Authors: Jason Chang, DNP, ARNP-C
Affiliations: AVYIA
Corresponding Author/Contact: jason.chang@avyia.com
Abstract
M&M, a 49‑year‑old woman burdened by lifelong depression, anxiety, and persistent suicidal ideation since her teens, found transformative relief through a bespoke ketamine microdosing protocol. After cycling through multiple SSRIs, SNRIs, neuromodulators, and even psilocybin microdosing with minimal benefit, she began a carefully titrated ketamine regimen at AVYIA. Early dose adjustments to mitigate sedation, combined with the addition of a new SSRI and ongoing therapy, led within days to reduced suicidal thoughts, stabilized mood, and for the first time in years, moments of “true happiness,” as noted by both M&M and her husband.
Background
Chronic, treatment‑resistant depression and anxiety—even when managed with successive pharmacotherapies and psychotherapy—often leave patients in a state of persistent suffering and elevated suicide risk. Emerging evidence positions ketamine as a rapid‑acting alternative for those unresponsive to SSRIs or SNRIs, leveraging its unique NMDA‑antagonist and synaptogenic effects.
Introducing the Research
Authored by Jason Chang, DNP, ARNP‑C at AVYIA, this case study examines M&M’s journey from decades‑long therapeutic trials to a personalized ketamine microdosing strategy. It highlights the critical role of dose customization and adjunctive support in maximizing benefit.
What You’ll Learn
How individualized ketamine microdosing can swiftly reduce suicidal ideation in chronic depression.
The importance of fine‑tuning dosing to balance efficacy and tolerability.
Strategies for safely integrating ketamine with standard antidepressants and psychotherapy.
Breaking Down the Research Article
A. The Big Question
Can a customized ketamine microdosing protocol alleviate entrenched depression, anxiety, and suicidality in a patient refractory to multiple prior treatments?
B. How They Did It (Study Design & Methods – Simplified)
Patient Profile: 49‑year‑old woman with psychiatric symptoms since age 14, including chronic depression, generalized anxiety, a history of anorexia/bulimia (now in remission), and longstanding suicidal ideation.
Previous Treatments: Trials of Effexor (venlafaxine), Cymbalta (duloxetine), gabapentin, THC, and psilocybin microdosing—all yielding transient or inadequate responses.
Trigger for Change: Inspired by a friend’s success with ketamine; sought AVYIA consultation.
Protocol Details:
Personalized oral ketamine microdosing, initiated at a low dose and adjusted upward to mitigate early sedative side effects.
Adjunctive pharmacotherapy: Introduction of a new SSRI to support baseline mood.
Psychotherapy: Continued regular psychotherapy sessions for integration and skills building.
Monitoring: Weekly clinical check‑ins to optimize dose and track mood/suicidality scales.
C. Key Findings (The Takeaway)
Shortly after regimen adjustments, M&M demonstrated:
↓ Suicidal Ideation: Fewer, less intrusive self‑harm thoughts, with increased safety and hope.
↑ Mood Stability: More frequent positive emotions, less emotional dysregulation.
↑ Social Engagement: Husband observed genuine smiles and rare glimpses of “true happiness.”
“I can’t remember the last time I felt genuinely happy—my husband says he sees me again.”
D. What Does This Mean For You? (Implications & Significance)
For Patients: Personalized ketamine microdosing may succeed where multiple traditional antidepressants have failed.
For Providers: Fine‑tuning dose and timing is crucial to balance therapeutic gains with minimal side effects.
For Treatment Planning: Early consideration of ketamine after initial SSRI/SNRI failure could shorten suffering and reduce suicide risk.
Adjunctive Synergy: Ketamine can be safely combined with SSRIs and psychotherapy to enhance and sustain recovery.
E. Important Considerations & Limitations
Single‑Case Evidence: While compelling, broader studies are needed to generalize findings.
Personalization Required: Dosing and adjunct strategies must be tailored to each individual’s response and tolerance.
Medical Supervision Mandatory: Self‑administration without oversight is not advised due to risks of dissociation or hemodynamic changes.
Research Gaps: Further trials should elucidate optimal dose ranges, long‑term safety, and maintenance schedules.
Conclusion: Personalized Dosing Could Be a Key to Unlocking Recovery
Recap
M&M’s experience underscores how a customized ketamine microdosing protocol—integrated with standard antidepressants and psychotherapy—can rapidly reduce suicidal ideation and restore genuine well‑being in treatment‑resistant depression.
Future Directions
As more clinicians adopt personalized ketamine approaches, accumulating case data will refine best practices and establish standardized guidelines for dosing, integration, and maintenance.
Call to Action
If chronic depression, anxiety, or suicidal thoughts have persisted despite multiple therapies, consult a licensed ketamine provider to explore whether a personalized microdosing strategy could offer a new pathway to healing.
