How Is Ketamine Administered in Therapeutic Settings?

Medically reviewed by Dr. Aviva Wolf, Consultant Psychiatrist. This article is educational. Holina Rehab does not provide ketamine-assisted therapy; we treat ketamine misuse and addiction through medically supervised care.

How ketamine is given matters as much as why it is given. In legitimate medicine, the route of administration, the dose, and the monitoring around it are what separate a controlled clinical treatment from unsupervised, high-risk use. This article explains how ketamine and its derivative esketamine are administered in therapeutic settings, and where structured addiction care fits when supervised use crosses into ketamine misuse.

Routes of Administration

Ketamine can be delivered through several routes, each with distinct pharmacokinetics and clinical applications:

• Intravenous (IV) infusion. Ketamine is delivered directly into the bloodstream, giving a rapid onset. It is used in hospital settings for anaesthesia and, more recently, for treatment-resistant depression. A widely studied subanaesthetic protocol for depression is 0.5 mg/kg infused over roughly 40 minutes, with the dose and rate calculated from the patient’s weight, medical history, and condition.
• Intramuscular (IM) injection. Ketamine is injected into a muscle and absorbed into the bloodstream. This route is often used when IV access is difficult. Onset is slightly slower than IV but still relatively prompt.
• Intranasal esketamine (nasal spray). The FDA has approved esketamine (Spravato), a derivative of ketamine, as a nasal spray for treatment-resistant depression. It is administered only under medical supervision in a certified healthcare setting, and patients are monitored for at least two hours after each dose.
• Oral administration. Less common because of lower bioavailability, oral ketamine is used mainly in research settings. Its delayed onset and reduced potency make it non-standard for depression or pain management.

Clinical Considerations

The choice of route depends on several factors:

• Medical supervision. IV and IM administration are performed in controlled environments, such as hospitals or specialised clinics, so clinicians can respond to immediate adverse reactions.
• Patient history. Individuals with a history of substance misuse are monitored closely to reduce the risk of misuse.
• Treatment setting. Under the FDA’s Risk Evaluation and Mitigation Strategy (REMS), esketamine nasal spray is given only in certified medical settings and is never dispensed for home use, because of the required post-dose monitoring.

Safety and Monitoring

Whatever the route, safety is built on the same steps:

• Pre-treatment assessment. A thorough evaluation, including medical history, psychiatric assessment, and physical examination, determines whether ketamine therapy is appropriate.
• Active monitoring. During and after administration, patients are observed for adverse effects such as raised blood pressure, dissociation, sedation, and allergic reactions. Blood pressure is checked before and after each esketamine dose.
• Post-treatment care. Because of possible drowsiness or altered perception, patients are advised not to drive or operate machinery for a set period after treatment.

“Supervised ketamine treatment works because of the controls around it: a measured dose, a certified setting, and monitoring after every session. Take those safeguards away and you are looking at a very different, and much higher, risk profile.”

— Dr. Aviva Wolf, Consultant Psychiatrist (draft commentary, pending sign-off)

The Line Between Supervised Treatment and Misuse

Every legitimate use above shares three features: a precise, controlled dose; delivery by trained clinicians in a medical setting; and monitoring afterwards. Recreational and unsupervised use has none of these safeguards, and chronic use carries serious risks, including bladder and urinary-tract damage and genuine dependence. For a fuller look at the conditions ketamine is used to treat, see our companion article, What Are the Therapeutic Uses of Ketamine?

What Holina Treats

Holina Rehab does not offer ketamine-assisted therapy. What we do treat is ketamine addiction, which often begins where supervised use ends. Care starts with medically supervised ketamine detox in Thailand and moves into structured, longer-term recovery.

Because ketamine misuse frequently co-occurs with depression, trauma, or anxiety, our Dual Treatment programme addresses addiction and any underlying mental-health condition at the same time. Ketamine dependence is part of the wider picture of drug addiction we work with on Koh Phangan.

Our Approach to Recovery

Holina Rehab combines a 12-step framework with a range of therapeutic modalities:

• Psychotherapy and trauma resolution through individual and group sessions that address the psychological drivers of addiction.
• Body movement and breathwork to support physical wellbeing and emotional release.
• Somatic therapy to help clients reconnect with the body and process stored trauma.
• Art therapy as a non-verbal way to explore and express emotion.
• Meditation and mindfulness to support mental clarity and stability.

Recovery continues after residential treatment through sober-living programmes, support groups, and tailored aftercare plans built around each person’s ongoing needs.

“I arrived at Holina in January 2026 feeling like a lost soul, struggling with substance and alcohol addiction. At the time, I truly believed I had no hope of getting sober. A friend who had been there before recommended it, so I reached out, and from the very beginning, the process was smooth and reassuring.”

— Jack W., verified Google review, 24 Mar 2026

The Bottom Line

Ketamine’s therapeutic value depends entirely on how it is administered: controlled dosing, a qualified clinician, and monitoring. When use loses those safeguards and becomes dependence, structured treatment offers a way back. If ketamine use has become a problem for you or someone you care about, our team on Koh Phangan is here to help.