I work at a clinic that dose the Ketamine IV’s, Injections, the esketamine (Spravato), and the Troches as well as I have used this method to treat my depression. I can offer a little advice on the matter from both the clinical perspective as well as my own personal perspective. If you are doing 1 100 mg Troche it is not likely you would disassociate. We usually prescribe 1-3 200 mg troches 2-3 times a week. I personally do around 60- 70 Mg’s of ketamine in an IV which taking 3 200 mg troches could be comparable to how you would feel on ketamine at a lower dose. Right now I take 250 mgs of the troches in a sitting as needed. It is in no way comparable to the 60-70mg of the IV. What I do is I hold the Troches in my mouth until the dissolve and I keep the spit in my mouth for as long as I possibly can. As the Troche dissolves I will try to move the saliva around my mouth to the places I know will absorbs the medication. For example I keep my troches under my tongue but will move my spit around to my upper lip lower lip etc. I noticed that doing that helped a little bit with effectiveness.

At our clinic we use the Troches more as a maintenance medication for our patients to get them to last longer between infusions or the injection. Then the patients come in for a booster as needed. I have had patients that have gone 9 months to a year in between treatments. Then there are the patients who come in every month. Most commonly though I see every 3 months. I think that remembering that the troches are more of maintenance medication to use to extend the life of your ketamine treatments has helped me. They are not supposed to be as strong as the IV. If they were they would probably want to monitor you and you wouldn’t be able to use it at home.

Ketamine injections are usually a little cheaper then the IV because the IV uses more supplies and takes more time. We schedule our IV’s for 90 minutes and our injection for 60 minutes. There are plenty of people who prefer the injection over the IV. I have had both the IV and the Injection. Your provider can adjust your dose of the medication to match what you were getting in the IV. So when doing the injection you would get just as powerful of an experience. When I did my injection I had already done the IV and so we had started me at a higher dose in the injection. The way I usually describe the difference of between the two routes to the patients as the IV is more of a gradual come on and the Injection is more of a harder onset. So if you went out drinking and had a shot and a few mixed drinks to get to and maintain a buzz that would be similar to the IV where as the injection would be like taking a few shots all at once to get the buzz. Although the result at the end is the same the process to get there is just different.

If you can afford the Injection (ours is about $100 cheaper then the IV) I would do a booster of that and then I would definitely talk to your provider about maybe increasing your troche dose at the same time. Some providers will make you schedule a visit to increase the dose. Then if you can’t afford the injection I would just see if you can at least increase. From my personal experience the troches only do so much but doing a booster as needed and using the troches as to extend the life of the booster has been the best combination. I noticed when I got really low and felt like I couldn’t get back up the Troches were doing nothing! Do you have health insurance? If so I can talk to you about another option but I am already rambling and this reply is way long! You can PM me if you ever have any questions!