Dose Ranges and Effects

Ketamine is administered either as an anesthetic, psychedelic, or psycholytic dose to yield different effects on the body and mind.

In this section, we’ll explore the expected effects of a client with a specific dose range. Later in the course, we’ll look at the recommended dose amount and the method of administration to trigger the desired effects.

Please ensure that you read through all items before proceeding by selecting each part of the image.

Psycholytic Dose

Psycholytic doses (IV dose of 0.5mg/kg) (Chong et al., 2009; Glue et al., 2021; Peltoniemi et al., 2016) generally lack the psychological effects seen in higher psychedelic doses, although some will experience an altered state of consciousness even from relatively smaller doses (Kohtala, 2021).

Those under the influence of ketamine can generally be expected to experience:

  • Reductions in pain

  • Reductions in anxiety

  • Reductions in depressive symptoms

When used as an antidepressant (and not within the context of ketamine-assisted therapy), a low psycholytic dose of ketamine seems to effectively manage depressive symptoms only in the short-term (Marcantoni et al., 2020). A recent review of the current literature observed that psycholytic doses of intravenous ketamine usually peak at 24 hours after infusion, with a significant decrease in ketamine’s effects in the subsequent seven days post-infusion (Marcantoni et al., 2020). Additionally, clinical relapse usually occurs from 7 to 30 days after the infusion, with approximately

30% of participants relapsing one week after infusion and

26% two weeks or more after (Marcantoni et al., 2020)

While psycholytic doses of ketamine produce only minor psychoactive effects, mitigating dissociative effects (Kohtala, 2021), psycholytic doses of ketamine still have therapeutic value.

Psychedelic Dose

At psychedelic doses (IV dose of 1mg/kg) (Chong et al., 2009; Glue et al., 2021; Peltoniemi et al., 2016), ketamine may induce:

  • Altered states of consciousness marked by dissociation or a "trance-like" state

  • Altered perceptions of time

  • A feeling of transcending normal time and space

  • Changes in sensory perception (especially vision and hearing)

  • Feelings of leaving one's body or becoming a non-physical being

  • Emotionally intense visions

  • Encounters with archetypal or non-terrestrial beings

  • Visits to mythological realms of consciousness

  • Feelings of being reborn

  • Vivid dreams or memories of past and future incarnations

  • Ego dissolution and loss of identity

  • Reliving one's life

  • Deep feelings of peace and joy

  • Feelings of interconnectedness with nature and others

  • Feelings of cosmic unity

  • A sense of sacredness

  • A sense of ineffability of the experience (Ceban et al., 2021; Domino, 2010; Kolp et al., 2014; Kolp et al., 2006; Krupitsky et al., 1992; Krupitsky & Grinenko, 1997).

Anesthetic Dose

At anesthetic doses (IV dose of 2-4.5mg/kg) (Rosenbaum et al., 2022), ketamine can cause a range of psychological effects, including:

  • Vivid dreams and dream-like states

  • Delirium

  • Hallucinations

  • Excitement

  • Irrational behaviour

  • Psychic abnormalities, such as confusion

  • Decreased ability to feel pain

  • Sedation

  • Reduced awareness of the environment (Domino, 2010; Kohtala, 2021; Marland et al., 2013; Sandoz Canada Inc., 2015)

These effects generally respond well to reassurance alone. They may persist for a few hours, and do not result in residual psychological effects (Sandoz Canada Inc., 2015).

Video: Phenomenology: What Does Ketamine Feel Like?

4:21

In this video, we will learn about some of the subjective experiences that are often reported from ketamine experiences.

References

Ceban, F., Rosenblat, J. D., Kratiuk, K., Lee, Y., Rodrigues, N. B., Gill, H., . . . McIntyre, R. S. (2021). Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients with Mood Disorders. CNS Drugs, 35(9), 925-934. https://doi.org/10.1007/s40263-021-00846-5

Chong, C., Schug, S. A., Page-Sharp, M., Jenkins, B., & Ilett, K. F. (2009). Development of a sublingual/oral formulation of ketamine for use in neuropathic pain: Preliminary findings from a three-way randomized, crossover study. Clin Drug Investig, 29(5), 317-324. https://doi.org/10.2165/00044011-200929050-00004

Domino, E. F. (2010). Taming the ketamine tiger. Anesthesiology, 113(3), 678-684. https://doi.org/10.1097/ALN.0b013e3181ed09a2

Glue, P., Russell, B., & Medlicott, N. J. (2021). Influence of formulation and route of administration on ketamine's safety and tolerability: systematic review. Eur J Clin Pharmacol, 77(5), 671-676. https://doi.org/10.1007/s00228-020-03047-z

Kohtala, S. (2021). Ketamine-50 years in use: from anesthesia to rapid antidepressant effects and neurobiological mechanisms. Pharmacol Rep, 73(2), 323-345. https://doi.org/10.1007/s43440- 021-00232-4

Kolp, E., Friedman, H. L., Krupitsky, E., Jansen, K., Sylvester, M., Young, M. S., & Kolp, A. (2014). Ketamine psychedelic psychotherapy: Focus on its pharmacology, phenomenology, and clinical applications. International Journal of Transpersonal Studies, 33(2), 84-140. https://doi.org/10.24972/ijts.2014.33.2.84

Kolp, E., Friedman, H. L., Young, M. S., & Krupitsky, E. (2006). Ketamine Enhanced Psychotherapy: Preliminary Clinical Observations on Its Effectiveness in Treating Alcoholism. The Humanistic Psychologist, 34(4), 399-422. https://doi.org/10.1207/s15473333thp3404_7

Krupitsky, E. M., Grineko, A. Y., Berkaliev, T. N., Paley, A. I., Tetrov, U. N., Mushkov, K. A., & Borodikin, Y. S. (1992). The Combination of Psychedelic and Aversive Approaches in Alcoholism Treatment. Alcoholism Treatment Quarterly, 9(1), 99-105. https://doi.org/10.1300/j020v09n01_09

Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs, 29(2), 165-183. https://doi.org/10.1080/02791072.1997.10400185

Marcantoni, W. S., Akoumba, B. S., Wassef, M., Mayrand, J., Lai, H., Richard-Devantoy, S., & Beauchamp, S. (2020). A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord, 277, 831-841. https://doi.org/10.1016/j.jad.2020.09.007

Marland, S., Ellerton, J., Andolfatto, G., Strapazzon, G., Thomassen, O., Brandner, B., . . . Paal, P. (2013). Ketamine: use in anesthesia. CNS Neurosci Ther, 19(6), 381-389. https://doi.org/10.1111/cns.12072

Peltoniemi, M. A., Hagelberg, N. M., Olkkola, K. T., & Saari, T. I. (2016). Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthesia and Pain Therapy. Clin Pharmacokinet, 55(9), 1059-1077. https://doi.org/10.1007/s40262-016-0383-6

Rosenbaum, S. B., Gupta, V., Patel, P., & Palacios, J. L. (2022). Ketamine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470357/

Sandoz Canada Inc. (2015). Product Monograph: Ketamine Hydrochloride Injection USP & Ketamine Hydrochloride Injection SDZ. https://www.sandoz.ca/sites/www.sandoz.ca/files/Ketamine_HCl_PMe_20150506.pdf