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The Importance of 6–8 Dosing Sessions:
- Titration for Best Dose: Every person responds differently to ketamine, so multiple sessions allow for dose adjustments to find the optimal level that provides relief without unnecessary side effects (Andrade, 2017). At Journey Clinical, the first two dosing sessions are intended to help the patient get accustomed to ketamine and determine the optimal dose for the patient.
- Cumulative Benefit: Studies on ketamine treatment suggest that multiple doses (rather than a single session) provide the most significant and lasting relief. Most research shows that 4–6 sessions at the patient’s optimal dose are needed to achieve the strongest antidepressant effects (Phillips et al., 2019). An initial treatment course of 6-8 dosing sessions allows for ~two sessions to titrate the dose, then 4-6 sessions at the patient’s optimal dose.
- Sustained Symptom Relief: IV and intranasal ketamine studies indicate that more frequent initial dosing followed by gradual tapering leads to longer-lasting effects (Daly et al., 2019). The same approach is applied to oral ketamine, ensuring that depression symptoms remain under control.
- Brain Adaptation: Ketamine promotes brain plasticity, meaning it helps the brain "rewire" itself. This process happens over time, and multiple sessions allow for continued neural changes, particularly when combined with therapy (Duman & Aghajanian, 2012). To better understand neuroplasticity, It can be helpful to picture a ski slope with well trodden ski paths. Ketamine functions like a fresh layer of snow, enabling the patient to make new pathways. After multiple dosing sessions, those new, adaptive pathways in the brain become more permanent.
Benefits of Oral Ketamine Compared to Other Forms of Ketamine Treatment:
- IV ketamine is well-researched, but it requires medical supervision and frequent visits (often 2-3 times per week) (Bahr et al., 2021).
- Intranasal esketamine is effective, but studies suggest that its long-term success depends on ongoing treatment and combination with other antidepressants (Popova et al., 2019).
- Oral ketamine is more accessible and convenient, and while fewer large studies exist, repeated oral dosing has been shown to be effective in depression treatment (Smith-Apeldoorn et al., 2022).
Long-Term Use and Maintenance:
- After completing an initial course of 6–8 sessions, patients may transition to a less frequent maintenance schedule. Some may need periodic booster doses, while others may be able to taper off. Because depression symptoms can fluctuate, ketamine dosing sessions offer flexibility—it can be scheduled as-needed, unlike traditional antidepressants (Aan Het Rot et al., 2010).
Summary:
- In summary, the 6–8 dosing session approach ensures that oral ketamine is given enough time to work effectively, allows for dose adjustments, and maximizes long-term benefits while minimizing unnecessary medication use. Additional treatment cycles of 6-8 doses or maintenance dosing after the initial course of 6-8 dosing sessions allow for prolonged alleviation of depression symptoms.