What Is Ketamine Therapy For Depression?
It’s easy to assume ketamine works like antidepressants—a doctor gives you a prescription, you pick it up at your pharmacy and off you go. Heck, it’s what I pictured and boy, was I wrong!
Ketamine isn’t a pill you grab at the pharmacy and pop into your mouth. It’s a medical procedure, not a dose of medicine. It happens in a ketamine clinic, under careful supervision, where a low dose of ketamine—an anesthetic—is administered through an IV, injection or nasal spray. The dose is far below what they’d use to knock you out for surgery but high enough to well, get you high. And by that, I mean you’ll enter an altered state of consciousness.
Once ketamine crosses the blood-brain barrier you’ll understand why clinics provide recliners, blindfolds, and a comfy blanket. You won’t be able to do much of anything except close your eyes and surrender to the experience.
With ketamine, you get a full sensory takeover—a plunge into an altered state of consciousness where your body stays rooted to the chair, but your mind takes flight. Vivid imagery dances behind your eyelids, psychedelic visions unfold like a movie only you can see, and messages from your subconscious bubble up, demanding your attention. It’s not just a trip; it’s a deeply immersive journey into the uncharted territories of your own mind.
These altered states of consciousness, these vivid, mind-bending visions, aren’t side effects—they’re part of the treatment. They’re believed to shake loose old patterns, carve new pathways in the brain, and create space for healing to happen. And that’s why ketamine therapy is done in a clinic, not at home. It’s not just taking medicine—it’s stepping into an otherworldly mind trip that rewires your brain and clears the path to full remission for up to 70% of patients.
This article dives into 7 key subjects. You can read it all the way through or skip straight to what interests you most by clicking the links below. The choice is yours—start where it feels right!
1. What Happens Between Arriving at the Clinic and Receiving Ketamine
2. What You’ll Physically Experience During A Ketamine “Journey”
3. What You’ll Experience Psychologically
4. How Long Does a Ketamine Therapy Session Last?
5. Why You Need To Have Someone Drive You Home
6. How a Therapist Helps Ketamine Work More Effectively
7. Deeply Personal: How My Therapist Transformed My Ketamine Journey
WHAT HAPPENS WHEN YOU ARRIVE AT THE KETAMINE CLINIC?
Before you arrive
No eating solid foods for 6-8 hours before your session. This ensures your stomach is empty, lowering the chances of nausea or vomiting during treatment.
Drinking clear liquids like water, black coffee, or tea is usually allowed up to 2 hours before your session, but you should avoid anything heavy like milk or juice.
When you arrive
You’ll fill out a short depression and anxiety test to track your progress over time. Then, a clinician will check your blood pressure and oxygen levels using a blood pressure cuff and a fingertip pulse oximeter. Since ketamine can temporarily raise blood pressure, you’ll need to start at a safe baseline—typically below 160/100, though criteria vary by clinic. The oximeter ensures your oxygen saturation is at a healthy level before the session begins.
What happens next depends on your chosen method of administration (see my “decision table” to figure out which method is best for you):
IV Infusion
The ketamine solution used for your treatment is typically prepared in advance, following strict medical protocols. In most cases, it’s not pure ketamine in the IV bag—it’s diluted with a saline or dextrose solution to ensure the dose is precise and easy to control. The solution is measured and prepared by trained professionals, often a pharmacist or a clinician, to match the exact dosage your doctor has prescribed based on your weight, medical history, and treatment plan.
Once you’re seated, the nurse or clinician will place an IV line into a vein in your arm or hand. If you’re nervous about needles, they’ll take steps to make the process as comfortable as possible, such as using a topical numbing agent. Once the IV is in place, the ketamine is administered slowly through the line over a period of about 40 to 60 minutes. This gradual delivery ensures that your body can adjust to the medication and minimizes the risk of side effects like nausea or dizziness.
The great thing about ketamine is that unlike SSRIs, the side effects are mild, manageable and gone in hours. Click here to see how different ketamine is from traditional antidepressants.
Injection
The ketamine is prepared in advance by trained medical professionals, often a pharmacist or clinician, who measure your exact dose based on factors like your weight, medical history, and treatment plan. The medication is typically mixed with a sterile saline solution to ensure the dose is delivered smoothly and accurately.
Once the medication is ready, you’ll settle into a comfortable chair or bed. The clinician will administer the injection into a large muscle, usually in your upper arm, thigh, or buttocks. Before injecting, they’ll clean the area with an antiseptic wipe and may use a small amount of numbing spray if needed to make the experience as comfortable as possible. The injection itself only takes a few seconds, and most people describe the sensation as mild, similar to a flu shot.
Ketamine delivered via injection acts quickly, often within 5 to 10 minutes, so you’ll notice the effects much sooner than with an IV infusion.
Spravato (nasal spray)
The first session begins with a detailed demonstration. The clinician will show you how to position the nasal spray device, how to tilt your head slightly back, and how to press the applicator correctly. Once you’re ready, they’ll hand you the spray and step back to observe, ensuring you administer it properly and safely.
Spravato is administered in three waves, with each wave consisting of one spray in your right nostril and one in your left nostril. After the first wave, you’ll wait about 5 minutes before moving on to the next. This staggered approach helps your body absorb the medication more effectively while reducing the chances of side effects like nausea. The clinician will remain nearby to guide you through the timing and ensure everything is going smoothly.
Oral Tablets
I focus on ketamine treatments with proven safety and effectiveness: IV infusions, intramuscular injections, and esketamine nasal spray. These methods are backed by decades of research and precise medical oversight. Oral ketamine, on the other hand, lacks the same reliability—its absorption is unpredictable, research is limited, and home use comes with risks like inconsistent dosing and misuse.
Speaking of misuse, don’t let Matthew Perry’s tragic death mislead you—ketamine, when used in medical settings, is safe and not addictive. Studies confirm that ketamine has a low potential for addiction, and in supervised therapeutic use, serious risks are extremely rare.
At any rate, I won’t be covering oral ketamine here. My focus is on the safest, most effective clinical treatments.
WHAT YOU’LL PHYSICALLY EXPERIENCE ON KETAMINE
What Happens To Your Body
You settle into a reclining chair as the treatment begins, the soft hum of the clinic in the background. The first fifteen minutes feel like a slow and gentle surrender as your body seems to sink deeper into the chair. During this stage, your heart rate and blood pressure might rise slightly, but you wouldn’t notice it—the world starts to feel softer, less rigid, as if the sharp edges of your thoughts are dissolving.
A Sensation of Leaving Your Body
A deep, physical relaxation spreads through you, and soon the medicine takes full effect. When dissociation affects the body, it can create a wide range of physical sensations that feel strange, unsettling, or even surreal. One common experience is numbness—a dulling or complete loss of physical sensation that makes it feel like your body isn’t entirely your own. This sense of disconnection can leave you feeling detached from your physical form, as if it’s happening to someone else.
Some people describe their bodies as weightless or empty, as though they’ve lost their substance or mass. For others, perception twists: their body might feel larger, smaller, or entirely the wrong shape.
Floating Free from Aches & Pains
Pain perception can also change dramatically during a ketamine session. If you experience chronic pain, like back pain or joint pain, you may find that it completely fades into the background. It’s as if your body’s usual alarms have been silenced, creating a sense of relief that allows you to focus entirely on your journey. Sensory distortions—like tunnel vision or altered hearing—may also arise, adding to the feeling of detachment, but they don’t diminish the overall sense of calm and physical release.
The intensity and nature of these physical sensations vary greatly from person to person, but they all share one common thread: the feeling that your body and your sense of self are no longer fully aligned. It’s a state that’s both strange and deeply personal, defying the usual rules of how we experience our own bodies.
What My Body Felt Like Under Ketamine
For someone like me, living with chronic back pain and a constant symphony of aches and creaks throughout my body, dissociation feels like a blanket of pain relief descends on me. The relief isn’t just partial; it’s complete and it lasts for hours. There’s a scientific basis for this: Ketamine disrupts the brain’s ability to process pain signals.
Interesting aside: Ketamine made its debut as an anesthetic in the killing fields of the Vietnam War. In the early 1970s it was referred to as “the buddy drug” because it could be administered by untrained personnel, even in the chaotic environment of combat. Its dissociative properties allowed soldiers to remain conscious but detached from pain, making it ideal for battlefield conditions where traditional anesthetic equipment was unavailable.
While the dissociation erases pain, it also brings this strange heaviness, like my body is part of the ground beneath me. It feels almost impossible to do something as simple as raise my arm. And that’s where a bit of unease creeps in—because more than once, I’ve found myself wondering, What if something happens? What if someone bursts into the room with a knife, or there’s a fire? How am I supposed to protect myself or escape when I can’t even muster the strength to lift an arm?
What’s fascinating—and unsettling—is how dissociation affects your mind just as much as your body. Those intrusive thoughts about danger don’t ignite the panic you’d expect. It’s like they’re happening to someone else entirely. You recognize the worry, but it feels distant, detached, almost unimportant. I’ve often found myself thinking, Should I try to lift my arm? And then I get stuck in this strange loop: Is it that I can’t move it, or is it that I won’t? It’s as though my mind and body are speaking different languages, and I’m caught in the middle, watching the conversation unfold.
That’s when I realized why the ketamine clinic emphasizes a soothing environment and a sense of complete physical safety. When you can’t trust your body to respond—or even fully trust your mind to care—you need to know, without a doubt, that nothing can harm you while you’re in that vulnerable state.
WHAT YOUR MIND WILL EXPERIENCE ON KETAMINE
What Happens To Your Mind
Dissociation is at the core of the ketamine experience. It creates a striking sense of separation between your mind and body, as though the two are no longer connected. You might feel as though you’re observing yourself from outside, floating above, or simply existing as something other than your physical self.
This detachment can be liberating, especially for those burdened by chronic pain (hello, me!) or emotional distress, but it’s also deeply disorienting. It’s not uncommon to lose the sense of where “you” begin and end, which can feel peaceful for some but unnerving for others.
Altered Perception of Time and Space
Time becomes slippery. Minutes stretch into what feels like hours, or entire spans of time seem to collapse into a single moment. It’s not just a loss of track—it’s a shift in how time exists for you. Space changes, too. A small room might feel infinite, or the world might seem to shrink until it’s impossibly small. These distortions can be fascinating but also unsettling, especially when your usual anchors to reality dissolve.
Cognitive Detachment
Thoughts arise, but they don’t feel like they’re yours. Worries about safety—What if I can’t move? What if something happens?—hover in your awareness but don’t grip you the way they normally would. It’s like hearing a conversation in another room—distant and oddly unimportant.
This detachment can be a gift, especially for people overwhelmed by anxiety or emotional pain. It lets you step back from the intensity of your feelings, seeing them for what they are without being consumed by them. At the same time, the lack of urgency can be disorienting. The mind you’re used to navigating the world with is suddenly unmoored.
Psychedelic Visions
The dissociative state opens the door to vivid, surreal experiences. You may see shapes, colors, or entire landscapes that seem to rise out of nowhere. These visions can be abstract or deeply symbolic—like watching a story unfold but not quite knowing its meaning. For some, the imagery feels calming or awe-inspiring. But ketamine doesn’t shy away from darker themes. Fear, horror, or feelings of being trapped can surface, pulling you into moments of emotional intensity that are hard to shake, even if they feel detached from your conscious self. The visions aren’t random; they can feel deeply personal, like they’re revealing something buried within you. In fact, they are a reflection of your subconscious working to process unresolved trauma.
I Had Tons of Psychedelic Visions
Every ketamine journey brought vivid, powerful psychedelic visions. They hinted at the childhood and adult traumas I’d buried or avoided, but they never spoke to them directly. Instead, they circled around the edges, pulling me closer to what I hadn’t fully faced. In my very first psychedelic experience, this is what happened:
I felt myself floating toward a giant martini glass, disappearing not just into the alcohol but into the glass holding the liquid, the table holding the glass, and the ground holding the table. I didn’t just disappear into these objects—I became them. I was the liquor, the glass, the table, and the ground, looking out into the world, happy to see I wasn’t in it.
I was conscious enough to recognize the impossibility of what I was experiencing. A table that thinks? A martini with opinions? The ground relieved I didn’t walk on it?
When I came out of the vision a deep ache welled up inside me as I fully grasped the meaning of the vision: I didn’t want to exist anymore.
The vision became a doorway, forcing me to confront why I wanted to disappear. As I dug deeper, guided by that unforgettable psychedelic experience, I began to see how it reflected my past. My family had spent years erasing who I was. When my father left us when I was ten, my mother remarried and pushed for her new husband to adopt me and my siblings. Our last name was changed, even though my father was still alive. Worse, they changed my first name—it was my father’s, and my mother didn’t want the reminder.
The visions of self-erasure mirrored these moments. My mother even forbade us from speaking Spanish, our native language, because it made her new husband uncomfortable. Within weeks, we’d forgotten how to speak it entirely. Psychiatrists later called it a rare case of trauma-induced “language attrition.” Our identity, piece by piece, was stripped away.
I feel a bit vulnerable sharing such intimate aspects of my life but I think they’re a powerful example of how psychedelic visions reveal what’s buried in the subconscious. When processed with a therapist, they can unlock profound healing, connecting the past to the present in a way that transforms how you understand yourself.
A Word About Psychedelic Visions
If you experience psychedelic visions during ketamine therapy (and not everyone does), it’s important to understand they’re an essential part of the healing process. These visions aren’t random or meaningless—they’re your mind’s way of uncovering hidden wounds and unresolved emotions, bringing them to the surface so they can be addressed. They act as a bridge between your subconscious and conscious mind, offering insights that might otherwise remain out of reach.
After the session, your therapist helps you explore what you saw and felt. This process, called integration, is a cornerstone of ketamine therapy. It’s not just about revisiting painful memories or emotions—it’s about making sense of them in a safe, supportive space. By unpacking these experiences, you begin to connect the dots between past wounds and present struggles, gaining clarity and perspective that can shift how you view yourself and your life.
Integration transforms the visions from abstract experiences into tools for growth. It allows you to process emotions, release what no longer serves you, and create room for healing. In this way, the visions aren’t just part of the journey—they are the journey, guiding you toward resolution and change in ways traditional therapies often can’t.
One More Word About Psychedelic Visions
Does the thought of psychedelic visions bother you? It shouldn’t. You won’t lose yourself. You won’t spiral into madness. No matter how strange, intense, or even terrifying a vision might seem, ketamine keeps you anchored.
This isn’t like a bad trip on psychedelics where panic can take over. Ketamine’s dissociation acts as a built-in safety mechanism, a buffer between you and whatever unfolds. It’s like watching a storm rage outside from the safety of a warm, locked house. You can see the chaos, even feel the weight of it, but it can’t touch you.
No matter what appears—memories, symbols, surreal landscapes—you remain an observer, not a victim. Your mind may present difficult truths, but ketamine ensures you experience them with distance, not devastation.
And when it’s over, you come back—not shattered, but with a deeper understanding of yourself. Safe. Intact. Whole.
HOW LONG DOES A KETAMINE SESSION LAST?
From the time the ketamine is administered…
Onset (5–10 minutes):
The session begins quickly. Within minutes of administration, ketamine starts to take effect. You might feel a lightness in your body, a sense of detachment, or the first signs of dissociation creeping in. This phase can feel strange but is generally brief, a doorway opening to the journey ahead.
Early Phase (10–15 minutes):
As dissociation deepens, your surroundings may begin to feel distant or unreal. This is when your mind starts to let go of ordinary thoughts and connections. You might feel a sense of transition, like moving from one state of being to another. It’s the start of the experience but not yet its most intense.
Peak Experience (15–20 minutes):
This is the heart of the journey. The dissociation is at its strongest, and the psychedelic visions, if they occur, are vivid and immersive. You may feel as though you’re exploring new dimensions or confronting deeply buried emotions. The experience is powerful but contained, protected by ketamine’s dissociative buffer, which allows you to observe without being overwhelmed.
Plateau Phase (10–15 minutes):
The intensity levels out. While the peak effects begin to soften, dissociation and introspection remain. This is often a reflective time, where the emotions and imagery from the peak settle into something clearer and more manageable. You’re still in the experience but on steadier ground.
Re-entering Normal Awareness (30 minutes):
This phase marks the transition back to yourself. The dissociation fades, and your body and mind reconnect. It’s a quiet, grounding time, where you begin to process what you’ve experienced. Often, some very important imagery or psychedelic visions can pop up during this period. When ketamine was first used as an anesthetic in surgery, doctors used to refer to the visions as “emerging delirium.” That seemed a rather ugly term so now they call it “emergence phenomena.”
Monitored Rest Period (30–60 minutes):
After the effects have subsided, you’re given time to rest. For injections and IV, the post-session monitoring is about 20-30 minutes. For the esketamine nasal spray, Spravato, it’s about 60 minutes (part of Spravato’s regulatory requirement). This period is designed for reflection and recovery, allowing your mind to adjust and your body to fully return to its normal state. Many people use this time to journal, share their experience, or simply sit with what they’ve learned. It’s the closing chapter, ensuring you’re ready to step back into the world.
Total Time of a Ketamine Therapy Session: 100–150 minutes
For injection or IV infusion therapy: About 1 hour and 40 minutes
For Spravato: About 2 hours and fifteen minutes (about 35 minutes longer than injection/IV)
Someone Has To Drive You Home
You might feel fine. You might even think, Hey, I’ve driven on less sleep than this. But make no mistake—getting behind the wheel after a ketamine session isn’t just a bad idea, it’s outright dangerous.
Ketamine isn’t like a drink that wears off in an hour or two. It alters perception, motor control, coordination, and reaction time—and just because the peak effects have faded doesn’t mean your brain has snapped back to full capacity. In fact, studies show that cognitive function and reflex speed remain impaired for several hours post-session, even if you feel normal.
The dissociation that makes ketamine so effective in treating depression? It’s still lingering in the background, even after you think you’re back to reality. Your depth perception is off. Your ability to judge speed and distance is compromised. You could be merging into traffic thinking you have plenty of space when, in reality, you’re cutting it razor-thin.
And then there’s the afterglow—the sense of calm, detachment, or even mild euphoria that many people experience. It’s not as obvious as being drunk, but it dulls urgency and slows reaction time. That’s the last thing you need when a pedestrian suddenly steps into the crosswalk or a car swerves in front of you.
Even if you believe you can drive cautiously, consider this: If you get pulled over or into an accident, you have no legal defense. Ketamine is a dissociative anesthetic. If a police officer tests you for impairment and finds you sluggish, off-balance, or confused, that’s it—you’re considered impaired. Your ketamine therapy session just turned into a DUI.
Clinics don’t require a ride home because they’re overly cautious—they do it because they’ve seen what happens when patients think they’re okay to drive. It’s not worth the risk. Arrange a ride. Call a friend. Take an Uber. Just don’t get behind the wheel.
The Importance of Having a Therapist
Most studies on ketamine’s effectiveness were done with ketamine alone, without psychotherapy. They show impressive results—somewhere between 50% and 70% of patients reach remission with just the biological effects of the drug. That’s a staggering number, but it also raises a crucial question: If ketamine alone works this well, what happens when you combine it with therapy?
We already know the answer when it comes to antidepressants. Patients who combine SSRIs with psychotherapy are 25% more likely to respond than those taking medication alone. They feel better longer, process emotions more deeply, and stay engaged in treatment.
It stands to reason that the same principle applies to ketamine—if it already delivers a 50–70% remission rate on its own, adding therapy could push those numbers even higher.
Studies Back This Up
Patients who received ketamine with therapy felt better longer, processed emotions more deeply, and stayed engaged in treatment. While research on the exact combinations varies—some studies involve therapy before, during, or after ketamine, and different approaches like CBT, Internal Family Systems (IFS), or mindfulness—the overall pattern is clear: therapy enhances ketamine’s power.
And that makes sense. Ketamine shakes things loose. It surfaces buried emotions, forgotten memories, and surreal, symbolic visions. You might see yourself as a bird trapped in a glass jar, desperate to escape but unable to break free. Those psychedelic visions aren’t random—they’re your subconscious breaking through. But without a trained therapist to help you decipher them, they can stay locked in confusion, powerful but untapped.
A therapist isn’t just someone to talk to. They’re your interpreter, your anchor, your guide. They help you turn those visions into meaning, connect them to your life, and process the emotions ketamine stirs up—grief, fear, rage, even joy. Without that, you’re left trying to make sense of it all on your own, missing the chance to turn fleeting insights into real, lasting change.
If you’re aiming for full remission—not just temporary relief—it makes sense to stack the odds in your favor. Therapy doesn’t just help—it could be the missing piece that takes you from partial improvement to permanent transformation.
So while there is nothing definitive, the links I gave you above are all for systematic reviews and meta-analyses that show a positive correlation. That makes sense, especially when you look at more definitive studies showing that combining SSRIs with psychotherapy is significantly more effective than SSRIs alone in reducing depressive symptoms. Patients receiving combined treatment (SSRIs + psychotherapy) were 25% more likely to respond compared to those receiving SSRIs alone.
I’m a big proponent of “Ketamine-Assisted Psychotherapy.” Here’s why: Ketamine shakes things loose. It brings up buried emotions, forgotten memories, and surreal, symbolic visions. You might see yourself, for example, as a bird trapped in a glass jar, desperate to escape but unable to break free. Those psychedelic visions aren’t random—they’re the subconscious breaking through. But without someone trained to help you decipher them, they can stay locked in confusion, powerful but untapped.
A therapist is your interpreter, your anchor, your guide. They help you turn those visions into meaning, connect them to your life, and process the emotions ketamine stirs up—grief, fear, rage, even joy. Without that, you’re left trying to make sense of it all on your own.
HOW MY THERAPIST HELPED
The psychedelic visions induced by ketamine can be profoundly disorienting and emotionally overwhelming. Without Joseph, my therapist, I would have been lost in a maze of cryptic symbolism and unprocessed grief. Take this vision I had:
I’m being buried alive. I’m the victim trapped in a coffin, pounding and screaming in sheer terror as the lid closes, but I’m also the perpetrator, slamming the coffin shut with cruel delight, climbing into a helicopter, and flying away, laughing gleefully as I abandon myself to die.
Joseph helped me understand these weren’t just random hallucinations, but powerful metaphors for my self-abandonment and self-hatred. His gentle but direct questioning helped me confront painful truths I might have otherwise avoided (how he did it I’ll describe in a later post).
I remember once expressing frustration about the cryptic nature of the psychedelic visions I was having. “Why doesn’t ketamine give me literal visions?” I asked him. “Something I can actually make sense of? Why not visions that force me to relive my father’s abandonment or my mother’s betrayal? Wouldn’t it make more sense for me to emotionally process the reality of what happened to me rather than all this symbolic imagery that takes so much work to figure out?!”
I’ll never forget his reply: “Your mind is trying to protect itself. Your visions aren’t riddles; they’re the emotional language of your subconscious, a way for your mind to express the pain that feels too overwhelming to confront head-on. It’s as if your psyche knows that reliving the raw, literal memories of, say, your father’s violence, would be too destabilizing—so it finds another way to communicate those feelings through symbols that are, in some sense, safer to experience.”
He explained that the psychedelic visions are a kind of emotional buffer, softening the impact of the trauma while still allowing me to process the underlying pain. This sort of “symbolic grief” enabled me to touch on the depth of my suffering without having to relive my memories exactly as they were. “It’s not that you’re avoiding ‘real’ grief,” Joseph said. “You’re processing it in the only way your psyche allows right now—through the safety of metaphor.”
I tell you all this not to overshare but to stress how important it is to have a therapist, and not just rely on the ketamine alone. Having a skilled therapist during ketamine treatment isn’t just helpful – it’s essential. The medicine opens doors in your mind, but you need someone like Joseph to help you walk through them with purpose and understanding.
Without Joseph’s guidance, these powerful visions might have remained just disturbing hallucinations, their deeper meanings lost in the fog of confusion and fear. His presence and insights helped transform these challenging experiences into stepping stones toward healing, allowing me to confront and process trauma that I couldn’t approach directly. A skilled therapist doesn’t just help you understand your ketamine visions – they help you integrate them into your journey of recovery, turning haunting images into tools for healing.
Pro tip: The 48-hour golden window after ketamine is when your brain is at its most flexible. Old thought patterns are loosened, and new connections are forming. This is the ideal time for therapy. A therapist helps you solidify breakthroughs, deepen insights, and make sense of emotions while your brain is most open to change. You can still benefit from ketamine without therapy, but if you want to maximize its impact, this is the time to do the work.