest of my body and down to my toes. Overall, it was a fun and very chill experience; if I had the opportunity and the funds, hands down, I would do it again.
How At-Home Ketamine Therapy Works
It’s impossible to say how all companies are doing it, but any one that is worth their salt will make sure to prioritize the safety and wellbeing of their patients – that includes a thorough psychological evaluation prior to beginning treatment, as well as talk-therapy for integration after the sessions; all with a licensed psychiatric clinician.
If treatment is deemed appropriate by the psychiatrist, the company will typically assign a sort of “psychedelic guide” who will meet with the clients virtually, and often times, will also be available to assist during the course of the treatment. Some companies may require that you have a trip sitter on site, for the off chance that a negative reaction may occur and immediate medical attention is required.
Once all of that is squared away and the first payment is made, a shipment of sublingual ketamine tablets are sent to the patient’s home. Some companies, like Mindbloom, also send a blood pressure monitor so users can make sure theirs stays within normal range, as ketamine can elevate it in some cases. Additionally, the Mindbloom box contains a journal to set intentions prior to treatment and to write down thoughts afterward, and a mask to cover your eyes if you want to facilitate an extra dark and lowkey environment.
“We have found that this route of administration is optimal for at-home use because it is simple and safe to administer, and provides for a peak experience that lasts for about 30-45 minutes,” explains Dr. Leonardo Vando, Board Certified Psychiatrist and Addiction Specialist. “Sublingual administration is similar to intravenous (IV) ketamine in that it produces its main effects by direct absorption and diffusion across the blood-brain barrier, while bypassing liver breakdown.”
“However, sublingual tablets are easier to administer than IV, and they avoid some of the risks associated with IV administration; we have found that this route of administration is optimal for at-home use because it is simple and safe to administer with appropriate guidance and support,” he added.
Is It Safe?
Short answer: most likely, but it depends on the patient. Me personally, I would prefer doing treatments like this in private. But I also have a lot of experience with recreational drug use (mainly psychedelics), I have a high tolerance for these types of drugs, and I’ve taken ketamine before. All that combined makes me feel very comfortable experimenting with these new ketamine treatment options, without direct professional supervision. However, this can’t be said for everyone, and many believe it’s best to have a licensed healthcare practitioner on site in case of any adverse effects.
But recent data suggests that, on the whole, these treatments are safe and effective. Research that was just completed a couple of months ago, outlined how several sessions of at-home ketamine treatments supported by telehealth talk-therapy is a promising way to treat moderate to severe depression and anxiety, all from the comfort of the patient’s own home. At-home ketamine therapy using tablets is also more affordable and accessible than intravenous or intramuscular infusions.
As per the press release regarding said study, “62% fewer patients report suicidal ideation after four sessions. Mindbloom, the leading provider of at-home ketamine therapy, announced Monday the findings of the largest-ever peer-reviewed clinical study of ketamine therapy. Authored by psychiatrists and researchers from MAPS, the Cleveland Clinic, UCSF, NYU and Houston Methodist, the study, which has been accepted into the Journal of Affective Disorders to be published in its October edition, shows that at-home sublingual ketamine therapy can be a promising treatment for anxiety and depression.”
Some experts warn that more extensive and in-depth research is needed to determine how ketamine therapy compares to traditional treatments for mental health disorders, in terms of safety and efficacy; but others claim that ketamine is already proving to be much more effective.
Mindbloom Founder Dylan Beynon believes there are two primary reasons that mental health care is so subpar in the United States: the first one being poor outcomes with traditional medications and little options, as well as lack of access. “Traditional treatments for depression and anxiety simply aren’t very effective. For example, only 40-47% of people who take conventional SSRI/SNRI antidepressants see improvement of symptoms,” he mentions. “These antidepressants also cause side effects in over 50% of patients, including sexual dysfunction, weight gain, and insomnia. Talk therapy has been shown to be even less effective at treating depression than SSRI and SNRI antidepressants.”
All in all, across a cohort of 1,247 patients, 89% both showed and reported notable improvements with their depression and/or anxiety after only four sessions. Based on existing research for traditional antidepressants such as SSRIs, ketamine is 34% more effective. Additionally, the research claims that ketamine is 54% more effective than traditional talk therapy alone.
It’s worth noting that this study was published by Mindbloom, with data from their own practice. While this is very useful information to make available to the public, any time a company puts out a study on their own business model or product, it does raise questions of ethics and accuracy. Not to say their information is skewed in anyway, because it’s likely not as people have been using ketamine in private for a long time and negative outcomes are very rare. As a matter of fact, a study from the UK found that between 1997 and 2016, only 30 deaths occurred in which ketamine was “implicated”. But still, it would be nice to have something to compare this data to, which will likely happen in the very near future.
If You Want to Try It For Yourself…
Your best bet is to hop on Google, search for “at-home ketamine therapy” and see what comes up. There are a couple of companies offering this service including My Ketamine Home and Wondermed, but the most well-known company to permeate this space is MindBloom. We are not currently affiliated with them in any way (although I would love to try their introductory program myself one day), but Mindbloom has really put a lot of work into corning the at-home sector of the ketamine therapy market.
That said, if you want a general idea of pricing for this type of treatment, the basic introductory program from Mindbloom costs $1158, broken down into 6 sessions at $193 each. You can pay it all at once, or in three monthly payments of $386 (the first one is due at sign-up).
Comparatively, Ketamine infusions, both intravenous and intramuscular, usually cost around $400 to $800 per treatment, and most ketamine clinics perform a series of 6 treatments over 2 to 3 weeks. This brings you to a total of almost $5,000 on the high-end, which is far out of reach for a large percentage of potential patients/consumers.
It’s not for everyone, but at-home ketamine therapy is an auspicious and convenient option for people who don’t feel like they need to be in a clinical setting, surrounded by nurses and doctors, attached to an IV, and the whole shebang. If you’re comfortable with it, it’s also much more affordable and accessible. It’s still a bit pricey, but I’ll be giving MindBloom a try in the near future, so check back in for a full review on that. If you’ve tried at-home ketamine therapy and have any thoughts to offer, we’d love to hear from you! Drop us a line in the comment section below and let us know what you thought about the whole experience.
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