Most people who experience relief from ketamine infusions want to know how to hold onto it — and that question has a clinical answer. Research on repeated and maintenance ketamine dosing shows that continued treatment can extend the duration of benefit significantly beyond what a single infusion course produces (American Journal of Psychiatry). At Nova Health Recovery, at-home ketamine therapy is how we support that continuation for patients who have completed in-clinic treatment and are stable enough to manage a lower-dose protocol outside a medical setting.
The Role of In-Clinic Treatment First
At-home ketamine is a continuation option, not a starting point. Before any patient is considered for at-home therapy, we complete an in-clinic evaluation and, for most patients, an initial series of IV ketamine infusions. This sequence matters for two reasons.
First, IV ketamine infusions allow us to observe how a patient responds to the medication under direct medical supervision. We monitor for side effects, assess the dose and rate that works best, and evaluate the psychiatric and clinical picture across multiple sessions. A standard loading series involves four to six infusions administered twice a week over two to three weeks, with each clinic visit running approximately 90 to 120 minutes and the active infusion portion lasting around 40 minutes. Because ketamine produces dissociative effects during infusion, patients are required to have a driver for every in-clinic visit.
Second, this supervised period establishes the clinical baseline we need to determine whether at-home therapy is appropriate and what form it should take. Not every patient is a candidate. The in-clinic evaluation also gives us the opportunity to address any questions or concerns before moving to an unsupervised setting. To learn more about what to anticipate before your first session, our guide on preparing for ketamine treatments is a helpful starting point.
What At-Home Ketamine Looks Like
We currently offer two forms of at-home ketamine therapy: oral troches and a compounded nasal spray. These are not the same as SPRAVATO® (esketamine), the FDA-approved intranasal formula available only through certified healthcare settings. The formulations we prescribe are compounded racemic ketamine — the same compound used in our IV infusions — prepared in a form that can be used at home.
Oral troches are tablets held under the tongue and absorbed sublingually (through the mucous membranes of the mouth, bypassing digestion). Research supports sublingual ketamine as a practical maintenance option following in-clinic infusion treatment (National Institutes of Health). The dose is individualized based on weight and condition. Some patients follow a standard dosing schedule; others use a microdosing protocol, which involves smaller amounts taken more frequently. The right approach depends on the clinical picture and is determined by Dr. Sendi in consultation with each patient.
The compounded nasal spray is administered several days per week and offers an alternative delivery route for patients who prefer it or who respond better to intranasal absorption.
Both formats are designed to extend and maintain the improvement achieved during the initial infusion series — not to replicate the intensity of an IV session. The experiences are meaningfully different. IV infusions produce more pronounced dissociative effects and require medical monitoring. At-home formats are lower in dose, more gradual, and intended for a patient who is already stable and familiar with how ketamine affects them. Patients who are curious about the broader landscape of safe ketamine therapy options in Virginia will find additional context on what clinical oversight looks like across different delivery formats.
Ketamine-Assisted Psychotherapy as Part of the Process
For some patients, at-home ketamine therapy is most effective when combined with psychotherapy — a practice called ketamine-assisted psychotherapy, or KAP. Research supports the combination of ketamine with therapeutic work, suggesting that the neuroplastic window that ketamine opens — the period of heightened neural flexibility following a dose — may make psychotherapy more productive during that time (National Institutes of Health).
KAP at Nova Health Recovery begins with an initial consultation and assessment, followed by a series of sessions that pair a low dose of ketamine with structured psychotherapy work. The specifics of the protocol are tailored to the individual patient. We discuss whether KAP is a good fit during the evaluation process and do not recommend it for everyone.
Scheduling and Practical Considerations
One of the reasons patients ask about at-home ketamine therapy is scheduling. The in-clinic loading series — two sessions per week for several weeks — is demanding, and not everyone can sustain that schedule indefinitely. At-home therapy removes the transportation requirement and allows patients to dose on a schedule that fits their routine, while still maintaining the clinical structure needed for safe use.
Follow-up monitoring continues even after a patient transitions to at-home therapy. Telemedicine appointments allow us to check in on response, adjust dosing if needed, and address any concerns without requiring a clinic visit for every interaction. We also offer periodic in-clinic maintenance infusions — approximately once every four weeks for the first year — for patients who benefit from the higher bioavailability that IV administration provides alongside an at-home protocol. Research into how ketamine’s effects persist over time is an evolving area; our page on the connection between sleep and ketamine treatments explores one dimension of how ongoing dosing supports overall well-being.
Insurance and Cost
Nova Health Recovery does not accept insurance directly. We can provide a SuperBill — an itemized statement of services — that you can submit to your insurance provider for potential reimbursement under out-of-network benefits. Whether reimbursement is available depends on your specific plan, and we encourage you to check with your insurer in advance. Our team is available at 703-952-1876, 24 hours a day, to walk through what this process looks like and what to expect. Results vary by individual, and the path from in-clinic treatment to at-home maintenance looks different for every patient.
Frequently Asked Questions
Can I start at-home ketamine without doing in-clinic infusions first? At Nova Health Recovery, at-home ketamine is offered as a continuation of in-clinic treatment, not as a first step. The initial in-clinic evaluation and infusion series give us the clinical information we need to prescribe at-home therapy safely and appropriately. Discuss your specific situation with Dr. Sendi during a consultation.
Is at-home ketamine the same as SPRAVATO®? No. SPRAVATO® (esketamine) is an FDA-approved nasal spray that is only available through certified healthcare providers in a clinical setting. The at-home ketamine we prescribe is compounded racemic ketamine — the same compound used in IV infusions — formulated as oral troches or a nasal spray. These are different products with different regulatory designations.
How do I know if at-home ketamine is working? Most patients have a sense of whether their mood, sleep, and cognitive function are holding steady or shifting. We also conduct regular follow-up appointments — by telemedicine or in clinic — to assess response and adjust the protocol as needed. If you notice changes in how you are feeling, that is something to bring to your provider promptly rather than waiting for a scheduled check-in.
What if I feel anxious about using ketamine at home without supervision? That is a common concern and a reasonable one. At-home ketamine is not appropriate for every patient, which is part of why the in-clinic phase comes first — it lets us assess how you respond to the medication before recommending an unsupervised format. Patients who do transition to at-home therapy typically have a clear dosing protocol, direct access to our team, and an established clinical relationship with Dr. Sendi. We do not hand off a prescription and disappear.
Can at-home ketamine be combined with my current antidepressant? In many cases, yes — but this depends on your specific medications, medical history, and how you have responded to treatment so far. Some patients continue existing antidepressants alongside ketamine therapy; others taper under medical supervision. This is a decision made individually, not a blanket policy, and should be discussed thoroughly with your provider before making any changes.
Key Takeaways
- At-home ketamine therapy is a continuation of in-clinic treatment, not a standalone starting point — an initial in-clinic infusion series comes first.
- Nova Health Recovery offers compounded racemic ketamine in two at-home formats: oral troches and a nasal spray. These are distinct from SPRAVATO® (esketamine).
- Dosing protocols — including standard dosing and microdosing — are individualized based on each patient’s weight, condition, and clinical response.
- Ketamine-assisted psychotherapy (KAP) can be combined with at-home ketamine for patients who may benefit from structured therapeutic work during the neuroplastic window ketamine creates.
- Telemedicine follow-up and periodic in-clinic maintenance infusions allow us to continue monitoring and adjusting the protocol after a patient transitions to at-home therapy. Results vary by individual.
For patients who have completed an in-clinic ketamine series and want to understand what comes next, at-home therapy is worth a direct conversation — not a general search. Every patient’s maintenance needs are different, and the right protocol depends on how you have responded to treatment so far. Call 703-952-1876 at any time or schedule a consultation through our website to speak with us about your options.
References
National Institutes of Health — Sublingual Ketamine: https://pmc.ncbi.nlm.nih.gov/articles/PMC9554222/
American Journal of Psychiatry — Single, Repeated, and Maintenance Ketamine Infusions: https://psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070834
National Institutes of Health — Ketamine-Assisted Psychotherapy: https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
Medical Disclaimer
The information in this blog is provided for educational purposes only and does not constitute medical advice. At-home ketamine therapy and related treatments vary in appropriateness by individual, and nothing in this content should be interpreted as a recommendation to pursue any specific treatment without the guidance of a qualified medical provider. Individual results vary. Please consult a licensed provider familiar with your full medical and psychiatric history before making any treatment decisions. If you are experiencing a mental health crisis or thoughts of self-harm, call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.