No one understands the exact mechanism of ketamine for depression even though there has been a lot of research and speculation on this topic. Therefore, you can't say which ROA is best for patients or if one works better than another.
Furthermore, all studies have been small and short in duration so there's no statistical significance to the fact that the IV ROA is used more in studies. If IV was the only route that worked it would be the first anti-depressant with that designation. Because of the cost of infusions patients are right to be skeptical about doctors that are running clinics.
> In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.
My doctor has clinical experience with ketamine and about 2+ years of prescribing patients with TRD with sublingual ketamine that is taken at home. Ketamine is an incredibly safe drug and nothing about his practice has changed. His insurance has even stayed the same. I know that’s a common justification for high prices from docs that run IV clinics.
The reason I’m not going anonymous on this is because I feel passionately that we need to stem the tide of shady ketamine doctors that don’t give a shit about patients. When I asked my doctor why he wouldn’t charge me a lot of money (he could!) for the treatment he asked me, “Would I charge you a lot for Lexapro because it works?” Good point.
See this book for background on Ketamine and the studies completed: Ketamine for Treatment-Resistant Depression: The First Decade of Progress (2016)
https://books.google.com/books/about/Ketamine_for_Treatment_...
$130 gets me 3000mg in a spray every month. That's enough for about 4 IV-equivalent treatments even with the low bioavailability. The biggest difference is that the intranasal (of course) absorbs more slowly than an IV, so some of the effects last for 2-3 hours after I stop administering the spray, whereas once the IV runs out, I'm ready to leave the clinic in about 15 minutes. (Taking an uber or the subway rather than driving, obviously.)
The therapeutic index for ketamine is ridiculous and I know I don't have adverse reactions to it, so I'm not at all concerned about harming myself with it accidentally. I wouldn't recommend it for anyone who hasn't had some IV treatments, partly because a small number of people do have strong negative reactions to it, and partly because it would be really difficult to know what kind of effect you need to achieve. It's pretty easy for me to tell how high the levels in my blood are because I'm so familiar with how it feels as the IV dose escalates.
While I wouldn't recommend it for an initial treatment, I would recommend it to anyone who has been successfully treated with ketamine. Unfortunately, I think that it's harder to get now. I know my doctor has stopped prescribing it to patients because too many people were selling or abusing it.
And if you're talking about starting an IV on yourself... without training, the risks of really bad health issues, including death, are pretty high. Almost no one outside of professional health care has that training. Even if they did, you still need to be monitored by someone else via pulse ox and sometimes blood pressure for safety reasons, and said person monitoring you needs to have the training to know how to help you if something goes wrong. Keep in mind that if ketamine is effective for you, you will end up needing to keep taking it for a long time, typically every 3-6 weeks, or the effects wear off. That frequency multiplies the risks.
In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.
I know from talking to my doctor that of the $375 I pay, his cost for the ketamine he uses for that one treatment is under 10 bucks. If you've got a medical license, you get access to buy legit pharma drugs very easily. I believe he told me that one vial of Ketamine is something like $20 and there's multiple doses in there.