Why One Size Doesn’t Fit All: Customized Ketamine Therapy in RALEIGH, DURHAM, and CHAPEL HILL, NC
If you’re exploring ketamine therapy for treatment-resistant depression, anxiety, PTSD, or other mental health conditions in the Triangle area, you’ve likely noticed that most ketamine clinics offer a standard approach: intravenous (IV) infusions administered in fixed-length appointments, often running 1-2 hours or more regardless of how long you actually need to be there. Maybe you’ve encountered Spravato clinics, which offer intranasal ketamine but provide very little therapeutic support. Or maybe you’ve found private practices that administer intranasal or oral ketamine but charge exorbitant rates by clinicians who aren’t even certified or trained in ketamine or psychedelic assisted psychotherapy.
At Canto Integrative Psychiatry, we do things differently. We believe that effective ketamine treatment should be as individualized as you are—not just in the therapeutic approach, but in how the medicine is delivered and how your time is structured. Every clinician in our practice has received extensive ketamine assisted and psychedelic assisted psychotherapy training - including MAPS certification - and every clinician demonstrates an ongoing commitment to education and training in ketamine assisted psychotherapy.
Most ketamine providers in Chapel Hill, Durham, and the greater Triangle area offer only one or two routes of administration, typically IV infusions or nasal spray. While these methods work well for many patients, they’re not the right fit for everyone.
At Canto, we offer four different routes of ketamine administration:
- Oral ketamine (lozenges or troches)
- Intranasal ketamine
- Subcutaneous injection
- Intramuscular injection
Each route has distinct characteristics in terms of onset time, duration of effects, intensity of experience, and practical considerations. Rather than forcing you into a one-size-fits-all protocol, we work together to choose the route that best aligns with your therapeutic objectives, medical history, lifestyle, and personal preferences.
Understanding Your Options: A Route-by-Route Comparison
Oral Ketamine (Lozenges/Troches)
How it works: Dissolves slowly in your mouth, absorbed through the oral mucosa and digestive system.
Onset: 15-30 minutes
Duration: 45-90 minutes
Experience Intensity: Mild to moderate; generally the gentlest option
Best for:
- Patients new to ketamine therapy who want to start gently
- Those with needle aversion or difficulty with IV access
- At-home maintenance therapy (after initial in-office sessions)
- Patients who prefer a more gradual, controlled experience
- Flexible dosing that can be adjusted easily
Considerations: Slower onset means longer total appointment time; some patients find the taste unpleasant; requires you to avoid swallowing for optimal absorption.
Intranasal Ketamine (Including Spravato)
How it works: Administered as a nasal spray; absorbed through nasal membranes.
Onset: 5-15 minutes
Duration: 45-75 minutes
Experience Intensity: Moderate
Best for:
- Patients who want FDA-approved esketamine (Spravato) that may be covered by insurance
- Those who prefer non-invasive administration
- Quick onset without needles
Considerations: Can cause nasal irritation; some patients find it less comfortable than other routes; insurance coverage varies, dosing/administration (especially with compounded intranasal ketamine) is imprecise
Subcutaneous Injection
How it works: Small injection just under the skin (similar to insulin injections).
Onset: 5-10 minutes
Duration: 45-75 minutes
Experience Intensity: Moderate to strong
Best for:
- Patients who want faster onset than oral but prefer smaller needles than IM
- Those who have tried oral and want more intensity
- Patients seeking a middle ground between oral and intramuscular
- Easy to self-administer for potential at-home therapy after initial sessions
Considerations: Requires injection (though with a very small needle); slightly longer onset than IM; may cause minor discomfort at injection site, somewhat unpredictable duration.
Intramuscular (IM) Injection
How it works: Injection into muscle tissue (typically shoulder or thigh).
Onset: 3-10 minutes
Duration: 45-90 minutes
Experience intensity: Moderate to strong; most reliable and predictable
Best for:
- Patients seeking consistent, reliable effects
- Those who have tried other routes without adequate response
- Faster onset for deeper therapeutic work
- Patients comfortable with injections
- More profound dissociative experiences when therapeutically indicated
Considerations: Requires injection; fastest onset means less time to settle in; may cause temporary soreness at injection site; generally produces more intense experiences than oral or nasal routes.
Why Not IV Ketamine?
You may notice that while many ketamine clinics focus primarily on intravenous (IV) infusions, we don’t offer this route at Canto. This is an intentional choice based on our values and treatment philosophy.
IV ketamine requires significant infrastructure: IV poles, infusion pumps, specialized nursing staff for IV insertion and monitoring, emergency equipment, and a clinical setup that (appropriately!) looks and feels like a medical facility. These requirements dramatically increase overhead costs, which inevitably get passed on to patients—often making IV ketamine therapy prohibitively expensive for many people who could benefit from treatment.
More importantly, the clinical environment required for IV administration runs counter to the therapeutic model we’ve carefully created at Canto. We’ve designed our space to feel warm, comfortable, and home-like—a place where you can relax, feel safe, and do deep emotional work. The medical equipment, clinical protocols, and hospital-like atmosphere necessary for IV infusions would fundamentally change the nature of the healing environment we’ve built.
The reality is that for most patients, the other routes of administration we offer—particularly intramuscular and subcutaneous injections—provide effects that are clinically comparable to IV ketamine, with faster administration, greater flexibility, at a lower price point, and in a setting that actually supports the therapeutic process rather than undermining it.
Our approach keeps ketamine therapy accessible, affordable, and aligned with our belief that healing happens best in spaces that feel safe and human, not clinical and institutional.
How We Decide Together
Choosing your route of administration isn’t something we decide for you—it’s a collaborative conversation based on several factors:
1. Your Therapeutic Goals: Are you looking for gentle symptom relief or deeper psychological exploration? Do you want to work through trauma or manage daily anxiety?
2. Your Medical History: Do you have cardiovascular considerations? Nasal issues? Previous experiences with medications? Your physical health plays a role in what’s safest and most effective.
3. Your Comfort Level: Are you comfortable with needles? Do you prefer a gradual experience or faster onset? Have you used ketamine before, or is this your first time?
4. Your Lifestyle: Do you want the option of at-home maintenance therapy eventually? Do you need shorter appointment times due to work or family commitments?
5. Your Response: Sometimes we start with one route and adjust based on how you respond. Your experience informs our next steps.
This collaborative approach ensures that your ketamine therapy is truly personalized—not just following a protocol, but responding to you as an individual.
Flexible Scheduling That Respects Your Time
Here’s another way Canto differs from other ketamine clinics in Chapel Hill and Durham: we bill by the 15-minute increment based on the actual time you need, rather than charging for lengthy appointments that include time you’re simply sitting around.
What this means for you:
Different routes require different amounts of time in the office. Intramuscular ketamine, with its rapid onset, typically requires a shorter appointment than oral ketamine with its gradual absorption. Why should you pay for—or block out—two hours when you only need 90 minutes?
Our flexible scheduling approach means:
- You pay for the time you actually need, not arbitrary appointment blocks
- Appointments are tailored to your chosen route of administration
- Billing is transparent and based on 15-minute increments
- Your schedule matters—we work with your life, not against it
For busy professionals, parents, students, or anyone who values their time, this approach makes ketamine therapy more accessible and sustainable. You’re not sacrificing half your day for an appointment that could be accomplished more efficiently.
The Triangle’s Most Comprehensive Ketamine Therapy Clinic
When you search for ketamine therapy in Chapel Hill, Durham, or Raleigh, you’ll find several options. But you won’t find another clinic in the Triangle offering the combination of:
✓ Four different routes of administration (oral, intranasal, subcutaneous, and intramuscular)
✓ Truly individualized treatment planning based on your unique needs
✓ Flexible Appointment Scheduling tailored to your route and your life
✓ Fair, transparent billing by the 15-minute increment
✓ Comprehensive preparation and integration support (therapy is included - not just the ketamine)
✓ A provider with emergency medicine and oncology experience who understands both safety protocols and compassionate care
Most ketamine clinics in the area offer a standard protocol: show up, get your ketamine, sit, go home. That approach works for some people. But if it hasn’t worked for you—or if you’re looking for something more personalized, more flexible, and more attuned to your individual needs—Canto offers something different.
Beyond the Medicine: The Canto Difference
At Canto Integrative Psychiatry, we believe that ketamine therapy is much more than the route of administration or the length of your appointment. It’s about creating the conditions for genuine healing and lasting transformation.
That’s why every patient receives:
1. Thorough medical clearance to ensure safety based on your health history
2. Collaborative treatment planning where your voice matters in every decision
3. Careful preparation to set intentions and create emotional readiness
4. Supported ketamine experiences with a trained, licensed provider who remains present throughout
5. Meaningful integration work to translate insights into lasting change
6. Ongoing adjustment as we learn what works best for you
This is therapy, not just a transaction. And that means treating you as a whole person with unique needs, preferences, and goals—not as a diagnosis to be managed with a standard protocol.
Which Route Is Right for You?
The honest answer? I don’t know yet. Ask our competitors? They’ll tell you ahead of time - because they only offer one or two forms of ketamine treatment options. :(
That’s why the first step is always a conversation. With us, we’ll discuss your history, your goals, your concerns, and your preferences. We’ll talk through the options and what might make sense as a starting place. And we’ll adjust as we go, because what works best often reveals itself through experience.
If you’ve been frustrated or unimpressed by the limited options at other ketamine clinics in Chapel Hill or Durham, or if you’re just beginning to explore ketamine therapy and want a provider who will truly customize treatment to your needs, I’d be honored to talk with you.
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Ready to explore personalized ketamine therapy in the Triangle area? Contact us to schedule a consultation. We serve patients throughout Chapel Hill, Durham, and the greater Raleigh area, and we’re here to answer your questions about which route of administration might be right for you.
