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As with most other drugs, there is a dose: response relationship with ketamine. That is why the relatively low doses that Spravato (the nasal form of ketamine) administration delivers require re-administration once a week at the least, and for many patients twice a week. That is also why the low doses of ketamine administered in clinics that are not staffed by anesthesiologists result in some patients being labeled as “non-responders,” when in fact they would get relief if only a higher dose infusion of ketamine was given.
The higher doses we routinely administer – some even up to 4 or 5 times higher and inducing a light general anesthetic – allow every patient who might respond favorably a chance to do so. That is also why our higher dosing allows longer periods of time to elapse between maintenance treatments, saving patients both money and disruptions in their lives.
Over the past twenty years, ketamine infusions have been extensively studied for the treatment of medication-resistant depression. Psychiatrists have performed the vast majority of studies, so only very low doses of ketamine have typically been used (0.5 mg/kg given over 40 – 60 minutes). Even at these low doses, we can expect approximately 60 – 70% of patients to find relief. However, within 3 weeks of completing the initial course of 6 low-dose infusions, half to three-fourths of patients have return of their depression.
Fortunately, anesthesiologists can administer much higher doses of ketamine (as much as 4 – 5 times higher), and some patients who do not respond at the lower dose will, fortunately, find relief with a more aggressive dosing regimen. In addition, the higher doses that we give allow a considerably longer period of relief, and patients can thereby extend the time period between “maintenance” infusions. This benefits patient both financially as well as being far less disruptive to their lives.