Ketamine is in the news more often than you may think. That’s because its uses are varied, and new treatment options keep emerging. But how many types of ketamine therapy actually exist?
To answer that, we’ve created this blog listing the main types of ketamine therapy. We’ll also cover the different chemical forms of ketamine and help you decide which one might be best for you.
A Quick Recap on Ketamine As A Medicine and Therapy
Ketamine therapy uses low doses of ketamine to treat conditions like depression, anxiety, PTSD, and chronic pain. The medicine works by blocking N-methyl-D-aspartate (NMDA) receptors, which increases glutamate activity and boosts neuroplasticity. According to research, this helps the brain form new connections and pathways. Unlike SSRIs, which target serotonin and can take weeks to show results, ketamine often brings relief within hours.
Because of its powerful and fast-acting effects, ketamine therapy is usually reserved for people who haven’t responded to standard treatments. It’s not used as a first-line approach but rather as an option when traditional medications or talk therapy haven’t worked.
The Different Types of Ketamine Therapy Administration
Ketamine has different variants in terms of administration. These main types of ketamine therapy are provided as an option to clients who want to explore ketamine safely.
1. IV Ketamine Infusion
IV ketamine involves administering the medicine directly into the bloodstream through an intravenous (IV) line. This route offers 100% bioavailability and a rapid onset of dissociative and antidepressant effects. IV infusions are typically provided in clinical settings and can be a stand-alone treatment or paired with psychotherapy as part of a broader ketamine-assisted therapy (KAP) protocol.
IV ketamine is best suited for clients with treatment-resistant depression, acute suicidal ideation, chronic PTSD, or severe anxiety who need fast-acting symptom relief. It’s also a viable option for clients who haven’t responded well to oral medications or talk therapy alone. In comparison to IM or oral routes, IV allows for real-time dose adjustment through booster dosing, giving clinicians greater control over the intensity and duration of the experience.
For therapists considering offering KAP, IV ketamine may be especially useful when immediate stabilization is the clinical goal. Clients undergoing IV infusions may benefit from preparation and integration support before and after sessions, even if the infusion itself is medically managed by a prescriber.
Each session is:
- The dose given is 0.1 mg/kg to 0.75 mg/kg per infusion.
- Each infusion session typically lasts about 40 to 60 minutes.
- Clinic visits can be 1.5 hours to 2 hours long, including preparation.
Whether you are suffering from depression or have lengthy PTSD episodes, the treatment plan usually is:
- Getting Started: Most people begin with six sessions over three weeks (usually two each week).
- Staying on Track: If the treatment works well, follow-up sessions may happen every two to four weeks, based on what the person needs.
- Checking Progress: Regular check-ins help decide if more sessions are needed or if anything should be changed, especially when exploring oral vs IV ketamine options for long-term care.
Note: Based on your diagnosis, your treatment plan can change. Your healthcare provider will contact you with your full plan before proceeding further.
Also Explore: The Difference Between Ketamine-Assisted Psychotherapy (KAP) and Intravenous (IV) Ketamine
2. Intramuscular (IM) Ketamine
IM ketamine is administered via injection into the arm, shoulder, or thigh, similar to how many anesthetics are delivered. With a high bioavailability of about 93%, this route offers reliable absorption and is gaining traction as an alternative to IV for mental health treatment in psychedelic-assisted therapy.
IM ketamine is well-suited for clients seeking a deeper, sustained psychedelic experience, especially in trauma-focused, psychospiritual, or process-oriented work. It’s often preferred when a client is somatically open, psychologically resourced, and working with themes that benefit from less verbal, more embodied access. It’s also a good fit for those who may be medically stable but uncomfortable with IV administration.
Because the entire dose must be delivered at once (unlike IV), intention-setting, therapeutic preparation, and post-session integration become especially crucial. That’s why this method is often chosen when the aim is emotional resolution, symbolic insight, or transpersonal exploration—rather than rapid symptom relief.
There are some notable advantages of intramuscular ketamine:
- Onset within 3 to 5 minutes and effects lasting up to 1 hour.
- No IV access is needed, making the procedure quick and easy.
- Similar efficiency compared to IV infusions for mental health outcomes.
A key limitation is that the dose cannot be adjusted mid-session, which removes the flexibility to modify dosage based on real-time client response. As a result, IM sessions may carry an elevated risk of dissociation, nausea, blood pressure spikes, or moderate hallucinations, especially at higher psychedelic doses. Careful screening, dosage planning, and clear therapeutic containers are essential.
3. Oral Ketamine (Lozenges, Capsules)
Taking ketamine orally includes both intake methods: swallowing (oral) and dissolving under the tongue (sublingual). It offers a slower onset and more gradual experience than IV or IM routes. While its bioavailability is lower (17–27% orally; 19–49% sublingually), it produces higher levels of norketamine, a metabolite linked to extended antidepressant effects.
Far from being just a maintenance option, oral ketamine is often intentionally chosen for process-oriented therapy within a well-supported psychedelic set and setting. Its gentler trajectory allows clients to remain more communicative and engaged, making it especially effective for psychospiritual exploration, identity work, and resolving inner conflict. This form also supports insight-driven sessions that deepen emotional healing and when paired with integration therapy, it can catalyze lasting transformation.
4. Nasal Ketamine (Spravato)
Spravato (esketamine) is currently the only FDA-approved nasal spray form of ketamine. It is available only for adults and prescribed to those suffering from treatment-resistant depression (TRD), or depressive symptoms in major depressive disorder (MDD) with suicidal ideation or behavior. It is always administered in conjunction with an oral antidepressant and must be taken under medical supervision.
Unlike other forms of ketamine-assisted therapy, Spravato is not used for psychotherapy sessions. Instead, it provides a vital medication-only option for individuals who may not be able to afford out-of-pocket ketamine care because it is often covered by insurance. This makes it a more accessible path to treatment for many.
Dosing Spravato is carefully structured and must be supervised by a clinician. Each device contains two sprays for a total of 56 mg. If a person builds tolerance, two devices (84 mg) may be used. The dosing schedule typically follows this structure:
- Induction: 56 mg (first dose), twice per week (Weeks 1 to 4)
- Maintenance: 56 or 84 mg, once per week (Weeks 5 to 8)
- Long-Term: 56 or 84 mg, every 1–2 weeks (Week 9 onward)
Clients are asked to fast for at least 2 hours before treatment and refrain from liquids 30 minutes prior. Following administration, patients remain under observation for 2 hours due to potential side effects such as dizziness, dissociation, or blood pressure changes.
Different Chemical Forms of Ketamine: Racemic vs. R-Ketamine and S-Ketamine
By now you are clear about ketamine being a dissociative anesthetic that is also used for the treatment of mental health conditions. But, did you know ketamine has 3 main chemical forms?
1. Racemic Ketamine
This type of ketamine contains a 50:50 mix of two mirror-image molecules (enantiomers): S-ketamine and R-ketamine. Clinically, both enantiomers act as NMDA receptor antagonists to produce the intended effects. Racemic ketamine is commonly used for intravenous infusions and general anesthesia. In the U.S., the most popular brand is Ketalar, though it’s also available as generic ketamine.
2. S-Ketamine
S-ketamine, or esketamine, is the isolated enantiomer used on its own. It’s the form of ketamine found in Spravato (nasal spray) and in injectable forms in some countries (Germany, Spain, Finland, etc.), and is FDA-approved for managing treatment-resistant depression (TRD). Compared to R-ketamine, it has 3 to 4 times stronger binding to NMDA receptors, making it highly potent as both an anesthetic and a pain reliever. Lower doses may be needed to achieve effects similar to racemic ketamine.
3. R-Ketamine
The last form often discussed is R-ketamine, also known as arketamine, which is currently being studied in research rather than offered as a standalone medication. Research shows it may be promising for pain management and inflammation. While R-ketamine has a lower attraction to NMDA receptors compared to S-ketamine, it may offer longer-lasting antidepressant effects with fewer psychotomimetic side effects.
All three of these forms of ketamine can be found in people in different settings. However, when comparing the 3, the safest form of ketamine therapy medicine turns out to be S-ketamine. This is widely used and documented to be regulated for medical use only, hence better for people.
How to Choose the Right Type of Ketamine Therapy for You?
With many types of ketamine therapy available, choosing the right one depends on your specific needs. Consider the following:
- Diagnosis: Certain forms of ketamine therapy work better for depression, PTSD, or chronic pain.
- Tolerance for dissociation: Some options, like psychedelic ketamine therapy, involve stronger altered states.
- Psychotherapy needs: If you want talk therapy support, look for clinics that offer ketamine integration therapy.
- Budget and insurance: Costs vary across treatments and providers. If your budget is limited, consider government-based support.
- Medical supervision: Decide if you prefer clinical settings or are open to at-home ketamine therapy.
- Comfort with delivery method: Consider IV, IM, or oral routes based on what feels safest and most accessible.
Matching the types of ketamine therapy to you is key. So remember, no ketamine therapy is “best”. Settle for an option that broadly covers your needs and wants.
Conclusion
Understanding the different types of ketamine therapy is truly important. From IV infusions to at-home ketamine therapy, the right one can help you make a more informed choice based on your symptoms, comfort, and care preferences.
Whether you opt for Spravato, IM injections, or lozenges, each form of ketamine therapy offers unique benefits and limitations. By considering your needs and discussing them with a KAP therapy provider, you can choose the type of therapy that feels both effective and safe for your healing journey.
The Ko-Op Difference
Maybe you are someone who has tried ketamine or a therapist who wants to provide this service to your clients. At the Ko-Op, we have informed ketamine therapists and KAP instructors who will train you to become a ketamine-assisted psychotherapy provider in Philadelphia.
If you are a patient:
- Match with a ketamine-informed therapist in minutes.
- Begin your healing journey, mind and body aligned.
- Feel safe, supported, and seen in every ketamine session.
If you are a therapist:
- Step-by-step KAP training, from intake to integration.
- Solo or group, this course adapts to your practice needs.
- Support clients with or without direct KAP involvement.
- Position your practice as a full-spectrum KAP resource.
- Get 9 CE credits (PA only) + optional practicum add-on.
- Virtual training, with real-life examples and understanding of KAP.
