Case Study: Benefits of Low-Dose Sublingual Ketamine

Low-cost, safety, and dramatic improvement in four weeks

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Introduction

Ketamine, a dissociative anesthetic, has gained attention for its off-label use in treating mental health conditions such as depression and anxiety. Sublingual administration, in particular, offers a convenient and effective delivery method. This case study highlights the benefits of low-dose sublingual ketamine based on clinical research and patient outcomes.

Patient Background

A 47-year-old male at the Leading Edge Clinic with a history of chronic fatigue, brain fog, and treatment-resistant depression sought alternative therapies after limited success with conventional treatments. His symptoms were exacerbated by post-vaccination complications, including severe fatigue, irritability, and cognitive difficulties. Previous interventions included dietary adjustments (carnivore diet), supplements (NAC, LDN), and hyperbaric oxygen therapy (HBOT), which provided partial relief but failed to restore full functionality.

Treatment Plan

The patient was introduced to a regimen of low-dose sublingual ketamine under medical supervision. The protocol included:

- Dosage: 0.35 mg/kg of ketamine dissolved sublingually. This dose was 25mg, delivered via a compounded 50mg/ml solution, which equals 10 drops, held under the tongue for five minutes.

- Frequency: 25mg every 3rd night for four doses, then every 2nd night for four doses, then nightly.

- Monitoring: Regular assessments of mood, energy levels, and cognitive function.

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Benefits Observed

1. Rapid Symptom Relief

- Within hours of the first dose, the patient reported significant alleviation of depressive symptoms and improved energy levels. This aligns with existing studies demonstrating ketamine's ability to act on NMDA receptors and boost glutamate activity, leading to rapid neural plasticity[2][3].

2. Improved Cognitive Function

- Over the course of the first four weeks of treatment, the patient experienced enhanced focus and clarity, enabling him to return to work-related problem-solving tasks. This improvement is attributed to ketamine's modulation of brain-derived neurotrophic factor (BDNF), which supports neurogenesis[3].

3. Reduction in Anxiety Levels

- The patient reported a marked decrease in anxiety episodes, improving his overall quality of life. Sublingual administration allowed for steady absorption and minimized side effects often associated with intravenous delivery.

4. Convenience and Safety

- Sublingual ketamine was well-tolerated with minimal adverse effects such as mild dizziness during initial doses. Its non-invasive nature made it a preferred option compared to intravenous or intramuscular routes[2]

5. Quotable Quotes

“It just gets better every day.” “One of my favorite things to do is to construct spreadsheets which handle different scenarios, and I haven’t done that in twelve months. I started to do that again this week.” “I feel like these past weeks, I have had one or two days that were off, but most days, I can dig in, work, read, and have that mental energy again.” “I have been there eight to ten times over the last four years where my energy gets up and then I get knocked back down again, and this is the longest good stretch I have had in two years.”

Discussion

The patient's response underscores the efficacy of low-dose sublingual ketamine for treatment-resistant depression and associated symptoms like brain fog and fatigue. By bypassing first-pass metabolism, sublingual administration ensures rapid onset while maintaining a favorable safety profile.

Ketamine's unique mechanism—blocking NMDA receptors and enhancing AMPA receptor activity—distinguishes it from traditional antidepressants that take weeks to show effects. Additionally, its role in reducing neurological inflammation may have contributed to the patient's recovery from post-vaccine complications.

Conclusion

Low-dose sublingual ketamine provides a promising alternative for individuals with treatment-resistant depression or complex chronic conditions. Its low cost makes it more accessible to a wider range of patients, including those on fixed incomes or Medicaid. The compounded version used for this patient cost $45 for a one month supply. Its rapid action, convenience, and safety make it an invaluable tool in personalized medicine. Further research is warranted to optimize dosing protocols and explore its long-term benefits.

Citations:

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC11070208/

[2] https://www.cureus.com/articles/333120-low-dose-sublingual-ketamine-for-the-treatment-of-raynauds-phenomenon.pdf

[3] https://www.buffalo.edu/news/releases/2024/11/How-ketamine-lifts-depression-so-quickly.html

[4] https://www.medrxiv.org/content/10.1101/2024.01.30.24301798v1

[5] https://www.pharmacytimes.com/view/sublingual-ketamine-demonstrated-to-be-safe-effective-for-patients-with-treatment-resistant-depression

[6] https://www.medrxiv.org/content/10.1101/2024.01.30.24301798v1.full-text

[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC9554222/

[8] https://www.healthline.com/health/anxiety/ketamine-for-anxiety

[9] https://publichealth.jhu.edu/2024/what-to-know-about-ketamine

[10] https://behavioralhealthnews.org/ketamine-for-mental-health-treatment-how-promising-is-it/

[11] https://www.sciencedirect.com/science/article/pii/S0165032722007625

[12] https://mind.clinic/benefits-sublingual-ketamine/

[13] https://academic.oup.com/ijnp/article/16/9/2111/797673

[14] https://www.osmind.org/blog/sublingual-ketamine-troches-for-home-use-an-evidence-based-introduction-part-1

[15] https://www.psychologytoday.com/us/blog/the-leading-edge/202409/low-dose-ketamine-for-depression

[16] https://www.sciencedirect.com/science/article/pii/S0165032724008759

[17] https://www.psychiatrist.com/jcp/ketamine-for-depression-dosing-administration-and-duration/

[18] https://academic.oup.com/painmedicine/article/13/9/1235/1865452

[19] https://www.joyous.team/blog/what-is-low-dose-ketamine-treatment

[20] https://www.psychiatrist.com/jcp/sublingual-ketamine-an-option-to-increase-accessibility/

[21] https://www.psychiatrist.com/jcp/oral-ketamine-for-depression-pharmacologic-considerations-and-clinical-evidence/

[22] https://www.clinicalpainadvisor.com/news/ketamine-lozenges-troches-safe-effective-chronic-noncancer-pain-reduced-opioid-use/