At-Home and Outpatient Ketamine Treatments: What’s the Difference?
Mental health disorders impact the lives of millions of Americans every year. While there are many available treatments for conditions like depression or anxiety, not everyone will respond well to standard care methods. Although antidepressants work for some people diagnosed with depression, they do not work for everyone. One study showed that antidepressants only improved symptoms in 20 out of 100 people compared to those who were given a placebo within six to eight weeks.(1)
In recent decades, patients and healthcare providers alike have been increasingly interested in additional treatment options. Ketamine is an exciting medicine that can potentially improve the lives of thousands with treatment-resistant mental health conditions.
Ketamine is a dissociative anesthetic with some psychedelic properties, which means that “set and setting” will play a key role in your experience. Your mindset or “set” refers to your thoughts, feelings, and expectations surrounding a drug. The “setting” is the environment you find yourself in while using a drug—both your immediate physical environment and current social and cultural factors.
Ketamine treatment programs allow you to use this medication in different settings. You may want to choose a program that teaches you how to explore your mind from the comfort of your own home via a ketamine telehealth provider, or you may prefer to go to an outpatient program that includes supervision in a medical provider’s office. Each option comes with different benefits and considerations.
Ketamine Treatments
Doctors have long used ketamine as an anesthetic (a medication that eases pain and puts a person in a sleep-like state), and it is still often used during surgical procedures where patients have experienced trauma or require sedation.(2)
However, breakthrough research in recent years has shown that ketamine can also be a beneficial medical treatment for those suffering from various mental and physical health conditions when taken in smaller doses.
What Conditions Can Ketamine Treat?One of the most common uses of ketamine is in treating depression. The U.S. Food and Drug Administration (FDA) has approved a form of the drug, esketamine (Spravato), for treatment-resistant depression and major depressive disorder with suicidal thoughts and actions.(3)
In some individuals, low-dose ketamine can be used to treat severe pain, including pain from broken bones, surgery, and in some cases, lower back pain, either alone or in conjunction with other pain relief medications.(4) This is typically done using a sub-anesthetic dose of ketamine, often delivered via an intravenous (IV) infusion.
These infusions can last up to 40 minutes, with results being felt quickly. However, the entire process can take a few hours. Generally speaking, your provider will require you to stay at the clinic for at least two hours, possibly more, for observation.
Ketamine treatments for some mental health conditions and pain management are considered off-label. This simply means that your medical provider is using ketamine in a way that is outside of its FDA-approved usage. It may also help mitigate some mental health conditions like:(2)
Virtual Ketamine-Assisted Psychotherapy
Ketamine-assisted psychotherapy, or KAP, can help you experience breakthroughs in seeing yourself or understanding the world around you. During KAP, a licensed therapist will help direct you through the experience of taking a ketamine dose. They may help you better understand your mindset before you start and help you set goals for the treatment sessions. The therapist may also help you explore your thoughts during treatment or review your experiences with you afterward. KAP can also be provided in a virtual ketamine therapy session.
Ketamine may also cause you to experience an altered state of consciousness. During these altered states, you may have perceptual changes to visions, color, and sounds. You may also experience changes to how your mind works, allowing you to better understand yourself, your emotions, and your motivations.(5)
Where Can You Receive Ketamine Treatments?The Food and Drug Administration is responsible for approving medication for certain conditions. As such, the FDA has approved the use of ketamine for anesthesia and esketamine for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidality, which means that medical providers in all states can use ketamine to treat certain conditions.(3)
While ketamine is FDA-approved as an anesthetic, it is commonly used by medical professionals off-label. This means they are prescribing it to treat a condition other than its original FDA approval. Off-label prescription of medications is a very common medical procedure where a provider uses discretion and knowledge of an individual’s symptoms to determine whether a medication could benefit their patients.(3)
While ketamine isn’t officially approved as a mental health treatment, doctors in any state can choose to prescribe it off-label if they think it will help treat a condition like anxiety or PTSD.
No states allow ketamine to be legally used without a medical provider’s recommendation.(3)
What is At-Home Ketamine Therapy?
At-home or virtual ketamine therapy is a treatment plan for using the medication without an office visit. At-home ketamine treatments typically include integration counseling and, in some cases, talk therapy. These sessions can take place either before, during, or after you complete a ketamine session. The exact method and type of psychotherapy or integration services you receive will vary by provider.
To get started, you will take an assessment that inquires about your depression or anxiety symptoms. Next, you will have a phone or video consultation with a provider who evaluates your mental health and confirms that you are a good candidate for ketamine treatments. After you have completed your at-home treatment, you may have some form of psychotherapy or integration counseling.
If the provider determines that ketamine treatment could be beneficial, they will send you ketamine tablets or lozenges and may also send other tools such as a journal and blood pressure cuff.
During a virtual ketamine therapy session, your provider will instruct you to take ketamine by placing the tablet under your tongue or between your cheek and gums. You may then meditate, listen to music, or journal. Before, during, or after the session, your guide can help you better understand the thoughts, emotions, and sensations you experience. This will vary from one provider to the next.(7)
Initial sessions tend to be more hands-on. You will meet with the mental health provider who prescribed the medication to review your experience and discuss side effects. You will also have regular video chats with your guide. After the first two sessions, you may be able to embark on a more self-guided experience and spend less time talking to your guide during sessions. Your provider may also adjust your dosage as needed.(7)
Who Is Eligible for At-Home Ketamine Treatments?There’s no official set of FDA-required criteria determining who can receive virtual and at-home ketamine treatment. Healthcare providers can prescribe ketamine off-label to patients they think would benefit from ketamine using their own internal rules. Most programs treat people with depression, PTSD, OCD, bipolar depression, or anxiety.(4)
You may not be eligible for ketamine treatments if you have conditions like high blood pressure or psychotic disorders like schizophrenia.
How Safe Are At-Home Ketamine Treatments?
Like any drug, ketamine may cause side effects. However, most people do not experience any significant or long-lasting issues. Fewer than one out of 20 people experience side effects, the most common of which include fatigue and dizziness.(7,8)
What is Outpatient Ketamine Therapy?
You will most often receive ketamine as an intravenous (IV) infusion into your vein or as an intramuscular (IM) injection into a large muscle group administered by an anesthesiologist. These treatments typically take about 40 minutes.
The FDA-approved form of ketamine, esketamine (marketed as Spravato), is available as a nasal spray. When receiving this treatment, a healthcare provider will show you how to use the spray, and then you will administer it to yourself. Esketamine nasal sprays must be used in a clinical setting and cannot be taken home. You will also be required to remain at the clinic for two hours for monitoring.(9)
After your treatment, you are not permitted to drive, so make sure you factor in getting home via a friend or loved one. Your healthcare provider will tell you when you’re cleared to leave.(3)
What is The Outpatient Ketamine Experience Like?Depending on your provider, you may have a very different experience. Some medical providers offer ketamine treatments in a healing and spa-like environment. In these cases, your provider will offer music and a comfortable setting in which to relax while undergoing treatment.
Many clinics specializing in the spa or wellness retreat style of experience will also offer additional services like yoga, mindfulness training, massage therapy, vitamin infusions, and even other medical services like transcranial magnetic stimulation. This style of ketamine treatment aims to help you feel relaxed, rejuvenated, and refreshed with a focus on mind, body, and spirit.
Other clinicians have a strictly medical focus, with an environment akin to a traditional doctor’s office. This style of ketamine treatment may be focused on addressing specific medical concerns without adding other wellness services. You will still receive high-quality, compassionate, and dedicated medical care, but there may be fewer bells and whistles.
In either case, there will be some shared procedures. You will undergo a pre-treatment consultation and health screening. Typically, a health screening will look for pre-existing and potentially disqualifying health conditions like certain psychotic disorders, high blood pressure, or heart conditions. You may also be asked about possible drug use. Depending on if it is offered, you may receive psychotherapy or integrative counseling before, during, or after your treatment.
When it comes to ketamine treatments in a clinic, there isn’t necessarily a right or wrong style of environment. It’s a matter of preference and what works for you. Ultimately, providers should put your health, safety, and successful treatment outcomes front and center. In nearly all cases, you should be prepared to arrange alternative travel plans, as you are not permitted to drive for several hours after receiving ketamine. Some providers may offer a shuttle service, but this will vary.
Who Can Get Esketamine (Spravato) Treatments?Medical providers prescribe two types of ketamine, racemic ketamine and esketamine. While racemic ketamine (typically referred to simply as ketamine) is used off-label (meaning outside its FDA-approved usage), esketamine has been granted FDA approval for specific conditions. Because esketamine is approved by the FDA, it comes with strict eligibility criteria:(3)
Due to its stricter eligibility requirements, you will need a diagnosis for one of the above conditions and likely a referral. Esketamine is self-administered under the direct supervision of a medical provider. It cannot be taken home or carried with you after your appointment.
How Safe is Ketamine?Ketamine is generally well tolerated, but it can cause side effects. The most common include nausea, vomiting, tiredness, dizziness, vision changes, and confusion. Typically, these are only felt during the ketamine treatment and dissipate quickly once you have completed your session. In rare cases, these side effects can linger for a few hours.(4)
Ketamine can also cause:(9)
At-Home vs. In-Office Ketamine: Which is Better?
Carefully consider what setting you feel most comfortable in while trying ketamine treatments. For example, using this medication at home and receiving aftercare virtually may be a more private experience. On the other hand, if you’re worried about side effects, receiving ketamine treatments in a clinic allows you to access quick medical help if you experience any problems. Whether you feel most comfortable in your home or a medical setting is up to you to decide.
It is also important to consider the cost of outpatient ketamine treatment vs. at-home ketamine. Typical costs for in-office (outpatient) ketamine treatments can range from several hundred to thousands of dollars when you factor in the desired number of treatments (six is often recommended). On the other hand, at-home ketamine therapy is generally a few hundred dollars for one treatment and then a little over a thousand dollars for multiple treatments. Some providers charge more or less depending on the level of service they offer or that you opt for.
Sources Cited
- https://www.ncbi.nlm.nih.gov/books/NBK361016/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8715255/
- https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified
- https://www.ncbi.nlm.nih.gov/books/NBK470357/
- https://pubmed.ncbi.nlm.nih.gov/30917760/
- https://www.dea.gov/sites/default/files/2020-06/Ketamine-2020.pdf
- https://www.sciencedirect.com/science/article/pii/S0165032722007625#s0075
- https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15404
- https://medlineplus.gov/druginfo/meds/a619017.html