Ketamine and its History

Ketamine is classified as a Schedule III dissociative anesthetic. It is widely used in hospitals and emergency medicine today for surgery, pain control, and sedation. At higher doses, it produces anesthesia (loss of awareness and pain sensation). At lower doses, it can create a sense of mental distance from thoughts or emotions, altered perception of time or imagery, reduced intensity of depressive or traumatic symptoms, increased neuroplasticity (the brain’s ability to form new connections).

Ketamine was first synthesized in 1962 and approved as an anesthetic in 1970. Its use in psychotherapy began to be explored in the 1970s when a team of researchers was investigating its psychedelic-like properties for the potential to facilitate deep psychological work. However, formal research was limited during this time, often confined to underground settings due to the war on drugs.

Interest expanded significantly in the early 2000s. Researchers observed that patients who received ketamine for pain management reported a significant reduction in depressive symptoms. This led to a series of studies investigating the antidepressant effects of ketamine. A landmark study in the early 2000’s by researchers at Yale University showed that low-dose ketamine produced rapid antidepressant effects in patients with major depression. It works primarily by affecting the brain’s glutamate system, particularly NMDA receptors which plays a role in mood, learning, and neural flexibility. This action appears to “reset” or disrupt rigid neural patterns associated with depression, anxiety, and trauma. That finding shifted ketamine from being viewed primarily as an anesthetic to being studied seriously as a psychiatric treatment. This mechanism is fundamentally different from that of SSRIs, which can take a long time to relieve depressive symptoms and works by increasing the levels of serotonin, a different neurotransmitter, in the brain.

Over the past 15–20 years, research on Ketamine continues to grow rapidly and clinical trials are still ongoing, particularly for: Treatment-resistant depression, PTSD, Suicidal ideation, Anxiety disorders, and Substance Use Disorders. Today, Ketamine is being used as an “off-label” treatment for a variety of mental health issues.

Many clients report a significant, rapid, and sustained reduction in treatment-resistant depression, anxiety, and PTSD with improvements often lasting for months. Outcomes are enhanced when the psychedelic-like experience is paired with therapy, with studies showing 50–75% of patients achieving clinically significant improvements

Is It a Psychedelic?

Ketamine is sometimes described as having psychedelic-like properties because it can alter perception and awareness. However, it is pharmacologically different from classic psychedelics like psilocybin or LSD. Its mechanism of action and subjective effects are distinct.

How Is It Used?

When used therapeutically, ketamine is provided in a controlled, supervised environment at much lower doses than in surgery. It may be administered in forms such as Intramuscular injection (IM), Intravenous infusion (IV), Nasal spray (such as Spravato, the FDA-approved form of esketamine for treatment-resistant depression), or Oral Lozenges. This practice only uses oral Lozenges, prescribed by a provider.

Is It Safe?

When prescribed appropriately, controlled, and monitored by qualified medical professionals, ketamine has a strong safety record. However, the safety of ketamine therapy is heavily dependent on professional supervision. The FDA has warned that at-home or unsupervised use of compounded ketamine poses serious risks, including potential for abuse, misuse, or dangerous side effects like severe sedation. It is not appropriate for everyone, and careful screening is essential to determine candidacy.

While generally well-tolerated, side effects can occur, most of which subside shortly after the session such as dissociation (feeling detached from the body), dizziness, nausea, headaches, blurred vision, flushing of the skin, confusion, and high blood pressure. Rare/Serious side effects can include: Respiratory depression (slowed breathing) and hallucinations. Studies have shown potential for bladder or liver problems with long term/repeated use.

Ketamine is a Schedule III substance which is defined as having a moderate to low potential for physical dependence and a high potential for psychological dependence. Studies show that dependence is low in clinical settings, and risk of dependency increases significantly with frequent, unsupervised use.

Is It Right for You?

Ketamine-Assisted Psychotherapy may be helpful for individuals experiencing:

• Treatment-resistant depression

• Trauma or PTSD

• Anxiety disorders

• Existential distress

• Persistent negative thought patterns

Ketamine-Assisted Psychotherapy (KAP) is not appropriate for everyone. Careful medical and psychological screening is required.

You may not be a good candidate if you have:

• Active psychosis (hallucinations, delusions, schizophrenia-spectrum disorders)

• Unstable or untreated bipolar disorder, especially recent mania

• Uncontrolled high blood pressure or serious heart conditions

• Current pregnancy or breastfeeding

• Active, untreated substance use disorder

• Certain significant medical conditions (e.g., kidney or liver dysfunction, high blood pressure, cardiac problems)

Some individuals may require additional preparation or medical collaboration before proceeding.

Ketamine-Assisted Psychotherapy is not about “escaping” your feelings. It is about creating a supportive space where your nervous system can process trauma, your mind can become more flexible, and healing can unfold with intention and care.