Ketamine and Esketamine for Depression: What is the Ideal Dose?

At Philadelphia Integrative Psychiatry, under the pioneering leadership of Dr. Danish, we have long been at the forefront of innovative treatments for depression. Dr. Danish was the first provider in the region to offer Intravenous (IV) ketamine therapy, a groundbreaking approach that has since been complemented by ketamine-assisted therapy and the use of Sprovato. Our commitment to these treatments stems from their significant effectiveness in combating depression, particularly in cases where other methods have failed.

As part of our ongoing effort to refine and optimize our treatment strategies, we continuously engage with the latest research to ensure that our approaches are both effective and scientifically sound. A recent systematic review and meta-analysis published in the Journal of Affective Disorders sheds new light on the optimal dosing of ketamine and esketamine, which is crucial for maximizing their therapeutic benefits while minimizing side effects.

A recent research article, titled "What Is the Optimal Dose of Ketamine for Treatment Resistant Depression?" published on psychiatryadvisor.com, delves into the efficacy of intravenous (IV) ketamine and intranasal (IN) esketamine for treating treatment-resistant depression. The study, conducted by investigators from the Mayo Clinic, systematically reviews and meta-analyzes the optimal dosages for both forms of ketamine administration, highlighting their effects on depressive symptoms. Below, the findings are broken down into sections for clarity.

IV Ketamine Dosage and Efficacy

The study categorizes IV ketamine doses into low (≤0.2 mg/kg), standard (>0.2 to 0.5 mg/kg), and high (>0.5 mg/kg) for analysis. It includes data from 5 randomized controlled trials (RCTs) with a pooled sample size of 262 participants. The findings indicate that IV ketamine is effective at lower doses of 0.2 to 0.5 mg/kg, with no significant increase in benefit at higher doses (1 mg/kg). The mean effect size of IV ketamine relative to control was significant, suggesting its efficacy in reducing depressive symptoms. However, the data does not support the superiority of higher doses (>0.5 mg/kg) over the standard dose (0.5 mg/kg).

For more on Ketamine-Assisted-Therapy (KAT), please visit our blog here. 

Intranasal Esketamine Dosage and Efficacy

For IN esketamine, the study includes 7 RCTs with a total of 1372 participants. Doses ranged from 28 mg to 84 mg. The efficacy of IN esketamine in reducing depressive symptoms increases with doses above 28 mg, reaching optimal response between 56 and 84 mg. Specifically, doses of 56 mg and flexible dosing between 56 and 84 mg were found to be more effective than control, with the highest efficacy observed at 84 mg.

Side Effects

Both treatments were associated with common side effects such as dizziness, headache, dissociative symptoms, and dysgeusia. Additionally, higher doses tended to cause transient elevation of blood pressure, indicating a dose-dependent increase in certain adverse effects.

For a more thorough blog on the safety of ketamine, please click here. 

Conclusion

The study concludes that for IV ketamine, lower doses within the range of 0.2 to 0.5 mg/kg are effective for treatment-resistant depression without additional benefits at higher doses. In contrast, the efficacy of IN esketamine increases with doses above 28 mg, with the most significant response observed between 56 and 84 mg. The findings suggest that while both forms of ketamine administration show promise in treating treatment-resistant depression, their optimal dosages differ, with no evidence supporting the increased efficacy of higher IV ketamine doses over the standard dose.

Getting in Touch with Dr. Danish and His Team

At Philadelphia Integrative Psychiatry, we specialize in using various forms of ketamine and esketamine to treat depression, PTSD, anxiety, and other concerns. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for PDA or similar conditions, please text or call 610-999-6414 to learn how we can help.

More Information: 

• Visit this blog to learn how ketamine treats depression. 

• Visit this blog for more on the transformative power of Ketamine Assisted Therapy (Ketamine treatment with a therapist present) at our practice. 

Visit this page on our website to view our therapists who specialize in Ketamine Assisted Therapy.