What’s the difference between IV ketamine and lozenges? Should you choose FieldTrip’s full-service protocol—or Keta MD’s app-based model? This episode breaks it all down. Host April Pride is joined by medical professionals and industry veterans to compare four ketamine delivery methods—IM, IV, lozenges, and nasal spray. From bioavailability to budget, each option offers unique benefits (and tradeoffs). You’ll also hear firsthand experiences, learn what doctors look for when prescribing, and get practical “trip tips” to start your own research. Whether you’re dealing with treatment-resistant depression or simply curious about optimization, this is the essential guide for anyone exploring at-home ketamine therapy.
🔵 Key Takeaways
At-home ketamine therapy options like lozenges are affordable and accessible—but lower in potency and bioavailability than clinical methods.
IV and IM offer the highest absorption rates and fastest onset, but can be physically uncomfortable or cost-prohibitive.
Nasal spray (Spravato) is FDA-approved and more likely to be covered by insurance—but less potent than other forms.
“Optimization” means using low-dose psychedelics to improve creativity, mood, or stamina—even without a formal diagnosis.
Platforms like WonderMed and Keta MD are reshaping access through telehealth, but integration support is key to long-term outcomes.
🔵 Timestamps
[00:22] Safety and dosing in clinical vs. home ketamine use
[00:48] Introduction to the four delivery methods: IV, IM, lozenges, nasal spray
[01:30] What “optimization” means in the context of ketamine
[03:23] The rise of telehealth ketamine therapy post-COVID
[04:29] Building Keta MD and the lozenge delivery experience
[05:26] Sublingual ketamine administration explained
[06:25] WonderMed’s weekly dosing protocol and neuroplasticity
[07:22] IV ketamine vs. lozenges: onset, intensity, side effects
[08:48] IV’s edge in dose control and anti-nausea benefits
[09:31] Why bioavailability matters in ketamine’s effects
[10:22] IM injections: powerful, but harder to dose
[11:13] Remembering vs. dissociating during therapy
[11:58] Inside FieldTrip’s full IM therapy protocol
[13:38] Nasal spray delivery and the science of esketamine
[15:28] Why racemic ketamine may be more effective than Spravato
[16:38] The business of ketamine: patents, insurance, and FDA approval
[17:02] Final “trip tips”: cost, frequency, and bioavailability breakdown
🔵 Featured Guests
Dr. Bridget Carnahan, Field Trip Health
Kaia Roman, Women’s Psychedelic Network
Lauren Swanson, Wondermed
🔵 Additional Resources
🎙️SetSet Podcast: Ep 50 “Ketamine Therapy and Psychedelic Psychiatry”
🎙️SetSet Podcast: Ep 51 “Trust and Ketamine Therapy: Letting Go to Heal”
🎙️SetSet Podcast: Ep 54 “Ketamine Therapy for Depression”
🎙️SetSet Podcast: Ep 55 “Ketamine-Assisted Therapy: Brain Effects Explained”
🎙️SetSet Podcast: Ep. 57 “Psychedelic Integration for Ketamine Therapy”
Substack: “Can Ketamine Help Save New Moms?”
What are your non-negotiables when choosing a ketamine protocol—cost, setting, frequency, or something else?👇 Let’s talk about it in the comments after the transcript below.
🔵 Transcript
[00:01] April Pride:
Hey, this is April, and this show, Set Set Show, discusses cannabis, psychedelics, and altered states of consciousness generally. It's intended for audiences 21 and over. Also, I am not a medical expert. If you are looking to engage with psychedelic substances, please consult your physician before doing so.
[00:22] Dr. Bridget Carnahan:
In a clinical setting where we're monitoring people. We have the capacity to give a higher dose because they're safety precautions when they're making sure somebody's okay. That I don't think would be advisable to do in a home-based setting.
[00:48] April Pride:
Hey, I'm April Pride, your host on the High Guide podcast. This is the show for women who have an open and curious mind, and this is a show all about women changing their lives thanks to altered states of consciousness. At the top of the show you heard from Dr. Bridget Carnahan, who you'll hear more from on today's episode as we learn about the four primary administrations of [at-home ketamine therapy], intramuscular or IM, intravenous or IV, nasal spray, and [ketamine lozenges]. Have you wondered which [ketamine-assisted therapy] is right for you? In today's episode, we're going to get into the specifics related to dose, duration, frequency, bioavailability, budget, desired outcome, and condition for which treatment is being sought with the three women, including two medical experts you've met this season. This is an episode not to be missed if the first five episodes piqued your curiosity, and now you're ready to start a or brass tacks investigation into [telehealth ketamine treatment]. But first, our word of the week, and stay tuned to the almost end for our trip tips...Optimization, the action of making the best or most effective use of a situation or resource. As optimization relates to psychedelics, you know that Bradley Cooper movie Limitless, I'm kidding. Choosing to intentionally experiment with psychedelics for optimization is another way of saying although I may not have a diagnosis it doesn't mean that I don't want to affect incremental improved change across my life from stamina to creativity to output to attitude. This is achieved by consuming a specific psychedelic medicine at a dose consistent with desired outcome throughout the day. Of course medicines can be layered all in the name of optimization. [Ketamine clinics] today cannot prescribe for optimization. Doctors need to prescribe [ketamine-assisted therapy] for qualifying conditions such as depression, anxiety, and PTSD. And while platforms like WonderMed and [FieldTrip ketamine], which we've discussed this season on the High Guide, have chosen not to treat patient seeking support for substance use disorder, lots of underground therapists and facilitators are treating patients for this. And the purpose of adding [ketamine] to a therapy session is to, you guessed it, optimize the time between therapist and patient. So what happens when there's no therapist?
[03:23] Kaia Roman:
During the pandemic, all the [ketamine clinics] had to shut down because it was COVID and everything was shutting down. So all these people who relied on [ketamine for depression] and their anxiety and just being able to manage life couldn't get their medicine.
[03:42] April Pride:
Kaia wasn't the only person realizing that a lot of people are going to need a new way of communicating with their doctors. [Telehealth ketamine treatment] shot into effect at lightning bolt speed. The FDA revised regulations around [telehealth ketamine treatment], making it easier for medical professionals to opt to treat patients remotely in this way. They had to make these changes specifically for Medicaid and Medicare patients. You may have heard the recent news that some COVID -19 era emergency declarations are slated to end in this May. According to the Consolidated Appropriations Act of 2023, telehealth is an extended flexibility through, is an extended flexibility through December 31st, 2024. Listen as Kaia shares how she was the absolute right person to build Keta MD, an at -home telehealth Ketamine company as COVID -19 settled in.
[04:29] Kaia Roman:
I was one of the first people as a consultant at the beginning with Dr. On Demand, which is one of the very first telemedicine platforms. [Keta MD] is an app on your phone. We built it during the pandemic so that people could have access to [at-home ketamine therapy]. And I think it's pretty amazing actually that these services exist where you can, if you get the dosage right in a [ketamine lozenge] and you have someone in your home making sure that you're safe and you have a nurse over [telehealth ketamine treatment] watching over you, you can actually pretty closely replicate the experience that you would have in a clinic, but when you're depressed, it's pretty hard to leave your house so you can do it in the comfort of your home and also reduce the cost.
[05:15] April Pride:
We'll get into the cost of the different administrations in today's trip tips. Kaia continues here and explains what a patient can expect when a [ketamine lozenge] arrives at their doorstep.
[05:26] Kaia Roman:
The [ketamine lozenges] that we use at [Keta MD], they're called a trochee. They look like a little starburst. They melt in your mouth. We have people hold them in their mouth for 10 minutes, and the medicine absorbs in the mucosa on the inside of your cheeks and under your tongue. And that's called [sublingual ketamine] administration.
[05:44] April Pride:
As I've shared with you this season, [at-home ketamine therapy] with low-dose [ketamine lozenges] is the only [ketamine] I've consumed. The platform I worked with is [WonderMed]. I've linked to WonderMed's eligibility survey in the show notes of this episode. After completing WonderMed's eligibility survey, intercoat the high guide at checkout for 20 % off your first four at -home ketamine lozenges. While there is support from medical professionals prior and following treatment, I felt WonderMed's ketamine was best used in conjunction with my routine therapy sessions, cheduling psychotherapy, 24 to 48 hours following a ketamine treatment. WonderMed's lead clinician, Lauren Swanson, goes on to explain the protocol for treatment with its telehealth ketamine service.
[06:25] Lauren Swanson:
Patients take it every week. The reason why we decided upon that frequency is because that is approximately the neuropathic window. It can vary from individual to individual, so it could be as little as three to four days, maybe even over seven days, but generally about a week. And so the idea is that you do take that every week, so that we're not losing any opportunities with the neuroplasticity. And if we have a patient that does have severe depression, we do recommend that they don't, even though they're feeling really good, at least they see it through for the month without spacing it out. But you're not going to have a regression of symptoms because you stopped for a couple of weeks.
[07:06] April Pride:
If you're curious to learn more about neuroplasticity, check out last week's episode titled, "How Does [Ketamine] Effect the Brain?" Lauren goes on to compare the onset of [sublingual ketamine] with the most common administration of [ketamine], an IV infusion.
[07:22] Lauren Swanson:
Yes, so it actually is because of how quick it enters your bloodstream. So when you have an IV administration, it's immediate because they have the needle, the catheter in your arm, in your bloodstream, versus a lozenge. It has to go through a different absorption pathway. It takes longer to hit your bloodstream, and it's more of a gradual transition there. It takes about 10 to 15 minutes. And so it is more mild. It is easier. There's actually, you know, the side effect profile is less, too. You know, it can be less nausea, which is the common side effect that a lot of people experience in those higher dose versions in the clinic.
[08:00] April Pride:
While their lower dose typical of a lozenge can help to mitigate nausea, an IV bag usually includes an anti-nausea med. Kaia Roman goes on to explain more about dosing ketamine with an IV, which is the standard of care. And that is what most ketamine, and what most ketamine clinics use.
[08:16] Kaia Roman:
You have a needle in your arm and it's giving you an amount of ketamine. Usually they'll mix in an anti -nausea medication too, which is nice and a small percentage of people experience nausea with ketamine. I think it's easier for them to control the dosing that way. They can give you more or they can dial it back. They can give you more after a certain amount of time. Let's say you go for half an hour and then they see you're coming back, they can up the dosage. So that one is a little bit easier to control, I feel like.
[08:48] April Pride:
Of course, the added benefit of anti-nausea meds isn't the only benefit of an IV. Dear listeners, I'm sure there's not one of you who's found themselves on the absolute wrong side of a hangover, only to later find yourself on the right side of an IV therapy infusion, because drinking water was like using a hose to tame a house of flame. Just like Lauren said, the IV is straight to the bloodstream. You're getting all the good stuff immediately. And this is where another key difference in these administration's lies: [bioavailability]. If you've been following along with me for a while, then you know that like [ketamine], the consumption method you choose for cannabis will also determine the amount of THC or CBD absorbed into your body. Listen on, as Kaia explains what this means for [ketamine] absorption.
[09:31] Kaia Roman:
[sublingual ketamine] administration, compared to those other ones that are going straight into the bloodstream, it's only about 25% [bioavailability]. So if you're taking a 200 milligram trochee, you're maybe getting 50 milligrams of [ketamine], whereas an injection might be 150 milligrams of [ketamine]. And a lot of times people, clinicians, doctors, they're not wanting to prescribe really high dose trochees because if people are doing it at home, they don't want them passing out or getting nauseous.
[10:03] April Pride:
As [bioavailability] pertains to the produced effect—the high—we'll come back to this later in the episode. Because like many of us have experienced, getting to your right high may require moments of discomfort. Kaia, who received both an IV [ketamine] treatment and an intramuscular [ketamine] treatment—think needle, syringe, a shot—she goes on.
[10:22] Kaia Roman:
I was very aware of this needle in my arm the whole time, and that kind of kept me anchored in my body, and it was like kind of uncomfortable and painful, and I just hate having needles in my arms. So for that reason, I didn't like it. And then when I had the intramuscular injection, it was quite similar, but without the needle. So I liked it better. However, it was a little harder to control the dosage. You kind of blast off really fast. And if the dosage is too high—in my case—and of course everyone is super individual.
[10:49] April Pride:
Did you catch what Kaia's saying here? The consistently monitored and consistent dose provided by an IV drip produces the ideally dosed [ketamine] experience, yet the physical distraction and discomfort was in conflict with an overall ideal experience. She goes on to explain how her [ketamine-assisted therapy] session administered intramuscularly, or IM, is too powerful to remember, so to speak.
[11:13] Kaia Roman:
I know that I had a profound experience, but when I came back, I didn't remember anything. It's not necessarily important. It's still quieting the default mode network. It's still, you know, stimulating the growth of new dendrites in the brain. It's still working on the glutamate receptors. Like it's still doing all the good brain stuff. But I do like to remember my experiences. So, I think, you know, I would try an intramuscular injection again and try to determine what the ideal dosage is with that one, because if maybe I had a slightly lower dose, I would be able to remember the experience. But I know the clinicians have told me that can be a challenge—getting people to have a high enough dose to dissociate but a low enough dose that they remember.
[11:58] April Pride:
The most talked about clinic that performs intramuscular or IM [ketamine] treatments is FieldTrip Health, the company where Dr. Bridget Carnahan works and serves as the director of the clinic here in Seattle. While the most expensive option patients will consider, FieldTrip also provides the most therapeutic support. FieldTrip's [ketamine-assisted therapy] protocol combines [ketamine] therapy with follow-up talk therapy sessions under the supervision of a dedicated team of medical and mental health professionals. A series of treatments with FieldTrip starts with a medical screening with Dr. Carnahan or a similar medical practitioner in your local FieldTrip clinic. Then two separate sessions with a therapist to learn about the patient's goals and prepare them for treatment. In a fourth session, patients are injected with [ketamine], are given a blindfold and headphones, and the [psychedelic therapy] journey ensues, lasting about two hours. In a fifth session, they reflect on the experience with the therapist. Dr. Carnahan compares in-clinic intramuscular administration of [ketamine] with an at-home [sublingual ketamine] lozenge.
[12:57] Dr. Bridget Carnahan:
So sometimes when we work with people in the clinic, we're using very low doses, even though it's an intramuscular injection, just based on that individual's needs, what we're doing for them, what we're working with them psychotherapeutically on, what they're interested in. Some people will do what's considered a more [psychedelic therapy] or low dose where they're still engaged and able to process mentally memories or what's going on experientially for them and they can interact with their therapist during their [ketamine] journey. And so there's a variety of different intensities or dosages that we're working with in the clinical setting.
[13:38] April Pride:
Similar to a [ketamine lozenge], the final method of [ketamine] administration, nasal spray, also absorbs the active compound through the mucosal membranes. But before we totally jump into [ketamine nasal spray], this is the right time to inform you that not only are there different ways to administer [ketamine], but there are different types of [ketamine]. I bring this up now because every company that provides [ketamine-assisted therapy] we've discussed, despite the different routes of administration, each provides the same type of [ketamine]. More on that as I continue. [ketamine nasal spray] is where this diverges, and to better understand why, let's jump into the science and the monetization of science.
[14:18] April Pride:
First, a quick [ketamine] chemistry lesson. [Ketamine] is a chiral compound. Simply put, this means [ketamine] has a right side and a left side. Imagine you put your right hand out in front of you and then place your left hand on top. They're not congruent when stacked on top of one another palm face down. The left and the right side of [ketamine] is also different in their 3D orientation. The left side is called S-[ketamine] and the right side R-[ketamine] because they have different shapes—they bind in the body and brain differently. So R- and S-[ketamine] are metabolized by our bodies differently.
[15:04] April Pride:
Preliminary research suggests that the greater implications of this difference range from one providing better outcomes for depression symptoms to the other having a higher likelihood of abuse. While the limited research that's been completed does indicate the differences are significant, the current evidence needs further investigation, so I'm not going to do a deep dive in this episode. But I expect to follow up with more information in the months to come.
[15:28] April Pride:
For our purposes in this episode, to get to your right high, this is what you need to know: every type of [ketamine] discussed so far—[lozenges], IV, and IM—deliver the same type of [ketamine] to patients, racemic [ketamine], which includes both R- and S-[ketamine]. Nevertheless, all types of [ketamine] work in the brain the same way. A review of what we learned in the previous episode: [ketamine] targets a glutamate receptor called the NMDA receptor, which we learned about in last week's episode.
[16:02] April Pride:
An important point to include here: when I'm talking about [ketamine nasal spray], I'm not referring to the liquid [ketamine nasal spray] passed between friends who are consuming [ketamine] for recreational purposes. These products are purchased illegally. The [ketamine nasal spray] we're going to discuss here goes by the brand name [Spravato] and is the only FDA-approved [ketamine] treatment. Every other modality discussed earlier in this episode is being prescribed off-label because racemic [ketamine], while FDA-approved for medical use as an analgesic in 1970, has not been approved for treating depression.
[16:38] Kaia Roman:
To speak on [Spravato] and the S-[ketamine] molecule, [ketamine] has been around since 1970, and you cannot patent it. It is a crystal, it is very abundant, it is easy to make from some natural elements, and it cannot be patented. So for any pharmaceutical company to be able to make money from [ketamine], they had to make what is called a mirror molecule, and then they could patent that. And this is [Spravato].
[17:02] April Pride:
In 2019, after four clinical trials, [Spravato] received FDA approval to treat TRD, Treatment Resistant Depression, with later approval to treat MDD, Major Depressive Disorder. And so with FDA approval for these specific conditions, patients must meet qualifying criteria related to TRD and MDD. Whereas patients who opt for the off-label use of racemic [ketamine] may do so because they are seeking treatment for OCD or PTSD, et cetera. The big difference—FDA approval means that your insurance company is more likely to cover treatment. But this endorsement from the government does not mean that [Spravato] is necessarily superior. For one, [Spravato]'s bioavailability is half of IV racemic [ketamine], and nearly half for muscular racemic [ketamine] administration. Additionally, according to one study, researchers found that IV racemic [ketamine] had a longer antidepressant effect for patients with depression. Additionally, it has lower dropouts due to adverse events. Therefore, if you are looking for the most effective treatment with minimal adverse effects, racemic [ketamine] could be your best option. In our next episode we are going to explore the third and final phase of [ketamine-assisted therapy]—Integration—which begins in the 24 to 48 hours following the [ketamine] administration. I leave you with today's trip tips, a comparison of different types of [ketamine] administration discussed in this episode. Potency. The more potent, the more likely dissociation and hallucinations will occur. Potency comes down to bioavailability. How much [ketamine] is absorbed by our body is a direct result of how it enters our body. IV provides the highest absorption at 100 percent. Intramuscular has a close 95 percent, yet IV allows for a more accurate, consistent dose. [Spravato] [ketamine nasal spray] has half the bioavailability of IV or IM, and a [ketamine lozenge] has half of [ketamine nasal spray], or a quarter of IV or IM. Frequency. How often do you need to receive [ketamine] treatments? IV administration typically consists of six infusions spread out over two or three weeks. Signing up for IM at a FieldTrip clinic is a commitment of 24 months, over which time patients receive six [ketamine] sessions plus four to six integration sessions. [Spravato]—How long between doses? The recommended frequency of dosing with [Spravato] is twice per week for four weeks. The protocol for at-home [ketamine therapy] in the form of a [ketamine lozenge] varies. Patients may continue this course of treatment every week for up to three, even six months. Some patients may opt to have a month-long round of treatments, take a break for a year, and then have a refresh round. The prescribed protocol varies depending on the patient's needs and desired outcome. And finally, the cost. IV and [ketamine] treatments range from $350 to $700 each. The most robust [ketamine] treatment option is IM clinic FieldTrip, with a price tag of $5,200 to $7,200—roughly $1,000 per treatment session. [Ketamine nasal spray] cost: [Spravato] ranges from $4,700 to $6,700 for the first month of treatment and then $2,300 to $3,500 in the months that follow. This shakes out to $590 to $885 per dose, which adds up when taking regular doses. But as I mentioned earlier, esketamine, the active ingredient in [Spravato], is almost always covered by insurance, including Medicare, as it is FDA-approved. To be eligible for insurance coverage for esketamine, you need to have tried at least two other antidepressants without benefit. The first course of treatment I received through WonderMed was $400 for four [ketamine lozenges]. I have linked to WonderMed's eligibility survey in the show notes of this episode. After completing the eligibility survey, enter code The High Guide at checkout for 20 percent off your first four at-home [ketamine] [lozenges]. The other at-home [ketamine telehealth] company we discussed—Keta MD, which Kaia Roman co-founded. A standard package includes six nurse-guided treatments and a cost of $1,299. Thank you for listening to this episode of The High Guide. I am your host, April Pride. Please check out our website, The High Guide, for our shroom strain reviews and guide to [psilocybin]. Tune in next Friday for another episode of The High Guide, a show all about women changing their lives thanks to [altered states of consciousness].
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