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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 altogether different reasons. How they are different from each other and what their purpose is will help you to decide which one is suitable for your needs.

These three types are:

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

Then comes the next line of questions such as, 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. It means that despite the same bond arrangements of the molecule, there is 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 in mind those differences, the pharma companies have used these drugs for different purposes.

Who is a good candidate for ketamine therapy?

May be like one out of every three anxiety or depression patients, you are also treatment-resistant to other standard methods of treating mental conditions, and you are struggling to know if ketamine therapy could help you, but before going for it, you need to 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 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 at the verge of giving up everything and constantly struggle to fight these negative emotions and these symptoms robe you off of your energy and time.

Who should avoid ketamine therapy?

Ketamine does not have any side effects when it is used in very 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 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 definitely 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 in past, the consultant must consider the risk before prescribing ketamine treatment to him.
  • If a person has tried ketamine therapy already some time ago but has some sort of adverse reaction (which is very rare). Then that person should also avoid retaking ketamine treatment.
  • Pregnant women should also opt for some 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, there is a chance of drug-drug interaction if you start giving him ketamine along with previous medication.

You must talk to an experienced clinical pharmacist to avoid any emergency conditions during the procedure.

What are the types of ketamine?

R-S ketamine

This type of ketamine is formulated in the labs 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.

This racemic mixture of ketamine is also available for recreational purposes in fine powder or tablets, so people can inhale it or take it orally respectively.

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 phases III trials. Two of them exhibited positive results with considerable efficacy. The improvement in symptoms becomes evident after 72 hours, and it stays for many weeks.

It is sold in the market 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 a more potent drug 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 also greater than its R-enantiomer.

Studies show that it also 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 useful drug to treat severe mental problems.

Its activity is weaker in the brain as compared to the S-ketamine. Therefore, it shows less 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 has the ability to re-form the damaged neural connections (synaptogenesis).

Which Ketamine type is right for you?

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

For major mental health disorders, currently, only esketamine has been approved by the government to treat the symptoms.

Contact us:

At Nepenthe Wellness Center, we make sure to understand your individual needs and reach the root cause of your problem and solve it instead of just treating the symptoms.

With the help of our advanced healthcare facilities and accommodating healthcare professionals, we do our best to help you get back to life. We try our best to make your experience with us home-like and pleasant.

The facility of at home ketamine treatment is also available for our clients. It is definitely a worth trying option with 100 percent results, also Ketamine at-home is cost effective as compared to in-office therapy. If you want to book an appointment or want to learn more about it, you can contact us for a free consultation anytime.