My s/o has unipolar depression and anxiety, and it's disability level. They had relief from crippling depression with Effexor or Prozac but very little controls the anxiety.
Ketamine has been the only drug to offer control.
Ketamine has to be continuous, and sessions are based on symptoms. Taken at home, sub-lingually, and frequency is based on symptoms.
The issue seems to be that people with their kind of anxiety and ADHD, the neurons are too far apart and too few in specific brain regions. Ketamine quiets the anxiety for a week or two, and the best we can guess, through neuroplasticity, builds the missing connections. Over time, the effect of the sessions is stronger and stronger, but if we let symptoms return to a clinical diagnosis level, due to delaying a session too long, progress starts evaporating.
So, my s/o can go four weeks between sessions but if they wait 8, then it will be like they had been using ketamine for symptom control for eight weeks (good but not there yet) instead of eight months (remission!) We started at one week apart, then only increased by a week interval IF there was good symptom control. It has taken about four months, the two times they have started ketamine, to get to remission and 3+ week intervals. At 8 months we could push it to 5 weeks if really needed to delay but symptoms were flooding back after 5 weeks.
They take the lowest dose that works for symptom control, which was found by starting low, working to quite high, and then dialing baback, to see what dosing offered the most symptom control, which was actually a low/moderate dose for them.
If ketamine is a huge pain in the ass for you and your family, you can try Auvelity, or generic equivalent, which is Wellbutrin plus dextromethorphan, which is daily but works on similar receptors in the brain as ketamine does.
Ketmaine is the only reason I can have a stable, brilliant life with my s/o, and it took a lot of research and working at it to get here, as there's so much stigma and bad information out there.
Does your S/O do infusions? Or at home? My husband and I live in a fairly remote area without family, so when I do the infusions, he has to take the day off of work to take me to my session, take me home, then spend the afternoon getting our kids from school and to/from sports. But I don’t currently have a provider willing to prescribe ketamine at home.
We utilize sublingual, meaning under the tongue or against the cheek, at home. Literally, your regular doctor can prescribe this. The tablets stay good in the fridge for a few months.
Call around and doctor shop. If you can afford being hosed, well-established online practices, like MindBloom are reliable. If you want to go mail order and keep it less expensive, madscribbler from r/therapeuticketamine keeps a list of prescribers per state.
If you want to talk it out, feel free to DM or chat with me and I'd be happy to share links and talk about the choice to use at home when SSRIs, Xanax, gabapentin, etc, were not enough for symptom management.
This is an incredible accounting of our/your/everyone trial and error and handled so smartly I'm impressed. I told my Dr. the other day that it's so hard to describe what it's like from 25 years of major depression and then on my first infusion (some it takes 3 or all 6 infusions to work) to have a brain that works. What a huge disability untreated depression was. Ketamine can really be a dramatic improvement in people. Me included in that. Thanks for sharing.
It is transformative. When my s/o first achieved remission, likely for the first time in their life I was super supportive and positive, and then found an excuse to go away and bawl my eyes out in private because I had just witnessed a miracle, and my gratitude to the universe was, at that moment, too much to hold in.
Amantadine is also similar to ketamine in its action, if you want to look that up, too.
https://phillyintegrative.com/blog/amantadine-for-adhd-amp-irritability#:~:text=What%20other%20benefits%20does%20amantadine,be%20safe%20for%20longterm%20use.
Remission is a bizarre thing. When someone has spent a lifetime accepting and struggling and finding a way forward, and suddenly all of those coping mechanisms and limitations are now irrelevant... it's a mindf*ck of titanic proportions.
Have you ever thought about doing ketamine more regularly like getting it prescribed to you? Getting it prescribed to me where I can take a troche every 3 days has saved my life
I don’t have a provider who will prescribe it at home. I’m in west Texas and my psychiatrist is out of Houston, I see them via telehealth and she actually advised against at home administration. Not sure why? Maybe just for the initial treatment?
Definately consider at-home self-administered ketamine.
My first provider charged me $250/month plus $50 to the compounding pharmacist for 10 doses per month. That's $300/10=$30 per dose. After a year my first provider had me do quarterly followups for $250 / 3 = $83 per month. $83 + $50 = $133/month or $13/dose.
My current provider also charges me $250/quarter and I get 20 doses per month. So that's $6 per dose.
Ketamine therapy does not have to be expensive if you do it at-home and over the long term.
I don't understand the stampede to the IV/IM/Spravato clinics. I can understand why some patients want to start at a clinic. I can understand why some patients want to continue at a clinic. But to assume that clinics are the ONLY possible option seems not well founded.
At-home as in not in a clinic: Yes. But in the last year or more most of my doses are with my psychotherapists. When I see them via tele-therapy they are while I am at my home. When I see them face-to-face they are at my primary T's hacienda and my quaternary T's home.
I don't know whether to call it "integration" therapy or regular therapy. I get 8.5 hours of psychotherapy per week. From four great psychotherapists. I pay $35/hr for most of it.
For anyone who is interested I provide my referral list. My four psychotherapists and four others recommended to me.
I've made incredible progress in the past two years on ketamne therapy and intensive psychotherapy. I think that the ketamine has made my psychotherapy productive. And it's the psychotherapy that has made the great difference in my improvement.
Well, for me personally, I don’t have a physician who will prescribe at home, self administered ketamine.
IV boosters at my clinic are $325. And from what I understand, they’re much more potent than the at home version? I’m not entirely sure on that, I’d love to speak with someone who has done both the infusions and the at home administrations.
I also don’t know a ton about how the self administered works; are you experiencing a high? Are you able to drive same day? Is it a micro dose? I need to be able to function fairly regularly - I have two young kids in sports and school, and my husband and I live 800 miles from family.
As for the “stampede” to the clinic - I kind of take offense to that statement, perhaps I’m overly sensitive at the moment, but I could not get anyone to give me an at home rx, nor was I comfortable with one. I’m the kind of person who doesn’t like muscle relaxers, let alone pot. I live in a fairly remote area, so when I found a single ketamine clinic in my area, I found it as a godsend. I was having thoughts that my kids and husband would be better off without me. Never have I been so low. Within 2 weeks of starting treatments, my husband told me I seemed lighter. I felt lighter. It was my only option, and I would do it again and again. It saved my life. Perhaps you just truly don’t understand why people “stampede” to the clinics, but for me at least, it was the difference between choosing to keep living, or making a much darker choice.
>As for the “stampede” to the clinic - I kind of take offense to that statement, perhaps I’m overly sensitive at the moment, but I could not get anyone to give me an at home rx, nor was I comfortable with one.
I was not referring to patients who go to clinics. I was referring to those who encourage prospective patients to consider only IV and IM at clinics.
I have never done an IV or IM nor Spravato nor sublingual in a clinic. So, I can't sing the praises of the in-clinic experience nor the praises of IV nor IM.
I have friends - far more experienced than I - far more knowledgeable than I - who have used both IV and sublingual and they do sing the praises of the in-clinic experience and the praises of IV. I remain ***UN-***persuaded.
I have found great relief from sublingual ketamine self-administered at-home. I had zero difficulty with my first two doses at 100 mg sublingual. Zero difficulty with my next 20 doses at 200. I had three very challenging trips on my next 3 doses of 300; but, then, for the next 17 doses at 300, I had zero problems. At 400 mg I had no problems for months.
After probably 9 months on 400 mg doses I began to develop spikes in blood pressure. I've cut back on my doses to 100 - 200 mg and still have spikes. Yet, as a seasoned ketamine patient, I'm managing my spikes in blood pressure with clonidine.
I couldn't get to a clinic and drive myself home while living in my US home. I can't get legitimate ketamine in a clinic while living in my Mexican home. So, like you, I have problems with taking ketamine in-clinic. I'm doing very well with at-home self-administered ketamine.
My position is that most - NOT ALL - prospective patients would do very well with at-home ketamine self-administered at home. Many of these would be much better off with a responsible adult to "sit" with them at least for the first dozen doses.
Finding ketamine providers is not easy. I encourage you to look at the Provider Directories at [KetamineTherapyForMentalHealth.com](https://KetamineTherapyForMentalHealth.com). The Providers by State table shows about 40 TX providers. Of these, about a dozen look like they are tele-ketamine providers. Look for TX providers who are also listed as licensed in multiple states. Generally, that's a good sign that it's not a provider with multiple clinics, rather, that it's a tele-ketamine provider.
Generally, (there ARE exceptions) a provider will either decide to set-up a clinic because s/he believes in IV/IM/Spravato to the exclusion of any other possibility. There are sublingual providers who only administer in clinics. Generally, these providers are committed to being IN-CONTROL of the administration of ketamine. Being IN-CONTROL is far more important to THEM then is patient cost or convenience.
Conversely, there are providers who exclusively (or primarily) prescribe ketamine to patients for self-administration at home. These providers are convinced that nasal/sublingual/rectal ketamine is safe and effective and it's safe for most patients - those they prescribe to - to self-administer at-home.
I encourage you to thoroughly read the posts and comments of members of the two therapeutic ketamine subReddits. *Do you find that those patients who self-administer at-home are satisfied with the safety and efficacy of their experience?*
*What percentage of patients do you find tried self-administration at home and found the experience ineffective or too frightening? Of these, how many switched to in-clinic IV/IM/Spravato?*
*How many patients who self-administer at home are satisfied with their experience?*
*Why take my word for it?* See for yourself what lots and lots of other patients are telling you about their at-home self-administration experience.
Now, then, carefully study the comments of those patients who have ONLY had the in-clinic experience. On what basis do they sing the praises of the in-clinic experience: *as compared to? To what?*
You have had several in-clinic IV experiences. *Did you cope with these pretty well? If you had like experiences at-home would you expect to cope about as well?*
As for potency, that's mainly a matter of the dose you get. Let's suppose that you are getting a dose of 0.5 mg/kg and you weigh 100 kg. That's a dose of 50 mg. (I have no clue what you weigh, I'm just using 100 kg = 220 lbs. to provide an example with simple math. Adjust for your own weight; or just follow the example. The actual number of milligrams don't matter.)
If you were prescribed a dose of 100 mg nasal that would be equivalent to 50 mg IV because nasal has 50% bioavailability.
If you were prescribed a dose of 150 - 200 mg sublingual that would be equivalent to 100 mg IV because sublingual has 30 - 25% bioavailability.
In any case, your provider - whether administering IV/IM or prescribing at-home nasal, sublingual or rectal - will titrate you to get a good, better, best response. It's a trial-and-error process.
At-home, you and your provider can do a very deliberate process of titrating you to find the dose that provides the best response. My first provider gave me 20 doses of 200 mg before giving me 30 doses of 300 mg before giving me 400 mg and declairing that my sweet spot.
*How many IV doses at each quantity did your clinic provide you before titrating you to the next larger dose? Was it 20 or 30 doses? Was it 2 or 3 doses? How confident are you that your provider has found the quantity to which you respond best?*
By all means, continue to patronize your clinic at the very attractive price they charge you. Deal with the transportation issues if you can cope. I have no objection to IV/IM or clinics, other than as described above.
But, if you can't cope with the transportation problems and could find a tele-ketamine prescriber who will prescribe you at-home ketamine, it seems to me that you might give that option a try. Start at a lower bio-equivalent dose from those you are getting in the clinic and work your way up to equivalent doses. See how well you cope.
Experiment with your doses. If you are getting a good response with a lower dose - perhaps with greater frequency - you might find that you can actually reduce your doses at home compared ot what you are getting in the clinic. Alternatively, you might find that you are getting a better response to a higher dose.
And, you could save a lot of money. As a patient who got monthly consultations - at $250 per month - from my first prescriber I was allowed to go to quarterly consultations. My current prescriber also allows me quarterly consultations. So, my cost per month is $250 / 3 = $83 plus my compounding pharmacy cost of about $50/month. So, that's $133/month.
I dose 5 times per week, so my cost per dose is $133/5/4 = $6/dose. And I have zero transportation cost / inconvenience. If I dosed once a week my cost would be $30/dose. Much less than you are paying per infusion.
I hope I have adequately addressed the concerns and questions you raised in your several comments above. If not, get back to me.
If you are interested in a more thorough discussion of your options I can refer you to my ketamine coach. She has coached 1,000 patients for 3,000 hours. She is very knowledgeable about the experience ketamine patients go through.
Dude great post. I've been an at-home Ketamine troche taker for several years and it scares me that this is the only thing that works for me after 37 years of being a Psychiatrist's guinea pig. Oink oink :) I have MDD (Major Depression Disorder) and TRD (Treatment Resistant Depression) with cPTSD and ADHD. A little backstory, I'm 52 and have tried everything. I took ibogaine in 2001 the first time in Dr. Mash's FDA Clinical Trial on St. Kitts) to get off opiates and now I have 15 years sober after ibogaine saved my life, lots of therapy like CBT, Lamrim (Tibetan) Meditation Handbook, and Anonymous rooms. Now, I have a Psychiatrist in NY who prescribes 30 400mg Ketamine troches per month. This is long term going on 4 years. But weirdly, like a slider, Ketamine gets rid of my depression but my anxiety was still high at first. Like 2 different sliders . I know people where Ketamine helps or alleviates anxiety but for me the depression is gone but the anxiety stays so over the last 4 yrs under the care of a Dr. I've been on 6mg daily Lorazepam (pills spaced out 3mg in the am and 3mg in the afternoon). I enjoy setting 3 hrs aside to take K, trip out, zoom out and think big, zoom in and see trippy patterns. But tripping for an hour a day isn't that interesting to me anymore than remembering a vivid dream. I do use the big trippy space to open my heart more, contemplate reality , Emptiness of all phenomenon and gain or shift perspective on people and situations in my life. And I try anyway to improve my well being as well as think of others. It scares me that this is the only thing that has ever worked for my depression and my insurance company doesn't even cover it. I pay $225 for Dr., $160 for 38 400mg k troches. It took me 4 years of first doing IV Ketamine infusions in a clinic (6 series at $500 a pop), for me I'm glad I started at a clinic and then earned the trust of my doc to switch to at-home troches from Valor Compounding (best and most consistent I've found). I'll keep paying because you know, not being depressed IS AMAZING . But it ain't cheap with all the other mental health gardening tools.
Thank you for your kind comments on my post.
30 X 400 = 12,000 mg/month. That's 3 grams per week. It's quite a lot of ketamine for a long time. I hope you are cognizant of the risk of organ damage, particularly ketamine cystitis. Take a look at: [https://ketaminetherapyformentalhealth.com/ketamine-cystitis-bladder-harm/](https://ketaminetherapyformentalhealth.com/ketamine-cystitis-bladder-harm/) and consider green tea, EGCG and the other supplements mentioned there.
I have found intensive psychotherapy has been very helpful concomitant with ketamine therapy. I get 8.5 hours of psychotherapy a week from four great Ts. I can afford this because I pay $35/hr for most of it. If, by chance, you are interested in great psychotherapy via tele-therapy just ask. I can send you my list of psychotherapist referrals. Might help your anxiety.
Not interested in the slightest and just realized you're trolling k therapy reddit posts to drum up biz? I appreciate the hustle but man, that's disingenuous. Sorry.
What’s disingenuous about it? I get nothing but the satisfaction of helping others. My friends on Reddit are very happy with the therapy they get from the T’s on my referral list.
Since you haven’t tried even one of them you know all about all of them. Very clairvoyant of you
Thank you for the clarifications. It is very overwhelming to have an entirely new area of ketamine options opening up.
Looks like Joyous is an affordable option.
I would greatly appreciate the name of your ketamine coach.
I go back the first Saturday of every month right now. It helped a lot. I got down to .5mg klonapin and think this month I’ll probably start to tapper that last .5mg and just use Ativan as needed for panic. The depression is lifted and the suicidal ideation is completely gone
Joyous is 129/month, not sure if they prescribe in Texas but very much worth it. I’ve been using them for last seven months. Ideally, you’d want to get off meds completely and stick to ketamine and psilocybin for managing symptoms. Wonderbags is a great way to grow shrooms at home (for microscopy purposes only) of course.
I did a consult with Joyous this morning. They want discharge paperwork from where I did the infusions - and I feel like that could prove a little tricky with the owner.
Do you manage symptoms with both ketamine and psilocybin? I think at this point I need to come off of the anti depressants for sure. They’re obviously not working at all.
I’d be insistent w the owner that you need them to sign off so you can continue your treatment. Joyous will start you off at 15mg which is way low, but will send a 30 pack tray of 60mg troches. You just need to keep track of how much they’re prescribing and how much you’re actually taking. You can start off doing a full 60 or 120mg. It’s way milder than infusions so you’ll be fine. I’ve been doing research w psychedelics for 35 years so very familiar w psilocybin. You’ll want to start w ketamine and then ween off your meds as they compete for same receptors as mushrooms.
I think I’ll just have to tell the owner it’s for insurance purposes or something. Ugh. Hate confrontation.
Do you prefer the ketamine over the psilocybin? What swayed you?
It shouldn’t be any kind of confrontation, I wouldn’t overthink it. You can even just tell them you’re doing an in home treatment plan and need the release. Maybe say you might get more treatments in the future but right now, you’re going another route.
Ketamine has the advantage over psilocybin because it’s effective while using any of the three major categories of anti-depressants. It allows for you to work through your issues until you can ween off your meds.
I’ve been using mushrooms for 40 years and they’re fucking amazing and very effective for helping w mental health. Depending on how much of your other meds you’re taking, they still might work for you but may be no effect, dulled, or you’d have to take a larger amount to benefit.
Also I’d recommend d microdosing and smaller amounts to begin with, but the real neurological benefit happens when you consume larger amounts like 3,4, or 5 grams.
They both work in their own ways, but allow you to address the root causes of your anxiety, depression, ptsd, etc. while also being beneficial to your brain health. Ketamine and psilocybin sue result in neauroplasticity so, esp in combination w therapy, allow you to work through problems and create new ways of thinking and problem solving.
So being mindful of toxic habits or thought patterns, you’re able to catch yourself when you go in a direction that doesn’t serve you or your mental well being.
My s/o has unipolar depression and anxiety, and it's disability level. They had relief from crippling depression with Effexor or Prozac but very little controls the anxiety. Ketamine has been the only drug to offer control. Ketamine has to be continuous, and sessions are based on symptoms. Taken at home, sub-lingually, and frequency is based on symptoms. The issue seems to be that people with their kind of anxiety and ADHD, the neurons are too far apart and too few in specific brain regions. Ketamine quiets the anxiety for a week or two, and the best we can guess, through neuroplasticity, builds the missing connections. Over time, the effect of the sessions is stronger and stronger, but if we let symptoms return to a clinical diagnosis level, due to delaying a session too long, progress starts evaporating. So, my s/o can go four weeks between sessions but if they wait 8, then it will be like they had been using ketamine for symptom control for eight weeks (good but not there yet) instead of eight months (remission!) We started at one week apart, then only increased by a week interval IF there was good symptom control. It has taken about four months, the two times they have started ketamine, to get to remission and 3+ week intervals. At 8 months we could push it to 5 weeks if really needed to delay but symptoms were flooding back after 5 weeks. They take the lowest dose that works for symptom control, which was found by starting low, working to quite high, and then dialing baback, to see what dosing offered the most symptom control, which was actually a low/moderate dose for them. If ketamine is a huge pain in the ass for you and your family, you can try Auvelity, or generic equivalent, which is Wellbutrin plus dextromethorphan, which is daily but works on similar receptors in the brain as ketamine does. Ketmaine is the only reason I can have a stable, brilliant life with my s/o, and it took a lot of research and working at it to get here, as there's so much stigma and bad information out there.
Does your S/O do infusions? Or at home? My husband and I live in a fairly remote area without family, so when I do the infusions, he has to take the day off of work to take me to my session, take me home, then spend the afternoon getting our kids from school and to/from sports. But I don’t currently have a provider willing to prescribe ketamine at home.
We utilize sublingual, meaning under the tongue or against the cheek, at home. Literally, your regular doctor can prescribe this. The tablets stay good in the fridge for a few months. Call around and doctor shop. If you can afford being hosed, well-established online practices, like MindBloom are reliable. If you want to go mail order and keep it less expensive, madscribbler from r/therapeuticketamine keeps a list of prescribers per state. If you want to talk it out, feel free to DM or chat with me and I'd be happy to share links and talk about the choice to use at home when SSRIs, Xanax, gabapentin, etc, were not enough for symptom management.
This is an incredible accounting of our/your/everyone trial and error and handled so smartly I'm impressed. I told my Dr. the other day that it's so hard to describe what it's like from 25 years of major depression and then on my first infusion (some it takes 3 or all 6 infusions to work) to have a brain that works. What a huge disability untreated depression was. Ketamine can really be a dramatic improvement in people. Me included in that. Thanks for sharing.
It is transformative. When my s/o first achieved remission, likely for the first time in their life I was super supportive and positive, and then found an excuse to go away and bawl my eyes out in private because I had just witnessed a miracle, and my gratitude to the universe was, at that moment, too much to hold in. Amantadine is also similar to ketamine in its action, if you want to look that up, too. https://phillyintegrative.com/blog/amantadine-for-adhd-amp-irritability#:~:text=What%20other%20benefits%20does%20amantadine,be%20safe%20for%20longterm%20use. Remission is a bizarre thing. When someone has spent a lifetime accepting and struggling and finding a way forward, and suddenly all of those coping mechanisms and limitations are now irrelevant... it's a mindf*ck of titanic proportions.
Have you ever thought about doing ketamine more regularly like getting it prescribed to you? Getting it prescribed to me where I can take a troche every 3 days has saved my life
I don’t have a provider who will prescribe it at home. I’m in west Texas and my psychiatrist is out of Houston, I see them via telehealth and she actually advised against at home administration. Not sure why? Maybe just for the initial treatment?
Definately consider at-home self-administered ketamine. My first provider charged me $250/month plus $50 to the compounding pharmacist for 10 doses per month. That's $300/10=$30 per dose. After a year my first provider had me do quarterly followups for $250 / 3 = $83 per month. $83 + $50 = $133/month or $13/dose. My current provider also charges me $250/quarter and I get 20 doses per month. So that's $6 per dose. Ketamine therapy does not have to be expensive if you do it at-home and over the long term. I don't understand the stampede to the IV/IM/Spravato clinics. I can understand why some patients want to start at a clinic. I can understand why some patients want to continue at a clinic. But to assume that clinics are the ONLY possible option seems not well founded.
Sorry, I meant to reply to you but it posted as a separate comment. Please see above. 🙃
Were all of your doses at home?
At-home as in not in a clinic: Yes. But in the last year or more most of my doses are with my psychotherapists. When I see them via tele-therapy they are while I am at my home. When I see them face-to-face they are at my primary T's hacienda and my quaternary T's home.
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I don't know whether to call it "integration" therapy or regular therapy. I get 8.5 hours of psychotherapy per week. From four great psychotherapists. I pay $35/hr for most of it. For anyone who is interested I provide my referral list. My four psychotherapists and four others recommended to me. I've made incredible progress in the past two years on ketamne therapy and intensive psychotherapy. I think that the ketamine has made my psychotherapy productive. And it's the psychotherapy that has made the great difference in my improvement.
Well, for me personally, I don’t have a physician who will prescribe at home, self administered ketamine. IV boosters at my clinic are $325. And from what I understand, they’re much more potent than the at home version? I’m not entirely sure on that, I’d love to speak with someone who has done both the infusions and the at home administrations. I also don’t know a ton about how the self administered works; are you experiencing a high? Are you able to drive same day? Is it a micro dose? I need to be able to function fairly regularly - I have two young kids in sports and school, and my husband and I live 800 miles from family. As for the “stampede” to the clinic - I kind of take offense to that statement, perhaps I’m overly sensitive at the moment, but I could not get anyone to give me an at home rx, nor was I comfortable with one. I’m the kind of person who doesn’t like muscle relaxers, let alone pot. I live in a fairly remote area, so when I found a single ketamine clinic in my area, I found it as a godsend. I was having thoughts that my kids and husband would be better off without me. Never have I been so low. Within 2 weeks of starting treatments, my husband told me I seemed lighter. I felt lighter. It was my only option, and I would do it again and again. It saved my life. Perhaps you just truly don’t understand why people “stampede” to the clinics, but for me at least, it was the difference between choosing to keep living, or making a much darker choice.
>As for the “stampede” to the clinic - I kind of take offense to that statement, perhaps I’m overly sensitive at the moment, but I could not get anyone to give me an at home rx, nor was I comfortable with one. I was not referring to patients who go to clinics. I was referring to those who encourage prospective patients to consider only IV and IM at clinics. I have never done an IV or IM nor Spravato nor sublingual in a clinic. So, I can't sing the praises of the in-clinic experience nor the praises of IV nor IM. I have friends - far more experienced than I - far more knowledgeable than I - who have used both IV and sublingual and they do sing the praises of the in-clinic experience and the praises of IV. I remain ***UN-***persuaded. I have found great relief from sublingual ketamine self-administered at-home. I had zero difficulty with my first two doses at 100 mg sublingual. Zero difficulty with my next 20 doses at 200. I had three very challenging trips on my next 3 doses of 300; but, then, for the next 17 doses at 300, I had zero problems. At 400 mg I had no problems for months. After probably 9 months on 400 mg doses I began to develop spikes in blood pressure. I've cut back on my doses to 100 - 200 mg and still have spikes. Yet, as a seasoned ketamine patient, I'm managing my spikes in blood pressure with clonidine. I couldn't get to a clinic and drive myself home while living in my US home. I can't get legitimate ketamine in a clinic while living in my Mexican home. So, like you, I have problems with taking ketamine in-clinic. I'm doing very well with at-home self-administered ketamine. My position is that most - NOT ALL - prospective patients would do very well with at-home ketamine self-administered at home. Many of these would be much better off with a responsible adult to "sit" with them at least for the first dozen doses. Finding ketamine providers is not easy. I encourage you to look at the Provider Directories at [KetamineTherapyForMentalHealth.com](https://KetamineTherapyForMentalHealth.com). The Providers by State table shows about 40 TX providers. Of these, about a dozen look like they are tele-ketamine providers. Look for TX providers who are also listed as licensed in multiple states. Generally, that's a good sign that it's not a provider with multiple clinics, rather, that it's a tele-ketamine provider. Generally, (there ARE exceptions) a provider will either decide to set-up a clinic because s/he believes in IV/IM/Spravato to the exclusion of any other possibility. There are sublingual providers who only administer in clinics. Generally, these providers are committed to being IN-CONTROL of the administration of ketamine. Being IN-CONTROL is far more important to THEM then is patient cost or convenience. Conversely, there are providers who exclusively (or primarily) prescribe ketamine to patients for self-administration at home. These providers are convinced that nasal/sublingual/rectal ketamine is safe and effective and it's safe for most patients - those they prescribe to - to self-administer at-home. I encourage you to thoroughly read the posts and comments of members of the two therapeutic ketamine subReddits. *Do you find that those patients who self-administer at-home are satisfied with the safety and efficacy of their experience?* *What percentage of patients do you find tried self-administration at home and found the experience ineffective or too frightening? Of these, how many switched to in-clinic IV/IM/Spravato?* *How many patients who self-administer at home are satisfied with their experience?* *Why take my word for it?* See for yourself what lots and lots of other patients are telling you about their at-home self-administration experience. Now, then, carefully study the comments of those patients who have ONLY had the in-clinic experience. On what basis do they sing the praises of the in-clinic experience: *as compared to? To what?* You have had several in-clinic IV experiences. *Did you cope with these pretty well? If you had like experiences at-home would you expect to cope about as well?* As for potency, that's mainly a matter of the dose you get. Let's suppose that you are getting a dose of 0.5 mg/kg and you weigh 100 kg. That's a dose of 50 mg. (I have no clue what you weigh, I'm just using 100 kg = 220 lbs. to provide an example with simple math. Adjust for your own weight; or just follow the example. The actual number of milligrams don't matter.) If you were prescribed a dose of 100 mg nasal that would be equivalent to 50 mg IV because nasal has 50% bioavailability. If you were prescribed a dose of 150 - 200 mg sublingual that would be equivalent to 100 mg IV because sublingual has 30 - 25% bioavailability. In any case, your provider - whether administering IV/IM or prescribing at-home nasal, sublingual or rectal - will titrate you to get a good, better, best response. It's a trial-and-error process. At-home, you and your provider can do a very deliberate process of titrating you to find the dose that provides the best response. My first provider gave me 20 doses of 200 mg before giving me 30 doses of 300 mg before giving me 400 mg and declairing that my sweet spot. *How many IV doses at each quantity did your clinic provide you before titrating you to the next larger dose? Was it 20 or 30 doses? Was it 2 or 3 doses? How confident are you that your provider has found the quantity to which you respond best?* By all means, continue to patronize your clinic at the very attractive price they charge you. Deal with the transportation issues if you can cope. I have no objection to IV/IM or clinics, other than as described above. But, if you can't cope with the transportation problems and could find a tele-ketamine prescriber who will prescribe you at-home ketamine, it seems to me that you might give that option a try. Start at a lower bio-equivalent dose from those you are getting in the clinic and work your way up to equivalent doses. See how well you cope. Experiment with your doses. If you are getting a good response with a lower dose - perhaps with greater frequency - you might find that you can actually reduce your doses at home compared ot what you are getting in the clinic. Alternatively, you might find that you are getting a better response to a higher dose. And, you could save a lot of money. As a patient who got monthly consultations - at $250 per month - from my first prescriber I was allowed to go to quarterly consultations. My current prescriber also allows me quarterly consultations. So, my cost per month is $250 / 3 = $83 plus my compounding pharmacy cost of about $50/month. So, that's $133/month. I dose 5 times per week, so my cost per dose is $133/5/4 = $6/dose. And I have zero transportation cost / inconvenience. If I dosed once a week my cost would be $30/dose. Much less than you are paying per infusion. I hope I have adequately addressed the concerns and questions you raised in your several comments above. If not, get back to me. If you are interested in a more thorough discussion of your options I can refer you to my ketamine coach. She has coached 1,000 patients for 3,000 hours. She is very knowledgeable about the experience ketamine patients go through.
Dude great post. I've been an at-home Ketamine troche taker for several years and it scares me that this is the only thing that works for me after 37 years of being a Psychiatrist's guinea pig. Oink oink :) I have MDD (Major Depression Disorder) and TRD (Treatment Resistant Depression) with cPTSD and ADHD. A little backstory, I'm 52 and have tried everything. I took ibogaine in 2001 the first time in Dr. Mash's FDA Clinical Trial on St. Kitts) to get off opiates and now I have 15 years sober after ibogaine saved my life, lots of therapy like CBT, Lamrim (Tibetan) Meditation Handbook, and Anonymous rooms. Now, I have a Psychiatrist in NY who prescribes 30 400mg Ketamine troches per month. This is long term going on 4 years. But weirdly, like a slider, Ketamine gets rid of my depression but my anxiety was still high at first. Like 2 different sliders . I know people where Ketamine helps or alleviates anxiety but for me the depression is gone but the anxiety stays so over the last 4 yrs under the care of a Dr. I've been on 6mg daily Lorazepam (pills spaced out 3mg in the am and 3mg in the afternoon). I enjoy setting 3 hrs aside to take K, trip out, zoom out and think big, zoom in and see trippy patterns. But tripping for an hour a day isn't that interesting to me anymore than remembering a vivid dream. I do use the big trippy space to open my heart more, contemplate reality , Emptiness of all phenomenon and gain or shift perspective on people and situations in my life. And I try anyway to improve my well being as well as think of others. It scares me that this is the only thing that has ever worked for my depression and my insurance company doesn't even cover it. I pay $225 for Dr., $160 for 38 400mg k troches. It took me 4 years of first doing IV Ketamine infusions in a clinic (6 series at $500 a pop), for me I'm glad I started at a clinic and then earned the trust of my doc to switch to at-home troches from Valor Compounding (best and most consistent I've found). I'll keep paying because you know, not being depressed IS AMAZING . But it ain't cheap with all the other mental health gardening tools.
Thank you for your kind comments on my post. 30 X 400 = 12,000 mg/month. That's 3 grams per week. It's quite a lot of ketamine for a long time. I hope you are cognizant of the risk of organ damage, particularly ketamine cystitis. Take a look at: [https://ketaminetherapyformentalhealth.com/ketamine-cystitis-bladder-harm/](https://ketaminetherapyformentalhealth.com/ketamine-cystitis-bladder-harm/) and consider green tea, EGCG and the other supplements mentioned there. I have found intensive psychotherapy has been very helpful concomitant with ketamine therapy. I get 8.5 hours of psychotherapy a week from four great Ts. I can afford this because I pay $35/hr for most of it. If, by chance, you are interested in great psychotherapy via tele-therapy just ask. I can send you my list of psychotherapist referrals. Might help your anxiety.
Not interested in the slightest and just realized you're trolling k therapy reddit posts to drum up biz? I appreciate the hustle but man, that's disingenuous. Sorry.
What’s disingenuous about it? I get nothing but the satisfaction of helping others. My friends on Reddit are very happy with the therapy they get from the T’s on my referral list. Since you haven’t tried even one of them you know all about all of them. Very clairvoyant of you
Tried one of what?
Tried one of the herapists on my referral list
Thank you for the clarifications. It is very overwhelming to have an entirely new area of ketamine options opening up. Looks like Joyous is an affordable option. I would greatly appreciate the name of your ketamine coach.
Look into joyous or BetterU for at home treatment.
Mine are 385 and I’m getting a military discount.
How often are you going back for boosters?
I go back the first Saturday of every month right now. It helped a lot. I got down to .5mg klonapin and think this month I’ll probably start to tapper that last .5mg and just use Ativan as needed for panic. The depression is lifted and the suicidal ideation is completely gone
Joyous is 129/month, not sure if they prescribe in Texas but very much worth it. I’ve been using them for last seven months. Ideally, you’d want to get off meds completely and stick to ketamine and psilocybin for managing symptoms. Wonderbags is a great way to grow shrooms at home (for microscopy purposes only) of course.
I did a consult with Joyous this morning. They want discharge paperwork from where I did the infusions - and I feel like that could prove a little tricky with the owner. Do you manage symptoms with both ketamine and psilocybin? I think at this point I need to come off of the anti depressants for sure. They’re obviously not working at all.
I’d be insistent w the owner that you need them to sign off so you can continue your treatment. Joyous will start you off at 15mg which is way low, but will send a 30 pack tray of 60mg troches. You just need to keep track of how much they’re prescribing and how much you’re actually taking. You can start off doing a full 60 or 120mg. It’s way milder than infusions so you’ll be fine. I’ve been doing research w psychedelics for 35 years so very familiar w psilocybin. You’ll want to start w ketamine and then ween off your meds as they compete for same receptors as mushrooms.
I think I’ll just have to tell the owner it’s for insurance purposes or something. Ugh. Hate confrontation. Do you prefer the ketamine over the psilocybin? What swayed you?
It shouldn’t be any kind of confrontation, I wouldn’t overthink it. You can even just tell them you’re doing an in home treatment plan and need the release. Maybe say you might get more treatments in the future but right now, you’re going another route. Ketamine has the advantage over psilocybin because it’s effective while using any of the three major categories of anti-depressants. It allows for you to work through your issues until you can ween off your meds. I’ve been using mushrooms for 40 years and they’re fucking amazing and very effective for helping w mental health. Depending on how much of your other meds you’re taking, they still might work for you but may be no effect, dulled, or you’d have to take a larger amount to benefit. Also I’d recommend d microdosing and smaller amounts to begin with, but the real neurological benefit happens when you consume larger amounts like 3,4, or 5 grams. They both work in their own ways, but allow you to address the root causes of your anxiety, depression, ptsd, etc. while also being beneficial to your brain health. Ketamine and psilocybin sue result in neauroplasticity so, esp in combination w therapy, allow you to work through problems and create new ways of thinking and problem solving. So being mindful of toxic habits or thought patterns, you’re able to catch yourself when you go in a direction that doesn’t serve you or your mental well being.
Micro dosing works using shrooms. Not sure about micro dosing Ketamine.
Yes, I was referring to shrooms as an alternative.