The Ketamine Research Institute
Not all ketamine treatment is the same
Ketamine is given in many ways, at many different doses. Does that matter?
Intravenous infusions, injections into a muscle, nasal sprays, tablets or lozenges dissolved in the mouth: ketamine is given all of these ways, at doses that vary widely from one clinic to the next. Most research has asked whether ketamine works. Far less has asked whether each patient actually receives the amount they need; a major multi-site trial comparing doses began by acknowledging that the best antidepressant dose was still unknown.
It does, and we have asked that question for years. Dr. Grass’s research and teaching have centered on how much ketamine actually reaches the brain, and RESTORE is built around the answer. It matters to you because the same dose can be too much for one person and too little for another, and that difference shows up in how the infusion feels and whether it helps.
The standard infusion dose, half a milligram per kilogram, came from a 1994 study that gave ketamine to healthy volunteers to model schizophrenia. It was never developed or designed to treat depression.
Read where the number came from, with the timeline
That ketamine relieves depression is not in dispute. It has been shown repeatedly over twenty-five years, and for people who have not responded to anything else it is one of the more important findings in modern psychiatry. None of what follows questions any of that.
What rarely gets examined is the dose [5]. The standard one — half a milligram of ketamine for each kilogram you weigh, infused over forty minutes — is still widely treated as settled. It is worth knowing where that number actually came from, because it explains a great deal about why results vary so much from one person to the next.
It comes from a 1994 study at Yale by Krystal and colleagues — which gave ketamine to healthy volunteers to study glutamate and schizophrenia, not of mood. They needed a particular concentration of ketamine in the blood, and measuring it in every subject was expensive and technically difficult. So they used a practical shortcut: half a milligram per kilogram of body weight, over forty minutes. [1]
Six years later Berman took that same dose and that same timing and showed, in Biological Psychiatry, that it relieved depression. [2] Zarate replicated it in 2006. [3] Neither study revisited the dose — there was no reason to. It was the dose that had worked in the paper before.
Then in 2013 Murrough showed the effect had to be repeated to hold: six infusions over two weeks, on a schedule lifted from electroconvulsive therapy. That became the default, and it is still what most clinics do today. [4]
Clinics are aware of this. A survey found that most begin at half a milligram per kilogram, but the great majority change the dose during a course of treatment, across a range running to six times the starting figure [6]. The number was meant to be a place to start. It is not always treated as one.
I was a faculty member in the department of anesthesiology at Yale that the psychiatrists came to for that infusion protocol. It was a sound approximation for a research question in 1994. Thirty years later it is still being used as a treatment plan.
So the standard of practice traces back through four papers to a number chosen because measuring the real one was inconvenient. The question of what would happen if you modeled the concentration and held it there instead, correcting the things that change it, was not revisited. Answering that took seven years.
The standard weight-based dose can lead to very different results. Here is what can happen, and why we do not use it.
What RESTORE does instead
Dosing to a target, in one picture
A dose set to a target rises into the range and stays there.
A weight-based dose climbs quickly, can overshoot the useful range, and then falls below it before the infusion is over. An infusion planned to your target level rises into the range and is held there for the whole session.
If you are coming from another state or country
Before you book a flight, you will know whether the trip is worth making.
The process is built around people who travel. Nothing about the decision is left until you arrive.
01
Before you travel
The first call is free. We review your records, and a consultation with the physician ($150, credited to your program if you go ahead) tells you whether RESTORE is right for you. If it is not, we tell you on the phone, before you book anything or pay for treatment.
02
What the trip involves
In the first year you make two visits: three consecutive days for the initial course, then a shorter visit two to three months later for two reinforcement infusions. We help you plan both, from airports to hotels a few minutes from the center.
03
After you go home
We follow up by email one to two weeks after your course, and we stay reachable after that. If a reinforcement infusion is needed later, we plan it with you. Our results, above, show how long relief has lasted in our own patients.
Had ketamine elsewhere, and it did not work or did not last?
RESTORE Rescue is for you. We review what was given and how it was dosed, and tell you honestly whether a different approach is worth trying.
Call and ask. We will tell you honestly whether this is for you.
What an infusion day is like
Calm, unhurried, and with your physician throughout.
Many people hesitate because they do not know what the day involves. This is what happens, from the moment you arrive.
STEP 1
You arrive
You check in, complete some paperwork, and have a private consultation with Dr. Grass before the session. When you are comfortable, you move to a private room with a reclining chair.
STEP 2
The infusion
Dr. Grass starts your IV, attaches the monitors, and stays with you for the whole infusion, adjusting the dose as you respond. You are welcome to have someone in the room, and you are never left alone.
STEP 3
Afterward
You rest for about thirty minutes in the recovery room. You can't drive for the rest of the day, so bring someone who can take you back to your hotel or home.
Before you spend anything
Not everyone should have this treatment.
Some conditions make ketamine unsafe. Every one of them is listed openly on this site, and you will hear about any that apply to you on the first call — before you travel, and before you pay anything.
See the conditions that rule someone out
Conditions that rule someone out entirely
- Heart and circulation. Rapidly worsening or uncontrolled high blood pressure, or unstable angina. A recent heart attack or stroke. An aneurysm or abnormal blood-vessel formation in the brain. Fibromuscular dysplasia. Narrowing of the aortic valve. Hypertrophic cardiomyopathy. Pulmonary hypertension.
- Inherited conditions. Polycystic kidney disease or vascular Ehlers-Danlos syndrome. Multiple endocrine neoplasia type 2.
- Mental health. Psychosis or schizophrenia. Delusional disorder or depersonalization disorder. A substance use disorder that is not in remission.
- Pregnancy, IVF treatment, or breastfeeding.
- A known allergy to ketamine.
And four things we will not do
- We will not treat you if we do not think you are likely to benefit.
- We will not treat you without reviewing your records first.
- We do not prescribe take-home ketamine in any form — no lozenges, no nasal spray, no oral formulation.
- We will not advise you to stop or reduce a psychiatric medication. That is your prescriber’s decision, and we will speak to them directly.
A separate and longer list — blood pressure, thyroid, liver and kidney disease, anticoagulants, benzodiazepines, lamotrigine — does not rule you out. Those change how treatment is planned, and we deal with them before the first infusion rather than during it.
Conditions we treat
Find the page for your condition.
How this is done
Seven stages. Four of them happen before you are anywhere near an IV.
This is the part that takes the time, and it shapes the result. A standard infusion has one stage: give the drug.
Evaluation
We read everything before we decide anything
Every medication trial, every prior treatment, what the side effects were and why things were stopped. If a course of ketamine has failed you elsewhere, we want its details. Much of what will shape your response is already in that history.
Selection
We decide whether to treat you at all
Some conditions make ketamine unsafe, and some medical and genetic factors make a response less likely. Both are reviewed before you book travel or pay for treatment. If we do not think we can help you, we tell you.
Optimization
We correct what the bloodwork finds, then treat
A full metabolic and hormonal work-up comes first: blood counts and chemistry, inflammation, thyroid, sex hormones, vitamin D, B12 and folate, magnesium and more. Where something comes back low, we correct it first and then treat, rather than treating around it.
Target concentration
We work out the level the infusion is built to reach
Rather than a milligram dose from your weight, we work out the level the infusion should reach and hold, from your body composition, how fast you clear ketamine and what else you take. In complex cases, a pharmacogenomic panel informs it.
Delivery and observation
One patient, one physician, the whole infusion
The infusion runs in three stages at variable rates, which reaches the target level sooner and holds it there. One patient at a time: the physician who set your dose gives it and stays for the whole infusion, watching heart rhythm, blood pressure and oxygen.
Adjustment and refinement
Each day is set from the day before
The infusion is adjusted while it runs: eased if the experience becomes too strong, raised if it is doing too little. Each day is then set from the one before, so three infusions work as one course of treatment rather than three separate appointments.
Follow-up and measurement
What happens afterward is measured, not remembered
You continue with the RESTORE supplement after the course, which is included in your fee, and complete the same symptom scales you filled in beforehand — so the result is measured rather than recalled. We send those results to your psychiatrist or prescriber, which we would generally prefer to do.
About the Ketamine Research Institute
We do one thing. The Ketamine Research Institute in Sarasota, Florida provides ketamine-based infusion therapy and trains clinicians to deliver it. We do not offer other services, and we do not plan to.
That narrowness is deliberate. It is what makes it possible to treat one patient at a time, to keep a physician in the room for the whole of every infusion, and to score every patient before treatment and afterward, so that whether it worked is a question with an answer.
Full background, academic history and publications →
Other physicians come here to learn this approach. Since 2016 the Institute has run an intensive training program in which licensed clinicians travel to Sarasota for classroom instruction and supervised clinical training in a working infusion suite. RESTORE itself is proprietary to this practice and is given only here. What clinicians take away is the KRI Precision Ketamine Infusion — the same principles of measured, individualized dosing, applied in their own practices. About the training program
Research and teaching
Dr. Grass is a published author and lecturer whose work includes peer reviewed articles, abstracts, book chapters, and educational presentations. He has presented his research at regional and national conferences and meetings, and to government agencies including the Veterans Administration and the Department of Defense. In 2016 he founded the Institute’s intensive training program for clinicians, which teaches the precision medicine and targeted infusion methods used here through classroom instruction and supervised clinical training in a working infusion suite.
Working with the physicians who already care for you
Ketamine therapy is one part of your care, not a replacement for it. You keep your psychiatrist, your primary care physician, and any specialist treating your pain. We are not asking you to choose between us and them.
We work with them directly. Before we treat you, we go over your history and every medicine you take with the clinician who prescribes it, because several common medicines change the way ketamine behaves in the body, and that has to be settled before an infusion rather than discovered during one [16]. Through your course of treatment and afterward, your own physicians get what they need from us to make their decisions well: what you were given, how you responded, and what we recommend next. We stay available to them for as long as you are our patient.
This coordination is part of the treatment, not a formality. Ketamine can change how a patient is doing within days rather than months, and the decisions that follow, about your other medicines, your therapy, and how closely you are watched, are made better by physicians who are working from the same information we are.
We do treat patients with active suicidal thinking, but only on the recommendation of their psychiatrist, and only with that psychiatrist continuing to co-manage their care.
Coming to Sarasota
Patients travel to us from across the country. The course runs over three days in a row, so you will need somewhere to stay. Airports, driving times, where people usually stay, and why we ask that you not drive yourself home after an infusion are all set out on the visiting page.Contact Us Today
800-850-6979
5969 Cattleridge Blvd - Suite 104 Sarasota, FL 34232 restore@ketamineinstitute.com
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