What Is Ketamine Therapy For Depression?
This article demystifies every aspect of ketamine therapy for depression, detailing the complete clinical experience from pre-treatment protocols to post-treatment recovery. It explains the physical sensations, altered mental states, and emotional responses patients experience across all administration methods (IV, injection, nasal spray).
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 is a deep dive into this revolutionary mental health treatment so let’s start with a…
Let Me Walk You Through Everything I’ve Put Together on This Page
- 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
- 8. Are You a Candidate For Ketamine Therapy?
Frequently Asked Questions About Ketamine Therapy
What is ketamine therapy—and what does it feel like physically and mentally?
It’s a low dose of the anesthetic ketamine given through an IV, injection, nasal spray, or tablet by trained professionals in a medical clinic. The dose is high enough to alter consciousness but low enough to avoid losing consciousness. Once the medicine crosses the blood-brain barrier, it creates a powerful dissociative effect.
Physically, you may feel like your body is melting into the chair—weightless, numb, disconnected from pain. For many, chronic aches vanish completely. Mentally, you might feel detached from thoughts or emotions, like an observer watching yourself from afar. Time stretches or collapses. Shapes and colors may bloom behind closed eyes, often forming symbolic or emotionally charged visions.
Roughly half to two-thirds of people experience psychedelic imagery. These aren’t random “trips”—they’re messages from your subconscious. Taken seriously, they can uncover buried trauma, grief, or self-perceptions you didn’t know were holding you back. They’re not the medicine, but they’re part of how the medicine heals.
Why is ketamine therapy done in a clinic—and not at home?
Once ketamine crosses the blood-brain barrier, you lose access to your usual mental and physical faculties. You may be unable to move your arms or speak. Your sense of time collapses. It feels like you mind detaches from your body. In that state, you can’t make decisions or protect yourself—so the clinic does it for you.
Clinics provide containment, not just medicine: a blood pressure check, oxygen monitoring, a recliner, a blanket, a blindfold. You’re not there to stay aware. You’re there to let go.
And if you’re using Spravato, the FDA requires you to take it in a certified clinic under their REMS program. It’s not optional. You must be supervised for two hours after dosing. Sometimes, difficult emotional baggage comes up during treatment. Having trained staff nearby ensures you’re supported—not just physically, but emotionally. You’re not alone in the experience. The clinic is there to keep you safe on every level.
What happens during a ketamine therapy session, and how long does it last?
When you arrive, you’ll fill out a short depression questionnaire so the clinic can track your progress over time. Then a clinician checks your blood pressure and oxygen levels to make sure you’re physically clear to begin.
A few minutes after the ketamine is administered—whether by IV, injection, or the Spravato nasal spray—you’ll enter an altered state that lasts about 40 to 60 minutes. With IV, your blood pressure is continuously monitored. With injection and Spravato, it’s typically checked at the halfway point, since ketamine is known to spike blood pressure.
After the journey ends, you may feel groggy, disoriented, or emotionally raw—which is why clinics build in a recovery period: 20 to 30 minutes for IV or injection, 60 minutes for Spravato (a federal requirement).
Total time for a ketamine therapy session is about 1 hour and 40 minutes for IV/injection, and about 2 hours and 15 minutes for Spravato—roughly 35 minutes longer.
What does ketamine feel like during treatment—physically and psychologically?
A deep, physical relaxation spreads through you. Some people describe their bodies as weightless or hollow, as if they’ve lost mass altogether. Others feel too large, too small, or shaped wrong. Chronic pain often vanishes—back pain, joint pain, even long-term tension can go quiet, like the body’s alarms have been cut. Movement may feel impossible, like you’re fused to the chair.
Dissociation is at the core of the experience. Your sense of self detaches from your physical form. You might feel like you’re floating above yourself, or like the “you” inside your body is gone. Thought loops arise, but they don’t feel like yours. You’re present, but distant.
The visuals can be subtle or surreal: colors, landscapes, symbols, even entire scenes. They can feel meaningful—or terrifying. Fear, awe, confusion—they all surface without warning.
The one through line is disconnection: from your body, from time, from the person you think you are. For some, it’s a relief. For others, it’s disorienting. Often, it’s both.
What percent of people have psychedelic experiences on ketamine, and what are they like?
Roughly 40–50% of patients report psychedelic effects during ketamine treatment. Some see vivid imagery—faces, symbols, entire dreamlike scenes. Others don’t see anything at all. But when visions happen, they can be intense—not like dreams or hallucinations, but like events you’re actually living through.
Psychedelic visions aren’t random “trips”—psychiatrists believe they act as a bridge between your subconscious and conscious mind, offering insights that might otherwise remain out of reach.
Often described as “watching a movie made by your subconscious,” psychedelic visions speak in the language of metaphor, and often require the help of an integration therapist to make sense of. Most researchers believe these visions serve as a portal to parts of the psyche that no conversation, analysis, or traditional therapy could ever reach.
Many patients who reach remission credit their psychedelic visions as instrumental to their healing.
Why do I need someone to drive me home after ketamine treatment, and what happens if I don’t?
Ketamine impairs your coordination, perception, and reaction time, making it unsafe and illegal to drive after treatment. Even after the peak effects fade, your brain is still under the influence. Depth perception is distorted. Reflexes are delayed. Your ability to assess risk and respond to sudden changes—pedestrians, traffic, swerving cars—is significantly reduced.
This isn’t a subtle shift. It’s a measurable impairment that persists for hours.
Many people experience what’s called an “afterglow”—a sense of calm, mild euphoria, or detachment. That emotional quiet can mask just how impaired your body still is. The dissociation that makes ketamine effective is also what makes it dangerous behind the wheel.
If you’re pulled over or in an accident, there’s no legal defense. Ketamine is a dissociative anesthetic, and visible signs of sluggishness or confusion are enough to count as impaired driving. Driving under ketamine isn’t just risky. It meets the legal definition of DUI.
Why is therapy important during ketamine treatment—and what does it actually do?
Therapy is important during ketamine treatment because it helps patients process the emotional material that ketamine brings to the surface. Ketamine often loosens psychological defenses and allows unresolved trauma, grief, or fear to emerge—sometimes suddenly and without context. Therapy provides a structure for working with those moments instead of just moving past them.
During a session, ketamine may trigger memories, symbolic imagery, or intense emotional shifts. These experiences can be disorienting, surreal, or difficult to interpret. Without support, it’s easy to miss their significance or suppress them once the drug wears off. A therapist helps you slow down, sort through what came up, and identify what matters.
This isn’t traditional talk therapy. It’s about integration—making sense of what you saw or felt while under the influence of ketamine. It can also help you track patterns across sessions and notice emotional shifts that aren’t immediately obvious.
Ketamine opens the door. Therapy helps you walk through it with your eyes open. Without it, much of the emotional work risks being lost.
How do I know if I’m a candidate for ketamine therapy, and who shouldn’t get it?
Eligibility depends on the form of ketamine therapy. Spravato is only approved for treatment-resistant depression. IV, injection, and oral ketamine can treat a broader range of diagnoses—including major depression, persistent depressive disorder, bipolar depression, and seasonal affective disorder.
Some medical conditions are automatic disqualifiers because they create immediate life-threatening risks: brain aneurysm, history of brain bleeding, severe heart disease, pregnancy, active psychosis, schizophrenia, or a current suicide plan.
Others are of high concern but might be manageable with proper medical oversight and extra precautions: uncontrolled high blood pressure, recent stroke, severe liver disease, seizures, serious breathing problems, or active substance abuse.
Some conditions might not be ruled out if treatment if they’re well-controlled: mild asthma, thyroid disorders, controlled blood pressure, eating disorders, anxiety, glaucoma, or bladder problems.
Medical eligibility isn’t the only barrier. For example, IV and injection therapy are expensive and entirely self-pay. Spravato is covered by insurance, but still costs around $8,000 out of pocket. And it must be administered in a REMS-certified clinic, which may not exist in your area.
How Can You Be Sure Ketamine Therapy Actually Works?
I pulled together 25+ systematic reviews from the last five years into one report—so you don’t have to rely on hype, guesses, or anecdotes. This is the highest level of real-world evidence we have.
Inside My Report You’ll Find
- What percent of patients enter remission—broken down by delivery method
- Which method is most effective—IV, injection, or Spravato nasal spray
- How fast ketamine can work to reduce or end symptoms
- Which combinations (like psychotherapy) may enhance response
- And a lot more…
Verified by the Platforms That Matter
This research summary report has been published across four trusted platforms that host peer-reviewed or open science content, including:
– Published ketamine research on Zenodo
– Ketamine evidence summary hosted on SSRN
– Scientific report on ketamine outcomes on Figshare
– Evidence-based ketamine therapy report on OSF
View the PDF Report Here:
WHAT HAPPENS WHEN YOU ARRIVE AT THE KETAMINE CLINIC?
This section explains the complete ketamine therapy clinic arrival process, from pre-appointment fasting guidelines through administration procedures. It details how clinicians monitor vital signs, prepare medications, and administer ketamine through three primary methods: IV infusion (40-60 minutes), intramuscular injection (effects within 5-10 minutes), and Spravato nasal spray (administered in three waves with 5-minute intervals).
How Should You Prepare Before Your Ketamine Treatment Session?
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.
What Happens When You First Enter a Ketamine Clinic?
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):
How Does IV Ketamine Infusion Work and What Will You Experience?
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.
What’s Different About Intramuscular Ketamine 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.
How is Spravato Nasal Spray Administered and What Makes it Unique?
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.
Why Are Oral Ketamine Tablets The Least Recommended for Depression Treatment?
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.
Takeaway
Ketamine therapy requires 6-8 hours fasting beforehand, involves depression screening and vital sign monitoring (keeping BP under 160/100), and offers three clinical delivery options—IV infusion (60-minute gradual dosing), injection (5-10 minute onset), or Spravato (administered in three staggered nostril sprays).
WHAT YOU’LL PHYSICALLY EXPERIENCE ON KETAMINE
What Physical Sensations Will You Feel During Ketamine Therapy?
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.
How Does Ketamine Create the Feeling 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.
Does Ketamine Really Eliminate Chronic Pain During Treatment?
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.
Takeaway
Ketamine creates complete dissociation between mind and body, eliminating chronic pain entirely while producing physical sensations of weightlessness, numbness, or altered body perception that feel surreal yet strangely peaceful.
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
How Does Ketamine Change Your Mental State and Thought Processes?
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.
Why Does Time and Space Feel Different During Ketamine Treatment?
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.
How Does Ketamine Create Mental Distance From Your Thoughts and Emotions?
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.
What Do Psychedelic Visions During Ketamine Feel Like and Do They Help?
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.
Takeaway
Ketamine transforms how your mind processes reality—warping time perception, creating mental distance from worries, and generating symbolic visions that can expose subconscious patterns driving depression.
Why watch this video:
- It shows how a single ketamine-induced vision revealed the depth of my self-hatred
- It explains how that vision slowly transformed into a symbol of self-worth
- It captures something talk therapy and SSRIs alone never touched
Click to see transcript
I want to show you how psychedelic visions can help end your depression. I know that sounds over the top—and it is—because the truth is, it takes a lot more than one vision. I should know. I went through ketamine therapy and had dozens. But I credit those visions as the reason I reached remission within six weeks.
When people hear “psychedelic visions,” they think of 1960s acid trips—Timothy Leary, The Electric Kool-Aid Acid Test, floating through space without Jeff Bezos or Elon Musk. But that’s not what they are in a therapeutic setting. In therapy, psychedelic visions are messages from your subconscious, always in the language of metaphor.
I want to tell you about one vision that was instrumental in creating the first green shoots of self-compassion.
Suddenly, I was seized by a vision of a wolf—red glowing eyes, radiating hatred—and it was eating me alive. I could hear my tendons snap and bones break in its jaws. It was horrifying.
Then I had a stunning realization: **I was also the wolf.**
That’s part of the gift of ketamine—dissociation. I could be two things at once: predator and prey. But that moment—the moment I realized I was the one eating myself—I don’t think I could’ve understood the depth of my self-hatred any other way.
Later, in therapy, I asked the wolf, “Why are you eating me?”
It answered: “To survive.”
When I told my therapist, he said, “That’s the most vivid expression of self-hatred I’ve ever heard.” I asked him what to make of the wolf’s answer. He said, “That’s your depression consuming your sense of self. Not out of malice, but as a survival strategy gone wrong. A twisted form of self-protection.”
Then he leaned in and said something I’ll never forget: “Self-hatred can be a desperate grab for control. For safety. A way to numb the pain.”
I asked him, “So… the wolf is eating me so I don’t have to look at what’s really making me depressed?”
He said, “Exactly.”
Later, I tried to engage the wolf again in meditation. It came quickly, but still hostile. At least it wasn’t eating me. I whispered, “There might be more nutritious things to eat than me. Like antelope. Or moose.”
And something shifted. The wolf backed off. It started hunting elsewhere.
Over time, the wolf kept returning in meditation. I wanted to be friends with it. I tried to communicate—not verbally, but… something like telepathy. And one day, it told me: **”I am not your friend.”**
It hurt. I was trying to make peace with this thing. But then I had a final vision. I was in a house, warm, while it snowed outside. The wolf was circling, howling—but this time, I didn’t feel threatened. I felt protected.
And I realized: the wolf was howling to the others, **”Michael’s okay. He’s safe.”**
What I understood was this: I don’t need to be your friend or family to recognize your worth. You are worth protecting. Period.
That’s what I want you to know about psychedelic visions. What started as self-hatred became the beginning of self-worth.
This didn’t cure my depression. It was early in the process. But it started a conversation with myself I never could’ve had through talk therapy or an SSRI.
So no—ketamine doesn’t work for everyone. But it can. And it might. It deserves your attention. And I want to help you figure out whether it’s right for you.
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)
Takeaway
A complete ketamine therapy session lasts between 100-150 minutes total—about 1 hour 40 minutes for IV/injection methods and 2 hours 15 minutes for Spravato nasal spray due to longer monitoring requirements.
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.
Takeaway
Ketamine’s cognitive impairment effects persist for hours after treatment ends, making driving illegal and dangerous even when you feel normal, with potential DUI charges that offer no legal defense.
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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.
What Does Research Show About Combining Ketamine with Psychotherapy?
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.
Takeaway
Therapists transform ketamine’s subconscious revelations into actionable insights, potentially boosting ketamine’s outcomes just as therapy definitively improves SSRI effectiveness by 25%.
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.