Understanding the Range of KAT Experiences through Routes of Administration
Sublingual vs. IM vs IV with contributions from Sage psychiatric provider, Kwasi Adusei, DNP
“At lower doses, ketamine can be more ego-relaxing than ego-dissolving, helping people access thoughts and emotions with greater ease. As the dose increases, experiences may shift toward dream-like states or even profound feelings of interconnection with the universe.”
What is Ketamine?
Ketamine is a synthetic medicine classified as a dissociative anesthetic—meaning it can temporarily create a sense of detachment from one’s body, environment, or ordinary sense of self. Developed in the 1960s and FDA-approved in 1970, ketamine became widely adopted in hospitals and medical settings because of its safety, fast onset, and short duration of action. It’s even listed on the World Health Organization’s List of Essential Medicines.
For decades, ketamine has been used in surgeries (including pediatric procedures) because it preserves breathing and airway reflexes more safely than many anesthetics. It’s also been applied to help with acute and chronic pain.
More recently, at much lower doses than used in anesthesia, ketamine has emerged as a promising therapy for conditions like depression, PTSD, anxiety, and substance use disorders, particularly when other treatments haven’t worked.
How Does Ketamine Work?
Researchers are still learning about the exact ways ketamine helps with mental health, but several key theories have emerged:
Routes of AdministrationOne of the unique features of ketamine therapy is that it can be delivered through several different routes, each offering a slightly different therapeutic profile:
As one of our Kwasi Adusei notes:
“Different routes of administration produce both different subjective experiences and objective outcomes that are shaped by factors like bioavailability, absorption, and metabolites. These differences influence not just the intensity and duration, but also the potential efficacy of ketamine treatment.”
How We Choose the Right Route
The decision about which route to use is never one-size-fits-all. It’s guided by the latest evidence, clinical judgment, and most importantly your needs, comfort, and goals.
Research to date shows that IV and IM have the strongest evidence base, particularly for people with more severe symptoms. But less invasive routes like oral or sublingual ketamine can still provide meaningful outcomes, and for many people, they’re more affordable and easier to integrate into ongoing treatment.
Adusei explains:
“IV and IM ketamine have the strongest evidence base, but oral and sublingual routes can be more accessible and better support treatment engagement. Sometimes the ‘less invasive’ option is the best fit, especially when set, setting, and support are carefully considered.”
Ultimately, route selection considers both clinical factors and the therapeutic environment. In ketamine-assisted therapy, set (mindset), setting (environment), and support (the therapeutic relationship) are just as important as the medicine itself.
What Do Different Doses Feel Like?
Just as the route changes the experience, so does the dose. Lower doses can feel subtle and supportive, while higher doses may open the door to profound psychedelic states.
He also states:
“At lower doses, ketamine can be more ego-relaxing than ego-dissolving, helping people access thoughts and emotions with greater ease. As the dose increases, experiences may shift toward dream-like states or even profound feelings of interconnection with the universe.”
In practice, this means: lower doses may feel more “heart-opening,” allowing for greater emotional connection and awareness. Higher doses can lead to more immersive, transformative experiences that some describe as ego-dissolving or spiritual. Both ranges of experience can be therapeutic, and what matters most is matching the approach to the individual’s goals and readiness.
✨Takeaway: Ketamine therapy is not just about the medicine itself, but about the whole experience including the route, the dose, and the therapeutic support that surrounds it. With the right set and setting, ketamine can be a powerful tool for healing, insight, and renewal.
Curious if ketamine therapy might be right for you?
Our team takes a thoughtful, individualized approach that is grounded in evidence, safety, and compassionate support. If you’d like to learn more about ketamine therapy or explore which options may best fit your needs, we invite you to complete a contact form.
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Ketamine is a synthetic medicine classified as a dissociative anesthetic—meaning it can temporarily create a sense of detachment from one’s body, environment, or ordinary sense of self. Developed in the 1960s and FDA-approved in 1970, ketamine became widely adopted in hospitals and medical settings because of its safety, fast onset, and short duration of action. It’s even listed on the World Health Organization’s List of Essential Medicines.
For decades, ketamine has been used in surgeries (including pediatric procedures) because it preserves breathing and airway reflexes more safely than many anesthetics. It’s also been applied to help with acute and chronic pain.
More recently, at much lower doses than used in anesthesia, ketamine has emerged as a promising therapy for conditions like depression, PTSD, anxiety, and substance use disorders, particularly when other treatments haven’t worked.
How Does Ketamine Work?
Researchers are still learning about the exact ways ketamine helps with mental health, but several key theories have emerged:
- Neuroplasticity boost: Ketamine interacts with the brain’s glutamate system and may spark the growth of new neural connections in mood-related areas like the amygdala and hippocampus—sometimes within hours or days.
- A reset for patterns of thought: By shifting perception and loosening rigid mental loops, ketamine may create space for healthier patterns of thinking and behavior to take root.
- Other pathways: Ketamine also engages other receptor systems (including opioid receptors), and new discoveries continue to shape our understanding of its therapeutic power.
Routes of AdministrationOne of the unique features of ketamine therapy is that it can be delivered through several different routes, each offering a slightly different therapeutic profile:
- Intravenous (IV) infusion – The most direct method, with 100% bioavailability and rapid onset.
- Intramuscular (IM) injection – Delivers quick, powerful effects without the need for an IV line.
- Subcutaneous (SC) injection – A gentler release under the skin, often resulting in a slower, softer experience.
- Intranasal spray – Convenient and moderately bioavailable; one FDA-approved version is available for treatment-resistant depression.
- Oral or sublingual tablets/troches – Dissolve under the tongue or are swallowed, offering slower onset and longer-lasting effects.
As one of our Kwasi Adusei notes:
“Different routes of administration produce both different subjective experiences and objective outcomes that are shaped by factors like bioavailability, absorption, and metabolites. These differences influence not just the intensity and duration, but also the potential efficacy of ketamine treatment.”
How We Choose the Right Route
The decision about which route to use is never one-size-fits-all. It’s guided by the latest evidence, clinical judgment, and most importantly your needs, comfort, and goals.
Research to date shows that IV and IM have the strongest evidence base, particularly for people with more severe symptoms. But less invasive routes like oral or sublingual ketamine can still provide meaningful outcomes, and for many people, they’re more affordable and easier to integrate into ongoing treatment.
Adusei explains:
“IV and IM ketamine have the strongest evidence base, but oral and sublingual routes can be more accessible and better support treatment engagement. Sometimes the ‘less invasive’ option is the best fit, especially when set, setting, and support are carefully considered.”
Ultimately, route selection considers both clinical factors and the therapeutic environment. In ketamine-assisted therapy, set (mindset), setting (environment), and support (the therapeutic relationship) are just as important as the medicine itself.
What Do Different Doses Feel Like?
Just as the route changes the experience, so does the dose. Lower doses can feel subtle and supportive, while higher doses may open the door to profound psychedelic states.
He also states:
“At lower doses, ketamine can be more ego-relaxing than ego-dissolving, helping people access thoughts and emotions with greater ease. As the dose increases, experiences may shift toward dream-like states or even profound feelings of interconnection with the universe.”
In practice, this means: lower doses may feel more “heart-opening,” allowing for greater emotional connection and awareness. Higher doses can lead to more immersive, transformative experiences that some describe as ego-dissolving or spiritual. Both ranges of experience can be therapeutic, and what matters most is matching the approach to the individual’s goals and readiness.
✨Takeaway: Ketamine therapy is not just about the medicine itself, but about the whole experience including the route, the dose, and the therapeutic support that surrounds it. With the right set and setting, ketamine can be a powerful tool for healing, insight, and renewal.
Curious if ketamine therapy might be right for you?
Our team takes a thoughtful, individualized approach that is grounded in evidence, safety, and compassionate support. If you’d like to learn more about ketamine therapy or explore which options may best fit your needs, we invite you to complete a contact form.
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