• Ketamine given in subanesthetic dose, usually 0.5mg/kg of patient body weight.
• Duration of the infusion is usually infused over 40-60 minutes.
• Protocol- administered under medical supervision, in a controlled,supportive enviroment.
• Frequency of treatments can be weekly or spread out and adjusted based on patient repsonse and tolerability, usually completing series of treatment sessions.

• Formulation can be a commercial formulation ( Esketamine) a derivative of Ketamine or a specialized compounded formulation of Ketamine, which are used intranasally.
• Protocol: Ddministered under medical supervision, often in a clinic setting.
• Frequency: Typically twice a week for the first month, then weekly or biweekly based on repsonse.

• Used less frequently but can be an option for some patients.
• Dosing: Similar to IV, but specific protocols vary.

• Ketamine is often administered in a controlled,supportive enviroment, usually incorporating preparatory and integration sessions.

Ketamine’s path from a old war time anesthetic to anti-depressant orginated in the late 1990’s with groundbreaking proof-of-concept studies conducted in depressed patients who recieved relatively small doses of Ketamine. These patients experienced a rapid, unmistakable reduction in depressive symptoms after twenty-four hours, and the effect lasted days after treatment. To put these findings into perspective, traditional antidepressant medications take weeks to show any effect and must be taken daily. In the meantime, patients continue suffer from depression and risk self-harm and suicidal ideations. The same results have been replicated in subsequent studies, showing that a high percentage of depressed patients responded to a single treatment of sub-anesthetic dose of Ketamine. Ketamine has additonally demostrated it’s usefullness in a more complex form of depression called treatment-resistant depression (TRD).In other studies physicians showed that sub-anesthetic dose of Ketamine combined with cognitive behavioral therapy (CBT) improved symptoms of treatment resistant depression (TRD).

Ketamine’s mechanism of action for treating depression,especially treatment-resistant depression (TRD), is unique because it sidesteps the usual pathways of traditional antidepressants.Unlike Serotonin Reuptake Inhibitors (SSRI’s) which affect Serotonin levels over a course of weeks,ketamine works fast-often within hours-by targeting the brain’s glutamate system and sparking rapid changes in neuronal connections.Glutamate’s the brain’s main excitatory nuerotransmitter that drives neuron activity. In depression,especially treatment resistant depression (TRD), there is evidence of malfunctioning glutamate signaling and weakend connections between neurons,particularily in the mood-regulating areas like the prefrontal cortex and hippocampus.By using ketamine to block NMDA receptors ( glutamate receptors) this causes a surge in the release of glutamate.The extra glutamate floats around and starts hitting other receptors, one being the AMPA receptor, which amps up neuron firing and sets off a process called synaptic plasticity-basically, the brain’s ability to rewire itself. In depression, synapses ( the connections between neurons) can atrophy or weaken.Ketamine flips this by boosting the release of brain-derived neurotrophic factor ( BDNF), a protein that acts like fertilizer for neuron growth and repair. Another downstream cascade that ketamine activates aside from (AMPA) and (BDNF) is the (mTOR) pathway, which is like a contruction crew for proteins that builds synaptic connections in the prefrontal cortex. This rapid rewiring is thought to “reset” the brain’s dysfunctional mood networks,explaining why people can feel better so fast. Ketamine also dials down inflammation and tweaks opiod receptors slightly to contribute to it’s mood lift and chills out the brain’s “default mode network” the part of the brain that gets stuck in negative rumination thought loops. In summary by ketamine’s ability to jumpstart glutamate,BDNF, and mTOR this offers a backdoor fix, rebuilding nueronal connections that tradtitonal SSRI antidepressant medications cant touch.

• Sucidal ideation
  Ketamine in known for it’s rapid effects on mood, and studies show it can help reduce sucidal ideations and negative thoughts quickly, often within hours to days.Ketamine improves how the brain processes information, particularily processing speed, which helps patients make better decesions and feel less overwhelmed by sucidial thoughts.
• Addiction Treatment
  Research suggests Ketamine may help treat addiction, particularly alcohol,opiod,and cocaine use disorders.It seems likely that Ketamine works by blocking NMDA receptors, promoting nueroplaciticity, and reducing cravings, which could support recovery.
• Post Tramatic Stress Disorder (PTSD)
  Research suggests that Ketamine can help treat PTSD by reducing fear responses and promoting brain plasticity. It seems likely that Ketamine works by blocking NMDA receptors, enhancing neuroplasticity, and lowering the amygdala repsonse. Evidence leans toward benefits when combined with pyschotherapy.
• Nueropathic Pain
  Research suggests that Ketamine may help treat nueropathic pain by blocking NMDA receptors,reducing central sensitization.It seems likely that Ketamine also enhances descending inhibitory pathways and has anti-inflammitory effects,contributing  to pain relief.Evidence leans toward benefits for conditions like complex regional pain syndrome, with mixed results for other neuropathic pains.
• Autism Spectrum Disorder
  Research suggests Ketamine may help some indivduals with Autism Spectrum Disorder (ASD) by modulating NMDA receptors and promoting brain plasticity.It seems likely that Ketamine could improve symptoms like social interaction,communication,and repetitive behaviors.

These criteria help ensure that Ketamine treatment is both safe and potentially effective for the patient.