Ketamine Dose - What is Best For Mental Health?
There are many ways to use ketamine for mental health. Matching the right dose to your situation, lifestyle, and goals is essential. From intravenous infusions creating disassociative states to very low dose ketamine microdoses taken in your daily life, there are a growing number of ways to experience the benefits of ketamine.
Not everyone can or wants to go to a clinic and disassociate with IV infusions. But that is now far from the only option. Various at-home protocols combined with telemedicine now exist to meet individual needs and goals.
Read on to find out the different doses and methods of using ketamine for mental health and how long they last.
Microdosing vs. Macrodosing Ketamine
There is a lot of emphasis on high-intensity experiences of mystical states and ego death when it comes to psychedelics. While the science of mystical experiences is fascinating, shedding one's ego and merging with the universe is intimidating. And can be tough to process.
Research into mystical states is based on giving high doses of psychedelics in a research environment. Ketamine, however, being legal and well-established as a safe and effective tool, is allowing for real-world experiences to inform how altered states can be utilized. As it happens, people are individuals with unique needs and comfort zones. Some may be attracted to experiencing a highly altered state with a “macrodose,” while others wanting to keep their feet on the ground might benefit from “microdosing.”
Microdosing is taking very small amounts of a substance without having a psychedelic experience. Traditionally, in medical literature, microdosing is taking 1% of an active dose of a substance. When people talk about microdosing psychedelics, commonly LSD or psilocybin, they are often taking one-tenth of a dose.
The idea behind microdosing is to have a sub-perceptual dose - meaning not feeling psychedelic effects. People microdosing want to function in their daily lives but experience benefits. Several studies have suggested microdosing benefits could exist in relation to depression, anxiety, and a growing list of other outcomes like creativity and mindfulness.
Macrodsoing, or high doses of psychedelics, involves being completely immersed in a psychedelic experience for many hours. These extended journeys involve hallucinations, spiritual experiences, and even ego death - where one's sense of self disappears. These experiences can be beautiful, terrifying and full of meaning.
Many of the successful mental health outcomes you may have read about are with large doses assisted by therapists to make sense of the experiences. A macrodose of psychedelics can be powerful, but not everyone will be attracted to these journeys as they are expensive while requiring a great deal of energy and time.
How Much is a Normal Dose of Ketamine?
A "normal dose" of ketamine depends on many factors, like delivery method and how an individual's body and mind respond. Ketamine can be delivered intravenously, intramuscular, orally, and as a nasal spray. For working with mental health, the ketamine dose will be determined by a professional, and all depends on the desired outcome.
For example, ketamine was originally approved as an anesthetic for field surgery, where it was injected intramuscularly. An anesthetic dose is designed to make someone unconscious for a medical procedure. For mental health goals, there are basically three types of ketamine doses:
- Anesthetic Dose
- Low Dose
- Very Low Dose
What is a High Dose of Ketamine?
A high dose of ketamine would be considered an anesthetic, called an induction dose. An anesthetic dose of ketamine is designed to make someone lose consciousness for a medical procedure. Typically, this dose would be 1 - 2 mg/kg with an IV or 4 - 8 mg kg for intramuscular injection. The dosage is much higher for intramuscular because it is less bioavailable.
High or anesthetic doses of ketamine are what established the safety profile for ketamine. It has made ketamine’s effects well understood and the compound available around the world. However, for mental health, low doses are used.
Low Dose Ketamine
Low-dose ketamine is used for acute and chronic pain, along with depression, anxiety, OCD, PTSD and other mental health concerns. Typically, in clinics giving IV treatment for something like depression, a normal dose of ketamine is between 0.1 - 0.75mg/kg, with the average being about 0.5mg/kg. The dose is either administered all at once or over about 40min. While this creates a disassociative state, it is considered “subanesthetic,” as it is less than doses used in surgery.
When delivered intravenously, the body can use 100% of the ketamine. Less ketamine is needed as it is very bioavailable. These treatments act rapidly, with many people experiencing antidepressant effects within hours. However, the risks of adverse experiences have been suggested to be higher with higher doses of ketamine.
At-home ketamine protocols, like Mindbloom or Nulife, use low-dose sublingual ketamine doses. Instead of having ketamine injected in a clinic, ketamine is mailed to people, and with the support of a practitioner online, they take the ketamine in their home in the form of a lozenge. Doses vary based on how people respond, but studies using oral ketamine for depression use 1-2mg/kg, which seems high compared to IV, but is less bioavailable.
These treatments can be safely done at home and typically have a few follow-up sessions. Results are less rapid than ketamine IV in a clinic. Assuming a patient has good care throughout the process, some people have experienced improvements.
Ketamine Microdose - The Very Low Dose
Microdosing ketamine, also known as very low-dose ketamine, is taking a continuous small dose of ketamine. There are many different microdosing protocols for substances like psilocybin (the compound in magic mushrooms) and LSD.
Microdosing is a somewhat new development, popularized by James Fadiman, an early psychedelic researcher, in the early 2000s. Paul Stamets, a renowned mycologist and inventor, also has advocated for microdosing. Each has its own dosing schedule and formulas, which involves taking about one-tenth of an active dose.
Despite the attention microdosing has received, it has proven difficult to study because microdosing most substances like psilocybin and LSD are illegal. Much of the information available on microdosing is from people who have self-administered with black-market psychedelics, of which the purity cannot be verified.
Because ketamine is legal with clear manufacturing standards, it is possible to experience very low-dose ketamine legally. For example, Joyous has developed a protocol for daily doses tracked by an app combined with professional evaluation to safely track a patient's progress.
Initially, the protocol starts at 20mg and can go all the way up to 120mg daily which is a far lower dose than a ketamine IV because oral ketamine is less bioavailable. Over time the protocol is adjusted based on how individuals respond rather than body weight. This design allows people to use a very low dose of ketamine while living daily life.
How Long Does Ketamine Last?
How long ketamine lasts will also depend on the dose and method of administration. Determining how long different doses of ketamine will last can influence which treatment to choose.
Intravenous ketamine infusion takes effect within seconds and usually lasts about 40 min. Afterwards, a period of recovery for at least an hour is recommended. At-home low-dose ketamine protocols last for a similar period of time, with many providers recommending an hour. Going into a highly dissociative state takes time to rejuvenate from, and a period of time is required to rest afterwards.
Low-dose ketamine’s effects on anxiety and depression last about ten days, more or less. This has been called "the window of opportunity" and can be a powerful time to make changes in one's life. But, if you have ever tried to establish a new habit, you will know that ten days is a short amount of time. Indeed, most ketamine protocols require a return to the clinic for many journeys.
Very low dose ketamine is given in the form of lozenges held under the tongue and lasts about 30-40 min. Alterations to perception are very little, to none at all. During the first very low doses taken, people can experience dizziness or feel lightheaded, but as the dose is adjusted, for many people ketamine can be taken without interrupting daily life.
What Ketamine Dose is Right for You?
So, with many options, protocols and effects of ketamine to choose from, which one is best for you?
The answer to this question is very individual. Ketamine is legal in many parts of the world, but not everyone has access to clinics with high-quality care. Ketamine infusion has helped for some people, but completing a series of infusions with adequate care is expensive. The window of opportunity for ketamine infusion is powerful, and the experience of a highly disassociative state brought on by ketamine, while intense, can be profound.
Very low dose ketamine is easily adapted to the modern lifestyle with the proper support and dose. While it doesn't send people on epic journeys in altered states, using ketamine to heal and change while keeping both feet firmly on the ground is now a possibility.