I take 50mg weekly, insnuflation, but suddenly considering sublingual. It's rid me of a lifetime of persistent ideation that had become a daily burden. It seems like I need way less than clinics give people

250mg seems exceptionally high (in reference to the OP's response below). The esketamine nasal spray that was just approved contains only 28mg per dose (1-2x/week). I don't know if that's because you need more if you take it sublingually. Snorting/nasal is almost certainly the most efficient/most effective way to take it.

1) The different ROAs have different bioavailability.

2) Ketamine is cheap. Convenience should be prioritized over efficiency.

It's not just about the expense, ketamine can damage liver and kidneys, and reduce iron uptake. Efficiency, in this case, is more about harm reduction than expense

I've read some of the most important papers and books and have never come across this. Please post a source.

Depression is a very serious illness and ketamine is a very safe drug. We need to give people more options.

Are you concerned about potential long term side effects of the drug?

Like MDMA, which has also garnered attention from researchers for potential medical benefits, I was under the impression K had nontrivial neurotoxic potential if abused.

Yes, and that's why I take small doses infrequently. I took a few months off because I was doing that much better, but the intrusive thoughts came back. But overall. No, my brain is fucked and tells me to kill myself every day; I don't need that abuse. Those brain cells deserve to die. More serious take: my quality of life is improved by an order of magnitude. I didn't want to survive another decade in that condition, but now I do. That's worth the risk

I take 250mg sublingual. I put it under my tongue at night while listening to music.

Can you describe your experience with it (how resistant your depression was, how effective ket is, what the short and long term effects you’re noticing are)?

I had tried several anti-depressants before ketamine. I feel a lot better and have much more energy.

A side effect while taking the drug in the short term is dissociation. As tolerance builds that eventually goes away.

I'm having some issues with sleep and productivity at night.

Is that a standard dose? Why do you take it sublingually instead of snorting it?

I have taken ketamine recreationally...that is quite a high dose at least from my experience, though I've never though to take it sublingually.

Doc here. Sublingual application bypasses the liver, which removes drugs from the bloodstream. Same reason why nitro is applied here.

Some of the drug will always be absorbed orally and travel to the liver through the the portal vein.

The liver will eventually remove ketamine from the bloodstream regardless of which route is used.

That's my understanding at least.

That’s interesting. What’s the mechanism for that? Uninformed intuition would lead one to think there would not be a difference.

It's a function of anatomy. The sublingual veins drain into the jugular and then vena cava. For drugs this avoids the first-pass effect, which is exploited when giving nitroglycerin for angina pectoris. Other ways to achieve this are suppositories (rectal veins) and intravenous (i.v.) or intramuscular (i.m.) injection.

https://en.wikipedia.org/wiki/Lingual_veins

https://en.wikipedia.org/wiki/First_pass_effect

There isn't a standard dose. Far too early for that.

I take it sublingually because that's what my doctor prescribes.