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Mental health: why a ‘bad trip’ with ketamine treatment isn’t what you think it is.

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Editor's Note

Any medical information included is based on a personal experience. For questions or concerns regarding health, please consult a doctor or medical professional.

Please see a doctor before starting or stopping a medication.

If you have experienced emotional abuse, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741.

It was Wednesday and time for my ketamine treatment . There is a certain amount of routine to getting my treatments. When I started with ketamine I thought I would get the IV treatments once every three months or so. That’s what everything I had read said would happen. Maybe the “treatment-resistant” part of my bipolar disorder applies to ketamine too. I don’t know. In any case, we have determined that every other week works for me. By the beginning of the second week, I start to dip in mood. I can reach suicidal thinking by the time it’s time for the next infusion. We try not to let me get to that place.

The infusions are accompanied by psychedelic “trips.” That’s just part of ketamine. In the beginning, I believed that the trip didn’t matter — the drug got in me regardless of if the trip was “good” or “bad.” A lot of my trips are “bad.” I believe this is largely because of complex post-traumatic stress disorder ( C-PTSD ). I put bad in quotes because it’s not an accurate description. The trips can be scary. I see things and feel things that are frightening or unpleasant. I have been literally terrified several times. That doesn’t mean they’re bad, though.

The trip before last Wednesday’s infusion was terrifying. I screamed so hard that I lost my voice for almost a full week. I just screamed and screamed. I was certain that I was permanently trapped in this other world that I was hallucinating. The people in the room with me, the nurses and anesthetist, looked like stick figures. They were walking around and they were talking. I didn’t know what they were saying; I was too busy screaming, “Please, somebody, notice that I’m still trapped over here in this alternate universe. Let me out!” One of them was telling me I was OK. I was insisting, “I am not OK.” As the ketamine wore off, I returned to this world and realized everything was fine. Just like every other time.

When it was time for the next infusion two weeks later, the clinic director decided to have a nurse, Colleen, sit with me for the trip. The thinking was I would feel safer and stay calmer. Maybe not scream my head off. Colleen is special to me; she has been with me since my first infusion. She has held my hand many times when trips turned frightening, always reminding me “you are safe.” It was a logical and welcome decision to have Colleen sit with me.

Except in this trip, Colleen turned evil. The world was red and black, no other colors. The walls in the room looked like the walls in “The Matrix” with green code running down black walls. Except my “code” was red. Colleen was red and terrifying. She was saying terrible things. I was convinced that the clinic was a front for an evil organization trying to do mind control and keep me trapped in that cold, black-and-red world forever. I didn’t scream because Colleen was there. I was afraid of her. I was afraid of what might happen if I screamed. What would she do to me?

Coming out of that trip, I was convinced that it would be my last. I couldn’t keep doing this, I didn’t trust anyone; that’s part of C-PTSD after all. I sent the clinic director an email the next day and asked him if he could sedate me for my next trip. Sometimes when I get especially agitated during a trip, he will add in a little sedative toward the end. When he does that, I go home with little to no memory of anything that happened during the trip. He wisely answered that the trips were important; he wanted me to experience them.

And he’s right because here’s the thing. Those “bad” trips? They aren’t bad. They’re unpleasant. They’re scary. They’re challenging and very hard to go through. But they aren’t bad. Let me explain.

The day after the Red Colleen (sorry, Colleen) trip, I went to dinner with a friend. We talked about a lot of things. This was the first time we had gotten together since my suicide attempt two months earlier. I filled her in on what it was like when I made the attempt, the ambulance ride, the emergency room, the week spent on the medical floor of the hospital, and the week after that on the psychiatric floor. I walked her through all of it. On my drive home after dinner, I had to pull into a parking lot because I was so overcome with emotion that I couldn’t keep driving. I sat in the parking lot and sobbed, letting out all the emotion that had come up while talking to my friend. It was a good, cleansing cry. When I was composed enough to drive, I made my way home. Turned out, that cry was just the beginning.

Later that same night, after everyone had gone to bed, I was up by myself. I put YouTube on the television and played my favorite music video. I had discovered this video months earlier and it had become a constant as a self-care thing I did. This video could make me cry, it could make me laugh. Something about the music touched me deep in my soul; I physically felt the music. As it played this night, tears started to flow. And I let them.

That’s something my therapist has been working on with me for over a year: Feel the feelings. Don’t avoid them, don’t push them away. Stop the struggle. Feel them. As the song came to its end, I started to smile through my tears. This is an amazing piece of music. The next video started to play. I cried some more. For the next half hour, I cried as I listened to and felt the music. But I didn’t just cry. I was turned inside out. Something broke inside me. I sobbed. I laughed. I cried about the suicide attempt. I cried about the time in the hospital. I cried about how hard the past two years have been as I rapid-cycled through bipolar , up and down, going through six different medications on the way to being declared treatment-resistant and getting off all drugs. How much work I had done with my therapist, working through all the trauma of my childhood. And I kept crying.

Then I remembered my therapist had suggested the day before that I do a meditation we know called “Working with Difficulty.” It walks you through grounding like normal. But then the guide suggests that you take any negative emotion that is coming up and place it on the worktable of your mind. Find the physical sensations of it in your body. Where are you feeling this emotion?

The guide instructs that you don’t do anything to change your breathing, just notice it, focus on it. I was sobbing hysterically. And I kept sobbing. I was breathing; it was just sobs and hyperventilating, not the calm, controlled breathing I think of when I think of meditating. I let myself do it. I gave myself permission to feel this. To express it. As I worked through this 25-minute meditation, I let myself feel all of it. And as the crying continued, that traumatized little girl who had never been allowed to cry showed up. She started to cry. This is the miracle of ketamine: It allows your mind to do things it hasn’t been able to do before. That little girl had been shamed into never crying . It wasn’t allowed. And she desperately needed to cry. She was not going to be able to heal from the trauma until she could express all that she had stuffed so far down for so long. And I was able to give her permission. I encouraged her: yes, dear one, cry. Cry until you don’t have any tears left to cry.

And she did. She cried. She rocked back and forth. She hugged a pillow and sobbed into it. I don’t have words to describe what this experience was like. The intensity was beyond description. There was one point when I felt I was back in the psychedelic part of the ketamine trip. It’s like ketamine lets your mind open in places it hasn’t opened before. This gave me the space and the permission I needed to let this little girl cry her heart out.

This was such a healing episode. I’m not the same today. I’ve been used to learning coping skills in therapy. I assumed that was the best I could hope for — learning how to cope. But, no. This was healing. The pain that that little girl had held inside all these years was released. This isn’t the first time I’ve had such a physical reaction and release of repressed pain. And it is ketamine that allowed this — caused it.

As I said in the beginning, I believe there’s no such thing as a bad trip. Every trip I’ve had that was painful ended with something good. A new insight. An expression of long-buried pain. I feel it necessary to say that I have not arrived at these good results alone. I have needed the guidance of the people at the clinic. I have needed my therapist. I have needed my psychiatrist. I don’t know psychedelics. Had I done these trips on my own, I think I would have ended up further traumatized. These trips can get very difficult and very intense. But my subconscious has been hard at work during them. Things have bubbled to the surface — the conditioned emotional responses, the fight-or-flight triggers, the repressed memories, they have been in my mind all along. Ketamine, along with therapy, has allowed those things to surface and be dealt with. It’s a very powerful and healing combination.

For more on ketamine treatments for depression, bipolar disorder, trauma and other mental illnesses, see The Mighty Community’s posts here .

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Early childhood trauma and lifelong struggles with mental health led me to The Mighty. I've learned the power of sharing and not staying in this madness alone. Sometimes I can support, sometimes I need support.

Psychedelic Spotlight

What Are K-Holes? The Ketamine Experience Explained

What Are K-Holes? The Ketamine Experience Explained

The words people use to describe falling into a K-hole—the psychedelic trip experienced on high doses of ketamine—read like opposites. Paralyzing. Introspective. Detached. Peaceful. Frightening. Euphoric. Transformative. Near-death. 

For some, that translates into a dream experience. For others, it’s a nightmare. 

What exactly happens to a person when they fall into a K-hole? To better understand, let’s take a closer look at what exactly the drug is. 

What is Ketamine?

Ketamine is a derivative of PCP (Angel Dust) that was first approved by the U.S. Food and Drug Administration (FDA) in 1970 as an anesthetic for diagnostic and surgical procedures. It grew to become one of the most widely used anesthetics in the world. Now, it's is considered by the World Health Organization an essential medicine for pain relief in both adults and children. 

At higher than therapeutic doses, ketamine delivers a dissociative high that has made it a popular party drug. It’s also why the U.S. DEA has listed it as a Schedule III substance in the same category as anabolic steroids, testosterone, and codeine. While not as shunned by the feds as Schedule I and II drugs like heroin and Oxycontin, as a scheduled drug, ketamine’s use remains heavily policed. 

In the 1990s, researchers began looking at it as a possible treatment for depression. When combined with cognitive behavioral therapy, ketamine has been shown to be life-saving. It can provide relief from depressive symptoms within hours as compared to weeks or months with antidepressants like Prozac. Researchers say it appears to reprogram the brain. Despite studies that show ketamine’s benefits for treatment-resistant depression, it’s been difficult to loosen the FDA’s grip around it.  

Since ketamine is not outlawed and has approved medicinal uses, it can be prescribed for off-label uses as depression therapy. This is how ketamine infusion centers can legally treat people with the medication without FDA approval for that indication. 

Depression treatment levels of ketamine are higher than doses used for anesthesia in medical settings and typically lower than doses taken in party scenes. But at even higher doses, the effects of ketamine kick into high gear and can drive you into the ‘K-hole'. 

ketamine slechte trip

What is the K-Hole Like?

Falling into a K-hole is nothing like the “zoned out” high from recreational use of ketamine. It’s like your body becomes paralyzed. You feel as if you’ve traveled outside your body and are watching yourself from afar. These episodes may accompany intense visuals as well as moments of deep reflection. In retrospect, those experiences can feel transformative or therapeutic. Some, however, have likened it to a near-death experience.

The entire experience only lasts for about 30 minutes, but while you’re in the k-hole, time can feel as if it’s standing still. When you emerge, you feel as if you’ve been gone for hours. 

Researchers use the term dissociative to describe this state. “You essentially feel completely dissociated from the world around you as if you don’t exist in this world,” says Bita Moghaddam, a leading researcher in the field of neuropharmacology and author of Ketamine , a MIT Essential Knowledge Book scheduled to be released next month.

Moghaddam recently spoke about the treatment and its possibilities on MIT Press podcast . saying the slang term “K-hole” refers to “how profoundly scary and aversive the experience can be” because, for some, it can feel like dying. But it’s not a negative experience for everyone. 

Is the K-hole Really Like a Near-Death Experience?

Ketamine works by blocking a receptor in the brain that is responsible for how nerve cells interact. That creates a dissociative effect. During these episodes, the brain may actually mimic death in some ways, according to a June 2020 study published in Scientific Reports .

For the study, University of Cambridge researchers administered ketamine to a dozen sheep and then studied the effects the drug had on their brains using electroencephalography (EEG). They found that, at sedation, the sheep’s brains showed alternating periods of high and low frequency. “This alternating EEG rhythm phase is likely to underlie the dissociative actions of ketamine, since it is during this phase that ketamine users report hallucinations,” researchers said. 

But at the highest intravenous dose, researchers observed a novel effect of ketamine, namely the “complete cessation of cortical EEG activity,” they said. This lack of electrocerebral activity—when confirmed with a 30-minute good quality EEG recording—is one of the most commonly used measurements in determining of death .  

While it may not be an actual near-death experience for users (overdoses of ketamine alone are quite rare), the Cambridge researchers noted that the phenomenon is likely to explain the ‘K-hole,’ “a state of oblivion likened to a near death experience.”

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Understanding What Ketamine Commonly Feels Like

ketamine slechte trip

  • Having questions and concerns is a normal part of beginning ketamine therapy.
  • The “felt experience” of ketamine therapy is less intense than people expect.
  • Clients often describe ketamine therapy as calming and relieving of negative thoughts.

Trying any new therapy or treatment can be scary. Here is what you need to know about how ketamine might feel. Keep in mind that every individual's experiences are unique, and each session will be different.

Ketamine is incredibly safe.

Ketamine has been approved by the FDA since the 1970’s and is included on the World Health Organization's list of Essential Medicines. 

When used in surgical anesthesia ketamine has been proven to have a remarkable safety profile at doses considerably higher than those used in ketamine therapy. 

Furthermore, in the largest clinical study of ketamine therapy the results show minimal risk of side effects. 

Notable outcomes from the study include:

  • 89% of the participants reported improvement in their depression or anxiety symptoms, and 63% of participants experienced a greater than 50% reduction.
  • For both depression and anxiety, over 30% achieved remission (or virtually no symptoms) after 4 sessions.
  • Fewer than 5% of participants reported side effects from treatment.

The experience has a gentle onset.

Mindbloom’s method of sublingual administration—using a rapid dissolve tablet placed under the tongue— has a more gentle onset than IV or IM-injections, which are commonly used at ketamine clinics. 

The experience is gentle, bringing you slowly into and out of the experience, and returning to normal consciousness around 60 minutes later.

A common timeline for the ketamine experience can look like: 

ketamine slechte trip

For most individuals following our protocols, the experience typically lasts less than an hour. It is important to note that exact timing may vary from person to person, and from session to session. 

This is a general overview of the ketamine experience provided by our clinical team.

Ketamine can be very calming.

One of the most common things we hear from clients is how their sessions can be very calming. 

Here are some direct quotes from previous Mindbloom clients who have gone through our Basics program:

  • “The most surprising part of my Mindbloom experience was how gentle and safe it felt.” — Brenna, Writer
  • “I expected a punch in the face, but it felt more like a tickle on the arm.” — Brittni, Project Manager
  • “I appreciate the comfort and safety of my own living room.” — Noah, Land Use Consultant

Ketamine can induce a feeling of relief.

During and after the experience, many clients describe feeling relief from ruminative thoughts and other, normally-present anxieties.

The ketamine experience can provide new and novel perspectives on your life, which gives you a new way to relate to and manage old thoughts that may have previously caused or contributed to daily stresses. 

Here are a few quotes from Mindbloom clients who have had similar experiences:

  • “Mindbloom gave me a better perspective on anxiety, depression, and life itself.” — Deborah, Student
  • “I’ve reframed my negative thoughts into positive ones.” — Sarah
  • “Mindbloom helped build a foundation that I needed to keep me from spiraling and feeling lost.” — Andrew, Financial Advisor

Ketamine works with you

While there are moments when working with ketamine that can be challenging or emotionally intense, ketamine has proven itself to be safe, approachable, and gentle throughout decades of use and hundreds of thousands of individual sessions.

Ketamine works with you, not against you, as you move towards your own healing and wholeness.

ketamine slechte trip

Eric Brown is a content writer and program creator at Mindbloom, and the Director of Apotheosis Retreats. As a facilitator, coach, guide, and creator, he combines cognitive science, psychedelic medicines, and healing modalities to create powerful spaces for personal growth and development.

ketamine slechte trip

Chelsea Tersavich, PA-C, is a psychiatric clinician who has conducted psychiatric evaluations and facilitated ketamine therapy sessions for over 250 Mindbloom clients. Chelsea obtained a master’s degree from the Interservice PA Program and has extensive mental health and primary care experience from her army career, where she treated thousands of Soldiers as a Battalion PA and a clinic Medical Director.

This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255 , call 911, or go to the nearest emergency room.

ketamine slechte trip

Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here .

Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).

Do not proceed with ketamine treatment if any of the following apply to you:

  • Allergic to ketamine
  • Symptoms of psychosis or mania
  • Uncontrolled high blood pressure
  • CHF or other serious heart problem
  • Severe breathing problem
  • History of elevated intraocular or intracranial pressure
  • History of hyperthyroidism
  • Other serious medical illness
  • Pregnant, nursing, or trying to become pregnant

Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.

While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.

  • In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
  • Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
  • Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom ® clinician before proceeding with treatment.
  • The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.

To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:

  • Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
  • Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
  • Continue to take antihypertensive medication as prescribed
  • Avoid hangovers or alcohol intake
  • Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
  • Ketamine treatment should never be conducted without a monitor present to ensure your safety

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Let’s Talk About Bad Trips: Separating Difficult from Traumatic

Bad trips are a polarizing concept in psychedelics. acknowledging that they exist - and knowing how to work with them - can be healing..

Bad trips with psychedelics

Want to start a war on social media? Post something like this: “Bad trips exist.”

As somebody who has worked in the psychedelic space for years now and has supported many, many people during their trips, it’s time to come out of the closet and say it: people can be harmed by psychedelics, and bad trips exist.

But allow me to define the term “ bad trip ,” because the vague phrase has become too polarized to be meaningful.

When I talk about bad trips, I’m not talking about the harrowing, painful journeys to the underworld from which we return raw and exhausted, with some important piece of our healing work having been catalyzed.

When I talk about bad trips, I mean the trips that register in the body as a trauma or injury to the nervous system. And that is not , in fact, the same thing as a difficult trip.

What happens when we deny this truth is that we inadvertently alienate those who have had traumatic or harmful experiences. These people have endured a trauma, and are now being told that they have not.

So let’s talk about traumatic trips: The psychedelic experiences that leave us injured. Thankfully, they are rare.

I’m not just speaking from my observations as a clinician, but also from personal experience: I had a traumatic psychedelic experience on ayahuasca many years ago. I was decidedly “not okay” afterwards and required much time and support to recover.

Despite the shock and injury to my nervous system, I eventually used psychedelics again. In fact, in the eight or so years that have passed since the traumatic trip, I have openly supported the legalization of psychedelics, and have built two businesses centered around empowering people to heal with psychedelics.

I have also taken sabbaticals from my practice to work in other countries as a psychedelic facilitator. I am now a lead educator in the country’s first training program for psilocybin facilitators to be licensed by Oregon’s Higher Education Coordinating Commission (HECC). I’m a ketamine prescriber, and I train other prescribers in the use of ketamine for treating chronic pain and mood disorders. I lead and run intensive healing retreats. I’ve also taken my own fair share of mind altering substances in a variety of sets, settings, and time zones.

All of which is to say: I am no newcomer to the world of psychedelics.

And yet I cannot swallow the field’s echo-chamber-like mantra that “there is no such thing as a bad trip .” In fact, I find the rabidity with which some of my fellow cosmonauts deny the existence of bad trips to be rather disconcerting. In the more-than-one heated debate I’ve had about this topic, I’ve noticed certain patterns – or myths, if you will – around the topic of traumatic trips. I address each one here.

Myth: Bad Trips Only Happen When the Set and Setting Are Improper

If the word “only” didn’t appear in the above sentence, it would be true. In my experience in working with hundreds of patients who have used psychedelics – and in administering psychedelics myself – I’ll say that the vast majority of traumatic trips happen when the environment is not safe, calm, and supportive.

When we talk about set and setting in psychedelic harm reduction , we mean two things: (1) the person’s mindset when they took the drug, and (2) their physical environment. If somebody had just had an argument with their spouse before taking LSD, for example, that’s their set. If they were at a noisy, crowded music festival, that’s the setting. Perhaps unsurprisingly, the majority of bad trips happen when individuals on drugs feel overwhelmed in a noisy, chaotic setting like that of a concert or party. Drug-drug interactions are also often at play during difficult trips, for example, when people combine alcohol with psychedelics.

When people insist a little too strongly that, “There’s no such thing as a bad trip, if the set and setting are right,” I feel uneasy. It’s perhaps like asking a rape survivor, “Yeah, but what were you wearing?” (If you think the analogy of a bad trip and rape is too far of a reach, you luckily have never had a traumatic trip.)

There are other factors in psychedelic harm reduction that influence the outcomes. These include the substance being used, the dosage taken, and the people you’re with.

ayahuasca ceremony in yurt with a bad trip

The night of my traumatic trip was the third of a three-night ayahuasca ceremony. I was there with my then-partner. I liked the other people attending. I trusted the facilitators completely and knew they were well trained and highly esteemed by their colleagues. The medicine was pure. The environment was soothing and well contained. The music was beautiful. The first half of the third ceremony was trippy, strange, and lovely.

After I drank my second dose of the brew, however, I was decidedly NOT OKAY. I will not describe the experience here, but I will say two things about it: (1) I felt like my nervous system was being gang raped, repeatedly, and (2) I can now absolutely understand why people with psychosis sometimes choose to die by suicide.

The facilitators of the circle took care of me, pulling me out of the ceremony space and letting me try to calm down outside. Somebody stayed with me at all times until I vomited up the salt water they gave me to drink.

There’s one factor of harm reduction we don’t discuss enough: dose. It’s possible that the second cup of ayahuasca I drank that night contained more voltage than my nervous system could handle – that it was too much, too fast, and too hard for me.

The Influence of Neuroticism

Aside from the environment, another factor that can predict bad trip potential is neuroticism. Neuroticism is one of the “Big Five” traits thought to collectively form the full picture of personality.

People who score high on neuroticism tend to overthink things, typically have a hard time relaxing, and may feel irritated in noisy settings or stressful situations. These folks are often described as “high strung.”

At least two studies have shown that people who score high on neuroticism scales are more likely to have a challenging psychedelic trip than those who score lower. [1] , [2] The theory behind this is that if a neurotic’s negative thoughts or feelings arise during a psychedelic trip, the person might get pulled into an amplification spiral of their own negativity.

But does that mean it’s somebody’s fault that if they tend towards neurosis and they have a bad trip? Aren’t psychedelics supposed to help heal negativity? What does it mean that the same drugs that help soothe negative thoughts and feelings can also make us feel worse? (Let a neurotic chew on that one.)

Once again, we could very easily slip into the territory of victim blaming if we are not mindful.

While writing this article, I took the Big Five Personality Test online. I scored in a higher-than-average percentile for negative emotionality (neuroticism). That may explain why grumpy cat is one of my heroes and why my friend Greg refers to me as “a female Larry David.” It could also explain why I’m one of the unlucky few who have had a traumatic psychedelic trip. (Side note: I also scored pretty high on open mindedness, so that could explain why got into psychedelics in the first place.)

I took ayahuasca and I still hate everything

Myth: Bad Trips Are Actually Just Difficult Experiences That Haven’t Been Integrated

I continue to stay in this field because traumatic trips are, indeed, exceedingly rare, and because the healing gains people typically experience from psychedelics are unparalleled by any other intervention I’ve found.

Working regularly with patients in non-ordinary states of consciousness, I see that the most challenging experiences are often the most rewarding. Drawing from my previous experiences in volunteering with the Zendo Project and White Bird , I teach my students the tenants of “trip sitting.”

As one of the Zendo principles states: difficult is not necessarily bad. Note that the phrase is not “difficult is not bad,” but rather, “ difficult is not necessarily bad. ” In other words, difficult can sometimes be bad.

Another layer to this argument is that if you wait long enough, the bad experience will prove itself to be good. This does, indeed, happen to many people after their challenging journeys. Yet there is a difference between suggesting this to a bad trip survivor and insisting that “everyone gets the trip they need.”

Many of my new-age peers have become allergic to the word “bad,” especially within the context of bad trips. “Is anything really bad?” I’m often asked. The argument here, as I understand it, is that with every cloud there comes a silver lining, and that silver lining might just hold a very valuable teaching for us.

I admit that my own traumatic trip gave me a lesson: It taught me that there is indeed such a thing as a bad trip. Another gift was that my bad trip helped me to better understand, validate, and support others who have been harmed by psychedelics. Another lesson was this: my bad trip was an amplifier of the toxic positivity that I see running rampant in the psychedelic field.

In fact, a patient once confessed to me, “I’m just so mad at her” – her being ayahuasca – “but everyone in the group is so in love with Great Grandmother that if I say one bad thing about her, it’ll be like heresy.” I noticed that he was clenching his jaw and only breathing into the upper part of his chest. I leaned forward, looked him in the eye, and said: “Tell me exactly what you think about that bitch – you won’t offend me.”

By the end of the hour, he had raged, wept, and laughed. His breath was reaching his abdomen and his jaw was relaxed. The client messaged me some days later, saying, “That was so healing for me just to be heard, to be able to say mean things without being afraid somebody would cancel me. Thank you.”

Perhaps for this client, “the medicine” was to be heard without anybody trying to stop him from expressing anger. Maybe the bad trip was just part of the arc that took him to that finale. I don’t know.

Myth: There’s No Such Thing as Bad

There’s that old story about the Zen master, whose son got a new horse. “What good luck!” The neighbors said. “We’ll see,” said the master. One day the son was thrown from the horse and broke his leg. “How terrible!” Said the neighbors. “We’ll see,” said the master. Then the country went to war, and the army came to recruit soldiers. Because the young man’s leg was broken, they army didn’t take him to battle. “How good!” said the neighbors. “We’ll see,” said the Zen master. Perhaps there is no good or bad.

What I’ve always found lacking in this story about the Zen master was the voice of his son – the one who actually fell from the horse.

Is a bad trip like falling from a horse? It absolutely can be. Yet something about the “you just haven’t integrated it yet, there’s gold there” argument feels like a dismissive bypass. Let us consider other situations in which we could apply such a statement:

  • After getting food poisoning and vomiting for hours
  • After taking penicillin and breaking out in a full body rash
  • After going on a horrible date
  • After surviving a sexual assault
  • After your child has been diagnosed with a life-threatening illness
  • After losing a loved one to cancer
  • After surviving a terrible accident that has resulted in disability
  • After your cat has been run over by a car
  • After losing a house to foreclosure

bad trips during psychedelics

Would we really tell the people in the above hypothetical situations that there was no such thing as bad shellfish? No such thing as a bad drug reaction or a bad date? No such thing as rape? No such thing as a bad diagnosis, a bad prognosis? Or how about just a bad day? Or something as non-threatening as a bad movie, a bad haircut, or a bad parking job? Would we really tell somebody whose child just died to avoid using the word “bad” to describe her condition?

Perhaps it is true that none of these things are bad, and that all of them are blessings in disguise. But would we really get righteous about it on social media, the way some of us do about denying bad trips?

And what’s so bad about saying “bad,” anyway? Must everything truly be a blessing? (The neurotic writing this article needs to know.)

I’d also like to share the story of Becks. Becks was a 24-year-old female patient of mine with anorexia nervosa who did MDMA-assisted psychotherapy to heal from PTSD (post-traumatic stress disorder) rooted in childhood sexual abuse.

In a follow-up visit, Becks told me that the MDMA-assisted therapy session (done with an underground provider) had done wonders for her. She was getting much more mileage out of her weekly therapy sessions. She was now remembering things she had repressed previously, and she was able to stay present when the memories arose.

Becks had also forgiven herself. She explained that without realizing it, she had blamed herself for what happened to her when she was a child, punishing herself through self-denigrating thoughts, food restriction, and high-risk drinking. Her MDMA-assisted therapy session helped her identify this pattern and realize that she didn’t deserve the blame or the punishment. Having forgiven herself, Becks was now sleeping better at night, eating when she was hungry, and avoiding alcohol. Clearly, much healing had occurred for her.

Yet Becks felt discouraged and worried. “I don’t think I’m doing it right,” she told me while pulling at the rings on her fingers.

“Why’s that?” I asked.

“Well,” she explained, “I know I’m supposed to get to this place where I feel like the trauma was a blessing – and that hasn’t happened.”

“You think you’re supposed to get to a place where you think that being repeatedly molested as a child is a blessing? ” I asked her.

“Yes,” she said with a defeated sigh as she looked at her shoes.

“Where’d you get that idea?”

Her head snapped up to look at me, breathless, huge-eyed. And then she burst out laughing. The laughter turned to tears. She sobbed and babbled something about a podcast she’d heard. Then she laughed some more. Her face lit up and the color returned to her cheeks.

“Becks, was being molested by your stepbrother every night a blessing?” I asked her.

“No, it was a fucking horrible nightmare that I wouldn’t wish on my worst enemy,” she declared.

“Okay,” I said, “and is it possible that it was a fucking horrible nightmare and that you still get to heal and have a happy adult life starting right now?” I asked.

“ Fuck yeah,” she said. And the look on her face told me she believed it.

(This, by the way, is what happens when you go to a doctor who scores high on neuroticism scales: We acknowledge and celebrate that life might be a fucked up mess sometimes, and that we can still heal even if we don’t buy into toxic positivity.)

(Also: I do have patients who come to see their traumas as gifts. It truly is a powerful and important step in their healing. But let’s not assume that healing cannot happen in other forms. Everyone’s path is different and valid.)

Myth: Talking About Bad Trips Is Going to Harm the Psychedelic Movement

On the day I graduated from medical school, I took an oath to First, Do No Harm . Sometimes, First, Do No Harm means doing the uncomfortable thing or saying what others don’t want to hear. In this case, it means acknowledging that there are risks to using psychedelic substances, and a traumatic trip is one of those risks.

Every therapy, every medicine, every experience comes with risks and benefits. One risk of taking vitamin C is that too much can cause diarrhea. One risk of antibiotics is that they can lead to vaginal yeast infections. One risk of using acetaminophen (paracetamol) is that it’s hard on the liver. One risk of eating a vegan diet is that it can deplete vitamin B12 stores and subsequently trigger depression. One risk of a life-saving surgery is that it can result in a lethal infection. And so forth.

Psychedelic medicines also come with their risks, and the risk of a traumatic trip should be on that list. Admittedly, it should be in small letters, towards the bottom of the list, next to the words “very rare when used in therapeutic contexts.” But traumatic trips are, in fact, “a thing.” They’re part of the fine print.

As far as I know, bad trips have not been reported in any of the clinical trials on psychedelics – but keep in mind that we haven’t had too many people go through the clinical trials as compared to the number of folks doing psychedelics “in the wild.” Bad trips may have also been down-played in the trials as “dysphoria” or “agitation” by the researchers.

Are the possible risks of psychedelic medicines worth wagering for the potential benefits? The answer to that question can only be answered on a case-by-case basis – as with any intervention.

For me personally: The healing engendered by psychedelics has far outweighed and more than redeemed the harm I’ve endured. Every time I take a psychedelic medicine now, I understand that I am taking a risk, and I make the clear, informed decision to proceed – or not to proceed, depending on the circumstance.

When I advocate for the destigmatization and legalization of psychedelics, furthermore, I don’t just act out of love for the movement: I act out of love for my patients.

What’s going to injure the psychedelic movement even more than a level-headed discussion about traumatic trips is the harm that may be caused by denying them.

How to Talk to a Bad Trip Survivor

So, what should we say to a survivor of a traumatic trip? Anything but: “There’s no such thing as a bad trip.”

If somebody tells you they’ve endured a bad trip, treat them as if they’d just told you that they survived an accident, an assault, or another kind of shock. Offer them comfort and support. Listen. Don’t ask them to prove the truth of what they say happened.

Essentially: treat them as you would treat the survivor of any kind of experience that was too much, too hard, and/or too fast for their mind, body, or spirit.

Remember that the word “trauma” does not refer to the distressing event itself, but rather to the resulting emotional and neurological response. Trauma can harm a person’s sense of Self, their sense of safety, their ability to navigate relationships, and their ability to regulate their emotions. Trauma, in other words, is injury to the nervous system that ripples outward. (To be clear: Trauma does not mean simply feeling uncomfortable or offended, as some people mistakenly use it.)

Even if integration of the experience would be helpful for the survivor – and might even help them stop using the term “bad trip” to describe it – that cannot happen at the beginning. The first thing the bad trip survivor likely needs is to know that they are safe now . The nightmare has ended, and they are loved and supported by trustworthy people who care.

How can we help others feel safe? By our presence. By regulating our own breath. By listening. By letting them know that we believe them. By showing empathy. By making them soup, gifting them a massage, or offering to pick their kids up from school. By being kind.

Even if the traumatic trip was the result of poor planning, improper set and setting, or other user error, hold your tongue for now. Think of how you might react if a friend was in a terrible car accident that resulted from driving when they were overly tired.

Think of how you might respond if a child dragged a chair to the kitchen counter and climbed atop it to try and reach the off-limits cookie jar sitting high up on a shelf – only to tumble backwards and slam onto the floor. Would you shout, “Well, that’s what you get for climbing on the chair!” while the poor kiddo cried on the linoleum? I hope not. I hope you would sit by their side, hug them, and stroke their hair. Once you felt their breathing return to normal and the smile return to their face – and not a second sooner – might you ask, “Honey, remember what we said about climbing on the furniture?”

Healing From My Bad Trip

It took me almost eight years to feel like I had fully integrated my bad trip. Curiously, what helped me complete the arc from wound to health was a peyote ceremony.

What prolonged my healing was people insisting that there was no such thing as a bad trip. I heard this line in my ayahuasca circle, at psychedelic conferences, on social media, on podcasts, and in books. The experience-denying and victim-blaming made me feel angry and alone.

Another factor that delayed my full recovery was peer pressure. Buckling to the well-intentioned insistence of friends, I returned to the ayahuasca circle (and other psychedelic circles) sooner than I truly wanted to. This meant that I was taking medicines with a mindset of doubt and fear, which resulted in several dysphoric, confusing, and terrifying journeys that only compounded the injury.

I was fortunate to find a healer who believed in bad trips and who confirmed that I was not fully in my body. Through regular sessions, I was able to return. While my therapist hadn’t had much psychedelic experience herself, she at least believed me. That allowed us to start from a place of trust and not from a place of defensiveness. I also took a break from psychedelics and instead cultivated gentler, more predictable health-affirming practices like singing and going to the gym.

Years after the experience, I read about the concept of “too much, too hard, too fast” in a book about psychedelic facilitation. I felt a surge of heat rush to my face as I read the words; hot tears filled my eyes. I hadn’t made it up. It had happened to me. I wasn’t weak, or stupid, or crazy. But why was the truth so hard for other people to accept?

I’m grateful to my own stubborn will to get better – to that spark within me that keeps me seeking out people, places, and things that can help me heal, grow, and learn.

There was, indeed, some good that came from my bad trip on ayahuasca all those years ago. The seams of that horrific shroud were sewn with golden thread. I am grateful for the blessings gleaned.

I am also grateful to my unconditionally supportive family, friends, and partner, and to Grandfather Peyote for helping me weave the blessings into my life and pull back the heavy curtain.

I had a bad trip, and that’s okay.

And you know? Considering that I’m a neurotic, I’m pretty proud of myself for saying so.

Follow your Curiosity

[1] Barrett FS, Johnson MW, Griffiths RR. Neuroticism is associated with challenging experiences with psilocybin mushrooms. Pers Individ Dif. 2017 Oct 15;117:155-160. doi: 10.1016/j.paid.2017.06.004 .

[2] Petter Grahl Johnstad (2021) The Psychedelic Personality: Personality Structure and Associations in a Sample of Psychedelics Users, Journal of Psychoactive Drugs, 53:2, 97-103,  DOI: 10.1080/02791072.2020.1842569

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Self-Discovery

Ketamine trips are uncannily like near-death experiences

<p><em>Photo by JR Korpa/Unsplash</em></p>

Photo by JR Korpa/Unsplash

by Christian Jarrett   + BIO

ketamine slechte trip

First-hand accounts of what it is like to come close to death often contain the same recurring themes, such as the sense of leaving the body, a review of one’s life, tunnelled vision and a magical sense of reality. Mystics, optimists and people of religious faith interpret this as evidence of an afterlife. Skeptically minded neuroscientists and psychologists think that there might be a more terrestrial, neurochemical explanation – that the profound and magical near-death experience (NDE) is caused by the natural release of brain chemicals at or near the end of life.

Supporting this, observers have noted the striking similarities between first-hand accounts of NDEs and the psychedelic experiences described by people who have taken mind-altering drugs.

Perhaps, near death, the brain naturally releases the same psychoactive substances as used by drug-takers, or substances that act on the same brain receptors as the drugs. It’s also notable that psychedelic drugs have been taken by the shamans of traditional far-flung cultures through history as a way to, as they see it, visit the afterworld or speak to the dead.

To date, however, much of the evidence comparing NDEs and psychedelic trips has been anecdotal or based on questionnaire measures that arguably struggle to capture the complexity of these life-changing experiences. Pursuing this line of enquiry with a new approach, an international team of researchers led by Charlotte Martial at the University Hospital of Liège in Belgium has conducted a deep lexical analysis , comparing 625 written narrative accounts of NDEs with more than 15,000 written narrative accounts of experiences taking psychoactive drugs ( sourced from the Erowid Experience Vaults, a US-based non-profit that documents psychoactives), including 165 different substances in 10 drug classes.

The analysis, published online in Consciousness and Cognition in February 2019, uncovered remarkable similarities between the psychological effects of certain drugs – most of all ketamine, but also notably the serotonergic psychedelic drugs such as LSD – and NDEs. Indeed, the five most common category terms in the narrative accounts of people who’d taken ketamine were the same as the five most common in the accounts of NDEs, suggesting ‘shared phenomenological features associated with an altered state of perception of the self and the environment, and a departure from the everyday contents of conscious mentation’.

From category to category, the semantic similarity is profound. When referring to perceptions, both groups used the words ‘face’ and ‘vision’. The emotional word most commonly used by both was ‘fear’. In the category of consciousness and cognition, drug-takers and participants who’d been close to death most often referred to words such as ‘reality’, ‘moment’, ‘universe’, and ‘learn’. The setting was often described as ‘door’ and ‘floor’. A negative tone emphasising unpleasant bodily sensations was a shared common theme, as well.

T he findings back up the observations of some of the most famous 20th-century explorers of the psychedelic world – the American psychologist Timothy Leary described trips as ‘experiments in voluntary death’, and the British-born writer and philosopher Gerald Heard said of the psychedelic experience: ‘That’s what death is going to be like. And, oh, what fun it will be!’ But claims about the similarities go beyond these famous reports. The new research legitimises the long-standing analogy between the experience of dying and the acute effects of certain psychoactive drugs. Links between dying, death, a potential existence of afterlife and certain hallucinogenic plants and fungi emerged independently across different societies, and are also ubiquitous in contemporary psychedelic culture. However, empirical research has been scarce, until now.

To an extent, the results also support neurochemical accounts of NDEs, and especially the controversial proposal that such experiences are caused by the natural release of an as-yet-to-be-discovered ketamine-like drug in the brain (adding plausibility to this account, ketamine is known to act on neural receptors that, when activated, help to prevent cell death and offer protection from lack of oxygen).

‘This body of empirical evidence supports that near-death is by itself an altered state of consciousness that can be investigated using quantitative psychometric scales,’ the researchers say. That in itself is quite a realisation. As they note wryly, ‘Unlike other human experiences, dying is difficult to study under controlled laboratory conditions by means of repeated measurements,’ making it a challenge to investigate NDEs experimentally. Although the new research lacks laboratory control, on the plus side, the lexical comparison that Martial’s team conducted is ‘massive both in terms of the investigated drugs and the number of associated reports’.

The limitations of the current approach, including a reliance on retrospective reports, often decades-old, means, as the researchers put it, that they cannot validate nor refute the neurochemical models of NDEs. ‘However,’ they add, ‘our results do provide evidence that ketamine, as well as other psychoactive substances, result in a state phenomenologically similar to that of “dying” (understood as the content of NDE narratives). This could have important implications for the pharmacological induction of NDE-like states for scientific purposes, as well as for therapeutic uses in the terminally ill as means to alleviate death anxiety. We believe that the development of evidence-based treatments for such anxiety is a cornerstone of a more compassionate approach towards the universal experience of transitioning between life and death.’

They also warn experimenters to be prepared and beware. ‘The intensity of the experience elicited by [ketamine] relative to cannabis may represent a shock to unsuspecting users, who could retrospectively report the belief of being close to death,’ the researchers say. Pot-smokers, you’ve been warned. As one of the most intense and life-changing altered states known, an NDE is no toke on a pipe after class or work.

This is an adaptation of an article originally published by The British Psychological Society’s Research Digest.

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What a Ketamine "Trip" for Depression Is 'Really' Like

Treating depression with the former party drug is a major development in psychiatric medicine, and now you can even do it from the comfort of your home.

Chelsea Greenwood is an award-winning writer and editor with a focus on lifestyle content at renowned local, regional, and national outlets — both in print and online. She has more than 15 years of experience in journalism, backed by her journalism degree from the University of Florida. She is currently a developmental editor for The Spruce and MyDomaine as well as a news editor at Static Media's The List. In additional to InStyle, she has also written for Teen Vogue, Self, Vice, Vulture, Business Insider, Apartment Therapy and more.

ketamine slechte trip

Leaving the house before the pandemic was hard enough, thanks to my social anxiety and depression. But once lockdown started? Forget about it. Being in quarantine exacerbated my symptoms until, one day, I realized that I could hardly get out of bed. From eating and working to binge-watching and texting, I did it all in my bed.

I was on antidepressants, and my depression was worse than ever.

While I'd heard good things about ketamine therapy, I figured it was too pricey, and the idea of going to an actual brick-and-mortar clinic was beyond me in my depressed state. But Google was onto me: I was served an ad for Mindbloom, an at-home ketamine treatment company.

When I looked it up, the cost was considerably less than I had expected (even though the company doesn't take insurance), and I read that dedicated "guides" would be there via video chat to help me along the way and process my experiences. So, after some more research, I signed up. What did I have to lose?

As it turned out, a lot. Over the past 12 weeks and 12 treatments, I've lost that heaviness that kept me stuck in bed like gravity. I lost that ever-present sense of impending doom. Plus, I found a little bit of clarity and a lot of hope. Things aren't perfect — I still have good days and bad — but I feel like I'm at the beginning of a season of change, full of possibilities.

I'm not alone. More and more depression sufferers who haven't found adequate relief via conventional methods are turning to ketamine therapy, and treatment clinics are popping up across the country. To explain what exactly the drug does to your brain and its potential for treating mental illness, I turned to two experts in the field for their input.

What is ketamine, exactly?

Although it was first discovered in 1956 and used as an anesthetic for animals, ketamine was cleared by the FDA in the 1970s as a human anesthetic. Since then, it's been used extensively to sedate patients for surgery, including soldiers injured in the line of duty during the Vietnam War.

In addition to sedation, the trance-like state ketamine produces comprises pain relief; amnesia; and a sense of dissociation, like you're outside of your body. Taking a high dose of ketamine may lead to a psychedelic experience known as a k-hole, involving severe dissociation, intense visual hallucinations, and feelings of unreality.

How does ketamine help treat depression?

So, when and why did researchers first begin testing ketamine as a treatment for depression? Well, at the start of the 21st century, ketamine was found to have potent and rapid antidepressant properties at sub-anesthetic doses, explains Ryan Yermus, M.D., co-founder and chief clinical officer of Field Trip Health , which provides ketamine therapy for depression. "While the most commonly used medicines, selective serotonin reuptake inhibitors (SSRIs), generally require weeks of continual dosing to achieve a response (and even then approximately one-third of patients will not respond after two or more courses of treatments), ketamine provides a safe, more rapid-acting treatment for depressive conditions," he says.

Although more research needs to be done on what exactly ketamine does to the brain, Gerard Sanacora, M.D., Ph.D., a Yale Medicine psychiatrist and a professor at the Yale School of Medicine, says that evidence suggests the drug alters the brain's adaptive capabilities — almost like rewiring it. The brain's ability to change both structure and function throughout one's life is called neuroplasticity.

"The synapses, the connections between cells in the brain, appear to be changing more rapidly shortly after treatment with ketamine," Dr. Sanacora says. "We believe this can influence a person's ability to change thought and behavior patterns that are associated with depression."

That's why ketamine treatment doesn't just hinge on the drug itself. It typically involves therapy and integration work, too: putting the mental and emotional revelations you experience during treatments to practical use in your daily life (e.g., starting a new meditation practice, creating a daily exercise ritual, etc.) during a time when your brain is in this state of change.

How significant of a development is ketamine as a treatment for depression?

"The discovery and development of ketamine for the treatment of depression has dramatically altered the way we think about depression treatment," says Dr. Sanacora.

On top of providing hope for those with treatment-resistant depression, the use of a drug not previously intended for psychiatric treatment has had a profound effect in the field of mental illness treatment. "This has led to a whole new wave of exploration in attempts to develop new and improved treatments for depression and other related neuropsychiatric disorders," Dr. Sanacora says.

So, is it legal?

Yes, but the law is not so cut and dry. Currently, ketamine is approved for clinical use as an anesthetic, explains Dr. Yermus. When a drug is prescribed for uses other than its original intended function, it's being used off-label.

"Using medicine off-label is very common in practice as doctors learn that safe medicines can be effective for other purposes, and the use of ketamine in mental health is just one of many examples," he says. So, if a doctor prescribes you ketamine for the treatment of depression or anxiety off-label, it is legal and safe.

However, in 2019, the FDA approved one form of ketamine, a nasal spray called esketamine (brand name Spravato), to treat depression — a promising step forward in this field of medicine.

But ketamine is still a controlled substance, so it's illegal to possess without a prescription.

What are the different ways you can take ketamine?

For therapeutic purposes, ketamine can be taken via intramuscular (IM) injection, intravenous (IV) infusion, orally (as a tablet), or nasally (as a spray). More research is needed to determine which method is the most effective. Generally, only the tablet, like the kind I take, is self-administered (i.e., taken at home), and the rest are administered by professionals in a clinical setting.

What does a ketamine treatment session feel like?

While everyone's ketamine treatment session will differ, many describe the experience as a euphoric, dreamlike state in which the world around them seems to fade away, everyday cares dissipate, unusual thoughts emerge, and vivid memories come to the surface. Some mild visual hallucinations are possible.

The psychedelic experience is intended to be gentle, not scary. Depending on the dosage, the length of the treatment will vary, but most sessions take anywhere from 40 minutes to two hours.

Here's what my first ketamine "trip" looked like:

Per the instructions, I didn't eat for four hours before my treatment. There's potential for nausea when taking ketamine, so Mindbloom provided me with anti-nausea medication, which I took one hour before I began my treatment.

When it was time to begin, I tucked the ketamine tablet inside my lip to let it dissolve. I swished it around with my saliva to help it absorb into my bloodstream, and then I spit the rest out. I turned on a zen Mindbloom playlist, put on an eye mask, and laid down in bed to let the trip begin.

Mindbloom encourages you to set an intention before each treatment — something that's not quite a goal but perhaps a question you want answered or a topic you want to explore. Mine was finding joy. As the session began, I felt a strong need to connect to something deeper and more powerful than myself, something spiritual (I consider myself an atheist). Then I saw an image of myself as a child. My first instinct was to fold her in my arms and protect her from everything to come in life. It made me weep.

Behind my closed eyes, I saw some mild visuals of swirling shapes and colors. I never felt scared or overwhelmed at any point — simply like I was floating down a river and observing thoughts, feelings, and memories as they passed by. I felt euphoric and slightly detached from my body, which felt somewhat tingly and numb, but I was still aware of the room around me.

Overall, you're supposed to dedicate one hour to your treatment. I found that the ketamine kicked in about 10 to 15 minutes after taking it, and then I would have about 40 minutes or so of the "trip" experience. Directly afterward, Mindbloom encourages patients to journal what they saw, felt, and experienced so they can later process it.

I felt a little groggy after my first session, but generally didn't feel any other side effects from taking the ketamine. My guide told me that this is a very "clean" way of taking the drug in that it produces very few side effects, if any.

How long does it take to work?

Like with most psychiatric medicines, your mileage may vary. While some see improvement in their depression symptoms immediately after the first treatment, it doesn't usually last, Dr. Sanacora says. Research indicates that ketamine therapy has a cumulative effect.

"Most people require a series of treatments in order to improve the chances of sustaining the response," he says. "Many of those people then also require some ongoing maintenance treatments every couple of weeks or monthly to keep the depression at bay." He notes that there are active research studies trying to find ways to extend this response, but there are no clear methods of achieving it at this time.

Dr. Yermus agrees that the timing depends on the person. "The severity of the condition is generally a guide for how many sessions people need — so someone with debilitating, acute depression will likely need more sessions than others with more moderate symptoms," he said. "Clients with mild anxiety and depression who feel stuck and disconnected can sometimes have a profound 'aha' moment after one or two sessions."

Personally, I had some significant revelations during the first couple sessions (e.g., I decided to move closer to family after years of hemming and hawing over it), but I didn't feel relief from my depression symptoms right away. That happened about six weeks in: I started to feel that lighter feeling, and doing everyday tasks wasn't so hard.

Early on in the treatment, my guide, Shannan, an Aussie based in Tulum, Mexico (shoutout to Shannan — she's the best!), helped me process what I experienced during my treatments during online video chats called integration sessions.

One time, I went into a session with the intention/question: Why am I so depressed? I wound up seeing memories of family and didn't think they were relevant to my intention, but she helped me talk it out and make the connections that I had missed — kind of like a therapist does.

Once you get through the first round of treatment (six sessions) at Mindbloom, then it's a little more DIY and there are fewer integration sessions, unless you want to buy them. The idea is that you get the hang of it in your first six sessions and can purchase additional support if needed.

Who is a good candidate for ketamine treatment?

Dr. Yermus says that anyone dealing with depression or anxiety who is in good physical health and has an open mind is a candidate for treatment.

However, the government is a bit more exacting when it comes to prescribing the esketamine nasal spray. The FDA has only provided approval for the treatment of treatment-resistant major depression (meaning depressive episodes associated with major depressive disorder that have not responded to standard forms of oral antidepressants) and major depressive episodes associated with serious suicidal ideation and/or behavior, says Dr. Sanacora.

What does ketamine therapy cost, on average?

Unless you're taking esketamine, which is FDA approved and thus eligible for insurance coverage, you'll be paying about $450 for one IV infusion, on average, per WebMD . At Field Trip Health, one IM injection costs $750, and Mindbloom charges $89 a week for three months ($1,060) for new patients, which includes six ketamine treatments. Returning clients pay $59 per week for three months.

Note that all these companies offer support services before and after treatment, the cost of which is typically included in the aforementioned prices.

What are the risks of taking ketamine?

Dr. Sanacora points out that the long-term effects of taking ketamine for depression remain unknown. During research involving animals, ketamine was shown to cause some toxic effects on the brain as well as behavioral and cardiovascular side effects, he said . While some human studies have also shown evidence of behavioral and brain abnormalities linked to ketamine use, this has generally been in people who use the drug recreationally, he notes.

Also, ketamine — known by its street names Special K, Vitamin K, Kit-Kat, and Super K — has been used recreationally for decades, particularly in the 1980s. So there's a possibility for addiction if dosing isn't professionally monitored. As its Schedule III label indicates, ketamine has "a moderate to low potential for physical and psychological dependence," per the DEA .

Personally, I don't feel that I developed any kind of dependence on the ketamine, but I do feel drawn to the healing nature of the ketamine experience. My Mindbloom guide said that, after doing an initial round of, say, three months of treatments, many clients do a refresher course once a year afterward to keep reaping the benefits of therapy.

That's likely what I intend to do, and I can only hope that — for myself and others — ketamine treatment becomes more widely accessible and affordable in the future.

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Improvement seen in 75% of patients

ketamine slechte trip

Why do some people have a bad trip? How do I prevent that?

Ketamine is a dissociative medication. A dissociative medication is a medication that causes you to feel separate or detached from their body or physical environment. Dissociative medications can cause hallucinations and other changes in thoughts and emotions. This means that ketamine can create a state of euphoria and provides a sense of detachment from reality. It is likely quite different than anything you have ever experienced before. But don’t let that scare you away. Ketamine has been around since the 1960s. Ketamine is a very safe medication when appropriately administered.

Because everyone’s ketamine experience is different from each other, there is a chance you may encounter a challenging or terrible one. Should that happen, your experienced staff at Reset Restore MD will assist you in navigating through that experience. Ketamine therapy can stir up strong emotions. If things get too overwhelming, focus on your greatest tool, your breath to calm yourself down. 

Another strategy is exploring, why does this frighten me? Take that fear and turn it into curiosity, explore and feel the feelings. What do you feel when you’re not reacting with fear? Facing your emotions is an important part of healing and moving in a positive light. 

The best advice we can give before is to go into this with an open mind. Embrace the journey. The staff at Reset Restore MD will assist you in this journey. At Reset Restore MD, we ensure your dose is specific to you and provide a monitored setting with trained healthcare providers rendering a more positive and healing experience.

  Wondering if Ketamine therapy is right for you?  Contact us today  to set up a consultation at one of our Wisconsin locations.

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The Ketamine Cure

The once-taboo drug has been repurposed to treat depression and is even available for delivery. But how safe is it?

ketamine slechte trip

By David Dodge

Chris Gathman, 40, has lived with chronic depression, a condition that runs in his family, for most of his life. He’s used a combination of antidepressants and cognitive behavioral therapy to treat his symptoms, with limited success. In 2018, he sunk into an even deeper depression that began impacting his ability to socialize and complete daily tasks.

“I knew I needed to do something,” said Mr. Gathman, who lives in Miami. So when his primary care physician suggested ketamine — an anesthetic that has improved symptoms of depression in early studies — he reached out to a clinic nearby.

“I woke up the next day and felt completely normal,” he said about his first IV infusion, administered at Ketamine Health Centers . “I didn’t feel depressed at all.” Mr. Gathman then persuaded his parents to seek out the therapy at the same clinic for their depression, and they both reported immediate relief as well.

Ketamine — an anesthetic first popular with the 1970s counterculture movement and then as a club drug known as “Special K” — has recently emerged as a promising mental health treatment. Unlike conventional antidepressants, which work by increasing serotonin levels, ketamine appears to impact a neurotransmitter called glutamate , which is thought to play a role in regulating mood.

In early trials, patients suffering from a wide range of drug-resistant mood disorders — including major depressive disorder , bipolar disorder , obsessive compulsive disorder and social anxiety disorder — have seen symptoms improve, often immediately.

Thanks to these success stories, hundreds of new ketamine providers have popped up across the country. Typically patients take ketamine through an IV, nasal spray or tablet once or twice a week for six to eight weeks (though some may need to take it longer). Sessions last between one and two hours and can cause feelings of dissociation, or feeling disconnected from reality, and euphoria.

Mr. Gathman, for instance, said the treatment made him “sleepy” and provoked an “out of body” experience. He described these sensations as “pleasant” — though he struggled with his balance and a sense of being “dazed” for several hours following each session. The ketamine boom has increased access to thousands who may benefit, but some scientists and doctors worry the drug is not yet ready for widespread use.

“I understand the rush for ketamine, in both private and public clinics,” said Dr. Carolyn Rodriguez, director of the Translational Therapeutics Lab at Stanford University, who conducted an early small trial of ketamine to treat obsessive compulsive disorder and saw an impressive and immediate decrease in symptoms. But given the lack of long-term data, potential for troubling side effects and possibility for abuse, “I believe that ketamine is not yet ready for safe general use,” she said.

Ketamine on Demand

Ketamine’s success in early trials has surprised and excited researchers who study mood disorders, a field where drugs like Prozac and Zoloft, paired with talk therapy, have been the main treatment options for decades. But, as with Mr. Gathman, interventions don’t work for up to 30 percent of those suffering from major depression.

Moreover, it can take up to two months to determine whether these interventions have any effect at all — a dangerously long time for those suffering from suicidal thoughts and other mood disorders , said Dr. Joshua Berman, the medical director for interventional psychiatry at Columbia University, who helps lead the development of the department’s ketamine program. Ketamine’s effects, on the other hand, are often immediate.

Though relatively new in the field of mental health, ketamine has been used in hospitals and on battlefields as an anesthetic since 1970. While the drug’s clearance by the Food and Drug Administration does not yet extend most ketamine treatments to mood disorders, any physician can prescribe it off-label to patients whom they believe might benefit — allowing the commercial ketamine business to flourish.

Chris Walden, the co-founder of Ketamine Media , a public relations firm that works with ketamine providers, said that ketamine clinics have grown from a few dozen to “many hundreds” in the United States but couldn’t give exact numbers.

Some of these providers are associated with academic institutions conducting clinical trials. Others operate out of private boutique-like clinics such as Nushama , which was recently opened on Park Avenue in New York City by designer Jay Godfrey.

And some patients skip the clinic entirely. Mindbloom , which launched in late 2018, is a telemedicine platform whose users get home delivery of ketamine lozenges. The company — among the fastest growing of several services enabling at-home ketamine therapy, like My Ketamine Home and TrippSitter — pairs its clients with psychiatric clinicians certified to prescribe drugs, who determine if the drug is appropriate for them. Then other employees, called “psychedelic guides,” meet with patients virtually before and after sessions to process the experience. There are no formal requirements to becoming a psychedelic guide, but most have completed training in fields such as mental health, life coaching or crisis management.

Dylan Beynon, Mindbloom’s chief executive and founder, said over 80 percent of his clients suffering from depression or anxiety experience significant improvement after four sessions — and that just 5 percent of patients experience side effects, which were mostly mild.

By shipping directly to clients, the company has lowered the cost of ketamine therapy — which averages $400 to $800 per session at many in-person clinics — to $120 to $190 per session, said Mr. Beynon. Given that ketamine is rarely covered by insurance, this is still prohibitively expensive for many.

Still, many experts do not believe patients should be self-administering ketamine — which can produce powerful dissociative sensations and even a seemingly catatonic state — outside of a clinical setting. Other side effects — like increased blood pressure, paranoia and suicidal thoughts — are rare and typically only appear at very high doses .

Dr. Leonardo Vando, Mindbloom’s medical director, claimed that out of tens of thousands of doses administered, the company has only observed mild side effects, like nausea.

Dr. Gerard Sanacora, director of the Yale Depression Research Program and the Yale-New Haven Hospital Interventional Psychiatry Service, agreed that serious side effects are rare but has seen patients experience chest pains and worried about exacerbating heart conditions. “If you treat enough people, something is going to go wrong,” he said.

“With a drug like ketamine that can affect heart rate and blood pressure, it’s especially important to get a well-documented cardiac history, laboratory screening assessments, and to be monitored during the infusions,” said Dr. Rodriguez. Screening candidates in this way led her to discover an undiagnosed heart condition in one patient. “It would not have been a good idea to give ketamine to that person.”

A Promising Yet Unregulated Industry

Many ketamine providers, including Mindbloom, require clients to meet with a psychiatric clinician to ensure they are a good fit for the therapy. Mr. Beynon said his company, which conducts these screenings remotely, turns away roughly 35 percent of those that apply — including people whose symptoms aren’t severe enough to warrant it or are too severe for at-home treatment. He declined to provide documentation to support this claim.

However, this level of screening is not required by law and some patients just find a prescribing doctor online who will issue the drug through a private pharmacy with no other oversight.

The potential for abuse is reason to be cautious about ketamine’s use outside of a carefully controlled clinical setting, said Dr. Rodriguez — particularly in clinics that may be providing higher doses than what has been studied. “There is potentially this opioid effect , this rush, that taps into brain regions that may be susceptible to addiction,” she said.

Ketamine’s impacts can also be transient, Dr. Berman said, meaning some patients may need to keep taking it — but most research has not looked at the long-term effects of ketamine therapy.

There is one exception. In 2019 the Food and Drug Administration approved esketamine, a ketamine nasal spray, for the treatment of drug-resistant depression and suicidality. This approval was given only after large, randomized, placebo-controlled trials, said Dr. Sanacora. This research also led to the creation of strict guidelines for use of the product — like conducting the therapy in a certified doctor’s office or clinic and monitoring a patient for two hours after treatment.

“I am not sure why the same evaluation and management guidance isn’t being used for other forms of the treatment,” Dr. Sanacora said.

Dr. Rodriguez said she believed ketamine providers should be relying on a 2017 Consensus Statement issued by an American Psychiatric Association task force, of which both she and Dr. Sanacora are members. The statement includes best practices for screening potential patients and for administering the drug — some of which would be difficult outside of a well-equipped clinical setting.

Waiting For Data

Most experts agree much more research about ketamine’s effectiveness in mental health is needed, and dozens of trials are currently underway globally.

However, there are real barriers to new large-scale trials like those conducted with esketamine, said Dr. Berman, since pharmaceutical companies are unlikely to pay for research into a drug that can already be prescribed off label. “The nasal spray was new technology so there was a greater incentive for the private sector to invest in large trials,” he said.

In the absence of this research, Dr. Sanacora and others have suggested the creation of a registry — similar to the Risk Evaluation and Mitigation Strategy program, which the F.D.A. requires for certain medications with serious safety concerns — to help gather data on side effects and how the drug is being administered.

Some researchers believe this type of data, once gathered, could be used to develop better standards in the industry — and could even expand ketamine’s use, rather than restrict it.

For instance, though ketamine has mostly been studied in drug-resistant patients, some believe it could prove to be an effective first-line treatment option for severe depression, said Dr. Berman, since its impacts are often felt immediately.

While more data is collected, Dr. Rodriguez said that plenty of patients are truly suffering. “They’re in such deep, deep pain,” she said. “As long as patients understand the limits of current research and are able to make an informed decision with their clinical care team, shouldn’t they be allowed to weigh potential side effects against the deep pain that they’re in?”

David Dodge is a freelance writer focusing on health, wellness, parenting, travel and the L.G.B.T.Q. community.

An earlier version of this article referred imprecisely to Mindbloom, a telemedicine platform. While its users get home delivery of ketamine lozenges, it is not an "at-home delivery service."

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Advances in Psychedelic Therapy

Psychedelics — though mostly still illegal — have surged in popularity in recent years as alternative treatments for mental health..

After decades of demonization and criminalization, psychedelic drugs are on the cusp of entering mainstream psychiatry , with U.S. combat veterans leading the lobbying effort .

Psychoactive mushrooms, legal in Oregon  but still illegal under federal law, are gaining popularity as therapy tools .

As psychedelics move from the underground to mainstream medicine, clinicians aspiring to work in the field are inducing altered states with deep breathing .

MDMA-assisted therapy , which seems to be effective in reducing symptoms of post-traumatic stress disorder, is inching closer to approval in the United States .

Ketamine has become increasingly popular as a therapy for treatment-resistant depression . But the misuse of the anesthetic drug has spurred F.D.A. warnings .

Many drugs known for mind-altering trips are being studied to treat depression, substance use and other disorders. This is what researchers have learned so far .

While psychedelics are showing real promise for therapeutic use, they can be dangerous for some. Here’s what to know about who should be cautious .

Sarah Rose Siskind

Should You Try Ketamine Therapy?

6 questions to ask yourself before trying ketamine therapy..

Posted August 16, 2021 | Reviewed by Devon Frye

  • What Is Ketamine?
  • Find a therapist to overcome depression
  • Ketamine is a dissociative anesthetic that is thought to improve the brain's neuroplasticity and was legalized for therapeutic benefits.
  • Ketamine has also been found effective in combating treatment-resistant depression, PTSD, and anxiety.
  • Ketamine is not 100 percent effective and is usually rather expensive (at least several hundred dollars a "session").
  • Ketamine therapy is as much (if not more) about the “therapy” than it is about the “ketamine.”

If you clicked on this headline, there’s a good chance the answer to your question is: possibly! Ketamine is safe and effective. If a passive-aggressive colleague sent you this link, maybe the cure for your problems is to move desks. If you googled this question, make sure the article you're reading isn't posted by a ketamine therapy clinic because, and you'll never believe this: they have an incentive for you to try ketamine therapy .

Google Trends

There has been a marked increase in exposure and interest for this novel therapy, as you can see in the Google Trends chart here. Ketamine has been in a state of heightened media frenzy ever since the FDA approved the ketamine-derived nasal spray Spravato for treatment-resistant depression in March of 2019. Since then, ketamine has been investigated as a helpful treatment for depression, PTSD , anxiety , and slow news days. Recently, there was a major scientific breakthrough in understanding ketamine’s mechanism of action . Last month, Field Trip, a chain of ketamine clinics, was listed on the Nasdaq. Plus, ketamine clinics have been popping up like Starbucks in major urban areas.

Ketamine is a safe and effective form of therapy and, possibly, the first proverbial “drip” in an eventual waterfall of psychedelic-assisted therapy options. Regardless, it's a watershed moment for this novel therapy.

What Is Ketamine Therapy?

Ketamine is a dissociative anesthetic, considered by some to have psychedelic properties. It is thought to affect the glutamate neurotransmitter in the brain, improving neuroplasticity and interrupting ruminative patterns such as those found with depression. Ketamine therapy entails an intake session with a therapist, then several “sessions” in which ketamine is administered, then integration and follow-up meetings with a therapist. Ketamine can be administered through nasal sprays, lozenges, intramuscular injections, or intravenous infusions.

So the question remains: should you try it? To answer that question, here are 6 others:

What’s Bothering You?

If you have treatment-resistant depression, then this treatment might break through that resistance. Ketamine has also been found effective in combating PTSD and anxiety.

If your depression isn’t “treatment-resistant” because you have yet to treat it, you may want to consider conventional antidepressants first. They have been studied more and longer than ketamine has been studied. Plus SSRIs are likely less expensive. However, they take weeks to start working, if at all. They’re only about 20 percent more effective than a placebo and they come with their own lengthy list of side effects.

Ketamine is both short-acting and fairly long-lasting. What does that mean? It means that the effects are felt within minutes and may last for a week to a month. One 2019 study found the heightened effects of ketamine started within minutes and lasted for at least a month after the session. But a different study from that same year found that the effects of a placebo and conventional antidepressants caught up to ketamine’s effects after seven days. So there is a range. But it’s a safe bet that ketamine offers some bang for your buck—if by “bang” you mean fairly stable relief from mental anguish.

If, however, you have ever suffered from psychosis , schizophrenia, mania , or paranoia , please be aware that ketamine may not be for you. There’s a reason ketamine has been considered a “ schizophrenomimetic .” That’s not just an award-winning spelling bee word, it’s the name for a drug that can mimic schizophrenia-like mental conditions.

Are You Prone to Addiction?

You might think that an affirmative response to this question would preclude you from being a good candidate. But in fact, ketamine may actually be a good treatment for addiction . Two clinical trials showed that ketamine reduced the chance of relapse for cocaine addicts and alcoholics. Ketamine has shown positive results in treating nearly every kind of addiction—except for addictions to ketamine, of course. (Shockingly, the treatment for ketamine addiction is not more ketamine.)

How Risk Intolerant Are You?

Currently, there are no long-term studies about the effects of ketamine as opposed to many conventional antidepressants. Also, ketamine is not 100 percent effective. But then again, literally no treatment is 100 percent effective at curing depression—except perhaps puppies (but this is personal conjecture as no clinical studies have been done yet).

There are also some concerns over risks to the liver, bladder, and kidney . Ketamine can increase heart rate and blood pressure. So people with issues like hypertension may want to steer clear. It’s really a question for your primary care doctor, not an internet blogger, no matter how informative and entertaining she might be.

ketamine slechte trip

Are You Afraid of Needles?

Intravenous Infusions are by far the most commonly used and most commonly studied method for administering ketamine. This is because the dosage can be extremely carefully controlled and the journey can be stopped at any moment. The drip controls the trip.

Intramuscular injections are delivered into the thick muscles of your arm, hip, thigh, or if you want the real veterinary clinic feel, the buttocks. With IM infusions , ketamine is administered all at once and cannot be titrated down once injected. IM infusions cannot be as easily mixed with medicines to combat nausea and increased blood pressure.

There are also lozenges and Spravato, the nasal spray which uses esketamine , to consider. Both are administered under supervision (either in an office or remotely on Zoom). These are cheaper alternatives since they do not require special equipment nor a physician trained in anesthesiology. They’re also convenient since patients may even administer the treatment at home themselves. However, both provide relatively lower dosage than the infusion route due to imprecise administration.

Whichever method you’re considering, by far, the most important part of the process is the role played by a mental health professional. Whether this is a psychiatrist, therapist, or integration coach, make sure this is an individual you feel safe around.

How Much Are You Willing to Spend?

Take a deep breath. Assuming you don’t have a chronic pain syndrome, there is a very high chance that insurance will not cover ketamine therapy. Infusions may set you back several thousand dollars but it will include a half dozen infusions sessions, an intake, integration sessions, and follow-ups. The nasal spray Spravato can cost from $590 to $885 per treatment session. But how many treatment sessions are needed is up for debate. Lozenges (administered in the office or monitored remotely over Zoom) can cost about a thousand dollars for 1-6 sessions depending on where you go.

All of the options have a range but all will cost at least several hundred dollars. Unfortunately, the field is new and speculative and therefore, draws many hucksters. Make sure to take time to research your clinic and read any reviews if available.

 Elena Kharchenko/Dreamstime, edits by Sarah Rose Siskind

What Else Should You Know?

Ketamine therapy is as much (if not more) about the “therapy” than it is about the “ketamine.” Make sure you’re working with a clinician you trust and make sure to see an integration therapist with whom you share a connection. Integration is the process of talking with a therapist after a psychedelic or psychoactive session in order to glean meaningful therapeutic insight. Ketamine is a novel and exciting part of the treatment but it’s the therapy that can really lead to lasting change beyond the neural rewiring.

Sarah Rose Siskind

Sarah Rose Siskind is a science comedy writer based in New York City.

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What's Behind the Mind-Expanding Powers and Popularity of Ketamine

And why all the ways to get this drug now is a little troubling.

now he can finally get all the rest he needs

WHEN BYRON MacLEAN was forced to retire from his police job in Nova Scotia for medical reasons last year, he saw a psychotherapist to deal with post-traumatic stress disorder from military duty in Afghanistan and time on the force. But after a while, talk therapy stopped working. His depression, anxiety, and night terrors returned, straining his marriage. “I felt really stuck,” says MacLean, 43. Then a military buddy told him about ketamine—the psychedelic drug that doctors have used for decades as an anesthetic and pain reliever and that has gained new popularity as a possible wonder drug for mood disorders.

Now there’s intense interest in the idea that ketamine might be the next best thing to alleviate the country’s mental-health crisis—at a time when it’s never been harder to find counseling. And ketamine isn’t difficult to get. Clinics like Field Trip, a Toronto-based company, have numerous locations in the United States. Telemedicine companies like Mindbloom, TripSitter.Clinic, and My Ketamine Home will ship you ketamine lozenges that you can take at home. All this said, some experts are calling for tighter regulation. While they generally agree that the drug itself is pretty safe, advertising and marketing may be overpromising what ketamine can actually deliver. Here’s what to know now:

The Effect Tends to Fade

Ketamine clinics are apt to promise speedy relief. And for the most part that’s true: One recent Columbia University study found that suicidal patients were significantly less depressed and were less likely to hurt themselves within 24 hours of taking a single dose of ketamine. Except experts agree that the benefits can be fleeting. (People taking ketamine for depression often relapsed within three weeks, according to a small 2013 study .) That’s a major downside for anyone paying several thousand dollars for a series of treatments. “The vast majority of ketamine clinics are opening up with the business model of dosing people and sending them on their way. It’s limited in its effectiveness,” says Alan K. Davis, Ph.D., director of the Center for Psychedelic Drug Research and Education at Ohio State University in Columbus. For changes to stick, research shows it’s best to pair ketamine with psychotherapy. “Often people have a meaningful experience, but that doesn’t solve the underlying problem,” Davis says. “Where the rubber meets the road is what happens outside the session and how you change your life.”

You Need the Right Dose and the Right Reasons

At many clinics, patients often don’t receive a high enough dose for the treatment to be effective, says Steven P. Cohen, M.D., a ketamine researcher and a professor at Johns Hopkins School of Medicine. Other concerns have emerged about clinics making dubious claims, failing to adequately screen patients, or administering inconsistent dosages.“I know of places where you don’t have to have a diagnosis for depression or anxiety,” says Austin-based psychiatrist and MH advisor Gregory Scott Brown, M.D., who’s among a chorus of experts calling for more regulation of the ketamine industry. Even the most promising of drugs won’t work if they’re not given for a condition they can actually help treat.

It'll Cost You

A treatment package from Field Trip consisting of a screening, a prep session, four ketamine sessions, and three integration sessions with a therapist runs about $3,500. Clinic treatments like this are rarely covered by insurance, and if they are, there are usually hoops. For insurance to pay for the FDA-approved treatment sold under the brand name Spravato, you typically must show proof you’ve taken two other antidepressants for at least six weeks and failed to derive any benefit.

So people may be tempted to get it on the street. Never a good idea, says Jedidiah Ballard, D.O., an emergency room physician and MH advisor in Augusta, Georgia. He’s concerned about the purity of the ketamine you could wind up with this way and what can happen if you don’t have a mental-health pro there to guide you through.

Having a bad trip is another risk, says psychologist Keith Trujillo, Ph.D., who studies ketamine at California State University San Marcos. “K-land can be a positive, blissful experience. Colors look more vivid. People see or hear things differently,” he says. “They also report the ‘K-hole.’ People feel separated from themselves or think they’ve died. That can be anxiety provoking.”

Last fall, MacLean, the former police officer, decided to undergo ketamine treatment. In a New Brunswick treatment-center room decorated with potted plants and thick floor cushions, he sat beside a counselor for the next hour and a half. The counselor placed a ketamine lozenge under MacLean’s tongue (the drug is administered as an injection in the U. S.) and MacLean closed his eyes. At first, he says, the experience was comforting; he sensed he was floating in the sky and told himself, as an eight-year-old boy, “Everything is going to be okay.” Then he saw a shoe he’d found belonging to an 18-year-old woman who had been choked to death by her boyfriend in the woods in 2013. MacLean had long questioned whether he could have changed the outcome—if only he’d intervened earlier when he suspected her abusive boyfriend was in town. Yet the ketamine helped him let go of his guilt. “I realized I couldn’t be responsible for someone else’s decisions,” he says. “Ketamine gives you distance to process traumas differently and then just leave them there.”

After additional treatments and therapy sessions, MacLean says, his home life is now more harmonious. He can let things go more easily, has started working out again, and is able to live more in the moment. “I just wish I’d done this sooner,” he says. Ketamine may help mental health care in a broader way, too: by opening minds to psychedelic drugs as legitimate therapies. Several biotech companies are patenting other psychedelic treatments, and Davis is studying the potential of psilocybin to treat depression with longer-term success. “Our society tends to focus on the harms of drugs,” he says. “Ketamine is starting to change the narrative about the positive effects.” Yet with ketamine, as with all things concerning your health, it’s on you to plan your trip the smart way.

Make Sure A Ketamine Provider Offers These Things

Whether you get it from a clinic or from an individual doctor, make sure you check all of these boxes first, says psychiatrist and MH advisor Gregory Scott Brown, M.D.

Monitoring before and after treatment

If you’re receiving your ketamine through the mail, you should be regularly monitored by a health-care professional who is trained to address your expectations for the therapy, spot signs of psychosis and addiction, help you make sense of the sessions, and know the nuances of depression.

Proper screening

Check with a psychiatrist before trying this if you have a history of schizophrenia or bipolar disorder; there have been reports of mania and worsening psychosis. Also check in if you have a heart issue or uncontrolled high blood pressure.

Treatment for a valid reason

If someone is willing to prescribe ketamine for “an existential crisis” or to “help you relax,” go elsewhere.

This story originally appeared in the July/August 2022 issue of Men’s Health.

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What Is Ketamine Therapy? A Detailed Scientific Guide

Jessica Migala

If you’ve seen signs for ketamine centers near you or noticed ads for at-home ketamine on social media, you’re probably aware that the psychedelic-like drug is gaining fame as a  mental health treatment for certain conditions.

But the excitement of ketamine therapy may, in some instances, be outpacing the demand. Just as quickly as ketamine treatment centers have opened, many have closed. Two nationwide companies in particular, Ketamine Wellness Centers and Field Trip Health & Wellness, have abruptly stopped operating in some states, according to Behavioral Health Business .

With all the buzz surrounding ketamine treatment, centers that provide it, and the expanding scientific research on its potential health benefits , here’s what you should know about ketamine therapy — from its five-decade-long history, to risks and what to expect if you pursue treatment under your doctor’s guidance.

Definition of Ketamine Therapy

Ketamine is a dissociative anesthetic hallucinogen, according to the United States Drug Enforcement Administration (DEA) . Meaning:

  • Dissociative You may feel disconnected from your own thoughts and feelings, those around you, and your environment.
  • Anesthetic It relieves pain.
  • Hallucinogen You may experience changes in consciousness.

Though ketamine, a Schedule 3 compound under DEA guidelines , is used legally in sedation in medical settings, it’s also used (and sometimes abused) illegally as a recreational drug. These two uses are both different from its psychiatric use, which requires a licensed provider to prescribe it as a treatment for a specific condition.

Ketamine therapy, or ketamine-assisted therapy, is a mental health treatment that uses “low doses of ketamine … for treatment-resistant depression , anxiety disorders, and post-traumatic stress disorder (PTSD),” according to the Pacific Neuroscience Institute . This may or may not be combined with sessions with a psychotherapist.

Common Questions & Answers

History of ketamine therapy.

Ketamine use isn’t new. It started being used in medical care as an anesthetic in the 1970s after it was approved by the U.S. Food and Drug Administration (FDA), according to a published review . At certain dosages, the substance sends people into a dissociative state, has temporary pain-halting properties, and it’s generally considered to be safe, per the above review. (Though there are always contraindications and other considerations. More on that below.)

Through clinical research over the decades, the use of ketamine has spread to include psychological treatment, most notably in treatment-resistant depression, as summarized in a review published in Therapeutic Advances in Psychopharmacology in 2020 . In one of the early published reports of this from 2000, the authors highlighted that an IV dose of ketamine rapidly reduced symptoms of major depression within 72 hours. Randomized controlled trials following that finding found that 60 to 70 percent of people with treatment-resistant depression responded to ketamine, the authors say.

In 2019, the FDA approved a new nasal spray medication called esketamine (Spravato), a form of ketamine, to be used with an oral antidepressant for people with major depressive disorder (MDD) who have treatment-resistant depression. This announcement outlined the first psychedelic-like drug to be approved for legal use; others, such as psilocybin (known as “magic mushrooms”) and MDMA, are approved for use in mental healthcare in certain states or are in the process of seeking federal approval for specific psychiatric conditions, which will expand access to these psychedelics in clinical settings.

In 2020, esketamine was also FDA approved for use to treat depressive symptoms in adults with MDD with acute suicidal ideation. In short, to date, only the esketamine form of ketamine is FDA approved for mental health conditions.

Piggybacking off that, other forms of ketamine, including oral and intravenous ketamine, despite not being formally FDA approved, are now widely available through mental health facilities, ketamine centers, as well as online for at-home use — all of which require a doctor’s prescription. Home use of ketamine has exploded in consumer popularity, even though these forms are still not FDA approved, according to an editorial in Missouri Medicine in 2023 . Currently, this means that ketamine, outside of esketamine FDA-approved use, is being used off-label.

Moving forward, other drugs could join ketamine in the realm of legal psychedelic medicine, as the FDA released draft guidance in June 2023 for clinical researchers in the field. It pertains to the use of psychedelic drugs as a potential treatment for psychiatric or substance use disorders. One pain point is the need for more standardized clinical studies on these substances, and the guidance advises on study design through drug development of psychedelic medicines. (This is currently in draft form, and the public has a chance to comment before the final version is released.) In other words, the field of psychedelic therapy — both in research and legislation — is rapidly evolving.

Potential Health Benefits of Microdosing Psychedelics

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How ketamine therapy works.

As a dissociative anesthetic, “ketamine works on the NMDA ( N -methyl-D-aspartate) receptors in the brain to inhibit the effects of a neurotransmitter called glutamate ,” explains Reid Robison, MD , a psychedelic psychiatrist and the chief clinical officer at Numinus, a company that offers psychedelic medicine, including ketamine therapy.

As Dr. Robison explains, this process is believed to allow neurons to form new connections and fire together in ways that create novel pathways in the brain (called brain plasticity or neuroplasticity, per StatPearls ). “In depression, the brain’s ability to make connections is impaired. Ketamine reboots this ability and wakes up the dormant, depressed brain pretty rapidly,” he says, in his clinical experience of treating patients.

In addition, ketamine therapy may also help turn off a stressed-out state that the brain can get stuck in. The scientific term for this stressed-out state, Robison says, citing animal research , is lateral habenula burst activity. Ketamine was shown to suppress this activity in depressed rats and mice, thereby turning on reward centers linked to mood. “Ketamine [may] hit a reset button in the brain and help people feel quite a bit better rather quickly — even though a single dose doesn’t last forever,” he adds. More research is needed to better elucidate the mechanisms of how ketamine may work in humans.

Indeed, the aforementioned 2020  research review noted that there is evidence that one dose of ketamine can have an antidepressant effect for one week; follow-up IV infusions may last longer, from 18 to 19 days. (A meta-analysis of studies published in Psychopharmacology in March 2021  concluded that ketamine’s antidepressant effects may last longer — up to six weeks following treatment.)

Because ketamine distribution for treatment is not widely regulated, each clinic or company has their own protocol for how many ketamine sessions are recommended and how follow-up sessions and maintenance doses are handled.

Along with new neural connections, the drug’s dissociative properties may lay the foundation for a perspective shift among people who use it. “As the medicine takes effect, you can have a feeling of being outside of your body or being connected with things beyond your limited sense of self,” says Robison. These can be positive feelings of peace and joy for many with mental health disorders.

But there is a second component to the treatment that is just as important as the medication: therapy.

For example, recent research, like this systematic review and this systematic narrative review , explore how ketamine-assisted psychotherapy may work, in that the drug might potentially support an opening emotionally and shifting of one’s perspective. This client-therapist relationship that develops with subsequent therapy and ketamine sessions may then support adherence to additional sessions to the treatment plan and its overall effectiveness.

“We believe that the combination of medication and therapy is better,” says Robison. He describes ketamine as a bridge that can help take someone out of crisis so that they can successfully engage in therapy. “Think of ketamine as a therapy accelerator,” he says. In therapy, you can then talk to a mental health professional about your experience and what you learned.

Because of potentially enhanced brain plasticity from the drug, you may be better able to make changes to your thought patterns and lifestyle that ultimately move the needle toward improved mental health.

Types of Ketamine Therapy

There are various ways you can obtain ketamine therapy, including:

  • Esketamine (Spravato) The FDA-approved form of ketamine for treatment-resistant depression, Spravato is a nasal spray given in a healthcare office.
  • Intravenous ketamine A ketamine infusion is given via an IV at a ketamine center or medical office. You may also have sessions with a psychotherapist to help you process the events.
  • In-office oral ketamine An oral tablet (often delivered sublingually) is given in a medical office, which may include medical supervision during the therapy. Similar to IV ketamine, this is often offered alongside psychotherapy, which may also be called integration therapy.
  • At-home oral ketamine Ketamine tablets are shipped to one’s home via an online company after receiving a prescription from a healthcare provider; virtual therapy may also be offered along with it.

Possible Benefits of Ketamine Therapy

As the science surrounding ketamine therapy grows, so too the potential applications of the treatment. Here’s how it may help alleviate certain health concerns, according to a sample of the research we found.

Treats Major Depressive Disorder or Treatment Resistant Depression

This is the FDA-approved use for esketamine (Spravato). One of the most impactful ways ketamine can be used for major depressive disorder is to decrease symptoms within 24 hours, according to the authors of the Psychopharmacology meta-analysis. This may be impactful for people who have treatment-resistant depression and who haven’t found relief with conventional treatment, such as antidepressants or psychotherapy. This doesn’t mean that depression is “cured” in a day, but it may help to rapidly lift the fog so patients can be aided by their current treatment regimens.

Another meta-analysis, published in April 2020 in Pharmacological Reports , concluded that for treatment-resistant depression patients, ketamine alone wasn’t effective in reducing depressive symptoms, but it was when the drug was added to a person’s existing antidepressant treatment. The researchers concluded that in patients with MDD, two to three weeks of ketamine treatments helped sustain the benefit of the initial dose, and people experienced reduced depression severity significantly compared with a placebo.

Finally, in a  meta-analysis of 28 studies published in the Journal of Affective Disorders in December 2020 , ketamine was found to decrease depression in patients with treatment-resistant depression four hours after an infusion, peaking at 24 hours, and continued to have some effect at seven days later, though the researchers note that more research is needed to understand the long-term effects.

May Help With Chronic PTSD

Seven or 8 out of 100 people will experience post-traumatic stress disorder (PTSD) in their lives, most commonly war veterans or those who’ve experienced assault, abuse, accidents, or disasters, according to the National Institute of Mental Health .

The mental health disorder can be notoriously difficult to treat, and in a brief report of a review and meta-analysis , the authors concluded that although there is potential for the use of ketamine-assisted psychotherapy for PTSD, the research is still limited at this time. Another review in Therapeutic Advances in Psychopharmacology in March 2023 came to similar conclusions. Ketamine may work by helping people dissociate from unhealthy thought patterns, clearing space for deeper processing of traumas, per a systematic review and meta-analysis .

May Be Useful in Anxiety Disorders

Nearly one in three adults will have an anxiety disorder in their lives, according to the American Psychiatric Association . Anxiety is an umbrella term for specific disorders such as social anxiety disorder , generalized anxiety disorder , panic disorder , among others.

Though there is not as much research on the benefits of ketamine for anxiety, a small meta-analysis of six randomized controlled trials that looked at various anxiety disorders (social anxiety disorder, PTSD, and obsessive-compulsive disorder) found that the treatment reduced anxiety scores compared to control groups in four of those trials (yet not for PTSD). People who received maintenance therapy with ketamine experienced the most sustained benefit.

May Treat Substance Use Disorders

Emerging research suggests that ketamine can be used to treat alcohol, cocaine, or opioid use disorder, per a systematic review published in Frontiers in Psychiatry in 2018 . How? Ketamine treatment has been found to improve cravings, enhance one’s motivation to quit, and lessen withdrawal symptoms, according to researchers. Right now, however, more research is needed to look at larger sample sizes and demographics of people, more controlled studies, and lengthier follow-up to assess the long-term effects of ketamine on substance use issues.

Ketamine Therapy Safety and Side Effects

For people with the certain mental health concerns mentioned above, ketamine therapy is generally considered safe and effective when practiced under the care of a licensed therapist or doctor.

One recent systematic review and meta-analysis that looked at 36 studies on ketamine and esketamine concluded that both drug forms are effective and safe for people with depression. More research, however, needs to be done on the long-term safety of ketamine, the authors noted, and more research should be done on the efficacy of at-home versus in-clinic treatments.

Certain side effects are more likely with ketamine treatment. These are typically mild, short-lived, and usually don’t need to be treated, though they’re good to be aware of. They include, according to research :

  • Dissociation
  • Elevated heart rate and blood pressure

It’s important to note that there is increased risk of lower urinary tract symptoms with esketamine. Cases of cognitive impairment have occurred with high doses of ketamine, yet these were not seen in the clinical trials at typical doses.

And additionally, per Spravato’s website :

  • Anxiousness
  • Feeling very happy or excited
  • Lack of energy
  • Feeling drunk

Furthermore, some health conditions may make you ineligible for ketamine use, according to StatPearls .

  • History of heart problems  Ketamine can increase blood pressure, making it potentially dangerous if you have uncontrolled hypertension or a history of heart attack, aneurysm , or aortic dissection.
  • Pregnancy or breastfeeding  It’s not known if ketamine can be passed through breast milk.
  • History of schizophrenia  Ketamine can trigger symptoms of schizophrenia .
  • History of bipolar depression  There are case reports of ketamine inducing mania.
  • History of liver or kidney disease  Some research has found risk of renal function decline in chronic ketamine abusers; other case reports show potential injury to the liver.

In addition, never use ketamine if you have been drinking alcohol, as this combination can be fatal, per StatPearls.

It’s important to receive clearance from your physician before you use ketamine. If, for example, you have uncontrolled hypertension, develop a plan with your doctor to manage your blood pressure before you seek ketamine treatment, or any of the other conditions above, suggests Carlos De La Hoz, MD , a triple board-certified anesthesiologist and a regenerative medicine and pain management doctor at the Neomedicine Institute in Doral , Florida. (The Neomedicine Institute offers ketamine-assisted psychotherapy via infusion.)

Also, note that there are drug-to-drug interactions that may make ketamine use unsafe, such as benzodiazepine sedatives and opioid analgesics , as well as stimulants used for ADHD . So it's best to discuss ketamine with your doctor or clinical pharmacist first, per Pfizer Medical Information .

Who Might Want to Try (and Avoid) Ketamine Therapy

The decision to pursue ketamine therapy is a personal one. Here’s who may benefit — and who might want to skip it.

Who Ketamine Therapy Is For

Ketamine is FDA approved for treatment-resistant depression. In addition, if you have depression, anxiety, or PTSD and are interested in ketamine therapy, talk to your primary care doctor and mental health provider about it, in conjunction with your usual medications for mental health. It also may be indicated for patients acutely experiencing major depression with suicidal ideation.

Who Should Avoid Ketamine Therapy

If you have any of the health concerns listed above or are pregnant or breastfeeding, you should avoid ketamine therapy.

Tips for Getting Started With Ketamine Therapy

First, if you want to pursue ketamine therapy, you’ll need to get cleared by your physician. At some ketamine in-person and online clinics, you are required to answer a series of screening questions about your physical and mental health; be sure to answer these truthfully, so the provider can determined if it’s safe and appropriate for you to try it.

Second, you’ll also need to find a clinic or a company that you are comfortable with. “The best question to ask a clinic is: Do you offer therapy with ketamine treatments?” says Dr. De La Hoz. “I feel that it is unethical and doing a disservice to a client if they are not offered therapy, which is essential in interpreting your experience and how it relates to your life,” he explains.

One concern is that there are a lack of established standards governing ketamine treatments, though there are more offerings through companies like Fluence to provide continuing education programs for licensed clinicians. That said, the increase in the number of companies offering ketamine treatment, both supervised and unsupervised by a clinician or with or without a therapy arm worries psychiatric experts, according to the  Missouri Medicine editorial. Ideally, the practitioner should monitor the session carefully to watch for side effects, including patient distress. Have a thorough talk with the clinic beforehand to understand their ketamine protocols, how they look for side effects, and if ketamine is a viable and safe option for you. “We hope that there’s more regulation in the future so that ketamine can be beneficial, not something dangerous or abused,” says De La Hoz.

What to Expect Before, During, and After Ketamine Therapy

If you’re considering ketamine therapy, know that the protocol will depend on the individual clinic or company. We're using Neomedicine Institute as an illustrative example, and patient experiences at other providers may vary.

You’ll have a consultation, which includes a screening to make sure that ketamine may be safe and effective for your goals. Ideally, you will be connected with a therapist to speak about what you hope to get out of ketamine treatment. Be open about your struggles, your coping mechanisms, whether you’ve tried therapy before and what has worked and what hasn’t, says Liliana Uribe, PhD , a cognitive behavioral therapist who specializes in ketamine-assisted psychotherapy at Neomedicine Institute.

At your ketamine treatment appointment, you will be prepped appropriately (you may be weighed to determine dosage; if you’re receiving it intravenously, an IV will be started). You will lie down in a room in a comfortable position with an eye mask and headphones to decrease noise and light from your surrounding environment.

It’s normal to be nervous during your first appointment. “A big thing I’ve seen is an inability to let go. We have an issue with wanting to control every aspect of our environment, and we feel uneasy when something doesn’t go as planned or expected,” says Dr. Uribe. Discuss with a practitioner ahead of time about a sign you can give if you’re particularly nervous during the treatment. (Like a thumbs up or down, for example.)

Duration will differ depending on where you go and whether you’re taking the drug orally or doing an infusion. De La Hoz's ketamine infusion sessions are 40 minutes long. In some instances, in addition to routine observation, ketamine will be given to you under medical supervision where your vitals are monitored.

Being “under” in ketamine is being in a wake state but resting, says Uribe. This is a dissociative state where you feel detachment from your body and your environment, per a study published in Anesthesiology in November 2020 . “You’re not paralyzed, but you feel a weight over you that makes it difficult to move around and speak,” says Uribe. If you are getting an infusion, the clinician can shut off the infusion at any time if you are uncomfortable, which will bring you back to consciousness.

You’ll likely need multiple ketamine sessions. “Ketamine has a cumulative effect,” says De La Hoz. The number of ketamine sessions needed will vary. Based on his own clinical experience, De La Hoz says, six sessions are typically needed before he understands the full spectrum of a patient’s response — and whether more therapy is necessary.

After the ketamine is administered, you’ll have the opportunity to recover. You should be monitored for any adverse reactions and the practitioner should ensure you're safe to go home. If you are using at-home ketamine, make sure you follow the aftercare directions. At a clinic? You will need someone to drive you home. Do not drink alcohol after your session.

Uribe suggests seeing treatment as a process. “Use the first session as discovery, and then try to surrender to the experience. After two or three sessions, people are typically more relaxed and open to let go and let the experience take them where it will,” Uribe says.

Ideally, you have integration sessions. These are psychotherapy appointments with a licensed therapist who can talk to you about what you experienced during your ketamine session. Though not all companies require this, experts say this is an integral part of the process and is needed for best results.

Following a predetermined series of sessions, you’ll then talk about what you may need in the future. “Some patients do a maintenance program, and some do not need it. But most patients continue psychotherapy [with the clinic or one’s own therapist],” says De La Hoz.

What Does Ketamine Therapy Cost?

The cost of ketamine therapy varies widely depending on the type of clinic you go to, if you’re getting psychotherapy alongside it (and how many sessions and if they are in-person versus virtual), or if you’re ordering from an online company.

If you have commercial insurance coverage, you may only need to pay $10 for Spravato through a savings program, according to the company . Monitoring sessions after the medication are required; after a rebate, this may cost $0. You will have to sign up for this benefit, and you can learn more at the link above.

That said, insurance does not pay for other types of ketamine. (Insurance may cover the cost of the psychotherapy sessions, however. Ask about your specific benefits.) “The cost of treatment is not an insignificant amount of money,” says De La Hoz. One issue is that because of the cost, it may only be available to those with higher incomes. “We have hope that this will become more accessible to all who need it, not just specific populations,” he says.

For an idea of how much this treatment can cost, you can look at various companies, though Everyday Health does not endorse these resources, and you should always check with your healthcare provider before starting any new treatment plan.

  • Mindbloom costs $89/week for three months, which includes six at-home ketamine treatments, two consultations with a clinician, three guided sessions, and unlimited group integration sessions. Additional virtual integration coaching sessions are $59 for 45 minutes.
  • Numinus charges $250 per session for ketamine treatment and $375 per session for ketamine-assisted therapy.
  • For IV ketamine infusions, costs can range from $300 to $2,000 per infusion, according to the website KetamineClinicsDirectory.com , a number that depends on duration, dosage, and condition treated.

There are also financing options available with medical credit cards (like CareCredit) or sliding scale fees offered at some companies that can help defray or offset the costs. In some cases, HSA/FSA cards may be used for certain services.

Resources We Love: Ketamine Therapy

Best organizations.

Mental Health America

For information on mood disorders, support tools for mental wellness, and how to stay mentally healthy, this organization is an accurate and thorough go-to resource.

American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP)

This nonprofit group focuses on the safe clinical use of ketamine for mental health disorders and pain conditions. The most useful resource for the public is their directory to help you locate a ketamine physician in your area.

Psychedelic Medicine Association

To learn more about specific psychedelic drugs that may play a role in medicine, check out the Resource Library from the Psychedelic Medicine Association, which is made up of physicians, therapists, and healthcare professionals.

Psychedelic Science and Medicine Interest Group

The National Institutes of Health is increasingly devoting resources and attention to psychedelic medicine. This is the homepage of the special interest group. Check back for information on their monthly virtual meetings, which feature guest speakers and reviews of new studies in psychedelic medicine.

UC Berkeley Center for the Science of Psychedelics

This consumer-friendly website covers the basics of psychedelic therapy, including what psychedelics are, choosing a psychedelic therapist, the risks and how to stay safe, as well as how the legal landscape surrounding these drugs is changing.

The Ketamine Breakthrough: How to Find Freedom From Depression, Lift Anxiety, and Open Up to a New World of Possibilities

Coauthored by Mike Dow, PsyD, and the Field Trip cofounder Ronan Levy, this book focuses specifically on ketamine, including the history of its use, the potential uses in mental health care and who it’s for, and what to expect during treatment.

Best Program for Providers

Polaris Insight Center

Certain continuing education training programs are designed specifically for healthcare providers who administer ketamine-assisted therapy to treat patients in a clinical setting. Polaris Insight, for example, aims to guide interested caregivers like physicians, psychologists, therapists, nurses, chaplains, and other medical professionals to better understand and execute the principles and procedures of ketamine-assisted psychotherapy to amplify and ensure patient care.

Ketamine is a dissociative anesthetic drug that has long been used for anesthesia. Due to numerous studies over the last two decades, ketamine has emerged as a potential treatment for various mental health disorders, for example, treatment resistant depression, anxiety, PTSD, and alcohol use disorder. It is only FDA approved as esketamine (similar to ketamine) for treatment-resistant depression and depression with suicidality, although ketamine is prescribed off label to treat other psychiatric disorders.

There are various ways ketamine can be given (IV, orally, nasally), yet clearly established protocols and standards are not available and there is variability in how clinics provide ketamine therapy. It’s important that the clinic you go to, or the company you use, screens your physical and psychological health prior to treatment to determine if it’s appropriate for you. In addition, though ketamine can be given with or without psychotherapy, experts say that a combination of ketamine and therapy, called ketamine-assisted therapy, provides the greatest benefits.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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  • What Is Ketamine Therapy? Pacific Neuroscience Institute .
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  • Matveychuk D, Thomas RK, Swainson J, et al. Ketamine as an Antidepressant: Overview of Its Mechanisms of Action and Potential Predictive Biomarkers. Therapeutic Advances in Psychopharmacology . May 11, 2020.
  • FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression; Available Only at a Certified Doctor’s Office or Clinic. U.S. Food and Drug Administration . March 5, 2019.
  • What Is Ketamine? United States Drug Enforcement Administration .
  • Sobule R, Ithman M. Ketamine: Studies Show Benefit. Missouri Medicine . January–February 2023.
  • Yang Y, Cui Y, Sang K, et al. Ketamine Blocks Bursting in the Lateral Habenula to Rapidly Relieve Depression. Nature . February 14, 2018.
  • Rosenbaum SB, Gupta V, Patel P, et al. Ketamine. StatPearls . November 24, 2022.
  • Nikayin S, Murphy E, Krystal JH, Wilkinson ST. Long-term Safety of Ketamine and Esketamine in Treatment of Depression. Expert Opinion on Drug Safety . April 19, 2022.
  • Bahji A, Zarate CA, Vazquez GH. Efficacy and Safety of Racemic Ketamine and Esketamine for Depression: A Systematic Review and Meta-Analysis. Expert Opinion on Drug Safety . June 2022.
  • SPRAVATO with ME. Spravato .
  • Ketamine Treatment Centers and Compound Pharmacies.  KetamineClinicsDirectory.com .
  • Gitlin J, Chamadia S, Locascio JJ, et al. The Dissociative and Analgesic Properties of Ketamine Are Independent. Anesthesiology . November 1, 2020.
  • Kryst J, Mitoraj AM, Pilc A, et al. Efficacy of Single and Repeated Administration of Ketamine in Unipolar and Bipolar Depression: A Meta-Analysis of Randomized Clinical Trials. Pharmacological Reports . April 16, 2020.
  • Post-Traumatic Stress Disorder. National Institute of Mental Health . May 2022.
  • Phillipp-Muller AE, Stephenson CJ, Moghimi E, et al. Combining Ketamine and Psychotherapy for the Treatment of Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry . February 6, 2023.
  • Marcantoni WS, Akouma BS, Wassef M, et al. A Systematic Review and Meta-Analysis of the Efficacy of Intravenous Ketamine Infusion for Treatment Resistant Depression: January 2009–January 2019. Journal of Affective Disorders . December 2020.
  • What Are Anxiety Disorders? American Psychiatric Association . June 2021.
  • Whittaker E, Dadabayev AR, Joshi SA, and Glue P. Systematic Review and Meta-Analysis of Randomized Controlled Trials of Ketamine in the Treatment of Refractory Anxiety Spectrum Disorders. Therapeutic Advances in Psychopharmacology . December 15, 2021.
  • Jones JL, Mateus CF, Malcolm RJ, et al. Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Frontiers in Psychiatry . July 24, 2018.
  • Drug Fact Sheet: Ketamine. Department of Justice/Drug Enforcement Agency . April 2020.
  • Janssen Announces U.S. FDA Approval of SPRAVATO® (esketamine) CIII Nasal Spray to Treat Depressive Symptoms in Adults with Major Depressive Disorder with Acute Suicidal Ideation or Behavior. Cision PR Newswire . August 3, 2020.
  • Berman RM, Cappiello A, Anand A, et al. Antidepressant Effects of Ketamine in Depressed Patients. Biological Psychiatry . February 15, 2000.
  • Puderbaugh M, Emmady PD. Neuroplasticity. StatPearls . May 1, 2023.
  • Ragnhildstveit A, Roscoe J, Bass LC, Averill CL, et al. The Potential of Ketamine for Posttraumatic Stress Disorder: A Review of Clinical Evidence. Therapeutic Advances in Psychopharmacology . March 6, 2023.
  • Liriano F, Hatten C, Schwartz TL. Ketamine As Treatment For Post-Traumatic Stress Disorder: A Review. Drugs Context . April 8, 2019.
  • Bhatt K, Yoo J, Bridges, A. Ketamine-Induced Manic Episode. Primary Care Companion for CNS Disorders . May 13, 2021
  • Bethesda. Ketamine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury . April 25, 2018
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  • Ketamine Hydrochloride Injection, USP Adverse Reactions. Pfizer Medical Information .
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Ketamine 101: Uses, Safety, & Dosage

Ketamine was invented to replace PCP as an anesthetic. Today, it’s considered one of the premiere treatments for depression. Here’s how it works.

ketamine slechte trip

What is Ketamine?

Other names for ketamine, what does ketamine feel like, how long does ketamine remain in the system, ketamine dosages according to form of administration, how much does ketamine therapy cost, is ketamine therapy covered by insurance, who is not a good candidate for ketamine therapy, is ketamine legal, side effects of ketamine, is ketamine addictive, ketamine overdose, how strong is ketamine compared to other psychedelics, 1. ketamine for anesthesia, 2. ketamine for depression, 3. ketamine for pain, ketamine in veterinary medicine, the history of ketamine, s-ketamine vs. r-ketamine: what’s the difference, what is kitty flipping, what the future of ketamine looks like, subscribe to tripsitter: newsletter & podcast.

Ketamine has been around since the 1960s where it was used exclusively as a surgical anesthetic .

Over the past three decades, there’s been a growing interest in ketamine as a recreational hallucinogenic and dissociative drug.

Even more recently, ketamine has been shown to offer a unique mechanism for treating depression — unlike anything we’ve ever seen before.

In this article, we’ll cover everything you need to know about ketamine. How it works, what the basic dosages are for each level of effects, and more.

Ketamine is classified as a dissociative hallucinogenic — which distorts the perception of sights, sounds, emotions, and decouple one’s first-person experience from reality. Users feel “outside their body.”

Chemically-speaking, ketamine is a member of the larger arylcyclohexylamine class of drugs . This group includes other popular compounds like PCP (phencyclidine) , DCK (deschloroketamine) , 2-FDCK (2-fluorodeschloroketamine) , and MXE (methoxetamine).

In medicine, ketamine is used as an analgesic . It doesn’t directly block pain signals like an opiate — instead, dissociative analgesics disconnect the thalamus from the cortex. When this happens, the body still feels pain, but the brain simply “doesn’t care.” We don’t actually feel bothered by the pain.

Experts on the use of ketamine, such as Albert Dahan (professor of anesthesiology at The University of Leiden), suggest ketamine to be “one of the best painkillers ever made.”

Beyond its use as a painkiller, ketamine is used as a recreational drug (illegally). The experience changes according to the dose.

Lower doses feel a lot like being drunk on alcohol.

Higher doses are more similar to psychedelics like DMT or salvia, but with a distinct dissociative action on top of any psychedelic visuals or effects.

A high dose of ketamine can lead to an experience called a “ K-hole ” — which is an extremely intense dissociative hallucination that can be both beautiful and terrifying all at once.

More recently, research has shown that low doses of ketamine offer powerful antidepressant qualities . It works through entirely different mechanisms than conventional antidepressant medications.

Unlike most drugs, ketamine targets many different receptors at once, making it very difficult to study exactly what’s going on or how it works.

There’s currently one FDA-approved ketamine spray called Spravato® — which is prescribed for treatment-resistant depression (depression that doesn’t improve with conventional medications).

ketamine slechte trip

Ketamine: Specs & Technical Details

Ketamine is sold under a wide range of different street names as well as various pharmaceutical trade names.

Here are some of the other names for ketamine:

ketamine slechte trip

The effects of ketamine are dependent on the dose you use, your individual body weight and metabolism, how often you use it, what form you’re using ( intravenous , troches / lozenges , intranasal ), and whether you’re using ketamine alone or with other substances.

In lower doses, the effects of ketamine resemble alcohol intoxication. It causes feelings of mild euphoria, as well as visual and auditory perceptual changes. It makes users feel as though they’re floating or operating on autopilot. Low doses are mildly stimulating and can make users feel more social or energetic.

Higher doses of ketamine feel very different. They can make you feel withdrawn and introverted. People often report feeling very light and floaty and often experience intense hallucinations, blurred vision, and out-of-body experiences.

In very high doses , people experience what’s commonly referred to as a K-hole — which involves strong out-of-body hallucinations. This is a demonstration of the dissociative aspect of ketamine to its fullest extent. Users feel as though they’re perpetually falling into blackness. It’s as if the fabric of time, as well as one’s sense of self is dissolving.

Some describe the K-hole experience to be like “peering into the keyhole of existence.”

A K-hole can feel both terrifying and exhilarating at the same time.

The effects of ketamine may include:

  • Difficulty thinking logically
  • Reduced anxiety
  • Delusions & ego inflation
  • Disinhibition
  • Memory loss
  • Spatial disorientation
  • Altered perception of time & space
  • Sedation or fatigue
  • Spontaneous bodily sensations (tingling, pulsating)
  • A feeling of being light or floating
  • Loss of muscle coordination or control
  • Reduced sensation of pain
  • Increased salivation
  • Lowered libido
  • Nausea & vomiting
  • The feeling of being on “autopilot” or not in control of your body

ketamine slechte trip

How Long Does Ketamine Last?

Ketamine is not a long-lasting drug . The effects usually take between 30 and 60 minutes to reach their full effect, which remain in place for about an hour before starting to taper off. These numbers will vary depending on the form of administration.

  • Insufflated (snorted)  — Effects kick-in within 5–15 minutes. Peak effect reached in 30 minutes. Total duration between 1 and 3 hours depending on dose.
  • Intravenous (IV)  — Effects kick in within 60 seconds. Peak reached in 3–5 minutes. Total duration between 40 and 60 minutes. Some lingering effects up to 2 hours.
  • Sublingual  — Effects from troches or lozenges kick in within 5-10 minutes. Peak effect reached in 30 minutes. Total duration between 1–3 hours depending on dose.
  • Oral  — Effects kick in within 20-30 minutes. Peak reached by 60 minutes. Total duration 2–4 hours.
  • Intramuscular (IM)  — Effects kick in within 1–5 minutes. Peak effects in 10–15 minutes. Total duration up to 2 hours.
  • Rectal/Suppositories —  Effects kick in within 15–20 minutes. Peak effects reached in 30-40 minutes. Total duration 1–2 hours.

ketamine slechte trip

Ketamine is rapidly metabolized by the liver into norketamine and other inactive metabolites, which are then eliminated through the urine.

The half-life of ketamine is 2.5 hours and it takes about 5 or 6 half-lives before a drug is completely cleared from the body. This means ketamine can remain detectable in the bloodstream for around 15–24 hours, depending on factors like dosage and frequency of use.

People who use ketamine often will take longer for the drug to be eliminated from the body entirely. This can take up to 48 hours in the bloodstream, and up to 72 hours in the urine.

All of this means that ketamine will typically show up on a drug test up to 24 hours for saliva tests, 48 hour later for urine and blood tests, and 4 months for hair or fingernail tests.

ketamine slechte trip

What’s The Dose of Ketamine?

Ketamine is highly dose-dependant — meaning the effects of high dose ketamine is dramatically different from low-dose ketamine.

The threshold dose refers to the smallest dose that produces noticeable psychoactive effects.

The lower dose ranges of ketamine — starting with the threshold dose — produces mild alterations in perception and feels most similar to GHB or alcohol. Lower doses create a sense of disinhibition, mild dissociation and depersonalization, and is even slightly stimulating. This makes low dose ketamine a popular party drug.

The standard psychoactive dose refers to the most common psychoactive dose range used for a given drug. This is the dose range that produces all the characteristic effects expected of ketamine — strong dissociation, visual and auditory perceptual changes, and sometimes even out of body experiences.

High doses produce significantly more dissociative and out-of-body experiences. Very intense dissociation from ketamine is referred to as a K-hole — which begins somewhere around the 200 mg mark for oral and sublingual ketamine.

ketamine slechte trip

What is Ketamine-Assisted Psychotherapy?

The field of psychedelic-assisted psychotherapy (PAP) is growing at an exponential rate.

So far, the only psychedelic that’s been approved for use in therapy is ketamine, but MDMA-assisted therapy and psilocybin-assisted therapy are both just around the corner.

Over the last 50 years, there have been over 70 individual Phase II clinical trials exploring the benefits of ketamine for conditions such as depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), drug addiction, and much more. This has fuelled a boom in the number of clinics around the world offering off-label ketamine for a wide range of mental health disorders.

At the moment, ketamine is only approved by the FDA as a form of anesthesia during surgery — with the exception of Spravato Ketamine Nasal Spray which is approved for treatment-resistant depression. Most of the ketamine being used with ketamine-assisted therapy are not formally approved by the FDA or equivalent regulators around the world.

There are 2 main forms of ketamine-assisted therapy in practice today:

  • In-Person Ketamine Therapy —  In-person clinics are the only way to get the more powerful IV or IM ketamine injections. This form of therapy is expensive in the short-term, but carries the greatest chances of getting longer-lasting results.
  • Online (Telehealth) Ketamine Therapy —  Positioned as the most affordable form of ketamine therapy. It involves an online consultation to attain the prescription needed to continue therapy. Ketamine lozenges are then sent in the mail and sessions are monitored through online video platforms.
  • Spravato Nasal Spray —  As the only FDA-approved use of ketamine for treating depression, this ketamine preparation has been gaining a lot of popularity lately and is covered by some insurance providers in the US.

Related: Does Ketamine Therapy Get You High?

Ketamine is promised as a quick, long-term solution to mental health conditions like depression, PTSD, and addiction. Ketamine providers are using this argument to justify the relatively high cost of treatment.

However, this isn’t how it’s been playing out in practice. Ketamine therapy users tend to require ongoing treatment — so therapy can get expensive, quickly.

Here’s what you can expect for the first month of ketamine therapy depending on the type of treatment you’re seeking. Note that consecutive months tend to be cheaper thanks to refill discounts offered by many (but not all) companies in this space.

Ketamine infusions tend to be the most expensive upfront — costing between $350 and $500 for a single session (usually purchased in packages of 6 to 8).

Online ketamine clinics boast cheaper per-session costs (around $150–$200 per session), but often fail to provide enough adjunctive support for users to stop taking ketamine without relapsing.

Spravato ketamine nasal spray is the most expensive form of ketamine therapy outside of the luxury clinic experiences which can extend into the thousands of dollars per session.

Related: How Much Does Psychedelic-Assisted Psychotherapy Cost?

Most insurance providers won’t cover the cost of ketamine therapy . The landscape surrounding psychedelic-assisted therapy is continually evolving, and more providers are adding ketamine to their premium-tier packages all the time — but this is highly dependant on the individual provider and which plan you’re on.

Some companies, such as Blue Cross Blue Shield, Gilsbar, Zelis/ PPO Plus, United Healthcare, United Behavioral Health, and Cigna Behavioral Health are now covering some or all of the cost for Spravato ketamine nasal spray, but not other forms of ketamine therapy. This is largely because Spravato is the only FDA-approved ketamine treatment for depression.

While ketamine is widely considered a “low-risk” drug — there are situations where ketamine can pose an elevated risk. Not all people are suitable for ketamine therapy.

Avoid ketamine therapy if you have any of the following:

  • A history or family history of schizophrenia or psychosis
  • Have not first attempted treatment with other (approved) medications or therapies
  • A history of cardiovascular disease, including hypertension
  • A history of bladder, kidney, or liver disease
  • A history of substance abuse disorder
  • Are unable to understand and provide informed consent
  • Are pregnant or nursing
  • Have known allergies to ketamine or other arylcyclohexylamines

ketamine slechte trip

Ketamine is available via prescription only . It’s mainly reserved for emergency medicine and surgery.

Some doctors may prescribe ketamine for the treatment of pain (usually in combination with an opiate), as well as for depression — but only when other treatments have been attempted first.

There are no countries where ketamine is legal for recreational use. This means any ketamine you order online or in-person without a valid prescription is illegal or black market ketamine. Some of this black market ketamine is stolen from veterinarian supplies — some are made in an illicit lab with varying levels of purity.

While we never condone the use of illicit drugs, we’d like to remind you to always test your drugs before you use them should you choose to do so. One of the biggest risks of taking black market ketamine is the adulteration with other dangerous drugs — such as NBOMes or fentanyl.

There are a few prescription ketamine drugs on the market today, including:

  • Ketalar® —  JHP Pharmaceuticals
  • Ketaject® — Phoenix Pharmaceuticals
  • Ketaset® — Zoetis
  • Spravato® —  Johnson & Johnson

Ketamine Risks & Side Effects

Overall, ketamine is considered very safe and is unlikely to lead to overdose — unless mixed with other drugs or alcohol.

As an analgesic, ketamine is one of the safest drugs available and isn’t nearly as likely to lead to respiratory or cardiovascular emergencies compared to other analgesics.

While ketamine is addictive, it has a much lower risk of addiction compared to other prescription medications — especially pain medications or antianxiety medications.

With that said, ketamine does come with inherent risks:

  • Ketamine can increase the risk of heart attack or stroke
  • Frequent use has been linked with bladder disease
  • Blackmarket ketamine may be laced with other, more dangerous drugs
  • Ketamine is often used as a date rape drug
  • Ketamine can interfere or interact with other medications or alcohol
  • Ketamine stops you from feeling pain, increasing your risk of developing serious injuries
  • Ketamine can be addictive with more frequent use
  • The psychoactive effects of ketamine can be terrifying and may trigger psychosis in susceptible individuals

It’s important to have a trip sitter around and follow the four pillars of safe psychedelic use if you plan on experiencing the deeper levels of ketamine (K-hole).

This experience will cause you to lose control of your body and can be extremely terrifying. So it’s critical that you have someone you trust nearby, and only take the drug in a safe and comfortable environment.

ketamine slechte trip

The most common side-effects of ketamine are dissociation (sometimes considered a primary effect), high blood pressure, and tachycardia (rapid heart rate).

These side effects are rarely severe, and tend to only pose danger to those with prexisting cardiovascular disease or those taking other medications that affect heart rate and blood pressure.

Side effects of ketamine include, but are not limited to:

  • High blood pressure
  • Perceptual disturbances
  • Loss of coordination
  • Slurred speech
  • Intoxication & disinhibition
  • Bladder pain
  • Dissociation (out-of-body experiences)

Ketamine is addictive and is often abused.

While it’s still not clear whether ketamine is physically addictive, you can develop tolerance — which means you’ll need to take a higher dose of the drug to get the same experience.

Users become addicted to the dissociative effects of the drug. They compulsively use the substance as a way to find an escape from their reality — which may feel objectively painful or uncomfortable. Addiction is defined as any act of compulsively using a substance (or activity) to find relief, despite clear negative consequences to using the drug.

Most people don’t experience withdrawal symptoms after stopping ketamine — with the exception of cravings for more ketamine (this is considered a psychological dependency). Physically, ketamine is less addictive than drugs like opiates, alcohol, amphetamines, or benzodiazepines.

With that said, heavy users may experience sleep disturbances, tremors, sweating, rapid heart rate, appetite loss, erectile dysfunction, and fatigue for a few days.

ketamine slechte trip

One of the biggest advantages ketamine brings to the medical field is it’s low-risk of causing overdose. Ketamine doesn’t affect respiration the way opiates do, and it has only a minor impact on the heart, brain, and other internal organs — even in high doses. It’s also relatively short-lived and fast-acting — two factors that significantly reduce the chances of consuming toxic doses.

With that said, ketamine can still cause overdoses that can result in long-term damage or death.

Ketamine overdoses become much more common when combined with other drugs or alcohol — particularily other depressants such as GHB, benzodiazepines, barbiturates, opiates, and alcohol.

The LD50 (lethal dose for 50% of individuals) for ketamine is 25 mg/kg (oral) or 11.3 mg/kg (IV) [ 13 , 14 ]. For a 70 kg human this works out to around 791 mg intravenously or 1750 mg orally— both of which are over 100 times higher than what’s considered a heavy dose of ketamine.

The biggest dangers come from loss of consciousness and disinhibition from ketamine. People who are unable to control their body are placed at a significantly higher risk of suffocation (usually on vomit) and critical injuries (from cars, other people, or falls). Ketamine also induces disinhibition, so even those who remain in some control of their body are more likely to place themselves in risky situations that could become life-threatening.

Signs and symptoms of ketamine overdose include:

  • Loss of consciousness
  • Slowed breathing
  • Slow heart rate
  • Low blood pressure
  • Apnea (periods of ceased breathing, followed by rapid breathing)
  • Lack of muscle coordination

Unfortunately, there are no good ketamine reversal agents currently available. Some drugs, such as various benzodiazepines and certain antipsychotic medications can be used to treat individual symptoms of ketamine overdose, but not reverse the effects the way Narcan does for opiates or flumazenil does for benzodiazepines.

Ketamine can be very powerful. While it’s less potent than other psychedelics in terms of the dose, the effects can become much more profound than many other psychedelic substances.

This drug is most comparable in terms of effects to PCP, but less potent and with a much safer profile.

Lower doses of ketamine are similar in their effects to MDMA , MDA, 2C-B , or 2C-E .

DXM , xenon gas , and nitrous oxide all work through similar mechanisms and have a similar dissociative effect.

The full dose of ketamine that leads to a K-hole experience is similar to DMT or salvia but feels subjectively different. A K-hole is usually dark (in more of a “low-light” way than evil or depressing), shadowy, and often involves the feeling of falling or being rapidly teleported to different locations.

How Ketamine Works

Ketamine is considered a “dirty drug.” This doesn’t mean the drug is toxic or poisonous — it refers to the specificity of the drug on its target receptors.

Ideally, a pharmaceutical targets one specific receptor to cause its effect. This makes its effects predictable and easier to study and understand. These drugs are precise and don’t cause any overflow effects on unrelated or irrelevant receptors.

Ketamine, on the other hand, is messy — it activates several different types of receptors, each with a different result. Ketamine stimulates some receptors and inhibits others.

This makes ketamine very difficult to study and understand. It’s also what makes this compound so useful for complex conditions like depression.

Ketamine has been shown to target the following receptors in the brain:

  • Opioid receptors
  • Blocks NMDA (glutamate) receptors at low doses
  • Stimulates NMDA (glutamate) receptors at high doses
  • Cholinergic receptors
  • Dopamine receptors
  • Adrenergic receptors
  • Innate repair (HCN1 receptors)
  • Sodium channels

Ketamine is primarily used as an anesthetic agent in patients undergoing surgery or following a severely traumatic event. It’s more effective for blocking pain than opiate painkillers, which work by activating the opioid receptors in the spinal cord and brain.

Ketamine works like most other dissociative analgesics — such as PCP, nitrous oxide, and DXM. They work by temporarily blocking the NMDA receptors — thus inhibiting communication between the cortex (the outer portion of the brain where higher thought occurs) from the thalamus. The thalamus is responsible for relaying messages from sensory information like pain, emotion, vision, and taste.

ketamine slechte trip

Studies have shown that ketamine owes most of its painkilling effects to its ability to block glutamate receptors (in lower doses) [ 2 ]. It also activates the opioid receptors, but to a much lower extent than typical opiate painkillers [ 3 ].

Other potential mechanisms for ketamine’s painkilling effects come from its ability to block the muscarinic and nicotinic receptors [ 4 ].

A meta-analysis exploring the outcomes of 11 clinical trials using ketamine for pain found it to be extremely effective for managing severe short-term pain but did not offer a good long-term solution for ongoing chronic pain [ 5 ].

Newer research (beginning in the early 2000s) shows that ketamine is also a powerful antidepressant. It works through mechanisms not offered by any other antidepressant on the market today. The effects of ketamine are fast-acting, exerting improvements in mood in as little as four hours after administration — even in treatment-resistant forms of depression.

Unfortunately, the effects of ketamine only last about seven days before another dose is required. It’s considered a third line of treatment for depression. Only when all other antidepressants have failed is ketamine prescribed to manage depression.

Only one ketamine product has been approved for use by the FDA — an isomer called esketamine, sold under the brand name Spravato®. This drug is made by the pharmaceutical company Janssen — a subsidiary of Johnson & Johnson.

ketamine slechte trip

How Spravato (and ketamine in general) works for treating depression is still not well understood. But here’s what we know so far:

Ketamine & Synapse Regrowth

Studies have shown that ketamine stimulates the growth of synapses [ 7 ]. This is an important finding because no other antidepressant that we know of can do this.

Chronic stress depletes the synapses in certain regions of the brain — especially the medial prefrontal cortex. This region is often implicated in the effects of depression. Researchers in the study gave mice ketamine and observed the formation of tiny spikes on the dendrites of the nerve cells. Spikes that survived for a few days after the treatment eventually formed into new synapses.

This effect is likely what causes the long-term benefits of using ketamine. However, this process takes a few days, so there must be other mechanisms that provide more fast-acting effects on depression.

The mechanism ketamine uses to cause this effect is extremely complicated and involves a cascade of effects [ 1 0 , 1 1 ]. It’s believed ketamine has a greater affinity for glutamate receptors that are located on GABA interneurons, which are inhibitory neurons [ 12 ].

Ketamine blocks the effects of these neurons, which cause a downstream increase in glutamate. Excess glutamate activates postsynaptic AMPA receptors, which bolster the effects of BDNF and mTORC1 — which are ultimately responsible for the regrowth of synapses.

Unfortunately, there’s little evidence to suggest that ketamine has a lasting impact on depression. Most studies show that ketamine requires another dose every 2–3 weeks to maintain the antidepressant effects.

Blood Sugar Regulation

Ketamine has been shown to regulate blood sugar levels in regions of the brain associated with depression [ 6 ].

It’s not clear whether this has a direct benefit on depressive symptoms or if it’s a byproduct of other improvements in these brain regions.

Circadian Rhythm Regulation

Ketamine has been shown to improve the body’s ability to regulate the circadian rhythm [ 9 ]. Researchers are still seeking to understand whether these improvements come as a result of improved mood or if this effect contributes to the greater mood regulation instead.

ketamine slechte trip

Ketamine is becoming a popular alternative treatment option for tough to treat chronic pain conditions such as fibromyalgia , complex regional pain syndrome (CRPS),postoperative pain, and neuropathic pain.

Research in this field is still evolving, but more studies are released showing promising results for certain types of pain conditions all the time [ 17 ].

For example, a meta analysis published in 2011 involving over 4700 patients found a significant reduction in total postoperative opioid use [ 15 ]. Researchers in this study suggested that patients administered ketamine as part of their post-operative pain management protocols were able to cease opiate medications sooner than those using only opiates. This suggests both an analgesic action and anti-addictive action for ketamine.

However, the effectiveness of ketamine for managing pain remains inconclusive.

For example, a meta analysis examining studies using ketamine for cancer pain reported that relief only lasted 3-hours and resulted in a high incidence of neurological side effects [ 16 ]. Another large-scale meta analysis looking at the role of ketamine as an analgesic for post-operative pain reported no sizeable advantage to using ketamine (poorer pain reduction and increased neurological side effects) [ 18 ].

Ketamine is an interesting analgesic option because it targets several neurotransmitter systems involved with pain transmission. This includes the mu-opiate receptors which are the target for powerful and commonly-used pain medicines like oxycontin, morphine, and hydrocodone.

However, unlike these classic pain medications, ketamine also interacts with other systems, such as the NMDA receptors, serotonin, and dopamine. Some researchers believe these other pathways are the reason why ketamine works so well in patients that haven’t found relief from their chronic pain using more conventional painkillers.

Related: Is Ketamine an Opiate?

Ketamine is widely used in veterinarian medicine as an anesthetic for dogs , cats , and horses undergoing surgery.

It’s considered an ideal anesthetic because of its impressive safety profile compared to other anaesthetic agents.

The primary reason ketamine was developed was to offer a replacement for PCP (phencyclidine) — which was the primary analgesic used for surgery prior to 1970.

Scientists have been searching for an alternative to PCP for a long time. While this drug worked to stop pain and suffering during surgical procedures and after severe traumatic injuries, it often led to long-term side effects like psychosis.

Ketamine was first synthesized by Calvin L. Stevens in 1962. At the time, Stevens was a professor of Chemistry at Wayne State University and worked as a consultant for the Pfizer Pharmaceutical subsidiary, Parke-Davis.

Ketamine (then called CI-581) was first tested on animals and showed very promising results as an analgesic. It was then tested (involuntarily) on prisoners in 1964 [ 1 ]. The results of these studies were enough to prove ketamine was just as effective as PCP, only with a much lower risk of side effects. The drug was finally approved in 1970 for use in medicine, and PCP was quickly removed from service.

Most drugs come in two different enantiomers.

Enantiomers are chemicals that have the exact same chemical structure but are mirror images of each other. Just like your right and left hand. Both hands have the same shape, but in order for them to share the same outline, you have to flip one of them upside down.

There are two enantiomers for ketamine — the “R” and “S” enantiomers.

Ketamine contains both of them at a ratio of around 1:1.

Esketamine (S-ketamine) contains only the “S” ketamine, which is the stronger of the two molecules. S-ketamine is also reported to produce 1.6 times the level of altered body image and hearing, 2.5 times stronger feelings of unreality, and four times the reduction in visual acuity.

Kitty flipping is the practice of mixing ketamine with MDMA. The effects are reported to share a blend of the empathogenic and euphoric effects of MDMA, with the dissociative effects of ketamine. This blend is commonly used at raves or music festivals.

It’s not wise to mix psychedelic drugs, especially synthetic drugs that could contain any number of adulterants already. Always test your substances before you take them, and use a smaller dose should you decide to mix two or more substances together.

ketamine slechte trip

There’s been a growing interest in ketamine surrounding its use as an antidepressant. This is largely due to the fact that this drug works through a mechanism not offered by any of the conventional antidepressant medications.

As more research uncovers how ketamine works, it’s likely we’ll see this drug become more common for people with treatment-resistant depression.

What’s even more likely, is that new (hopefully safer) drugs will be developed that share similar mechanisms of action but that can offer more long-lasting benefits.

The recreational use of ketamine is likely to continue to thrive in the shadows. There have not been any moves to make recreational ketamine use more accessible.

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  • Domino, E. F., & Warner, D. S. (2010). Taming the ketamine tiger. The Journal of the American Society of Anesthesiologists, 113(3), 678-684.
  • Visser, E., & Schug, S. A. (2006). The role of ketamine in pain management. Biomedicine & Pharmacotherapy, 60(7), 341-348.
  • Persson, J. (2013). Ketamine in pain management. CNS neuroscience & therapeutics, 19(6), 396-402.
  • Abelson, K. S., Goldkuhl, R. R., Nylund, A., & Höglund, A. U. (2006). The effect of ketamine on intraspinal acetylcholine release: involvement of spinal nicotinic receptors. European journal of pharmacology, 534(1-3), 122-128.
  • Hocking, G., & Cousins, M. J. (2003). Ketamine in chronic pain management: an evidence-based review. Anesthesia & Analgesia, 97(6), 1730-1739.
  • Lally, N., Nugent, A. C., Luckenbaugh, D. A., Ameli, R., Roiser, J. P., & Zarate, C. A. (2014). Anti-anhedonic effect of ketamine and it’s neural correlates in treatment-resistant bipolar depression. Translational psychiatry, 4(10), e469-e469.
  • Li, L., & Vlisides, P. E. (2016). Ketamine: 50 years of modulating the mind. Frontiers in human neuroscience, 10, 612.
  • Moda-Sava, R. N., Murdock, M. H., Parekh, P. K., Fetcho, R. N., Huang, B. S., Huynh, T. N., … & Lopez, K. (2019). Sustained rescue of prefrontal circuit dysfunction by antidepressant-induced spine formation. Science, 364(6436).
  • Duncan Jr, W. C., Slonena, E., Hejazi, N. S., Brutsche, N., Kevin, C. Y., Park, L., … & Zarate Jr, C. A. (2017). Motor-activity markers of circadian timekeeping are related to ketamine’s rapid antidepressant properties. Biological psychiatry, 82(5), 361-369.
  • Matveychuk, D., Thomas, R. K., Swainson, J., Khullar, A., MacKay, M. A., Baker, G. B., & Dursun, S. M. (2020). Ketamine as an antidepressant: an overview of its mechanisms of action and potential predictive biomarkers. Therapeutic Advances in Psychopharmacology, 10, 2045125320916657.
  • Abdallah, C. G., Sanacora, G., Duman, R. S., & Krystal, J. H. (2015). Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics. Annual review of medicine, 66, 509-523.
  • Zorumski, C. F., Izumi, Y., & Mennerick, S. (2016). Ketamine: NMDA receptors and beyond. Journal of Neuroscience, 36(44), 11158-11164.
  • Hansen, G., Jensen, S. B., Chandresh, L., & Hilden, T. (1988). The psychotropic effect of ketamine. Journal of Psychoactive Drugs, 20(4), 419-425.
  • Ben-Shlomo, I., Katz, Y., Rosenbaum, A., & Hadash, O. (2001). Intravenous midazolam significantly enhances the lethal effect of thiopental but not that of ketamine in mice. Pharmacological research, 44(6), 509-512.
  • Laskowski, K., Stirling, A., Mckay, W. P., & Lim, H. J. (2011). A systematic review of intravenous ketamine for postoperative analgesia. Canadian Journal of Anesthesia, 58(10), 911.
  • Jonkman, K., van de Donk, T., & Dahan, A. (2017). Ketamine for cancer pain: what is the evidence?. Current Opinion in Supportive and Palliative Care, 11(2), 88-92.
  • Jonkman, K., Dahan, A., van de Donk, T., Aarts, L., Niesters, M., & van Velzen, M. (2017). Ketamine for pain. F1000Research, 6.
  • Lee, E. N., & Lee, J. H. (2016). The effects of low-dose ketamine on acute pain in an emergency setting: a systematic review and meta-analysis. PloS one, 11(10), e0165461.

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List of All Common Dissociative Drugs & Their Effects

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[Xe] | Tripping On Xenon

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Arylcyclohexylamines

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PCP (Phencyclidine) & Analogs

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DXM (Dextromethorphan): Effects, Dosage, & Safety

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N2O: Nitrous Oxide

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Psilocybin Therapy: A Client’s Healing Journey with Canada’s Special Access Program

Hear about the power of psilocybin-assisted psychotherapy from a Field Trip therapist & client, plus learn about Canada's Special Access Program and who qualifies.

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Ketamine vs. Psilocybin for Therapy

Explore the therapeutic uses of ketamine and psilocybin (aka “shrooms”) plus the major similarities and differences between the two.

Treatment at Field Trip

Understand our approach to Ketamine-assisted therapy and how Field Trip's protocol helps clients report marked improvements in their anxiety and depression symptoms immediately after treatment – and continued a month later.

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Three Reasons to Choose Field Trip

Read about why Field Trip's program is safe, effective, and beneficially "mind manifesting."

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As Seen on the Today Show: Ketamine, A New & Promising Mental Health Treatment

NBC’s TODAY Show covers the breakthrough medicine 'ketamine' and Field Trip's treatment with it.

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Field Trip's Philosophy on "Bad Trips"

Field Trip has created an environment where big, challenging experiences are expected and welcomed. Your therapist will help you create a plan to ground yourself and return to safety, while continuing to grow into your authentic self.

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Why Ketamine-Assisted Psychotherapy is Worth It

Ketamine-assisted therapy is a welcomed catalyst for change, shifting perspective and unsticking old thought patterns. Learn why it's worth it.

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How to Prepare Yourself for Ketamine-Assisted Psychotherapy

Much like planning a vacation, the time between arranging a therapeutic ketamine session and actually departing on the trip can be filled with anticipation, curiosity, and even some anxiety.

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How Do I Know If I Qualify for Ketamine-Assisted Psychotherapy

With so many treatment options available for mental health and the various settings and ways in which one can receive ketamine therapy, how do you know if Ketamine-Assisted Psychotherapy is the right fit for you?

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Psychedelic Therapy In-Clinic vs At-Home

Learn about our two core offerings: Ketamine-assisted psychotherapy In-Person or through our hybrid program, "Freedom"

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Psychedelic Medicine Whitepaper

A comprehensive overview of current challenges and unmet needs in mental health conditions, budding clinical and health economic research in psychedelic therapy, and Field Trip Health’s approach to psychedelic-assisted therapy.

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How Ketamine Feels

Learn about the somatic and emotional sensations that ketamine brings up, and what to expect from your experience with the medicine.

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How to Change Your Mind Safely: The Importance of a Therapeutic Approach

Ready to Change Your Mind? Learn how Field Trip offers safe, legal, and personalized psychedelic-assisted therapy that is fast acting & long-lasting.

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Creating a Safe Container: The Importance of Set & Setting

Have you watched “How to Change Your Mind” and are considering psychedelics? Learn about what the psychedelic community means by creating a “safe container” with a focus on set and setting.

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Tips and Resources: Preparing for the Consult

Preparation is an integral and ongoing part of the Ketamine-Assisted Psychotherapy Journey. Learn more about what to do to prepare yourself for a consult.

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The Importance of Integration

Learn more about how Field Trip Health uses integration with its patients to help distill and process experiences during psychedelic-assisted therapy.

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Tips to Help you Talk to your Doctor about Psychedelic-Assisted Therapy

Find the right way to talk to your doctor about psychedelic-assisted therapy with our helpful tips!

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Why Ketamine and How Does it Work?

Learn more about the background of ketamine and ketamine therapy in this informative article.

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The Field Trip Experience

Field Trip Health's outpatient mental health centers combine the science of modern medicine and technology with the wisdom of the psychotherapeutic psychedelic approach.

Backed By Science

Explore credible research and discover the fascinating science behind Ketamine. Learn why we choose it as part of our treatment to help unlock inner healing wisdom.

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Ketamine vs. LSD for Therapy

Learn about the medicinal, sensational, and therapeutic similarities and differences between Ketamine and LSD.

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Ketamine vs MDMA for Therapy

Despite their similarities, ketamine and MDMA are unique medicines with key differences in the way they are each used in therapeutic settings.

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What Results Can I Expect from Ketamine-Assisted Psychotherapy?

Learn about the powerful healing and results of Ketamine-assisted psychotherapy backed by research and our own client stories.

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How Does Ketamine Affect the Brain?

Dive into the contemporary research on Ketamine and how it is a safe and effective treatment for depression, trauma, anxiety, and other mental health disorders.

Psychedelic Perspectives

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The Importance of Talk Therapy

Learn why talk therapy is an important practice and how Field Trip's virtual counseling program is different than the rest.

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Mental Health Resources

A directory of information for help with mental health conditions and psychedelic harm reduction.

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The Power of Intention Setting

Learn about the why & how of intention setting. This practice helps to focus energy and attention on what matters most in the purpose of this journey, and it helps to keep you aligned throughout the process.

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Maintaining Your Mental Health During the Holidays

The holiday season is here, and there is a universal pressure to remain "merry and bright." However, this time can also be an influx of added stress and pressure. For many, the holidays can be a difficult time of year if they are struggling with mental health challenges, family dynamics, or uncomfortable memories

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David Sax On Psychedelics, The Singularity & His Book 'The Future Is Analog'

David Sax is an award-winning writer and speaker whose journalistic writings have been featured in The New York Times, The New Yorker, and Bloomberg. He believes that not only has digital technology failed to fulfill these utopian expectations but that we're deliberately (yet perhaps unknowingly) rejecting that narrative and embracing the analog experience instead.

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Joe Patitucci Explains Plant Music & Connecting With Nature Through Sound

Joe Patitucci shares his views on plant consciousness, his experiences with psychedelics, the future of biofeedback, and more.

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Responding to Gun Violence with Mental Health Awareness and Support

The urgency to support community-based mental health services in this country is here and now.

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LGBTQIA2S+ Affirming Healthcare and Why Language Matters

June is Pride month. A time to celebrate LGBTQIA2S+ voices, equality, and achievements. It is also a time of reflection to ask ourselves, how the psychedelic community can take strides to be more inclusive to LGBTQIA2S+ individuals and other marginalized communities. 

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Living with Loss

To face dying may be what it means to be fully alive. Understand the steps to transforming grief and sorrow - individually, interpersonally and collectively.

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Magic Mushroom Day

Macy Baker, Content Lead at Field Trip, is joined by Marshall Tyler, Director of Research, to discuss Magic Mushroom Day

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Kenny Stills: Finding Freedom Through Psychedelic Therapy

Kenny came to Field Trip for mental health treatment, so he could work with psychedelics (specifically Ketamine) in a comfortable and safe environment, with the support of an experienced therapist.

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Quantum Mechanics, Consciousness & Psychedelics: Live Discussion

Learn about what quantum mechanics is, the nature of reality as we know it (based on this theory,) and the ineffable experience that consciousness expansion/psychedelics can bring us as humans beings.

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Ask an Expert and Change Your Mind: The Field Trip Experience

Dr. Mike Dow, psychedelic psychotherapist at Field Trip Health & Conrad Page, director of growth, discuss all things Field Trip.

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Ask an Expert and Change Your Mind: Five Things to Know Before Working with Psychedelic Medicine

Dr. Mike Dow, psychedelic psychotherapist at Field Trip Health & Conrad Page, director of growth, discuss top preparation tips and things to know before deciding if psychedelic medicine is a good fit for you.

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Ketamine for Mental Health

Dr. Michael Verbora will discuss the current evidence and ongoing clinical work that Field Trip Health is facilitating, using psychedelic medicine to treat treatment-resistant mental health conditions.

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Field Trip's "Tales from the Treatment"

Our speakers will walk you through exactly what to expect when embarking on a healing journey at Field Trip Health, the importance we place on a holistic model of care, and the impact it can have on peoples' lives.

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Field Trip Health: Amsterdam

We're excited to give you a glimpse inside our newest clinic in Amsterdam; alive with natural light and plant life, it's the perfect setting for a perspective-changing psychedelic experience.

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Field Trip Health: Chicago

We welcome you to our Field Trip Health Centre in the Chicago Metropolitan Area, and get to know our dedicated team of professionals as they speak about the driving ethos behind the work we do at Field Trip Health.

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Field Trip Health: Toronto

We invite you to explore our Field Trip Health Centre in downtown Toronto and hear remarks directly from our dedicated team of professionals as they speak about the driving ethos behind the work we do at Field trip Health.

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Field Trip Health Brings Psychedelic Medicine to Atlanta

We are excited to introduce you to our family in Atlanta and hear directly from our team about what makes this work so unique & powerful.

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Field Trip Health: New York

We invite you to explore our New York Field Trip Health Centre, and hear remarks directly from our dedicated team of professionals as they speak about the driving ethos behind the work we do at Field trip Health.

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Field Trip Health Brings Psychedelic Medicine to Chicago

Dr. Ben Medrano, MD and Judy Seals, FNP-C will walk through the history & current progress in the field of psychedelic medicine as well as discuss our clinical model and lasting, meaningful patient outcomes in the ketamine-assisted therapy work we facilitate in Chicago.

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Field Trip Health: Los Angeles

Take a tour through our Field Trip Health Centre based in Los Angeles, California, and hear remarks directly from our on-site team about the driving ethos behind our healing journey.

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Psychedelic Medicine: The Next Frontier In Mental Health with Dr. Ben Medrano & Dr. Michael Verbora

Dr. Ben Medrano, MD and Dr. Michael Verbora, MBA MD will discuss the paper, present the researched-based evidence of the efficacy of psychedelic therapies, and outline the ongoing clinical work that Field Trip Health is facilitating, using ketamine-assisted therapy to treat treatment-resistant mental health conditions with lasting success.

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Psychedelic Medicine at Field Trip Health

Take a tour through our Field Trip Health Centre based in Toronto, Ontario, and hear remarks directly from our on-site team about the driving ethos behind our healing journey.

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Psychedelic Therapy: A Therapist's Perspective

In this webinar, leaders of Field Trip Health's clinical therapy team – Dr. Katelyn Kalstein & Dr. Mark Shortt – will engage in a discussion about the therapeutic processes that are essential to healing, specifically within the context of psychedelic-assisted psychotherapy.

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Psychedelics for Mental Health with Dr. Michael Verbora & Dr. Ben Medrano

Focusing on a new treatment paradigm, this webinar will touch on the history of and recent progress in the development of psychedelic-assisted psychotherapy for mental health disorders, including current options in ketamine-assisted psychotherapy.

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Psychedelics for Mental Health

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Field Trip Health New York: Clinic Walkthrough

Join us in a tour of our New York clinic! From the moment you walk in the door, we are here to greet you and ensure a comfortable experience at our clinic.

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The Alchemy of Set & Setting

In this webinar Nurse Practitioner, Emily Hackenburg, Director of Business Development, Matt Emmer, and Psychotherapist, Susan Brody will share how Field Trip’s clinics take ‘set and setting’ into account for every decision made, as a means to craft an environment that promotes long-lasting healing.

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Field Trip NYC on CheddarTV

The CheddarTV team came by to walk through our patient journey!

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IGTV: Rainbo Mushrooms & Field Trip Health

Join Tonya Papanikolov, Founder & CEO of Rainbo Mushrooms, and our own Marshall Tyler in a chat about all things mushroom! They chat about how wellness properties are inherent to fungi, their own cultivation protocols, and a little bit of chemical biology to boot.

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IGTV: Fungi Academy & Field Trip Health

Our Director of Research, Marshall Tyler, joins Fungi Academy Founder Oliver Merivee to chat about all things fungi!

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IGTV: Sweat and Tonic & Field Trip Health

Join Amber Amendola and S&T Innovation Director Julian Ho in a chat about mindfulness practices and how people can use them to better their own day-to-day lives!

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Psychedelics for Mental Health - August 2020

Focusing on a revolutionary treatment paradigm with a storied past, this webinar will touch on the history of and recent progress in the development of psychedelic-assisted psychotherapy for mental health disorders, including current options in ketamine-assisted psychotherapy.

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Psychedelic Psychotherapy: A Therapist's Perspective

In this webinar, members of Field Trip Health's clinical therapy team – Martha Kezemidis, Sabina Pillai, and Dr. Joseph De Leo, will engage in a discussion about the therapeutic processes that are essential to healing, specifically within the context of psychedelic-assisted psychotherapy.

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Clinical Findings in Psychedelic Therapy: KAP for Depression

In this webinar, nurse practitioner Monica Mina and psychotherapist Sabina Pillai will walk through the general trends and treatment outcomes of patients who have completed Field Trip Health's ketamine-assisted psychotherapy (KAP) protocol.

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Psychedelic Therapy: From Coping to Healing (with Daniel Carcillo)

Focusing on a revolutionary treatment paradigm with a storied past, this webinar will touch on the history of and recent progress in the development of psychedelic-assisted therapy for mental health disorders, including current options in ketamine-assisted psychotherapy.

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Harnessing the power of psychedelic drug therapy: CTV W5

A W5 investigation into an unconventional treatment for severe depression and PTSD that involves the drug ketamine.

ketamine slechte trip

Ketamine & Depression: How it Works - Yale Medicine Explains

One of the things that Ketamine does, that helps to explain its antidepressant effects, is help the brain to regrow the synapses, the connections between nerve cells.

ketamine slechte trip

Field Trip Health & Wellness Officially Launches on the TXS Venture Exchange

Field Trip is officially split into two distinct companies. We will be continuing to evolve Field Trip with the TSX Venture Exchange as Field Trip Health & Wellness Ltd. (TSXV: FTHW). Our sister company, Reunion Neuroscience, will focus on psychedelic drug research and development. Reunion will remain on the NASDAQ (Nasdaq: REUN).

TESTIMONIALS

What Our Clients Say

“It was like I was born with a new brain after going through those sessions. I never thought I would feel this way in my lifetime, and that I would be able to so effortlessly think and feel the way I finally do about myself.”

- Janine, Toronto

Join our next virtual open house

Field Trip offers regular opportunities to hear about the client experience firsthand. Join us in a virtual conversation with one of our lead therapists, connect with someone who completed their healing journey and learn about what it's like working with us. The session will review the importance of a holistic model of care and discuss the positive outcomes and sustained impact it can have on peoples' lives. Sign up and come curious, as there will be ample time for questions.

Begin to heal

Are you disappointed with the results from other therapies or medications? Is something blocking progress, but you’re not sure what? Find out if psychedelic-assisted psychotherapy is right for you.

ABOUT FIELD TRIP

News and Media

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Field trip news

June 23, 2023

Stella Expands Trauma Care with Acquisition of Ketamine Therapy Leader Field Trip's Assets in U.S.

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industry news

February 21, 2023

Psychedelic Assisted Therapy: Last Week Tonight with John Oliver (HBO)

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January 4, 2023

Today Show: Clinics offer ketamine to treat depression

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  • Publications
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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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StatPearls [Internet].

Ketamine toxicity.

Vwaire J. Orhurhu ; Rishik Vashisht ; Lauren E. Claus ; Steven P. Cohen .

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Last Update: January 30, 2023 .

  • Continuing Education Activity

Ketamine is a structural analog of the dissociative anesthetic and recreational drug phencyclidine (PCP). Similar to phencyclidine, ketamine causes analgesia and amnesia without the cardiovascular and respiratory depression associated with common anesthetics. Originally called CI-581, ketamine has one-tenth the potency of PCP and causes less severe dysphoria and hallucinations. Intramuscular and intravenous forms of ketamine are commonly used to provide pediatric anesthesia, especially for high-risk children or patients in limited-resource settings. In surgical settings, ketamine is typically combined with benzodiazepines, which can reduce the adverse psychological symptoms that occur during emergence. Off-label, subanesthetic doses of ketamine also have a use for acute and chronic pain management, sedation, and treatment of severe depression. Like its chemical cousin phencyclidine, ketamine’s psychomimetic effects have made it a popular recreational drug. In low doses, its euphoric and dissociative effects are sometimes referred to as “k-land,” whereas at high doses, the immobilizing and hallucinogenic effects are referred to as being in a “k-hole.” In the context of an illegal, recreational drug, ketamine goes by the street names “K,” “vitamin K,” “super K,” “special K,” “super C,” “special LA coke,” “jet,” “superacid,” and “green.” Ketamine toxicity can cause a variety of neurological, cardiovascular, psychiatric, urogenital, and abdominal symptoms, which are dose-dependent, and whether ketamine administration was in an iatrogenic or illicit context. For example, some experts have attributed the higher incidence of ulcerative cystitis in recreational users to the adulterants with which the drug is mixed. Providers using ketamine should be aware of the various mechanisms to treat ketamine toxicity and to prevent acute complications such as rhabdomyolysis and seizures, and chronic complications such as psychiatric disturbances and ulcerative cystitis. This activity reviews the evaluation of ketamine toxicity and the role of the interprofessional team in managing this condition.

  • Describe the chemical basis of ketamine.
  • Discuss the expected side effects of ketamine.
  • Explain the symptoms and signs of ketamine toxicity.
  • Outline medical team evaluation and management of a patient with ketamine toxicity.
  • Introduction

Ketamine is a structural analog of the dissociative anesthetic and recreational drug phencyclidine (PCP). [1] Similar to phencyclidine, ketamine causes analgesia and amnesia without the cardiovascular and respiratory depression associated with common anesthetics. [1] Originally called CI-581, ketamine has one-tenth the potency of PCP and causes less severe dysphoria and hallucinations. [1]

After the chemist Calvin Stevens first synthesized ketamine in 1962, ketamine was tested in clinical trials performed in pediatric and adult surgical patients, and the Food and Drug Administration approved it for human use in 1970. [1] [2] Ketamine was the most common battlefield anesthetic used during the Vietnam War (fact file on ketamine). Intramuscular and intravenous forms of ketamine are commonly used to provide pediatric anesthesia, especially for high-risk children or patients in limited-resource settings. [3] In surgical settings, ketamine is typically combined with benzodiazepines, which can reduce the adverse psychological symptoms that occur during emergence. [4] Off-label, subanesthetic doses of ketamine also have a use for acute and chronic pain management, sedation, and treatment of severe depression. [5] [6] [7]

Like its chemical cousin phencyclidine, ketamine’s psychomimetic effects have made it a popular recreational drug. In low doses, it’s euphoric and dissociative effects are sometimes referred to as “k-land,” whereas at high doses, the immobilizing and hallucinogenic effects are referred to as being in a “k-hole.” [1] [8]  In the context of an illegal, recreational drug, ketamine goes by the street names “K,” “vitamin K,” “super K,” “special K,” “super C,” “special LA coke,” “jet,” “superacid,” and “green.” [8] [9]

Ketamine toxicity can cause a variety of neurological, cardiovascular, psychiatric, urogenital, and abdominal symptoms, which are dose-dependent, and depend on whether ketamine administration was in an iatrogenic or illicit context. For example, some experts have attributed the higher incidence of ulcerative cystitis in recreational users to the adulterants with which the drug is mixed. Emergency medicine providers should be aware of the various mechanisms to treat ketamine toxicity and to prevent acute complications such as rhabdomyolysis, seizures, and chronic complications such as psychiatric disturbances and ulcerative cystitis.

Ketamine toxicity can result from the medical use of parenteral or intranasal ketamine or the recreational misuse of ketamine, commonly through intravenous or intramuscular injection, insufflation (snorting), oral consumption, or smoking. [8]

  • Epidemiology

The World Drug Report in 2015 categorized ketamine as a worldwide recreational drug, with 58 countries reporting illicit use. However, ketamine misuse occurs on a relatively small scale, and PCP derivatives constituted only 1% of “new psychoactive substances” reported to the United Nations Office of Drugs and Crime in 2014 (fact file on ketamine). Ketamine misuse often occurs in combination with other substances, including alcohol, amphetamines, MDMA, cocaine, and caffeine.

In the United States, where ketamine classifies as a C-III controlled substance since 1999, ketamine misuse has increased since the 1980s. [9] However, compared to the surges in opioid and illicit cannabis misuse, ketamine misuse has occurred on a relatively small scale. Ketamine was involved in 0.033% of the United States Emergency Department visits involving illicit drugs in 2005, with this proportion increasing slightly to 0.12% in 2011 (Drug Abuse Warning Network, 2011). Ketamine-related emergency department visits often involved other drugs, with 71.5% of ketamine-related visits in the United States in 2011 involving alcohol (Drug Abuse Warning Network, 2011). The national survey-based ‘Monitoring the Future Study’ in the United States reported that ketamine use decreased between 2012 and 2002, from 2.5% to 1.5%, and from 1.3% to 0.4%, among 12th graders and college students, respectively. In the United Kingdom, where ketamine has been classified as a Class C drug since 2006, [9] ketamine misuse has also decreased during the 21st century. According to the World Health Organization fact file on ketamine, the percentage of adults and young adults in the United Kingdom who used ketamine decreased from 0.6% to 0.4% and from 1.8% to 0.8%, respectively, between 2011 and 2013.

Ketamine use is becoming increasingly popular as a recreational drug in Southeast Asian countries such as Taiwan, Malaysia, and China. [9] In Hong Kong, where ketamine classifies as a Schedule I drug since 2000, ketamine became the most commonly misused drug in the early 2000s. [9] Between 1996 and 2000, an epidemiological study involving drug-related motor vehicle collision fatalities found 9% involved ketamine use, representing a disproportionate number of fatalities compared to alcohol and opioid misuse, which are drugs in which tolerance develops more rapidly.[10] Surveys demonstrate that ketamine misuse is more common in southeast China than in other regions of the country. [10]

  • Pathophysiology

Ketamine's main site action is a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor, though it exhibits effects on a myriad of other receptors. It acts as an antagonist at muscarinic and nicotinic acetylcholine receptors, blocks sodium and potassium channels, activates high-affinity D2 dopamine receptors and L-type voltage-gated calcium channels, and facilitates gamma-aminobutyric acid (GABA) inhibition. Ketamine may also increase neurotransmitters such as norepinephrine, dopamine, and serotonin in the brain. [11] [12]  As a drug that stimulates the sympathetic nervous system, tachycardia and hypertension are common with ketamine use, which masks its direct cardiac depressant effects. However, in patients in the intensive care unit who are catecholamine-depleted, the use of ketamine may result in hypotension. Although ketamine binds to mu and other opioid receptors, naloxone does not block its analgesic effects. [13]

  • Toxicokinetics

To date, there remains sparse information about the toxicokinetics of ketamine in the human population.

In animal studies, however, the safety ratio (defined as the proportion of the usual recreational dose to a fetal or lethal dose) has been used to evaluate the acute risk observed with ketamine.

The definition of the lethal dose (LD50) is the amount of drug that results in death in 50% of experimental animals tested. Gable et al. determined the oral ketamine safety ratio for rodents as 25 and estimated that the median lethal dose averaged at 11.3 mg/kg IV or 678 mg for a 70 kg human. [14] [15]

Ketamine has been used to provide analgesia in refractory chronic pain conditions and even anesthesia for short surgeries. However, the safety data is mixed regarding its toxicity when administered neuraxial in animals, with some authors suggesting that its neurotoxicity derives from preservatives. According to the latest Polyanalgesic Consensus Conference for intrathecal drug delivery, the designation for the administration of spinal ketamine was as a 6-line adjuvant used in conjunction with other neuraxial analgesics in individuals with refractory cancer or other terminal chronic pain conditions. There is a current ban on the publication on the study of intrathecal analgesics that lacks adequate safety data in several of the top pain and anesthesia journals. [16]

  • History and Physical

Ketamine overdose symptoms are similar to those of PCP overdose, although the effects of ketamine tend to resolve more quickly. Physical signs and symptoms are dose-dependent through the loss of consciousness.  Patients may be unable to provide a relevant history, and clinicians should seek pertinent clinical information from witnesses. Clinicians should also maintain familiarity with street names for ketamine.

The following symptoms may be present during ketamine use and intoxication: 

  • General – sedation, impaired consciousness
  • Head, Ear, Eyes, Nose, Throat – horizontal, vertical or rotary nystagmus, mydriasis, excessive salivation 
  • Cardiovascular – hypertension, tachycardia, palpitations, arrhythmias, chest pain 
  • Abdominal – abdominal pain, abdominal tenderness, nausea, vomiting 
  • Neurological – altered mental status (disorientation), paranoia, dysphoria, anxiety, confusion, slurred speech, dizziness, ataxia, dysarthria, trismus, muscular rigidity, psychomotor, psychomimetic, or acute dystonic reactions
  • Genitourinary – lower urinary tract symptoms
  • Trauma – a thorough examination for evidence of trauma is needed as injuries secondary to ketamine intoxication can occur due to the diminished perception of pain.

Symptoms mostly unique to overdose, overly rapid infusion, or combined with other drugs include: 

  • Respiratory – respiratory depression, apnea
  • Cardiovascular – hypotension, bradycardia, myocardial infarction 
  • Neurological – seizure, stupor, coma 

Symptoms mostly unique to iatrogenic, intravenous delivery include [17] :

  • Respiratory – respiratory depression, laryngospasm

Several laboratory tests could be obtained to evaluate the degree of metabolic or cellular derangements.

  • Serum PCP, acetaminophen, salicylate levels, to rule out common co-ingestions
  • ECG, to rule out conduction abnormalities and arrhythmias
  • Urine myoglobin and serum creatine kinase, to rule out the complication of rhabdomyolysis
  • Imaging, to rule out other causes of altered mental status such as hemorrhage or secondary trauma
  • CSF, to rule out central nervous system infection such as meningitis as a cause of neuropsychiatric symptoms
  • CBC, to evaluate for leukocytosis
  • CMP, to evaluate for blood urea nitrogen and creatinine elevation (renal compromise) or elevation in the liver function tests (hepatotoxicity)
  • Fingerstick blood glucose, which can suggest hypoglycemia as a primary cause of mental status changes, or hypoglycemia secondary to ketamine toxicity
  • Treatment / Management

Typically, only supportive care is necessary for patients with ketamine toxicity. The effects of ketamine intoxication typically last between 15 minutes to several hours depending on the dose, route of administration (e.g., oral more than intravenous), metabolic capacity, and intrinsic sensitivity to the effects of the drug, which depends on genetics and several other factors. [18] Patients who are asymptomatic at presentation but report recent ketamine use should undergo observation for six hours. Patients who experience symptom relief after intoxication should have continuous monitoring for 1 to 2 hours after their last symptom resolves.

Monitoring includes the patient’s airway, breathing, and circulation, as ketamine can potentially cause cardiopulmonary compromise, especially when taken in combination with other drugs. If the patient vomits, the patient should be positioned to lean forward or lie on the left side with the head facing down to avoid airway compromise and aspiration. Ketamine has been shown to cause bronchodilation and maintain a protective airway better than other anesthetic agents used for sedation, although there have been reports of aspiration. [19]  If airway compromise occurs, intubation can provide respiratory support. The patient’s vital signs, especially temperature, should also be monitored for other symptoms, especially hyperthermia. If the patient develops severe symptoms or complications, the patient should be placed on a monitor and admitted for observation.

If ketamine was ingested, especially in large quantities or with other drugs, activated charcoal could be used for gastrointestinal decontamination. Activated charcoal is typically given in a 1 g/kg dose, with a maximum oral dose of 50 g/ng. [20] Activated charcoal should be avoided in patients with unprotected airways or absent bowel sounds. [20] Activated charcoal administration within a sufficiently brief amount of time may obviate the need for gastric lavage. Hemoperfusion and dialysis tend to be ineffective due to ketamine’s large volume of distribution.

According to the toxicology data network, there are no medications approved by the U.S. Food and Drug Administration to treat a ketamine overdose, but medications can provide management of agitation and psychosis. Benzodiazepines such as lorazepam and diazepam can alleviate agitation, psychomimetic effects, hypertension, hyperthermia, and seizures. Lorazepam is typically given 2 to 4 mg intravenously or intramuscularly, and diazepam dosing generally is 5 mg to 10 mg IV. Butyrophenones, including haloperidol, have been used to treat psychotic episodes and agitation. [8] Haloperidol is typically given in doses of 5 mg to 10 mg IM and can be administered every 10 to 15 minutes until adequate sedation is achieved. However, providers should exercise caution when using haloperidol, as lowered seizure thresholds, QT prolongation, and torsades de pointes correlate with the prolonged use of haloperidol. Unnecessary stimulation should be avoided, and the patient’s room should be dim and quiet. If necessary, the health care team may provide physical restraints to initiate IV access and secure the patient’s safety. If sedation does not adequately manage hyperthermia, evaporative cooling can decrease heat production.

Other medications can manage other symptoms. Alpha-2 agonists such as clonidine can treat or prevent ketamine’s psychomimetic side effects, increase hemodynamic stability by decreasing blood pressure, and provide synergism with ketamine’s analgesic effects. [6] [21] [22] Clonidine is typically given at 2.5-5 mcg/kg in oral form, though patches are an option for long-duration inpatient infusions, and intravenous clonidine can be used to address acute symptoms. Atropine or glycopyrrolate can prevent and treat the excess salivation associated with ketamine use, while physostigmine can address nystagmus and blurred vision. Hydration with crystalloids can improve dehydration.

  • Differential Diagnosis

Ketamine intoxication can present similarly to PCP, methoxetamine, and dextromethorphan intoxication, all of which bind to the N-methyl-D-aspartate receptor. Also, providers should consider intoxication with alcohol, amphetamine, cocaine, LSD, MDMA, and salicylate, as well as delirium tremens from alcohol withdrawal. Malignant hyperthermia that develops after succinylcholine or volatile anesthetics such as halothane, and side effects from antihistamines like diphenhydramine and anticholinergics such as benztropine, can also mimic signs of ketamine intoxication.

Psychiatric conditions such as bipolar disorder and schizophrenia and complications from psychiatric treatments such as serotonin syndrome from SSRIs, neuroleptic malignant syndrome from antipsychotics, and side effects from tricyclic and tetracyclic antidepressants, can present similarly to ketamine intoxication.

Especially in the presence of altered mental status, CNS infections such as meningitis and encephalitis, and CNS malignancies also merit consideration. Acute conditions affecting the central nervous system, such as head trauma and intracerebral hemorrhage, can cause mental status and vital sign changes that simulate ketamine toxicity. Acute systemic conditions such as hypoxia, hypoglycemia, sepsis, hyperthyroidism, and electrolyte abnormalities such as hyponatremia should be differentials.

Because ketamine overdose is a relatively uncommon condition and co-ingestions often complicate severe cases, limited information is available with regards to survival rates. Cases of addiction to ketamine are relatively infrequent, and there are scant statistics on relapse rates and prognosis. Nonetheless, ketamine remains one of the few psychoactive drugs with serious complication rates of less than 1%. [23] [24]

The risk of death from accidents when intoxicated with ketamine is associated with the highest mortality rate, according to several studies.[24][25] In a longitudinal study, two ketamine users died within one year, one from drowning in a bath and the second from hypothermia. [25]

Ketamine in the setting of other cardiovascular comorbidities can lead to catastrophic outcomes. Ketamine stimulates the sympathetic nervous system resulting in increased heart rate, cardiac output, and blood pressure. Hence, intoxicated patients with severe cardiovascular disease or hypertension may be at increased risk for stroke, myocardial ischemia, or increased intracranial pressure. The chronic pain ketamine guidelines note several case reports of ketamine precipitating unstable angina and arrhythmias. [6]

Acute use of ketamine may rarely cause encephalopathy, seizures, or coma. Acute kidney injury, electrolyte abnormalities, liver failure, and rhabdomyolysis may also occur.

Chronic ketamine misuse is associated with ulcerative cystitis  [26] , which may diminish bladder capacity and ureteral size and contribute to hydronephrosis. Symptomatically, the urologic complications of chronic ketamine misuse may cause abdominal pain, pelvic pain, hematuria, dysuria, frequency, urgency, and urge incontinence. Chronic ketamine use may also be associated with hepatic anomalies, as suggested by LFT abnormalities, or biliary anomalies, or diagnosed by imaging studies including CT and ERCP. [3]  The urogenital and hepatic effects of ketamine appear to be dose-dependent. 

Some psychiatric effects of ketamine, including hallucinations and vivid dreams, may recur days or weeks following ketamine use, although these effects are usually transitory. [27] However, chronic use of ketamine causes more lasting psychiatric effects such as depression and memory and concentration impairment. Ketamine dependence may occur, as chronic PCP or ketamine users have reported psychiatric symptoms, including anxiety, irritability, depression, and changes in sleep and energy patterns within a day after cessation of ketamine use. [28] However, there is no definitive evidence of physical dependence in the form of withdrawal symptoms. Ironically, an intranasal ketamine formulation was recently approved to treat depression  [29] and received attention as a treatment for a recalcitrant posttraumatic stress disorder. The drug is also actively being investigated as an agent to reduce alcohol, cocaine, or opioid dependence. [30]  

  • Complications

The adverse effects of ketamine use include:

  • High blood pressure
  • Impaired motor function
  • Respiratory complications
  • Impaired coordination and judgment
  • Risk of depression
  • Ketamine induced ulcerative cystitis
  • Deterrence and Patient Education

Patients require education about the dissociative effect associated with ketamine, which can result in a significant alteration in consciousness, thereby resulting in accidental injury to oneself or others. Ketamine can impair psychomotor performance, such as coordination, balance, and hand-eye movements. This lack of coordination can result in an increase in mortality from motor vehicle collisions if patients choose to drive while intoxicated. Since ketamine is subject to misuse and is classified by the U.S. Drug Enforcement Agency as a schedule-III controlled substance, patients given access to ketamine for chronic pain or depression should receive education on the risk of addiction and risk-stratified similar to those under consideration for chronic opioid therapy.

Ketamine misuse can result in chronic health problems that can be costly to manage. Ulcerative cystitis, a common effect associated with ketamine, is often refractory to conventional management. A diagnosis of ketamine-induced ulcerative cystitis often leads to repetitive cystoscopies and palliative bladder catheterization. These patients may require life-long treatments.

  • Enhancing Healthcare Team Outcomes

Ketamine use continues both medically and recreationally. Practitioners use it in anesthesiology, acute and chronic pain medicine, psychiatry, and veterinary medicine. In patients who misuse ketamine, the likelihood of serious sequelae, including end-stage organ damage, increases significantly. It is incumbent upon healthcare practitioners, including nurse practitioners, nurses, and pharmacists, to prevent acute complications from ketamine use and monitor and treat cognitive impairment, psychomimetic effects, and other associated adverse events associated with ketamine intoxication. Working with the clinicians, it is essential to educate patients and, in some cases, the families on the safe use of this medication.

In conclusion, ketamine toxicity and addiction pose significant risks to a small segment of the population, and given increasing utilization, the prevalence of these phenomena is expected to increase. As a schedule III controlled substance, the various formulations of ketamine are not as tightly regulated as most opioids, which, along with the low risk for fatal overdose, warrants increased attention by both regulatory bodies and practitioners on the front-line combating pain and depression.  

Patients who need ketamine medically or who misuse the drug are best managed by an interprofessional team that can provide monitoring, counsel, and information regarding the drug. This team includes physicians, mid-level practitioners (i.e., NPs, PAs), pharmacists, and nurses. This interprofessional approach increases the chances of optimal patient care and outcomes. [Level 5]

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Disclosure: Vwaire Orhurhu declares no relevant financial relationships with ineligible companies.

Disclosure: Rishik Vashisht declares no relevant financial relationships with ineligible companies.

Disclosure: Lauren Claus declares no relevant financial relationships with ineligible companies.

Disclosure: Steven Cohen declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

  • Cite this Page Orhurhu VJ, Vashisht R, Claus LE, et al. Ketamine Toxicity. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Every day, police rely on common tactics that, unlike guns, are meant to stop people without killing them. These include physical holds, Tasers and body blows.

As with George Floyd, however, when misused, these tactics can still end in death.

An agitated man trespasses in a parking lot.

DEMETRIO JACKSON

A grandfather off his schizophrenia medication loiters outside a store.

DELBERT McNIEL

A young man suffers a seizure at home.

AUSTIN HUNTER TURNER

Officers shocked all three with Tasers and pinned them facedown in handcuffs. Medics administered powerful sedatives to two of them.

How many people die after encounters involving what is known as “less-lethal force”?

Damien Alvarado image

A team of journalists led by The Associated Press set out to investigate. Looking over a decade, they documented more than 1,000 deaths.

Those who died were of all walks of life and races, though the toll disproportionately hit Black people.

The oldest was 95. The youngest was just 15.

Many were experiencing a mental health or drug crisis.

Police say they are often responding to volatile and sometimes violent situations, and deaths are rare.

Medical officials cited law enforcement as causing or contributing to about half of the deaths. In many others, significant police force went unmentioned and drugs or preexisting health conditions were blamed instead.

How do these encounters play out? What is known about those who died? And why does the nation understand so little about these cases?

Lethal Restraint

An investigation documenting police use of force.

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Demetrio Jackson was the oldest child in a large Indiana family, and later became a father himself. He was known for his big smile, playful jokes and the cross he wore around his neck.

His younger brother Brandon Miller said Jackson was his mentor.

Jackson struggled with his mental health and an addiction to methamphetamine. He had been in and out of jail and ended up living on the streets of Eau Claire, Wisconsin.

Before dawn on Oct. 8, 2021, a morning radio host called 911 to report a man standing on a truck in the station’s parking lot.

Altoona police arrived at the scene, near the border of Eau Claire. Jackson was high on meth, struggling to focus and speaking incoherently. Officers said he could leave if he gave his name and asked if he wanted an ambulance, but Jackson declined.

After a 40-minute interaction, the officers decided to arrest Jackson when they learned he was known to carry a knife, was on probation for meth possession and noticed the truck’s roof was damaged.

Jackson took off running. The officers chased him.

Jackson stopped, turned around and began to move toward an officer. She shocked him with a Taser.

Officers struggled with Jackson and shocked him a second time as he was on the ground.

Altoona Police Department policy cautions that shocking a suspect multiple times should be avoided when possible. The weapon’s maker warns that drug-intoxicated people may be particularly susceptible to “the risk of death or serious injury,” a warning echoed in other national policing guidelines.

Altoona PD Policy: Stun Guns

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Officers should apply the ECD for only one standard cycle and then evaluate the situation before applying any subsequent cycles. Multiple applications of the ECD against a single individual are generally not recommended and should be avoided unless the officer reasonably believes that the need to control the individual outweighs the potentially increased risk posed by multiple applications.

Taser Manufacturer Warnings for Law Enforcement

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Particularly Susceptible Individuals. Include those who are already physiologically or metabolically compromised due to heart disease, asthma or other pulmonary conditions, and people suffering from excited delirium, profound agitation, severe exhaustion, drug intoxication or chronic drug abuse, or over-exertion from physical struggle.

Officers from the Eau Claire Police Department arrived as backup and came up with a plan to get him handcuffed.

Officers moved Jackson facedown and held him in what is known as the prone position while they cuffed and searched him. They found no weapon.

The department’s policy says officers should avoid placing people who are experiencing “drug-induced psychosis” in the prone position once they are restrained because it increases their risk of sudden death.

A department review later found that the officers’ actions were within guidelines because they kept Jackson in prone for a short period of time, and used “the lowest level of physical force available to them.”

Jackson’s condition deteriorated as he repeated, “I can’t breathe.”

“I can’t breathe.”

Police body cameras recorded those words in dozens of deaths reporters reviewed, from an Arizona parking lot to the front yard of a rural Georgia home.

Police officers are commonly trained that putting suspects on their stomachs is a safe way to handcuff them — but medical experts warn not to keep them in that position for long.

The prone position can restrict breathing, especially if officers put pressure on the person’s back.

There are no national rules about applying force, so policies and training on the prone position vary widely.

Most policing experts and doctors agree that officers should roll suspects onto their sides or sit them up as soon as possible.

Several experts on the impact of prone told the AP that for those held facedown, inhaling oxygen and exhaling carbon dioxide becomes harder, increasing the likelihood of death. The heart can stop if a person can’t get rid of carbon dioxide fast enough.

Failing to breathe in enough oxygen can also lead to asphyxiation.

A couple of minutes after handcuffing Jackson, the officers turned him on his side and then sat him up. As he struggled to breathe, medics treated him with oxygen.

Then one of them injected him with ketamine — a powerful sedative.

Minutes later, Jackson suffered cardiac arrest and was taken to the hospital.

His mother, Rita Gowens, learned the news from one of Demetrio’s brothers.

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Those who died included dads and moms. Grandparents and students. Military veterans and churchgoers.

Taylor Ware image

White, Black, Hispanic, Asian, American Indian and Pacific Islander — no race or ethnicity was untouched. Nearly all were men.

Among the deceased were executives and tradesmen. A poet, a critical care nurse, a rodeo clown. A handful worked in law enforcement but were not in uniform.

The investigation identified deadly encounters in nearly every state.

Because some states release little information, they appear to have fewer deaths than might truly be the case.

The deceased lived not just in big cities, but also in suburbs and small towns.

The most common location of the encounter was in or near their own home.

One summer night in 2017, Austin Hunter Turner told his girlfriend that he wasn’t feeling right, then collapsed.

Turner had a history of seizures, and that’s how the 911 call came in. When medics arrived at his apartment in Bristol, Tennessee, they thought the 23-year-old was on drugs. They were unable to control him and called the police to help.

The police and medics eventually pinned Turner facedown on a recliner, and an officer shocked him with a Taser. A paramedic sprayed a sedative up Turner’s nose, but most of it ended up on the medic.

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Turner was kept facedown, while one of the officers put a spit hood on him. He stopped breathing in the back of an ambulance, where responders tried to resuscitate him for about 10 minutes.

A paramedic asked, “What the hell happened here?” and if the officer’s body camera was recording.

Then the police officer turned off his body camera.

The pathologist who performed the autopsy said Turner died from “multiple drug toxicity,” citing marijuana and a prescription drug that treats opioid addiction. The use of force was not cited as a contributing cause.

But two former medical examiners consulted by the AP reviewed the body camera footage and autopsy report and said that the police use of force contributed to Turner’s death.

Neither the police nor the fire department in Bristol would comment on the case.

The Sullivan County District Attorney told the AP that he reviewed the findings and materials from a state investigation and concluded that Turner’s death was a drug overdose. The DA said none of the police officers’ techniques had contributed to his death.

In sheer numbers, white people of non-Hispanic descent were the largest group, but deaths disproportionately affected Black people.

Carl Grant had served for almost a decade of active duty in the U.S. Marine Corps, including during the Vietnam War. He was living with dementia.

On Super Bowl Sunday in 2020, Grant drove off from his Georgia home. A few hours and nearly 200 miles later, he was wandering and confused in a Birmingham, Alabama, neighborhood.

Twice he tried to get into houses that he thought were his. At the second residence, the homeowner called in a burglary, and responding officers found Grant sitting on a porch chair. He insisted he was at home. In the interaction, an officer pushed Grant down the front steps, then officers handcuffed him.

Grant was hurt, so the officer who pushed him went with Grant to the hospital. According to the officer’s account, just before Grant was about to be discharged, he left the exam room to charge a cellphone he imagined he had. When he wouldn’t stay put, the officer slammed Grant onto the floor.

The force damaged the spinal cord in Grant’s neck, paralyzing him. Family members say he apologized for the injury, which he thought happened during Vietnam. He died nearly six months later. The death certificate worksheet listed the injuries from the body slam as the cause.

After an internal investigation, the Birmingham Police Department said the officer used excessive force. He was suspended for 15 days and required to be retrained on use of force and de-escalation techniques. He now works for a nearby department, and his attorney declined to make him available for an interview.

A judge, citing a procedural error, dismissed a lawsuit filed by Grant’s estate against the city and the officer. The case is being appealed.

Carl Grant wasn’t violent. But, in some of the cases, officers faced dangerous situations.

About 30% of the people who died had injured others or posed a threat of danger, a review of the data shows.

Many encounters began in response to a mental health crisis or erratic behavior linked to drug use — and sometimes both.

Delbert McNiel was, his daughter recalls, a doting grandfather and friendly “country boy” who lived in Hamlin, Texas. He also had a history of schizophrenia, drug use, and conflicts with the police. In 2014, after stealing a police car, he was found not guilty by reason of insanity of assault, robbery and evading arrest.

One night in 2017, an officer responding to a disturbance call outside a convenience store approached McNiel, who was holding some tools. The officer knew him from prior incidents, including one that turned violent months earlier and led to an assault charge.

McNiel went across the street to a nearby residence. The officer followed him and tried to get him to hand over a screwdriver. Another officer arrived on the scene, and they detained McNiel.

McNiel told the officers he was having a mental health problem and had done nothing wrong.

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The officers responded with force when McNiel fought them as they tried to get him into a squad car. On the way to jail, he began kicking the window and, police said, pulled out the wires of the in-car video camera. They stopped and called medics for assistance.

During the struggle, officers repeatedly shocked McNiel. In all, they fired Tasers 11 times in 17 minutes.

The officers restrained McNiel in the prone position for nearly 22 minutes. He became unresponsive and soon died at a hospital.

The medical examiner ruled the death accidental and cited McNiel’s meth use and mental illness. He said “it cannot be ascertained that deployment of Taser and physical restraint were the primary underlying cause.”

Two experts who reviewed the case for the AP said the officers kept McNiel in the prone position for far too long, and one called their use of the Taser excessive.

The officers said in their reports they believed the restraint was the safest way to control McNiel.

A grand jury declined to bring any charges in the case.

The Hamlin police chief said the officers were no longer with the department; neither of them responded to requests for comment.

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Demetrio Jackson was on life support after his interaction with officers in Wisconsin. His younger brother arrived at the hospital after an eight-hour trip.

After two weeks in a coma, Jackson’s ventilator was removed. Family members gathered to watch him take his final breaths.

His mother says she’s still haunted by the night her son was restrained by the police.

Before Jackson was injected with ketamine, officers said that he might be experiencing “excited delirium,” a term intended to describe the actions of extremely agitated people who may be dangerous. It has long been cited to explain sudden deaths of people restrained by police.

The AP investigation found officers repeatedly using the term excited delirium to describe a wide range of behaviors of people who died.

In recent years, prominent medical groups and experts have disputed law enforcement’s and medical examiners’ use of the concept of excited delirium to explain injuries or deaths in police custody.

In dozens of cases where officers or medics cited excited delirium, people detained by police were injected with powerful sedatives such as ketamine and midazolam.

AP’s investigation found the practice of sedating people outside hospitals when they are suspected of having excited delirium has quietly spread over the last 15 years.

The intent is to calm people who may be a threat to themselves or others so they can be safely transported to hospitals for treatment.

But the medical groups and experts have pointed to a pattern of misuse of sedation during law enforcement encounters and a disproportionate impact on Black people.

EMS trainer and paramedic Eric Jaeger says the concept of excited delirium has led to an overuse of sedation, despite risks that include serious side effects, such as respiratory depression, and, in rare cases, death.

He evaluated Demetrio Jackson’s case for the AP.

Five experts, including Jaeger, told the AP Jackson’s behavior did not appear to be dangerous enough to justify the use of ketamine.

In their public statements, the police departments did not mention ketamine.

The sedation was redacted in an EMS report, but when AP uploaded the document, some redactions disappeared, revealing Jackson was given 400 milligrams of ketamine — enough to immobilize someone his size within minutes.

The autopsy report stated he’d only been given 100 milligrams. A spokesperson for the medical examiner said the discrepancy wasn’t significant.

Jackson’s death was ruled accidental due to complications from meth use.

Police involvement was not noted on his death certificate. But two forensic pathologists who reviewed the case for the AP said meth wasn’t the only factor. They both pointed to police restraint as likely contributing to his death, and one blamed the use of ketamine.

After a state investigation, the county prosecutor cited the autopsy findings in determining that Jackson’s was not an “officer-involved death” under Wisconsin law.

Eau Claire County District Attorney Letter

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Upon review and consideration of that information, I have concluded that this incident does not meet the statutory definition of “officer-involved death.”

All seven officers who put their hands on Jackson were cleared by their departments after internal reviews found no policy violations and that their force was justified. The chiefs of the two police departments and the fire department declined comment.

Jackson’s relatives would like to pursue a lawsuit aimed at holding police and paramedics responsible but have struggled to find a lawyer to take the case.

Officers faced criminal charges in less than 3% of the deaths this investigation documented. At least 168 deaths led to civil court settlements or jury verdicts totaling more than $374 million. Additional lawsuits are pending.

The Associated Press worked with The Howard Center for Investigative Journalism programs at the University of Maryland and Arizona State University to identify deaths after “less lethal” force. The investigation found 1,036 cases during the decade covering 2012–2021. Search through these cases, read their names and learn more about the circumstances of their deaths.

All Cases background image

View related articles, watch the documentary and read the reporting methodology.

Articles background image

Documentary

Documentary background image

Methodology

Methodology background image

Produced in collaboration with The Associated Press, FRONTLINE, and The Howard Center for Investigative Journalism programs at the University of Maryland and Arizona State University.

View project credits

Elon Musk  Uses Ketamine for Depression. What the  Science Says.

MARCH, 21, 2024

Elon Musk said in an interview on X that he takes prescription ketamine for depression, adding,

from an investor’s standpoint, if there  is something I’ve been taking, I should keep taking it.”

Considered a “dissociative anesthetic that has some hallucinogenic effects” by the  Drug Enforcement Administration, ketamine was first approved as an anesthetic in 1970. It is not approved to treat depression, but some clinics offer ketamine treatment for that, as well as for anxiety and chronic pain.

Clinics can do this because the Food and Drug Administration “didn’t put any restrictions” on ketamine when it approved it more than 50 years ago, Yale psychiatry professor Gerard Sanacora said in an interview on the Yale School of Medicine website.

Ketamine clinics are booming, with a 2022  U.S. market value of  

$3.1 Billion

Clinics across the U.S. and Canada offer the treatment for as little as $100 a session. Soap company Dr. Bronner’s offers “ketamine medicine sessions” as an employee benefit via health provider Enthea. 

Above: Therapy room at Field Trip, a psychedelic therapy clinic in Toronto, Canada, that offers ketamine treatments.

There is also a ketamine derivative called Spravato , which was approved in 2019 to treat depression. Made by Janssen Pharmaceutical, the nasal spray must be used under the supervision of a healthcare provider.

Anyone using ketamine should be aware of unwanted side effects, including:

Cognitive difficulties

An overdose can cause:

Unconsciousness 

Dangerously slowed breathing

Source: U.S. Drug Enforcement Administration

Questions for AI

Older workers, more from barron’s.

Nick Hallam

Getty (3), Dreamstime (1), courtesy of Janssen

Anita Hamilton

The rise of the work drug

Elon Musk is taking ketamine and techies are microdosing mushrooms. So it's OK to do drugs at work now?

ketamine slechte trip

Elon Musk can be cagey about his purported drug use . After bombshell reports about internal concerns over the Tesla-SpaceX-Twitter-Neuralink executive using LSD, cocaine, ecstasy, and ketamine, Musk's line has typically been that it's not happening . More recently, he's shifted: OK, fine, it is happening, but it's just ketamine for depression, and actually it's good for shareholders . If his companies are doing well, Musk argued recently, and he's taking drugs while running those companies, then he should stick with the drugs, for capitalism's sake. One might pause at the logic, but Musk is hardly the only person making that calculation — plenty of people have come around to the idea that drugs are a decent work tool.

Professionals are increasingly using substances like LSD, psilocybin, and ketamine as mechanisms to improve their performance. Startup hustlers and working women say they're turning to "magic" mushrooms to be more productive and creative, to take the edge off, or maybe just to get a bit of a hangover-free after-hours buzz. Some executives are attending luxury psychedelic retreats , where they spend a few days tripping in a forest, trying to expand and unlock their minds in ways that they hope will expand and unlock business opportunities, à la Steve Jobs . The psychedelics market is a lucrative one and expected to reach $11 billion by 2027.

Drugs used to be viewed as dangerous, a hindrance to life success, or, you know, just something you did for fun. Now they're increasingly seen as a useful tool for work. Instead of trying to get high, people are using them to try to get ahead.

"It's not uncommon for the public view on things to flip-flop, going from negative to, 'Oh, wow, these things are great,' and viewing them as potentially good for everything," Greg Fonzo, a codirector of the Center for Psychedelic Research & Therapy at the University of Texas at Austin's Dell Medical School, told me. "The truth lies somewhere in between, right? No drug is for everything, and most drugs are not purely negative."

Microdosing — which means taking, say, one-tenth of a normal dose of a drug — is a trend popular among moms on the playground and workers in the office. Anecdotally, people say it helps with creativity, focus, productivity, and just feeling better on the job. Scientifically, the story gets more complicated.

The jury is still out on whether and how microdosing works, said Matthew Johnson, a senior researcher for the Center of Excellence for Psilocybin Research and Treatment at Sheppard Pratt. There hasn't been a ton of research, and while people say in surveys that microdosing helps improve cognitive function and reduce anxiety, some placebo-controlled trials suggest that, in actuality, it may not do much.

"The science of microdosing is: So far, we don't really know what's going on, whether it's all placebo effect," Johnson said.

You could get a mushroom that has a little bit more or a little bit less psilocybin ... which, depending on the activity of the day, might be more than you bargained for.

In theory, microdosing is subperceptual. It's not like sipping a glass of wine to relax or having a cup of coffee to wake yourself up, both of which hit pretty immediately. The idea is instead to take tiny doses over time you don't notice, which hopefully benefit you in the long run.

If people are indeed feeling something off what they ingest, it's possible they're not technically microdosing — they're just getting a little bit high on the job. A glance at Reddit would indicate that unintentional at-work "oops" highs happen, which is because measuring these drugs precisely is hard.

"You could get a mushroom that has a little bit more or a little bit less psilocybin, and then you would end up having a perceptual experience, which, depending on the activity of the day, might be more than you bargained for," said Katrina Michelle, a clinical therapist in New York and the former director of harm reduction for the Multidisciplinary Association for Psychedelic Studies.

Of course, not everyone is looking for a micro experience to improve work performance. Some people are experimenting with psychedelics on the macrodose level. Some corporate elites are seeking out psychedelic retreats to improve their leadership skills, shift their perceptions, and, in some cases, even bond with their teams.

Rob Grover and Gary Logan, the founders of the Journeymen Collective, which offers luxury guided magic-mushroom retreats in Vancouver, British Columbia, told me their company worked with a multitude of executives, entrepreneurs, and visionaries to help them elevate their businesses to "conscious businesses," which they recognize sounds fluffy.

"When leaders become conscious leaders so that they're aware of what's going on around them, they have greater precision of thought, greater clarity, greater creativity that they can lead in a different way and they can lead in a more effective and efficient way," Grover said. "So that's where we come in and help people with a massive reset of their consciousness so that they can impact their company, their boards, their vision of what they're here to do in a deeply impactful way."

They work with people for a minimum of four months — one month of preparation leading up to two days of "ceremonies," followed by three months of "integration" post-retreat. Their experiences, which start at $15,000 a person for a group session, have seen a huge boom over the past couple of years: Bookings increased 183% from 2022 to 2023.

The deal sounds pretty great: Go to the mountains, have your experience, and kill it at work. But that's not a guaranteed outcome. Someone might trip and discover that they love their job again, but they could also decide they actually hate the corporate world and are over it.

"These medicines are not something we can necessarily have superconsistent expectations about," Michelle said. "It's really hard to ever say with any psychedelic medicine that this is going to have this one effect when it comes to your psycho-emotional health."

Some executives appear to have such strong convictions about the power of psychedelic retreats that they're bringing their colleagues and business partners along , hoping that it will bring them all closer together and push them forward. The issue of team retreats and drug use is a complicated one. Psychedelic experiences can be deeply intense and personal, not something everyone wants in a work environment. There are also questions of pressure and power dynamics in play. People around Musk, including some of his board directors, reportedly felt pressured to take drugs with him to avoid upsetting him. My boss is lovely, but I don't really want to vomit in front of him at an ayahuasca retreat as I share my deepest, darkest secrets, nor do I want to feel like I have to in order to keep my job.

We're all aware of corporate etiquette, and no matter how close and tight that team is, if you come to a psychedelic retreat, there's nowhere to hide.

Justin Townsend, the CEO and head facilitator of MycoMeditations, which offers psilocybin-assisted retreats in Jamaica, told me that many of his clients say his services, which can run from $6,500 to $23,000, help them to be better leaders and perform better professionally. He's working on launching retreats for business leaders, but it's a prospect that entails some special considerations. If a company calls and says it wants to send five executives down, it might get awkward and difficult if not handled correctly.

"We're all aware of corporate etiquette, and no matter how close and tight that team is, if you come to a psychedelic retreat, there's nowhere to hide," he said.

I asked him for advice on what to do if such a situation landed at someone's feet. He said to look into the safety, efficacy, and legal status of the proposal, think about what your boss wants to achieve and whether there are alternative solutions, and consider your personal boundaries. If it's not for you, he said, "just say no."

Some of these dynamics aren't novel. Social pressures at work have always existed — just look at happy hour . So has the idea of performance enhancement, whether via coffee (legal), Adderall (legal, depending on how you get it), or cocaine (illegal).

My main concern is that people understand the risk, any risk — bad-trip risk, psychiatric risk, or legal risk. Matthew Johnson, senior researcher for the Center of Excellence for Psilocybin Research and Treatment at Sheppard Pratt

The type of psychedelic substances in vogue in the workplace also have a socioeconomic slant to them. Marijuana has been decriminalized in many more parts of the country than psilocybin , but you're still likelier to lose your employment over smoking a joint on the job than you are if you eat a square of a magic-mushroom chocolate bar. You can still be fired over psychedelics, though — in 2021, a startup CEO was axed after saying he'd microdosed LSD at work. Regardless, all three are still federally illegal. With hidden fentanyl sometimes in the mix, many drugs may be extra dangerous. There are also questions about the effects that long-term psychedelic use has on the heart.

"My main concern is that people understand the risk, any risk — bad-trip risk, psychiatric risk, or legal risk," Johnson said.

Whatever the risks and benefits, given our optimization-obsessed corporate world, some elements of drugs as a work-enhancement tool appear to be here to stay. Not to mention that there's money to be made in the psychedelics industry, and plenty of boring or annoying jobs could stand to be made more tolerable by whatever means possible.

A lot of executives and workers have a little bit of Elon Musk in them. Figuring a little microdose here, a little trip there, might not hurt performancewise. Townsend, who runs the Jamaica retreats, told me that if anything, he thought Musk might want to pay him a visit, given how much he seems to be working and his use of ketamine for depression.

"I'd say give me Elon for a week," he said, "and I'll give you a different man."

Emily Stewart is a senior correspondent at Business Insider, writing about business and the economy.

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How your future self can help your present well-being

We’ve all had moments when we wished we could say, “Beam me up, Scotty!”

This desire to be in a better place or time is related to a psychological strategy called temporal distancing. Imagining ourselves in the future is a way to cope with the stress and anxiety of the present.

“Just because time travel takes place inside our heads doesn’t mean it can’t change reality,” said Hal Hershfield , a professor of marketing, behavioral decision-making and psychology at the University of California at Los Angeles’s Anderson School of Management and author of the book “Your Future Self: How to Make Tomorrow Better Today.” “How you think about your future can have a huge impact on your present and future selves.”

Research shows that during the early days of the pandemic, adults who were randomly assigned to write letters to their future selves or from their future selves to their current selves experienced an immediate reduction in negative emotions and an increase in positive ones, compared with those who focused only on the present.

Another study found that using a temporal-distancing technique helped both younger and older teens regulate their emotions, easing their self-reported distress.

And in a 2022 study of 160 women residing in the San Francisco Bay Area, researchers found that people who frequently engaged in temporal distancing in response to daily stressful events over an eight-day period experienced more positive emotions and fewer negative emotions on a daily basis.

“Stress is a part of life — engaging in temporal distancing can put everyday stressors in context in our lives and help us focus on the impermanent nature of the stressor,” said Emily Willroth , an assistant professor of psychological and brain sciences at Washington University in St. Louisand co-author of the 2022 study. “This strategy also helps us challenge unhelpful or harmful thought patterns.”

By using science-based techniques for temporal distancing, you can ease your current distress and enhance your mood and motivation, experts say.

Question your emotional reactions

When you’re stuck in a traffic jam and late for a meeting or your credit card was fraudulently used, your emotions may be running high. But will this upsetting situation matter in the long run?

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“We have a tendency to exaggerate how bad these things are in the moment — our brains are not good at distinguishing between things that need immediate attention, like your house is on fire, and things you’re stressed about that you can’t do anything about today,” said Mark Leary , a professor of psychology and neuroscience at Duke University and author of the book “The Curse of the Self.”

Pause and consider whether this situation is likely to matter in a month, a year or 10 years. Ask yourself: “Is this going to make a difference to my overall life?” With many sources of stress, the answer is likely no.

Shifting your perspective this way “helps you detach from the emotions you’re experiencing, which makes them seem less overwhelming,” said Michele Patterson Ford , a licensed psychologist and chair of the psychology department at Dickinson College. “Taking a future perspective reduces your emotional reactivity and your cognitive reactivity, making it less likely that you’ll overthink things.”

Write a letter to your future self

If you’re feeling stuck, writing a letter to the future you about what you want for your work, school or personal life “can help you learn about your priorities and generate new ideas for how you might get there,” said Susan Krauss Whitbourne , a professor of psychological and brain sciences at the University of Massachusetts at Amherst. “It’s almost like a recipe for yourself. It gives you an arc into future hopes for yourself, which is a positive motivator.”

Then think about the steps that can help you reach that goal. Imagine future you reflecting back to today and advising you on how to get to that better place, such as taking courses to enhance your skill set, networking in your field to improve your work life, or upgrading your diet and exercise habits to enhance your health and fitness.

This mental exercise may feel like trying on different roles and seeing what suits you as you envision your future self. “It may seem artificial, but there’s real value in it, especially if it gets you out of a bad situation now,” Whitbourne said.

It can also motivate you to make better decisions now. Research by Hershfield and his colleagues found that when college students wrote letters to themselves 20 years in the future, those who felt a greater connection with their future selves exercised more in the days after the writing task.

Revisit the past

To help bolster your ability to weather the current storm, Willroth recommends diving into your past. Think about a time when your circumstances felt stressful. Then appreciate how that situation no longer affects your current life. That alone can be reassuring and help you put what’s happening into perspective.

You can also use lessons from your past. Think about specific strategies that helped you navigate that distressing period — such as talking to a trusted friend, lightening your workload or getting extra sleep — and consider employing those strategies again. “Being able to take a distance perspective can help with problem-solving,” Ford said.

Visualize how you want to be in the future

If you are struggling to find motivation to make changes , imagine how you want your future health and life to be. Maybe you want to be fit enough to actively play with your kids or grandkids. Maybe you want to save money for a special trip or retirement. The more vivid you can make this image of your future self, the more likely you are to take action on your future self’s behalf.

“Any time we’re going to make productive changes, it requires imagining a future where things are better based on those changes — that’s a motivator,” Leary said. Research has shown that when people engaged in a mental imagery practice focused on their future self twice a week for four weeks, their ability to view their future self with an empathic perspective increased, which helped them reduce procrastination .

With temporal distancing, “the big lesson you learn is that the quality of your life is so dependent on how you’re thinking,” Leary said, “and we can’t always trust our evaluation of our thoughts.”

Engaging in various forms of mental time travel lets you give your negative thoughts a reality check. And picturing yourself in a better state in the future can help you feel better right now.

Stacey Colino is a writer specializing in health and psychology. You can follow her on Twitter at @ColinoStacey .

Do you have a question about human behavior or neuroscience? Email [email protected] and we may answer it in a future column.

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  1. Ketamine Side Effects: Short And Long Term Consequences

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  2. What is Ketamine?

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  3. Ketamine Trip Report #1

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  4. What a Ketamine "Trip" for Depression Is Really Like

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  5. The Good and Bad of Ketamine

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  6. A new study found that ketamine trips are the most similar to near

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VIDEO

  1. Does Ketamine erase PTSD?

  2. A Ketamine trip report

  3. The Legal Use Of Ketamine Drug

  4. Ketamine Therapy Music for Depression Treatment & Wellness (NO ADS) #3

  5. Trip Report Cocaine, DMT, Ketamine and MDMA

  6. Waking Up From Ketamine In The Emergency Room

COMMENTS

  1. Mental Health: Why a 'Bad Trip' With Ketamine Treatment Isn't What You

    The infusions are accompanied by psychedelic "trips.". That's just part of ketamine. In the beginning, I believed that the trip didn't matter — the drug got in me regardless of if the trip was "good" or "bad.". A lot of my trips are "bad.". I believe this is largely because of complex post-traumatic stress disorder ( C-PTSD ).

  2. What Are K-Holes? The Ketamine Experience Explained

    The Ketamine Experience Explained. The words people use to describe falling into a K-hole—the psychedelic trip experienced on high doses of ketamine—read like opposites. Paralyzing. Introspective. Detached. Peaceful. Frightening. Euphoric. Transformative.

  3. The Stages of a K 'trip' from an experienced user : r/ketamine

    The Stages of a K 'trip' from an experienced user. hi all, just wanted to share my experiences with Ketamine for the newbies as before I started taking it I wanted to read something like this but could never find a detailed report on the stages of a ketamine 'trip'. 1 - Starting off with probably one decent sized bump will start making me feel ...

  4. What to Know About Ketamine for Psychiatric Use

    Ketamine Side Effects. At the low doses of ketamine used for psychiatric treatment, most side effects are transient and usually resolve in an hour, with the most common being sleepiness, dizziness ...

  5. Addressing the Concerns of a "Bad Trip"

    Mindbloom's method of sublingual administration—using a rapid dissolve tablet placed under the tongue— has a more gentle onset than IV or IM-injections, which are commonly used at ketamine clinics. The experience is gentle, bringing you slowly into and out of the experience, and returning to normal consciousness around 60 minutes later.

  6. Let's Talk About Bad Trips: Separating Difficult from Traumatic

    I'm a ketamine prescriber, and I train other prescribers in the use of ketamine for treating chronic pain and mood disorders. I lead and run intensive healing retreats. ... Another gift was that my bad trip helped me to better understand, validate, and support others who have been harmed by psychedelics. Another lesson was this: my bad trip ...

  7. Ketamine trips are uncannily like near-death experiences

    Ketamine trips are uncannily like near-death experiences. Christian Jarrett. is the editor of Psyche. A cognitive neuroscientist by training, his books include The Rough Guide to Psychology (2011), Great Myths of the Brain (2014) and Be Who You Want: Unlocking the Science of Personality Change (2021). Edited by Pam Weintraub.

  8. What a Ketamine "Trip" for Depression Is Really Like

    At Field Trip Health, one IM injection costs $750, and Mindbloom charges $89 a week for three months ($1,060) for new patients, which includes six ketamine treatments. Returning clients pay $59 ...

  9. Everything You Need to Know About Using Ketamine

    Advertisement. Other not entirely pleasant effects of ketamine can include anxiety, dizziness, or loss of balance. Patients often don't enjoy the experience, and make comments like "time is ...

  10. How to Prevent A Bad Ketamine Trip

    In this video Dr. Ko shares one way you can minimize the likelihood of a "bad" ketamine experience during your infusion therapy. What do you think? Please le...

  11. Why do some people have a bad trip? How do I prevent that?

    Dissociative medications can cause hallucinations and other changes in thoughts and emotions. This means that ketamine can create a state of euphoria and provides a sense of detachment from reality. It is likely quite different than anything you have ever experienced before. But don't let that scare you away. Ketamine has been around since ...

  12. Avoiding Bad Trips During Ketamine Therapy

    In part one of this two-part blog series, we talked about the rare occurrences of "bad trips" among those who receive ketamine therapy, plus some initial tips for how to avoid them. While bad trips are not common in this form of treatment, and are typically nowhere near as intense or long-lasting as some people might think, it's true that they may occasionally take place - but there are also ...

  13. I Tried Ketamine Therapy for Depression. Here's What I Learned

    In order to shift out of depression, "people need to change their thinking and behavior," Dr. Shannon says. "Ketamine provides a temporary boost, and then fades. Psychotherapy and ...

  14. The Ketamine Cure

    By shipping directly to clients, the company has lowered the cost of ketamine therapy — which averages $400 to $800 per session at many in-person clinics — to $120 to $190 per session, said Mr ...

  15. Should You Try Ketamine Therapy?

    Ketamine is a dissociative anesthetic that is thought to improve the brain's neuroplasticity and was legalized for therapeutic benefits. Ketamine has also been found effective in combating ...

  16. Any regular users have a very scary trip? : r/ketamine

    Pharmaceutical drugs create something called serotonin syndrome when you take hallucinogens with them. Serotonin syndrome makes you feel like you're in a whole other world, it's a lot to take and the real world practically falls away. Thankfully, with K it's short lived.

  17. The Pros and Cons of Ketamine Clinics for Mental Health

    A treatment package from Field Trip consisting of a screening, a prep session, four ketamine sessions, and three integration sessions with a therapist runs about $3,500.

  18. What Is Ketamine Therapy? A Detailed Scientific Guide

    Definition of Ketamine Therapy. Ketamine is a dissociative anesthetic hallucinogen, according to the United States Drug Enforcement Administration (DEA). Meaning: Dissociative You may feel ...

  19. Ketamine 101: Uses, Safety, & Dosage

    In medicine, ketamine is used as an analgesic. It doesn't directly block pain signals like an opiate — instead, dissociative analgesics disconnect the thalamus from the cortex. When this happens, the body still feels pain, but the brain simply "doesn't care.". We don't actually feel bothered by the pain.

  20. In-person ketamine-assisted therapy

    Intake is thorough in order to determine which of our ketamine programs is the best treatment fit for you and your goals. Our intake involves two steps: an intake medical questionnaire and a thorough personal assessment with one of our licensed Psychiatric Mental Health Nurse Practitioners (PMHNPs). 2. Preparation.

  21. Learn About Ketamine-Assisted Therapy

    Clinical Findings in Psychedelic Therapy: KAP for Depression. August 10, 2020. In this webinar, nurse practitioner Monica Mina and psychotherapist Sabina Pillai will walk through the general trends and treatment outcomes of patients who have completed Field Trip Health's ketamine-assisted psychotherapy (KAP) protocol.

  22. Ketamine

    Ketamine hydrochloride, commonly known as ketamine, is a medication approved by the United States Food and Drug Administration (FDA) for use as a general anesthetic either on its own or in combination with other medications. The medication is highly effective for brief medical procedures that do not necessitate skeletal muscle relaxation and can be utilized as a pre-anesthetic for the ...

  23. Ketamine Toxicity

    Ketamine is a structural analog of the dissociative anesthetic and recreational drug phencyclidine (PCP).[1] Similar to phencyclidine, ketamine causes analgesia and amnesia without the cardiovascular and respiratory depression associated with common anesthetics.[1] Originally called CI-581, ketamine has one-tenth the potency of PCP and causes less severe dysphoria and hallucinations.[1]

  24. Stories of those who died after a struggle with police: Investigation

    Jackson struggled with his mental health and an addiction to methamphetamine. He had been in and out of jail and ended up living on the streets of Eau Claire, Wisconsin. Before dawn on Oct. 8, 2021, a morning radio host called 911 to report a man standing on a truck in the station's parking lot. Listen to the audio.

  25. Elon Musk Uses Ketamine. What the Science Says About It.

    Above: Therapy room at Field Trip, a psychedelic therapy clinic in Toronto, Canada, that offers ketamine treatments. There is also a ketamine derivative called Spravato , which was approved in ...

  26. Elon Musk Isn't the Only One Using Drugs As a Work Performance Boost

    Mar 24, 2024, 2:57 AM PDT. Elon Musk can be cagey about his purported drug use. After bombshell reports about internal concerns over the Tesla-SpaceX-Twitter-Neuralink executive using LSD, cocaine ...

  27. How your future self can help your present well-being

    By using science-based techniques for temporal distancing, you can ease your current distress and enhance your mood and motivation, experts say.