One of the biggest advantages of working with board-certified anesthesiologist Dr. David Mahjoubi is choice. Most telehealth programs prescribe a single formulation and hope it fits every patient. NutraBrain™ prescribes five distinct compounded ketamine formulations so your dose, onset, and experience can be matched to your goals — whether that is fast relief from a panic spike, a deep therapeutic session, or a steady microdose for mood maintenance. Below is a plain-English guide to each delivery method, how to use it, and when one may be a better fit than another.
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Ketamine Nasal Spray: Fast-Acting Relief for Anxiety and Depression
The compounded Ketamine Nasal Spray is the workhorse of the NutraBrain™ program. It is compounded at either 100 mg/mL or 150 mg/mL, which translates to roughly 10 mg per spray at the standard concentration and 15 mg per spray at the higher concentration. Dr. Mahjoubi selects the strength based on your tolerance, body weight, and condition.
How the Ketamine Nasal Spray actually works
A common misconception is that nasal spray ketamine is inhaled into the lungs. It is not. Ketamine Nasal Spray is absorbed directly through the nasal mucosa — the thin, blood-vessel-rich tissue lining the inside of your nose. From there, it enters the bloodstream and crosses into the brain within minutes. That is why onset is so fast compared to oral forms. You tilt your head slightly forward (not back — this minimizes the drip), gently insert the nozzle into one nostril, press the pump during a slow inhale through the nose, and alternate nostrils with each dose as prescribed.
Advantages of Ketamine Nasal Spray
- Rapid onset. Effects typically begin within 5–15 minutes — ideal for acute anxiety surges, low-mood days, or when you need quick relief.
- Fast-acting anxiety and depression relief. The nasal route is excellent for ketamine-assisted treatment of anxiety and ketamine therapy for depression, often cutting through a panic wave or depressive episode within the first session.
- Racemic ketamine — arguably better than Spravato. Our compounded nasal spray is the same racemic ketamine that has been used safely in operating rooms for over 60 years. It contains both mirror-image (enantiomer) molecules of ketamine, while Spravato contains only one mirror image (esketamine). In real-world practice, many clinicians — and patients who have tried both — find the racemic spray is at least as effective as Spravato, and often better, because you receive the full pharmacology of the molecule rather than half of it. You also avoid the in-clinic monitoring requirement Spravato mandates.
- Dose flexibility. Because each spray delivers a consistent 10 or 15 mg, Dr. Mahjoubi can titrate your protocol in small, predictable increments.
Disadvantages of Ketamine Nasal Spray
- Posterior nasal drip. A small amount of the solution can drip down the back of the throat. The taste is briefly bitter but harmless — drinking water afterward resolves it.
- Not ideal for “deep” therapeutic sessions. The fast onset and shorter duration make the nasal spray wonderful for symptom relief, but if you are working with a therapist on trauma, planning a long journaling session, or want a deeper, more introspective experience, the sublingual troche is usually the better choice.
Ketamine Troche: The Sublingual Tablet Built for Therapy Sessions
The Ketamine Troche is a sublingual lozenge compounded specifically to dissolve slowly under the tongue or between the cheek and gum. Because it releases its medication gradually, the therapeutic experience is longer and more immersive — typically about 25 minutes of active journey time, give or take about 5 minutes depending on dose, individual metabolism, and how long you hold the liquid sublingually. Dr. Mahjoubi can prescribe troches in doses up to 200 mg for patients who need a stronger session.
Why patients love the troche
- Deep, immersive sessions. The slower release produces a richer, more introspective experience — ideal for psychotherapy-adjacent work, integration therapy, and journaling.
- Microdosing flexibility. Because the troche is a solid, consistent tablet (not a liquid), you can bite off a half or a quarter to microdose on low-energy days without losing dosing accuracy. Most patients use a full troche once or twice per week for dedicated sessions and save smaller pieces for mood maintenance.
- Predictable experience. Patients who want to plan around the duration of effects — for example, setting aside a protected afternoon with a therapist or trusted sitter — appreciate the 25-minute experience window.
- Clean sublingual absorption. Medication is absorbed through the oral mucosa and enters the bloodstream directly, bypassing first-pass liver metabolism.
How to use it: Place the troche between your cheek and gum (or under the tongue), let it dissolve slowly over 10-15 minutes, swish the saliva around your mouth to maximize absorption, and then — depending on Dr. Mahjoubi’s instructions — either swallow or spit out any residue. Do not eat or drink for 15 minutes before or after.
Rapidly Dissolving Tablet (RDT): The Middle Ground
The rapidly dissolving ketamine tablet (RDT) is the troche’s faster cousin. As the name suggests, it is formulated to dissolve quickly under the tongue — typically within a few minutes — so it behaves more like the nasal spray in terms of onset, but without the nasal drip. The trade-off is that the experience also wears off faster than a troche; the window of active effects is shorter.
Who it’s best for: Patients who want oral administration (no nose spray) and prefer a quicker in-and-out session over a long, immersive journey. It is also a good option for patients who do not love the taste or texture of a slow-dissolving troche. Because the absorption is sublingual, avoid swallowing saliva for as long as possible while the tablet dissolves, and avoid food and drink for 15 minutes before and after.
Sublingual Ketamine Droplet (California Only)
The sublingual ketamine droplet is a liquid formulation delivered under the tongue with a dropper. It is another oral option in the NutraBrain™ toolkit, but in practice we have the least clinical experience with this form — both at our clinic and across the field generally — because many compounding pharmacies simply do not know how to prepare it consistently. For that reason, the sublingual droplet is currently limited to California residents, where we have identified pharmacies that reliably compound it. If you are outside California or want a formulation with a longer evidence base in our program, the ketamine nasal spray, troche, or rapidly dissolving tablet are generally the better starting point.
A NutraBrain™ Membership Perk: Direct Access to Dr. David Mahjoubi
Picking the right formulation, adjusting your dose, and troubleshooting a session is not a one-and-done decision — it evolves with you. That is why every NutraBrain™ member gets something no algorithm or app-based clinic can offer: once you are a member, you can always text or email Dr. David Mahjoubi directly for guidance. Whether you want to fine-tune your microdose, switch from the nasal spray to a troche for a deeper session, or simply ask a question before your next dose, he is there. He will never leave you. That kind of continuity of care — from a board-certified anesthesiologist and President of the American Board of Ketamine Physicians — is the backbone of the program.
At-Home Ketamine Delivery Methods: Frequently Asked Questions
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Our compounded Ketamine Nasal Spray is available at 100 mg/mL and 150 mg/mL. Each pump delivers approximately 0.1 mL, which works out to about 10 mg of ketamine per spray at 100 mg/mL and about 15 mg per spray at 150 mg/mL. Dr. Mahjoubi chooses the concentration that best fits your tolerance, body weight, and treatment goals.
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No. The Ketamine Nasal Spray is not inhalational. It is absorbed directly through the nasal mucosa — the thin tissue lining the inside of your nose — and enters the bloodstream from there. You breathe normally; you do not need to forcefully inhale the spray into your lungs.
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They are related but not the same. Spravato is esketamine — only one of the two mirror-image molecules of ketamine. Our compounded Ketamine Nasal Spray is racemic ketamine, meaning it contains both mirror-image molecules — the same ketamine that has been used safely since the 1960s. Many patients and clinicians find the racemic spray is at least as effective as Spravato, and often better, while also being more affordable and usable from home rather than requiring in-clinic observation.
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The Ketamine Nasal Spray kicks in fast, typically within 5–15 minutes. It is excellent for rapidly zapping acute anxiety and lifting depressive symptoms, and because the racemic formulation contains both mirror images of the molecule, many patients feel it works as well as or better than Spravato. It is also the easiest formulation to titrate in small, consistent increments.
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The two main drawbacks are (1) a small amount of posterior nasal drip that can taste bitter at the back of the throat, which is easily resolved with water, and (2) the nasal spray is not ideal for patients who want long, deep therapeutic sessions or deep journaling. For those use cases, the sublingual troche is usually the better fit.
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A Ketamine Troche produces an experience that lasts about 25 minutes, give or take 5 minutes, depending on dose, how long you hold the dissolving troche sublingually, and your individual metabolism. That longer window is one reason the troche is preferred for dedicated therapy sessions and integration work.
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Dr. Mahjoubi can prescribe Ketamine Troches in doses up to 200 mg for patients who need a stronger session. As always, dosing is personalized and titrated from a lower starting point based on your response, goals, and tolerance.
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Yes — and this is one of the troche’s biggest advantages. Because the Ketamine Troche is a solid, consistent tablet, you can bite off a half or a quarter to microdose, or use a full troche one or more times per week for full “sessions.” That flexibility lets a single prescription serve both maintenance and session-level use.
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Choose the Ketamine Nasal Spray when you want fast-acting relief for anxiety or depression and a shorter, lighter experience. Choose the Ketamine Troche when you want a longer, deeper therapeutic session — for work with a therapist, deep journaling, or immersive integration therapy. Many NutraBrain™ members keep both on hand for different purposes.
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The rapidly dissolving tablet (RDT) is a sublingual tablet engineered to dissolve quickly under the tongue. Because it dissolves faster, the experience comes on faster and also tapers off faster than a troche. It is a good option for patients who prefer an oral formulation but want a shorter session window.
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The sublingual ketamine droplet is a liquid formulation administered with a dropper under the tongue. Clinical experience with this form is more limited, largely because many compounding pharmacies do not yet know how to prepare it consistently. For that reason, we currently prescribe the sublingual droplet only to California residents, where we have identified reliable compounding pharmacies.
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During your initial telehealth consultation, Dr. Mahjoubi will review your diagnosis, goals, medical history, and prior experience with ketamine to recommend the best starting formulation. Because NutraBrain™ offers five different at-home ketamine formulations, your protocol can be adjusted over time — for example, starting on the nasal spray for fast anxiety relief and later adding the troche for deeper sessions.
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Yes. One of the biggest perks of a NutraBrain™ membership is direct access — once you are a member, you can always text or email Dr. David Mahjoubi for guidance. Whether you need help adjusting your dose, choosing between the nasal spray and a troche, or preparing for your next session, he is available. He will never leave you.
Why Choose NutraBrain™ for Your Ketamine Journey
NutraBrain™ stands apart in the realm of at-home ketamine therapy due to our commitment to personalized care, extensive physician oversight, and convenient delivery methods. Our team is dedicated to providing customized treatment plans tailored to each individual’s needs, all while ensuring a safe and effective therapeutic environment.
Get StartedStart Your Journey to Wellness Today
For individuals looking for effective at-home ketamine treatment applications in multiple states nationwide, NutraBrain™ offers a comprehensive and supportive program. Under the care of Dr. David Mahjoubi, you can explore your treatment options in the convenience of your own home. Begin your path to wellness and reach out today to learn more about how our at-home ketamine therapy can benefit you.
