Authors: Jason Chang, DNP, ARNP-C
Affiliations: AVYIA
Corresponding Author/Contact: jason.chang@avyia.com
Abstract
RK, a 51-year-old male with a background of anxiety, depression, and ADHD, transitioned from a macro-dosing regimen of sublingual ketamine to a structured microdosing protocol following increased anxiety during significant stressors triggered by recent divorce and custody battles. His treatment led to profound mood improvements, with him describing his progress as being “1,000 percent better…I don’t know how else to describe it.” This case details his initial presentation, treatment transition, and sustained improvements.
Keywords
Anxiety, depression, ADHD, ketamine microdosing, dose transition, patient-reported improvement
Introduction
Patients with chronic mood disorders may benefit from dosing and schedule adjustments in their therapeutic ketamine regimen. This case report describes RK’s transition from a high-dose, macro-dosing ketamine regimen, which induced dissociative effects, to a more sustainable microdosing approach that maintained therapeutic benefits with fewer side effects.
Case Presentation
Patient Information:
- Demographics: 51-year-old male (RK)
- History: Chronic anxiety and depression, with past treatment using venlafaxine and Wellbutrin; additional stress from divorce and custody battles.
Clinical Findings:
- Symptoms: RK experienced mild anxiety (GAD-7 score of 7) and intermittent mood disturbances.
- Previous Treatment: Prior use of sublingual ketamine (750–1,000 mg twice weekly) produced dissociative side effects but managed his anxiety moderately.
- Patient Feedback: Although effective to a degree, RK sought a treatment with fewer adverse effects.
Diagnostic Assessment
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- Evaluation: A thorough psychiatric and medical evaluation reviewed his past medications and current symptom severity.
- Assessment Tools: Utilized anxiety scales and ongoing monitoring to tailor his treatment.
Therapeutic Intervention
RK was initiated on a moderate titration schedule for microdosing ketamine.
- Transition Process: Dosage calculations based off his previous treatments led to a personalized ketamine microdosing regime at AVYIA. The dose was titrated until a significant mood improvement was reported, and he began to wean off other medications such as Effexor and Wellbutrin.
- Adjunctive Measures: Continued regular therapy sessions supplemented his medication changes.
Follow-up and Outcomes
Benefits were reported shortly after the transition to microdosing ketamine, but after approximately eight months on the microdosing regimen, RK reported dramatic improvements. He stated he was “1,000 percent better…I don’t know how else to describe it,” reflecting significant mood stabilization and overall enhanced quality of life.
- Medication Adjustment: His improvement allowed for the discontinuation of other psychiatric medications while keeping anxiety well-controlled.
Discussion
RK’s transition from a high-dose macro-dosing regimen to microdosing ketamine highlights the potential benefits of tailored dosing strategies. The marked improvement in his mood and quality of life—clearly captured by his own words—supports further exploration into personalized ketamine dosing protocols for complex psychiatric presentations.
Conclusion
RK’s case demonstrates that transitioning to a microdosing ketamine regimen can lead to substantial and sustained improvements in mood and anxiety management. His personal account reinforces the treatment’s efficacy and underscores the importance of individualized treatment plans.
Patient Consent and Ethical Considerations
Informed consent was obtained from RK for the publication of this case study, and all patient details have been anonymized.
References
References available upon request.
