Ketamine has reshaped the conversation around treatment-resistant depression. What began as an anesthetic has become one of the fastest-acting antidepressant tools available today. For years, IV infusion dominated clinical practice—effective, yes, but also resource-heavy, time-consuming, and anxiety-provoking for many patients.

As interventional psychiatry evolves, clinicians are searching for delivery methods that are equally effective but simpler, smoother, and more patient-friendly. That’s where subcutaneous (SC) ketamine steps in—quietly becoming one of the most practical and scalable ways to deliver ketamine therapy in modern outpatient settings.

Subcutaneous administration isn’t experimental. It’s a well-established route in medicine, and when calibrated for psychiatric use, it offers a balance that patients and clinicians increasingly appreciate: predictability, tolerability, speed, and convenience.

Why We Needed an Alternative to IV, IM, and Nasal Ketamine

Every route of ketamine administration has strengths—and frustrations.

IV infusions are precise but require hospital-style infrastructure and long appointments.
IM injections work quickly but offer less control over intensity.
Intranasal esketamine promises accessibility but is expensive and often inconsistent.
Oral and sublingual routes are easy but have highly variable absorption.

Subcutaneous ketamine enters the picture as a route that is:

• easier than IV
• gentler than IM
• more predictable than oral
• far more affordable than nasal formulations

In short, SC ketamine preserves the efficacy of higher-bioavailability routes while removing much of the inconvenience.

How Subcutaneous Ketamine Works in the Body

The magic of SC ketamine lies in its pharmacokinetics.

When injected into the subcutaneous tissue:

• absorption is gradual and steady
• blood concentration rises smoothly
• peak effects are gentler and more controlled
• dissociation tends to be milder
• hemodynamic changes are more stable

Compared with IM, SC produces a softer landing and smoother experience, which many patients prefer—especially those who are anxious about intense dissociation.

Clinical Research: Matching IV Outcomes Without the Complexity

Growing evidence shows that subcutaneous ketamine:

• delivers antidepressant effects comparable to IV ketamine
• reduces dissociation intensity
• shows excellent tolerability
• fits well within maintenance and booster models
• improves scalability for clinics and accessibility for patients

For many people with treatment-resistant depression, consistency is the key—and SC ketamine provides that without the need for pumps, IV lines, or prolonged monitoring.

The Patient Experience: Calm, Predictable, Convenient

For patients, the route matters. Subcutaneous ketamine is often described as:

Less intimidating.
Less medicalised.
Less disruptive to the day.

A typical session can be completed in 60–90 minutes, compared with the half-day commitment sometimes required for IV infusions. For working professionals and caregivers, this difference alone can determine treatment adherence.

The gentle pharmacokinetic curve also means fewer sudden shifts in perception, reducing anxiety for first-time users.

A Scalable Option for Clinics—and the Future of Interventional Psychiatry

Subcutaneous ketamine allows interventional psychiatry practices to offer ketamine therapy with:

• minimal equipment
• high safety standards
• reproducible dosing
• shorter sessions
• better clinic workflow

As more centres adopt neuromodulation (rTMS, theta-burst), QEEG-guided interventions, and neurofeedback, SC ketamine blends naturally into multi-modal, time-limited treatment pathways focused on plasticity, recovery, and deprescribing.

It is not a replacement for other routes—but a smart, convenient evolution.

Final Thoughts

Subcutaneous ketamine is a reminder that innovation in psychiatry doesn’t always require complex machines or expensive formulations. Sometimes, the most powerful advances come from refining what already works—making it safer, smoother, and more accessible.

For patients, it means quicker relief with less disruption.
For clinicians, it means precision without complexity.
For the field, it represents the steady shift toward practical, neuroscience-led care.

About the Author

Dr. Srinivas Rajkumar T, MD (AIIMS), DNB, MBA (BITS Pilani)
Senior Consultant Interventional Neuropsychiatrist
Mind & Memory Clinic, Apollo Clinic Velachery (Opp. Phoenix Mall)
✉ srinivasaiims@gmail.com 📞 +91-8595155808