Ketamine-Assisted Psychotherapy: What It Is & Who It Can Help

What Is Ketamine?

Ketamine is a dissociative anesthetic, which means that it changes the way the brain perceives pain. It impacts neurotransmitters in the brain, which is thought to allow the brain to form new connections. This can create pathways for new thoughts and behaviors. Ketamine can be especially helpful for a person who has tried other mental health treatments without relief.¹

What Is Ketamine-Assisted Psychotherapy?

Ketamine-assisted psychotherapy (KAP) combines the use of the pharmaceutical drug ketamine with mental health therapy techniques to treat various conditions. This is an emerging therapeutic approach that has grown in research and interest in recent years. While more research is needed, ketamine therapy for PTSD, depression, and other mental health conditions has shown efficacy in reducing symptoms. Ketamine therapy for anxiety has also shown effectiveness in treating anxiety disorders that haven’t responded to traditional anxiety treatments.

Is Ketamine-Assisted Psychotherapy Legal?

Ketamine is a Schedule III controlled substance, which indicates that it has potential for abuse. Ketamine was first approved by the FDA in 1970 for pain relief. In 2019, the FDA approved a derivative of ketamine called esketamine for treatment-resistant depression. Esketamine is only given under medical supervision. The use of ketamine for depression and any other mental health condition is off-label, which means it has not officially been approved for that purpose.²

It is legal and very common for providers to prescribe off-label medications, but the Controlled Substance classification places prescribers under tighter control. Providers have a responsibility to follow the available research as well as applicable laws and regulations. When prescribing ketamine off-label for mental health, it is critical that providers have specialized training and experience due to the potential for side effects and risks.

Ketamine-Assisted Psychotherapy Vs. Ketamine Therapy

The difference between ketamine-assisted psychotherapy and ketamine therapy is the use of talk therapy. Ketamine-assisted psychotherapy combines ketamine with therapy and is most effective when the client has a connection and trust with their therapist before treatment begins. Ketamine therapy is when ketamine is administered and monitored by the healthcare provider, but there is no talk therapy involved.

What Disorders Can Ketamine-Assisted Psychotherapy Treat?

Ketamine-assisted psychotherapy has been shown to be an effective treatment option for several mental health conditions, especially in cases where other more conventional treatments have not been helpful. While Ketamine treatment for depression is probably the most well known use for this modality, it also shows promise in the treatment of addictions, suicidal ideation, anxiety, and PTSD.³

Mental health disorders that may benefit from ketamine-assisted psychotherapy include:

• Depression
• Suicidal ideation
• Anxiety
• PTSD
• Substance use disorders

Is Ketamine-Assisted Psychotherapy Effective?

Ketamine-assisted psychotherapy is a recent development in mental health treatment, and new research is rapidly emerging. Ketamine, which was previously used as an anesthetic for surgery, is shown to be a powerful antidepressant. It has been shown to reduce depression more quickly than traditional medications, and has also been found to be especially beneficial for people who have not improved with conventional treatments.⁴

Is Ketamine-Assisted Psychotherapy Safe?

Safety concerns related to ketamine-assisted psychotherapy are to be taken seriously, due to the potential for abuse and adverse effects. Some people find the effects of ketamine to be unsettling or even frightening. Ketamine can cause changes to blood pressure as well as disorientation or dizziness. In order to use ketamine safely, it must be administered by professionals who have specific training and have done a thorough assessment beforehand.⁵

Risks of ketamine-assisted psychotherapy include: 

• Psychosis and the development of brief psychotic disorder
• Dissociation
• Hallucinations
• Changes to heart rate, blood pressure or breathing
• Potential for abuse or dependence
• Emotional numbing

Ketamine Treatment Side Effects

Ketamine therapy can lead to several possible side effects, which can vary in intensity. These include nausea, elevated blood pressure, and potential for serious side effects including bladder and urinary problems. While the effects of ketamine are promising and have the potential to provide rapid relief, it is important for someone undergoing this treatment to be under close monitoring with a trained professional.

Potential common side effects of ketamine treatment include:

• Nausea or vomiting
• Sleepiness
• Dizziness
• Headache
• Confusion
• Short-term memory loss

Potential serious side effects of ketamine treatment include:

• Dangerous changes to heart rate or blood pressure
• Respiratory depression
• Urinary and bladder problems
• Liver damage
• Long-term cognitive impairment
• Severe dissociation or psychosis

What to Expect in Ketamine-Assisted Psychotherapy

Ketamine-assisted psychotherapy is divided into four distinct stages, each of which plays a role in helping a person gain the most possible benefit from their experience. This includes a preparation stage, in which a thorough assessment is performed. Then, ketamine is administered while a therapist provides therapy both during and after the ketamine. Finally, a person continues to receive therapy afterward to process and integrate their experiences.⁶

Here is what you can expect during the ketamine-assisted psychotherapy process:

Pre-Therapy Assessment

The first step in the process is a psychiatric evaluation, including a medical screening to make sure that a person is a good candidate for ketamine-assisted psychotherapy. This is an important step due to the potential for risk for people who have certain medical conditions. It is also important that potential patients have a clear understanding of the process and are able to commit to the necessary therapy.

Ketamine Preparation Therapy Sessions

This stage prepares patients for ketamine administration by focusing on setting intentions and therapeutic goals. Patients are guided through the process of exploring their expectations, setting intentions, and identifying clear goals. This helps the therapist guide someone throughout the process, and also gives people a way to evaluate whether or not the treatment was helpful or effective after it’s been completed.

Ketamine Administration

During the treatment, ketamine will be administered  in a relaxing environment by injection, lozenge, IV, or nasal spray. During the psychotherapy, a person is closely monitored by a healthcare professional while the therapist helps guide their experience towards reaching their goals. The therapist will help them explore the thoughts, emotions, and memories that come up during the treatment.

Post-Ketamine Therapy Integration

It is important for a person to continue therapy sessions after receiving ketamine in order to process and integrate their experiences into ongoing therapeutic work. This stage allows a person to translate the insights they gained during the ketamine session into long-term changes that support their emotional and mental well-being. The integration therapy might include cognitive behavioral therapy, mindfulness, or other therapeutic techniques.

Cost of Ketamine-Assisted Psychotherapy

The cost of ketamine therapy varies significantly depending on the type of treatment, the duration, and a person’s needs. Ketamine treatments can run as low as $89 per session for basic at-home treatments from online providers like Mindbloom, to $750 for integrated therapy modalities, and even several thousand dollars for a multiple-day retreat experience. Since ketamine is off-label for mental health treatment, it is often not covered by insurance and is paid out of pocket.

Does Insurance Cover Ketamine-Assisted Psychotherapy?

Some aspects of the treatment may be covered, such as assessments, consultations and psychotherapy visits. However, the ketamine treatment itself is often not covered by insurance due to its off-label use. Individuals who are considering ketamine treatment will want to discuss potential costs with their healthcare provider as well as with their insurance company and consider potential benefits as well as cost.

Who May Not Be A Good Fit for Ketamine-Assisted Psychotherapy?

Doctors will consider any potential medical conditions that may contraindicate the use of ketamine. This can include uncontrolled high blood pressure, a history of addiction or substance abuse, or certain psychiatric disorders like schizophrenia. In addition to these medical considerations, providers will also look at whether someone is a good fit for the intense psychological effect ketamine can have.

Individuals who should not do ketamine-assisted psychotherapy include:

• A person with uncontrolled hypertension
• Someone with a history of certain medical conditions
• A person with limited to no support system
• Anyone who is not committed to ongoing psychotherapy in order to integrate the insights gained during ketamine treatment
• Someone with unrealistic expectations about what ketamine can do
• A person who is not able to communicate their experiences during and after treatment
• Someone who will experience a financial strain due to the cost of ketamine therapy

Is Ketamine-Assisted Psychotherapy Right for You?

A person thinking about ketamine-assisted therapy will want to consider their mental health diagnosis and treatment history, since it has been shown to be more effective for some conditions than others. They will also need to consider their medical history, current health, and potential side effects. It is important that a person considering this therapy be committed to following up with treatment and have a strong support system in place.

How to Find a Therapist Trained In Ketamine-Assisted Psychotherapy

Finding a therapist who provides ketamine-assisted psychotherapy requires research and patience. As this is a new and emerging treatment, providers may not be readily available in every area. It’s important to work with a provider who is trained and experienced in using ketamine. Make sure that a provider is following the latest research and guidance, and not simply administering ketamine without the proper training.

Ketamine-assisted therapy is performed at special ketamine treatment centers, psychiatrist’s offices, major medical centers, and retreat settings. When determining how should someone choose a therapist, it is important to find someone who is experienced in ketamine, not just other types of therapy. A person can search an online therapist directory using the terms ketamine or psychedelics to find therapists who mention these areas of expertise in their bio.

Mindbloom offers at-home ketamine treatment for those who are a good fit. It’s a unique way of harnessing the power of psychedelics from the comfort of your own home. Learn more in our full Mindbloom review, where one of our editors went through the program to see what it’s like.