Understanding Sublingual Ketamine Treatment: A Comprehensive Guide
Navigating the complex world of mental health treatments can be daunting, especially when you are considering a new treatment. This post aims to break down what sublingual ketamine is, how it works, its potential benefits and side effects, as well as what to expect during the treatment process. Our objective is to provide you with the information necessary for you to make an informed decision about your mental health treatment.
In this post, we hope to provide an overview on everything you need to know about sublingual ketamine:
What is sublingual ketamine?
How does it work?
What are its potential benefits, side effects, and the frequency of treatment?
What should you expect during your first session?
What is the difference between sublingual and IV ketamine?
What is Sublingual Ketamine Treatment?
Ketamine is a medication traditionally used in anesthesia, but in recent years it has been recognized for its potential in treating various mental health conditions using low doses. Sublingual simply means taking the medication under your tongue, allowing it to be absorbed directly into the bloodstream. This method of administering ketamine eliminates the need for any needles, unlike with IV or IM ketamine.
How Does Sublingual Ketamine Work?
Experiencing chronic anxiety and depression can result in decreased neuronal growth and rigid patterns of thought and behavior that can make full recovery difficult. This can significantly impact your mental health and overall well-being. By working on a type of receptor in the brain known as the NMDA receptor, and impacting the neurotransmitter glutamate and a substance called BDNF, ketamine can help foster neuronal growth and increased connections between neurons to help break out of ingrained patterns and alleviate the symptoms of anxiety, depression, addiction, and other psychiatric conditions.
What are the Benefits of Sublingual Ketamine Treatment?
Ketamine treatment has shown great potential for a wide variety of mental health conditions. It's a versatile therapy that can be beneficial not only for treatment-resistant patients, but also for those who wish to explore alternatives to daily medications such as SSRIs. Here are some notable therapeutic benefits:
Improved mood
Decreased intensity and frequency of suicidal thoughts
Reduced negative thoughts and ruminations
Decreased cravings for addictive substances
New insights and perspective shifts around stubborn problems or ingrained behavior patterns
Getting “unstuck” in talk therapy
Easier to start and maintain healthy habits that support your mental health
In addition to the therapeutic benefits above, common to all types of ketamine treatment, sublingual ketamine specifically offers some advantages over other delivery methods:
No need for needles
Flexibility to self-administer at home (with a safety sitter and when clinically appropriate)
Gentler onset of effects during the session
What are the Potential Side Effects of Sublingual Ketamine?
As with all treatments, there are potential side effects. Most commonly, these can include:
Nausea (can be managed with preventative anti-nausea medication)
Dizziness
Blurred vision/light sensitivity
Increased blood pressure and/or heart rate during treatment
Psychological Effects: Most people experience changes in perception, dream-like states, or other psychological effects during treatment
These effects are typically transient and subside after the session. You will have an opportunity to discuss any concerns you may have with your clinician before starting treatment, including reviewing the ketamine informed consent in your initial evaluation appointment.
What is the Typical Frequency of Sublingual Ketamine Treatments?
Treatment frequency depends on your individual needs and takes into account both your symptom severity and response to other treatments. A typical treatment course begins with six sessions over six weeks, though your treatment plan may be adjusted as you go depending on your response to each session. For some, twice-weekly sessions offer better outcomes, while others benefit more from a session every other week.
The initial 6-session induction series is often followed by a maintenance phase that is tailored to you. This could involve lengthening the time between sessions or adopting a “wait and see” approach through scheduling booster sessions only when the therapeutic efforts start to fade (typically ranges from weeks to months). This adaptable strategy helps to maintain your progress after the induction phase.
In-Office vs. Virtual Sublingual Ketamine Treatment Sessions
When it comes to the setting of your sublingual ketamine treatment, there are numerous factors to consider. We offer both in-office and virtual sessions, and the choice between these primarily depends on your clinical needs/diagnosis and personal comfort. It is also generally recommended that the first session take place in-office. The initial experience with sublingual ketamine can be unfamiliar, and it can be helpful to have professional support readily available.
Virtually guided sessions are structured to closely simulate the support of an in office session, with your clinician present with you via zoom for the full 2-hour session observing you with your camera and microphone on, as if you were in office. Home sessions do require you to have a sitter, aka a responsible sober adult, who can assist you if needed and ensure you are safe and supported during your session. Your clinician will conduct an orientation with you and your sitter prior to your first virtual ketamine session.
What to Expect During the First Sublingual Ketamine Treatment Session?
Your first sublingual ketamine session is a unique and personal experience, and you can rest assured that your clinician will work with you to prepare you and make the experience as stress free as possible from the start. It's normal to feel a bit nervous before your first session, but know that we take every measure to ensure your comfort. We begin with a conservative dose of ketamine, increasing it gradually as you grow more comfortable with the process. This approach allows us to build trust with the medicine and ensures you have the safest and most comfortable experience possible.
Your session will start with about 30-minutes of preparation with your clinician, who will assess for changes in your mental and physical health, help you set intentions for your session, and select a playlist and relaxation practice best suited to your needs and preferences. A brief guided meditation and/or gentle breathwork session is offered to help prepare your mind and body for the medicine session.
The 1-hour medicine portion of your session starts with taking a dose of sublingual ketamine under the guidance of your clinician, after which you will lay down with eye shades and headphones with a curated playlist and relax into the unfolding experience. The experience itself is different for everyone and can range anywhere from a deep meditative state to a vibrant psychedelic experience. During a session, many people experience the music as more immersive, their thoughts more intriguing or insightful, and their body as more relaxed. Some report visual experiences akin to dreaming, or may see colors or geometric shapes during their sessions.
In the final 30-minutes of your session, you will have an opportunity to journal, ground, and unpack your experience with your clinician. Your clinician will help you to make a plan to get the most of the 3-day neuroplasticity period following your session, as well as make recommendations for integration practices to engage in between sessions.
What’s the Difference Between Sublingual vs. IV Ketamine?
Sublingual ketamine and IV ketamine are two different administration methods for ketamine therapy with a few significant differences. Let's explore them further:
1. Administration Method:
Sublingual ketamine: You place a ketamine tablet under your tongue, allowing it to dissolve and gradually be absorbed via the oral tissues into the bloodstream over a period of 5-10 minutes.
IV ketamine: An intravenous administration, where an IV is placed in your arm and ketamine is administered directly into your bloodstream.
2. Onset:
Sublingual ketamine: slower onset of action as it slowly absorbs into the bloodstream, taking time for its effects to manifest and resulting in a gentle onset of medicine effects during the session.
IV ketamine: rapid onset of action, with full effects often within 1-2 minutes of administration, sometimes resulting in a feeling of “blasting off” into an immersive psychedelic session.
3. Duration:
Sublingual ketamine: The duration of the session can vary but tends to be 20-30 minutes of strong effects after a single dose, followed by gradual fading out over another 20-30 minutes. Mid-session booster dose can be administered to extend effects.
IV ketamine: Typical IV sessions for psychiatric treatment are 40-60 minutes in duration, usually maintaining a constant level of ketamine in the bloodstream for the duration of the infusion. Once the infusion is stopped, there is a relatively quick fading out of effects over the course of 5-10 minutes.
4. Setting and Monitoring:
Sublingual ketamine: When clinically appropriate, patients can self-administer sublingual ketamine at home with a safety sitter under proper supervision and guidance. This method requires less intensive monitoring, ensuring convenience and comfort during the treatment.
IV ketamine: It is typically administered in a clinical setting, such as a doctor's office or clinic due to potential risks associated with IV infusions. This controlled environment allows healthcare professionals to closely monitor vital signs and other parameters throughout the infusion process, which can be important for those with certain underlying medical conditions (i.e. cardiac arrhythmias).
5. Experience During Session:
Sublingual ketamine: usually in the mild-moderate range of dissociative and psychedelic effects, with most people experiencing deep physical and mental relaxation, and some also experiencing visuals such as colors, shapes, or dreamlike scenes and memories. There is often a sense of alternating between being the passenger and the driver of the experience and people may find they are able to think about things differently during their sessions and come out with new perspectives. Experiences are usually able to be recalled and worked with therapeutically in integration between sessions.
IV ketamine: usually in the moderate-high range of dissociative and psychedelic effects, with many experiencing full dissociation including out of body and psychedelic experiences that feel more like being in the passenger’s seat rather than the driver’s seat of the experience. Experiences in this range can sometimes be chaotic and difficult to recall for later processing and integration.
6. Therapeutic Effects:
Sublingual ketamine: therapeutic effects gradually build over the course of several sessions, though a minority of people do experience dramatic therapeutic effects after 1-2 sessions. Periodic maintenance treatment is often required.
IV ketamine: slightly more common to have dramatic therapeutic effects after 1-2 sessions, especially for those with severe symptoms, but effects continue to build over the course of several sessions. Can be particularly beneficial as a kickstart to provide rapid relief to those who are unable to function in their lives due to the severity of their psychiatric symptoms. Periodic maintenance treatment is often required.
Final Thoughts
Ketamine is an incredibly impactful treatment for a variety mental health conditions. If you are feeling stuck in finding adequate relief from psychiatric symptoms, ketamine can be a powerful addition to your treatment regimen by and helping the brain create healthier patterns and reduce negative thoughts. Sublingual administration of ketamine in particular can be a gentle, versatile, and powerful introduction to this treatment.
Starting on this therapeutic journey is a personal decision, and we here to provide the guidance and support you need. We commend you for having taken the first step and learning more about this treatment. If you feel ready to explore this promising treatment, click here to schedule a preliminary screening call with one of our clinicians. We look forward to supporting you on your healing path!
