The Differences Between At-Home and Clinical Ketamine Therapy

Mental health treatment is changing fast. For years, ketamine – a general anesthetic with well-documented antidepressant effects – was available only in specialized settings. If you wanted access, you booked an appointment, drove to a clinic, and received the drug under the close supervision of a medical professional.

That’s no longer the only option. The rise of telehealth alongside industry development and growing research has made at-home ketamine therapy possible. For some, that shift makes treatment more accessible and less intimidating. Others may be skeptical about the perceived lack of in-person medical oversight.

At-home ketamine is more convenient and often less expensive. In-clinic treatment offers tighter medical monitoring and more precise dosing. Both approaches can be effective, but they’re not interchangeable. The differences matter, especially when it comes to cost, safety protocols, and how the drug affects the body.

The Two Paths of Ketamine Therapy: An Overview

While both models utilize the same drug, the delivery method creates two different experiences.

The Clinical Model

In a clinical setting, ketamine is administered intravenously (IV) or via intramuscular (IM) injection under the supervision of a medical professional, with continuous monitoring throughout the session. 

In-clinic ketamine treatments typically run anywhere from about $400 to well over $1,000 per session, depending on the provider and location. Because most protocols involve a series of six or more sessions, total costs can quickly climb into the several-thousand-dollar range. For patients with severe or treatment-resistant symptoms, the precision may justify the expense. For others, it’s a significant barrier.

The Telehealth Model

At-home ketamine therapy takes a different approach. Patients are typically prescribed oral lozenges or troches (dissolvable tablets) through a licensed telehealth provider – though other routes of administration are available – then take the medication at home. Sometimes remote oversight is provided, sometimes a person will ask a trusted friend or family member to be with them, and sometimes there’s no oversight at all. Some programs include virtual check-ins or require a support person to be present during sessions.

This model prioritizes accessibility and affordability. At-home ketamine programs generally cost roughly $100 to $300 per session, with some providers offering monthly plans that fall in the low-to-mid hundreds. The trade-off is reduced oversight: dosing is fixed, monitoring is limited, and adjustments occur between sessions rather than in real-time. For patients with milder symptoms or strong support systems, that balance can make sense. 

Bioavailability and Dosing: The Science of Absorption

One of the biggest practical differences between in-clinic and at-home ketamine use isn’t the drug itself, but how much of it actually affects your brain. That’s where bioavailability comes in. That is, the percentage of the dose that reaches your bloodstream and can get to the brain. 

It’s helpful to understand a pharmacological concept called first-pass metabolism, which is when the concentration of an orally administered drug is significantly reduced before it reaches the brain. This means you’ll typically need a higher dose of oral ketamine to equal a smaller dose of ketamine administered by IV or IM.

IV ketamine has 100% bioavailability. When the drug is delivered directly into a vein, it bypasses the digestive system entirely. If a doctor prescribes 50 milligrams (mg), your brain receives the effect of that exact dose. This precision means the onset, duration, and intensity of the ketamine experience will be relatively consistent.

At-home ketamine is almost always swallowed (oral), held under the tongue (sublingual) or taken via nose spray (intranasal). All three hit the bloodstream less efficiently than an IV because of that first-metabolism effect. 

• Intravenous ketamine has a bioavailability of 100% while intramuscular administration yields 93%.
• Sublingual tablets or lozenges have better uptake than swallowed pills, because some of the drug is absorbed directly through the mucous membranes under the tongue. Studies show sublingual bioavailability is roughly 20 to 30% of the dose reaching systemic circulation.
• Oral ketamine that’s swallowed has even lower efficiency, typically around 10 to 20% bioavailability after passing through the liver.
• Intranasal ketamine – really, a ketamine derivative called esketamine – that’s taken by a nose spray, has a bioavailability of 45 to 50%.
• Intrarectal ketamine is another method that doesn’t sound pleasant, but is a viable option for folks. It has a bioavailability of 25 to 30%.
  

That means if you took a 200mg oral dose at home, only 30 to 50mg worth makes it into the bloodstream in its original form, compared with 50mg given IV. To compensate, at-home protocols often use higher oral doses (sometimes 200 to 400mg or more) to approximate the overall effect.

What This Means in Practice

Because oral and sublingual absorption is much less predictable – affected by your liver’s metabolism, blood flow in the mouth, what you ate that day, and how long you hold the dose – the intensity and onset of effects can vary more from session to session. IV ketamine, by contrast, behaves the same way every time. That’s part of why clinicians prefer IV for precision and why at-home dosing feels less consistent.

Medical Monitoring vs. Remote Guidance

In a clinic, ketamine is treated like what it is: a drug that can temporarily change consciousness and shift vital signs. Patients are typically monitored for blood pressure, heart rate, and oxygen saturation during treatment, and staff can intervene immediately if someone becomes nauseous, panicky, or experiences a significant rise in blood pressure.

In contrast, the FDA has issued alerts regarding the risks of at-home, compounded ketamine, specifically noting concerns about respiratory depression, bladder symptoms (“ketamine cystitis”), and the lack of real-time monitoring. While serious adverse events are rare, the lack of a medical professional in the room means the safety net is different.

At-home protocols rely heavily on a “sitter” – a trusted friend or family member who stays with you. Their role is not to treat you but to keep you safe. For patients with a history of high blood pressure or severe panic attacks, this distinction is a vital consideration.

Is At-Home Ketamine Therapy Effective?

A 2022 study by Hull et al. analyzed data from over 1,200 patients using at-home sublingual ketamine. The findings were promising:

• 62.8% of patients reported a 50% or greater reduction in depression symptoms.
• The study found the treatment to be well-tolerated, with few adverse events reported.

These outcomes are comparable to the success rates often cited for IV therapy, suggesting that for many patients, the higher oral dose effectively compensates for the lower absorption rate.

Who Should Choose Which? (Patient Profiles)

There is no “better” option, only the option that fits your preferences. 

When the Clinic is Necessary

• Severe Treatment-Resistant Depression (TRD): If you are in crisis or have acute suicidality, the rapid, guaranteed absorption of IV is often safer and more reliable.
• Medical Complexity: Patients with uncontrolled hypertension or cardiovascular issues need the continuous monitoring that only a clinic provides.
• Need for Separation: For some, home is a place of stress or chaos. A clinic provides a neutral, safe sanctuary to dissociate from daily triggers.

When At-Home Makes Sense

• Barriers to Access: For those who cannot travel to a clinic or afford the high per-session cost, at-home therapy is a vital lifeline.
• Maintenance: Many patients use at-home therapy as a maintenance tool after completing an initial IV series.
• Comfort Seekers: Clinics are usually made to be as comfortable as possible for the patient, but some people simply prefer to take ketamine in their own home for comfort and convenience’s sake.

Frequently Asked Questions

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Ketamine therapy carries risks and is not suitable for everyone. Always consult with a qualified healthcare provider to determine the best treatment plan for your specific medical history and mental health needs.

Sources

1. McIntyre RS, Rosenblat JD, Nemeroff CB, et al. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry. 2021;178(5):383-399. doi:10.1176/appi.ajp.2020.20081251
2. Rosenbaum, S. B., & Palacios, J. L. (2024, January 30). Ketamine. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470357/
3. Hull TD, Malgaroli M, Gazzaley A, Akiki TJ, Madan A, Vando L, Arden K, Swain J, Klotz M, Paleos C. At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial. J Affect Disord. 2022 Oct 1;314:59-67. doi: 10.1016/j.jad.2022.07.004. Epub 2022 Jul 6. PMID: 35809678.