Why Route of Administration Matters in Ketamine Assisted Psychotherapy

Why Route of Administration Matters in Ketamine Assisted Psychotherapy (KAP)

In ketamine-assisted psychotherapy, how the medicine is delivered shapes the entire therapeutic experience. Different routes, intravenous (IV), intramuscular (IM), intranasal (IN), and oral, produce very different patterns of ketamine concentration in the brain and body over time. Those patterns affect how quickly the medicine comes on, how intense it feels, how long it lasts, and whether it supports or interferes with the psychotherapy process.

What We Mean by an “Optimal Range” or Peri-Dissociative State

In KAP, the goal is to work within a therapeutic window — often called the optimal range or peri-dissociative state — where ketamine is active enough to open the mind, soften defenses, and increase neuroplasticity, but not so intense that the therapy itself is disrupted.

A well-calibrated peri-dissociative state allows a patient to:

• Engage in conversation during the session.
  
  
• Think clearly enough to explore emotions and memories with the therapist.
  
  
• Feel safe and supported, without the medicine becoming overwhelming.
  
  
• Avoid underwhelming doses that yield no meaningful therapeutic content or fail to expand the window of tolerance.
  
  
• Stay grounded, rather than entering a fully dissociative state — which research and experience suggest can interrupt therapy and is less effective for antidepressant benefits.
  
  

In other words: the sweet spot is where the medicine supports the work, rather than replacing it.

How the Routes Compare

Intravenous (IV)

• Most precise and controllable: IV infusion allows the provider to ramp up gently, keep the patient in the optimal range for the duration of the session, and taper down smoothly.
  
  
• Therapy-friendly: The steadiness of IV makes it possible to maintain a conversational, interactive therapeutic process throughout.
  
  
• Our specialty: At Transcend, IV KAP is the only method we’ve ever used since our inception in 2019. This means we’ve delivered more sessions using this precise dosing approach than anyone else in the industry, and we know exactly how to fine-tune it for each patient.
  
  
• Extremely rare elsewhere: Few clinics have the resources, training, and protocols to offer true IV KAP at this level.
  
  

Intramuscular (IM)

• Fast and intense: IM injections can bring on strong effects quickly, often overshooting the therapeutic window.
  
  
• Hard to adjust: Once injected, the dose can’t be fine-tuned mid-session.
  
  
• Shorter therapeutic window: The optimal range may only be sustained briefly, making interactive therapy difficult.
  
  

Intranasal (IN)

• Brief peak: IN ketamine can brush the optimal range but doesn’t hold it for long.
  
  
• Inconsistent absorption: Effects vary greatly between patients and even between doses for the same patient.
  
  
• More suited for non-therapy protocols: The short window makes interactive therapy challenging.
  
  

Oral

• Slow and low: Oral dosing often produces a delayed onset and a mild effect that may never fully reach the therapeutic range for KAP.
  
  
• Highly variable absorption: Influenced by digestion and metabolism.
  
  
• Minimal time in optimal range: Limits the opportunity for productive therapy.
  
  

Why IV Is the Gold Standard for KAP

When the aim is to sustain an interactive, transformative therapy session within a safe and effective state, IV infusion is the only route that realistically provides the control and precision needed.

At Transcend, we’ve made IV KAP our sole method since the very beginning — not just because it’s the most reliable way to work in the optimal range, but because it consistently supports deeper therapeutic engagement and better outcomes for our patients.

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