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What are the different types of ketamine therapy?

Medically reviewed by: Dr. Peck
Reading Time: 4 minutes
What are the different types of ketamine therapy?

Whenever you hear people talk about ketamine, they are just talking about it generally, but in reality, it is available in three different forms for various purposes. The factors that differentiate them and their purpose will help you decide which is the best fit for you.

These three ketamine therapy types are:

  •          R-ketamine
  •     S-ketamine
  •         R-S ketamine

Then comes the following line of questions: How are they different from each other? What is their purpose of using? How to find out which one will work for you?

You need to understand these three types of ketamine before knowing about their function and everything.

How are these different?

Ketamine is available in different isomeric forms, like many other drugs. Despite the same bond arrangements of the molecule, there is a difference in their three-dimensional structures. You can call these R (+) and S (-) ketamine due to their different spatial arrangements, which are right-hand and left-hand mirror images of each other.

With this difference in their molecular structure, their pharmacological properties, metabolism, and how they bind in your brain change.

Both isomers of ketamine have their individual properties respectively; keeping those differences in mind, pharma companies have used these drugs for different purposes.

Who is a good candidate for ketamine therapy?

One of every three anxiety or depression patients, you are also treatment-resistant to other standard methods of treating mental conditions. You are struggling to know if ketamine therapy could help you. Still, before going for it, you must go through a complete consultation and clinical diagnosis for anxiety/depression/chronic pain before getting a prescription for ketamine therapy.

You could be a possible candidate for ketamine treatment if:

You may have tried numerous anti-psychotic medicine combinations of high potency to treat your symptoms of depression or anxiety (but did not get better).

Alternative ways of ketamine administration, such as therapy and exercise, do not work for you.

You are a chronic depression or anxiety patient and often feel that you are on the verge of giving up everything and constantly struggle to fight these negative emotions. These symptoms rob you of your energy and time.

Who should avoid ketamine therapy?

Ketamine has no side effects when used in minor doses, but there are always some rare cases. If not very common, everything must be made very clear to the patient before suggesting this treatment method.

It is an anesthetic drug and also possesses some addictive properties. So, the consultant must know his patient well enough if he has been a history victim of drug abuse.

Ketamine works for depression by increasing dopamine levels in our brains. It is a chemical that triggers motivation. When the patient gets it once and feels good, he will go for it again and again. This is where the crucial part lies. A patient could go for repeated infusions multiple times and get severely dependent on this drug to even function.

If the patient has been involved in substance abuse, the consultant must consider the risk before prescribing ketamine treatment.

Suppose a person has tried ketamine therapy some time ago but has some adverse reaction (which is very rare). Then that person should also avoid retaking ketamine treatment.

Pregnant women should also opt for alternative options such as yoga, exercise, and CBT instead of ketamine to avoid dependency.

Lastly, if the patient is suffering from some chronic or terminal illness, such as:

  •          Cardiac disease
  •          Uncontrolled hypertension
  • Increased intracranial pressure

    Already on medication, so there is a chance of drug-drug interaction if you start giving him ketamine along with previous medication.

It would be best to talk to an experienced clinical pharmacist to avoid emergency conditions during the procedure.

What are the types of ketamine?

R-S ketamine

This type of ketamine is formulated in the labs as a mixture of dextrorotatory and levorotatory ketamine in equal proportions. We can also call it a racemic mixture of both isomers.

It is available under the brand name Ketalar and has been used as a potent anesthetic and analgesic since the 1960s. It is used for medical purposes and is available as oral, rectal, and sublingual tablets, nasal sprays, and muscular and subcutaneous injections.

S- ketamine

It is the levorotatory isomer of ketamine and is an FDA-approved drug for treating some mental health issues, such as treatment-resistant anxiety. It was approved in 2019 by FDA.

This drug gives rapid relief to the recipients from depression and suicidal thoughts. It was suggested to be approved after a thorough analysis of five phase III trials. Two of them exhibited positive results with considerable efficacy. The improvement in symptoms becomes evident after 72 hours and stays for many weeks.

It is sold as a prescription medicine under the brand name Spravato. Since it is a controlled substance, it is provided to the patient in the presence of a medical health care provider in a proper medical setup.

S-ketamine is more potent and has more psychedelic effects than its other isomer. Its potency is four times more than R-ketamine. Also, the dopaminergic and NMDA receptor affinity is more significant than its R-enantiomer.

Studies show that it stays less time in your body than R-ketamine and gets cleared from your system.


This isomer of ketamine is not approved by FDA yet as an anti-depressant.

But still, clinical trials and researches are in progress to prove it a valuable drug to treat severe mental problems.

Its activity is weaker in the brain as compared to S-ketamine. Therefore, it shows fewer dissociative effects than ketamine.

But the good thing about this is that there will be less chance of drug abuse because it produces fewer hallucinogenic effects on the brain.

It could be a more potent anti-depressant medicine than its mirror image molecule because it stays longer in your system and can re-form the damaged neural connections (synaptogenesis).

Which Ketamine type is right for you?

Ketamine works differently and faster than other anti-depressant treatments. Still, there are always concerns shown by new users before getting this treatment, and it is only fair because every person has different needs. Everybody also responds differently to this treatment.

Mostly sub-anesthetic doses of racemic ketamine are used to treat the depression symptoms of patients when the other standard treatment methods fail.

Currently, the government has approved only esketamine to treat the symptoms of significant mental health disorders.