Contraindication is a term that arises throughout the course of psychedelic therapy a fair bit, particularly during the intake process, and for good reason. Over and above individual healing and client outcomes, client safety is always the number one priority of a trained practitioner.

These experiences are designed to facilitate healing, and it is counterproductive to embark on a healing journey that has the potential to do more harm than good. Contraindications are one of the ways that practitioners ensure client safety, and make sure that the right people are embarking on experiences best suited for them, their circumstances, and their healing goals.

Defining Contraindication

A contraindication is any specific drug, procedure, or medical condition that demonstrates that it is not safe or advised for a particular individual to move forward with a particular treatment. In other words, they are warning signs that if an individual has a contraindication for a particular medical treatment, it is inadvisable, and potentially dangerous, if they continue moving forward with that treatment.

There are two levels of contraindication: relative and absolute.

Relative contraindication

A relative contraindication means that the client and care team should exercise caution when moving forward with the protocols of choice, as the potential exists for some negative interaction.

Combining certain types of medications, for example, can be a relative contraindication. If the individual and care team feel that the benefits most likely will outweigh the potential risk, then they can move forward with the treatment plan.

Absolute contraindication

An absolute contraindication means that the client and care team should not move forward with the potential treatment protocol as it is likely this will cause more harm than good, and in some cases can be life-threatening.

An absolute contraindication should be a hard stop for individuals and care teams if they become aware that a serious contraindication exists.

Psychological and physiological contraindications

Though contraindications are often noted as a complete group, you can further segment these by psychological contraindications, and physiological contraindications.

Psychological Contraindications

These are contraindications relating to the individuals mental state and overall psychological health. Examples of potential psychological contraindications can include things such as suicidal ideation, schizophrenia, or active mania or hypomania as seen in bi-polar personality disorder.

Physiological Contraindications

These are contraindications relating to the individual’s biology and physical state. Examples of potential physiological contraindications can include medical history such as high blood pressure, abnormal heart rate, certain kinds of medications, pregnancy, or glaucoma.

Honouring contraindications is done for two specific reasons: to prevent and mitigate both short-term acute, and long-term enduring adverse events or reactions to the experiences. There can be acute impacts such as bodily discomfort, nausea, abnormal heart/breathing rates, or fainting/death. These also help mitigate long-term adverse reactions such as depersonalization, manic or psychotic, depression and/or suicidal behaviour, etc.

Fortunately, if practitioners honor and respect the specific contraindications for each medication and experience, psychedelic medicines and psychedelic therapy can be well-tolerated, safe, and effective experiences for healing. If a person is physically and mentally able to receive the medicine, these experiences have only a minor body load, and hopefully do more healing than harm for whatever it is the individual is working through.

As always, whenever you are in doubt or would like a second opinion, share openly and honestly with your care team, and seek second opinions so that you are making the best decisions for your health and your healing journey.

Body Load and the LD50

On the whole, most compounds used in psychedelic therapy do not have an extreme body load —the overall impact directly on the body, when compared to other recreational drugs or certain medications.

There are many other compounds, such as alcohol, tobacco, caffeine, or some pharmaceutical medications that have a much more direct and pronounced effect on the body. These effects can lead to illness, debilitation, or death if ingested in too great amounts too quickly.

A reference point here is what is known as the LD-50: the amount of the compound that would serve as a lethal dose for 50% of the general population. Many classical psychedelics (psilocybin, LSD) have very high LD-50’s and it would prove very difficult for an individual to reach a physically lethal dose. In comparison, caffeine and nicotine are much more acute and have lower LD-50’s.

Although the compounds themselves are often handled reasonably well by a large portion of individuals, this is not the only basis for a contraindication. As psychedelic compounds work on the mind as well as the body, it is important to take this full picture into consideration. There are some physiological concerns, particularly around heart rate, and blood pressure alongside contraindications concerning mental health.

Psychedelic Therapy Contraindications

Psychedelic therapy can be healing for individuals, but it can also be challenging for some and end up causing more harm than healing. This is why the medical screening and intake process is so important, so that you arrive at safe and effective healing protocols for each individual. A major part of the medical screening process is to look for contraindications.

As psychedelic therapy involves the use of certain medicinal compounds, there are both psychological and physiological contraindications that must be screened out. These contraindications can cause serious long-term damage if not acknowledged before going into a psychedelic experience.

This list is not exhaustive and should not be taken as medical advice, always seek the input of a trained and licensed practitioner before working with these experiences.

Examples of possible psychological contraindications for psychedelic therapy include:

• Personal history of schizophrenia, bipolar disorder, or severe depression
• Family medical history of schizophrenia, bipolar disorder, or severe depression
• Active suicidal ideation or previous attempts
• Major emotional dysregulation

Examples of possible physiological contraindications for psychedelic therapy include:

• Actively taking certain medications like SSRI or MAOI, and the specific dosages
• Very high or very low blood pressure
• Heart arrhythmia or irregular heart beat
• Personal or family history of epilepsy/seizures

It is important to discuss these contraindications with your practitioners and care team, so that everyone is fully aware of the situation, and that the best plan of care can be made for each individual. Some practitioners and therapeutic experiences are better able to handle particular instances, and a personalized program can be created to serve these unique cases.

Ketamine Therapy Contraindications

Much like any other medical compound and psychedelic medicine, ketamine has its own list of associated contraindications that are important to honor to ensure client safety. There are many similarities with the previous psychedelic therapy contraindication list, and a few other considerations given the mechanisms of action and the particular body load that comes with ketamine ingestion.

Possible psychological contraindications of ketamine include:

• Personal or family history of schizophrenia, manic and hypomanic bi-polar disorder
• Active suicidal ideation, previous attempts
• Psychosis and major emotional disregulation

Physiological contraindications of ketamine include:

• Very low or high heart rate
• Very low or high blood pressure
• Personal/family history of epilepsy/seizures

What If I Am Contraindicated?

You may be reading this and notice that there may be a point or two here that could apply to you. This is alright, getting appropriate information is always the first step.

If you believe that you may be contraindicated for psychedelic therapy or ketamine treatment, it’s always important to speak to your primary care provider and with the practitioners / clinicians administering the medicine / experience. This is not something that you can or should try to determine on your own. Work alongside the trained and experienced practitioners that are here to support you and provide the best possible healing protocols for your growth and wellbeing.

If you think you have a contraindication, you can do the following:

Contact your practitioner and tell them

Safety is always the number one priority. Specific contraindications exist to ensure your safety and prevent further harm from these treatments. They should not be taken lightly or overlooked. If you have any concerns or questions, contact your care team and open a discussion.

Share all relevant information

All information is helpful, it is never a bad idea to share as much as possible with your care team. It helps them to make the most informed and effective decisions possible. Some practitioners are more comfortable working with certain symptoms than others, so giving them the full picture will be helpful.

Address them with care

As mentioned above, some contraindications may only be relative contraindications, meaning you and your care team can make an informed decision, look at all the options, and make a decision to move forward.

Some contraindications can be managed or mitigated, such as working with your care team to wean off of SSRI medication if they are contraindicated. Never do this by yourself, always do this under the supervision of clinical staff. However, you can work with your practitioners to effectively manage and mitigate any relative contraindications. If they are absolute contraindications, see the next section.

Find the appropriate medicine

If you have an absolute contraindication for a certain medicine or type of experience, that just means that this avenue may not be best suited for you at this time.

Despite a potential interest in psychedelic therapy, doing this work with a contraindication can severely aggravate the condition, or do much more harm than good. Working with trained professionals to find the experience that is suited for you will do far greater than trying to force your way into a potentially dangerous situation.

Differences in Medicines/Experiences

This is a broad overview and introduction into contraindications found in psychedelic therapy and ketamine treatment. It is not possible to summarize all the contraindications for all medicines, as some medicines are able to work with contraindications that others are not.

For example, ketamine works on a different system in the brain, working with the glutamate instead of the serotonergic system. As a result, it is better able to work with clients actively taking SSRI medications.

Each medicine and each therapeutic experience will come with its own personal list of contraindications, so if you are contraindicated for one medicine, you may be able to find other medicines or other experiences that are better able to serve those specific symptoms.

Whenever you are considering any form of new experience that works on your mind and body, from meditation, to breathwork, to psychedelic therapy,  it’s important to look up the associated contraindications. Yes, even contemplative or embodied practices such as yoga, meditation, and breathwork have specific contraindications.

Conclusion

Contraindications are established and response protocols for them are enacted for client safety, to ensure that these remain spaces and experiences for healing and not for harm. They are not to be taken lightly, and you should work alongside trained professionals to help determine the best course of action for yourself.

However, by sharing any questions or concerns, by consulting the trained experts you are working with, you can determine the best course of action for you, personalize your programs so they fit with your unique circumstances, and move forward on your journey of healing and wholeness.

The therapeutic potential of ketamine can be a surprising concept to the average person outside of the medical world.

For those who are unfamiliar with its clinical application, ketamine is likely known as “Special K” or “K”, often used illegally in club and rave circles. It’s also been colloquially referred to as “horse tranquilizer” or “horse tranq”, since ketamine is primarily used as an anesthetic in humans, as well as veterinary practices.

So how did ketamine come to be known in so many different contexts?

Ketamine’s Long History of Treatment Applications in Humans

Ketamine, when used as an anesthetic in humans, puts you in a “twilight state” —a combination of pain-relieving, analgesic and memory-suppressing, amnestic qualities. That means, you’re in a state where you’re conscious, but not aware.

In medical circles, this is commonly referred to as “dissociative anesthesia”, a term coined by the wife of Dr. Edward Domino, who, along with Dr. Guenter Corssen, was the first to publish a clinical study of ketamine as a human anesthetic in 1966.

In their research of ketamine, Domino and Guenter found that in this dissociative state, patients appeared to be conscious, based on preserved airway reflexes and respiratory drive, but weren’t unable to respond to sensory input.

Zach Walsh is a PhD and professor in the department of Psychology at the University of British Columbia, whose focus is on drugs and human behavior. He explains that ketamine has a history of use as a dissociative anesthetic in humans that dates back to the 1960’s, becoming an FDA approved anesthetic medicine in the U.S. in 1970. Since then, it’s been used everywhere from battlefields to hospitals all over the world.

Ketamine’s Use in Horses and in Veterinary Practice

Despite its moniker as a “horse tranquilizer,” often with recreational and humorous overtones, ketamine is commonly used to anesthetize many species —horses and humans included— and is proven to be a safe and effective anesthetic medicine.

In large animals, such as horses, gas-based anesthetics like nitrous oxide require several parts to administer. Dosage and administration are important safety considerations when dealing with an animal weighing several hundred pounds. This is why ketamine, which can be safely administered in one injection, is often used in veterinary clinics.

The “horse tranquilizer” mythos is often conflated around this point: the medicine’s strength. The anesthetic doses of ketamine a horse would receive are much different than what a human would, based solely on size. Additionally, the use and dosage of ketamine in humans varies depending on the context it’s used —anesthetic or for mental health purposes.

In sum, is ketamine used as a horse tranquilizer? Yes, safely and in its own specific medical context. Is it fair or analogous to compare its veterinary application with its therapeutic application and healing potential in humans? Likely not.

Ketamine’s Mental Health Application in Humans

Ketamine as a treatment for mental health conditions

When ketamine is used to treat a client with mental health conditions, in lower doses, it’s felt differently. They’re still conscious and aware of what’s going on, and often able to remember some or all of the experience. This type of therapeutic application can be a powerful tool for some to break through traditional thought patterns.

“It’s an opportunity to learn and experience different ways of consciousness that might be free of whatever repetitive negative thoughts or schemas that are present during regular consciousness,” says Walsh. ”It can be helpful in that way of the subjective effects, like other psychedelics. But unlike [traditional] psychedelics, people pretty much agree that those subjective effects are key. That you have an experience and that somehow informs your subsequent consciousness and attitudes and cognitions.”

Walsh says there’s continued debate about whether or not that subjective experience is necessary.  

There is a school of thought in ketamine research that looks at its benefits mechanistically. Some researchers believe that the conscious effects are actually an artifact or even unnecessary side effect, and are focused on effects on NMDA receptors as the primary anti-depressant and anti-anxiety catalyst.

Ketamine administration and dosing basics

Clinician-prescribed ketamine is administered in different ways and dosages, depending on the context in which it’s being used. When used to treat mental conditions such as PTSD and treatment-resistant depression, it can be taken through a nasal spray, intramuscular / intravenous injection, or even a lozenge.

When ketamine is used illegally as a recreational club drug, it’s often a very low dose. When it’s used as an anesthetic, it’s administered intravenously in a higher, clinically-controlled dose.

“You wouldn’t want to be at a club if you’re taking the types of doses that are useful in [psychiatric treatment],” says Walsh.

Ketamine’s Therapeutic Benefits

What’s clear is that therapeutic use of ketamine can be effective for short term relief for severe depression. In 2019, the FDA approved esketamine, a nasal spray related to ketamine that’s used as a fast-acting antidepressant treatment. Walsh says the results are well established, and while it’s mostly used on its own, some people have used it in conjunction with traditional modalities such as psychotherapy, mental health medications like SSRI/SNRI and more invasive treatments such as electroshock therapy.

“It seems to be quite effective at relieving treatment resistant depression, at least for short periods of time,” he says.

Now, one of the challenges for those looking to develop these types of therapies is to find a way to prolong the healing effects. Walsh says the hope is combining it with an active therapeutic outlet.

“Actually engaging with that psychedelic aspect of [the experience] is something that might prolong the effects,” he says. “As it stands, it’s short acting but very effective. Especially with people who are severely suicidal, it alleviates them from that suicidal ideation.”

Walsh says some of the early research suggests that some patients using ketamine therapy can return to baseline after a couple of weeks, or sooner, depending on the severity of their condition or symptoms. Still, each experience can be really important to people who are acutely, severely depressed and suicidal.

“If you can alleviate those symptoms even for a relatively brief period then that provides a window where you might be able to make some other types of therapeutic gains,” he says.

The remarkable effects of ketamine might not be common knowledge, since progress in this arena is relatively new to the layperson. Still, it’s only a matter of time before ketamine is more widely recognized as a mental health treatment, rather than a street drug confusingly associated with horses.

Psychedelic and ketamine therapy are becoming common topics in common culture and public parlance more and more each day. For good reason, continued research and clinical studies show positive results when these medicines and compounds are used to treat a variety of mental health conditions. 

Combined with the existing safety and efficacy profiles of ketamine, and the supportive reports of clients who have completed ketamine treatment, it’s easy to herald these experiences, programs, and medicines as “wonder drugs.” 

This is compounded when legendary figures in the space such as Stanislov Grof, responsible for thousands of early studies on LSD psychotherapy, submit claims like “…psychedelics, used responsibly and with proper caution, would be for psychiatry what the microscope is for biology and medicine or the telescope is for astronomy.” 

These are big, bold statements, and there are solid arguments in support of this across academic research, clinical studies, and real client experiences. However, it’s easy for ketamine and other psychedelic medicines to develop a sort of “halo effect” as a magic pill that can cure whatever is ailing you. All you need to do is show up and take it, right?

This “magic pill” moniker has its downsides. It diminishes the importance of ”Set and Setting” and adequate experience, preparation and integration, and overstates the long-lasting impact of the psychological benefits that ketamine and psychedelic medicines can and do provide. 

All of the additional components of safe and effective psychedelic therapy —the clinicians/practitioners, the therapeutic containers they are taken within, the ongoing individual evolution of personal narratives and challenging habit change— can be just as significant to realizing powerful results and experiences in individual sessions and throughout the entire programmatic arcs of these experiences.

Defining the “Magic Pill”

At a first look, it’s easy to derive the essence of what is meant when someone says that ketamine, psychedelic medicine, and psychedelic therapy is a “magic pill.”

Given that the method of administration for many of these compounds is in a pill or other easily ingestible form, it’s easy to make the assumption that all an individual needs to do is show up, take a psychedelic medicine, and be magically cured of existing ailments.  

Psychedelic medicine is being explored as a treatment everything from treatment-resistant depression, to major anxiety challenges, OCD, substance abuse problems, and a host of other mental health conditions. Since traditional treatment modalities typically require months to years to see improvements, psychedelic medicines can seem like a “magic pill” treatment in comparison.

It is true that there are impressive and substantiated results throughout the clinical and therapeutic worlds of the profound potential and promise of psychedelic medicines. However, the myopic view of narrowing down psychedelic therapy to solely the physiological effects of ingesting psychedelic medicines can do more harm than good to individual clients. This view also can negatively affect the emergence of psychedelic medicine as a whole as it moves into maturity.

As with anything that is oversimplified, this “magic pill” designation leaves out important nuances, steps of the process, and the small refinements that are critical and necessary components in helping clients heal, integrate, and enjoy powerful experiences in the sessions and throughout the program. 

What Gets Left Out of the “Magic Pill” Conversation

There are many essential components of any reputable psychedelic therapy protocol that are left out in the definition of psychedelic medicines as “magic pills”. 

Some critical aspects of the experience include:

Trained practitioners 

Working alongside trained and licensed practitioners/clinicians throughout the psychedelic therapy process is an essential factor in the results that a client may realize throughout the process. Practitioners and clinicians facilitate the initial intake ensuring client safety, titrate or adjust doses effectively,  and help explore the results and begin the integration process.

Preparation and intention

Preparing the individual’s mindset and physical space they will have their experience in (also referred to as ”Set & Setting”), as well as clearly defining personal intentions for embarking on these experiences, have a massive influence in the experience an individual has. This is entirely antithetical to the notion of the magic pill as something you just “show up and take.” 

Processing and Understanding Experiences

It is possible that many dormant or novel emotions, insights, and experiences may arise throughout a psychedelic therapy session. It is not a given that it will be immediately understandable and actionable by a client once they have completed the session. The purpose or importance of some of these insights/experience may not be obvious until they have been carefully unpacked in the integration process, or with the assistance of the practitioner and/or licensed therapist. 

Although there can be significant experiences that have immediate and long-lasting effects on the individuals, this is not always the case. Presenting psychedelic medicine experiences as if no additional processing work is necessary afterwards —that an individual just emerges from an experience “:completely changed for the better, forever”— is simply not true. Giving clients this expectation going into the experience can make the reverberations more difficult or strenuous.

Ongoing Integration

Building off the last point, there may be a significant integration process afterwards, as the individual begins to take the lessons and emotions  from the medicine session and enact and embody them in their life back at home. This process can take days, weeks, months, or years to fully realize, and some lessons or next steps may not have clearly defined end dates at all. 

Though there can be significant and powerful healing done immediately within the sessions, as one would hope for the individual, the reality is that enduring and significant personal change from psychedelic therapy often has a long-tail of integration work that accompanies it. This should be known and communicated to clients before they undergo an experience, so that they are clearly aware that the medicine experiences themselves are but the first step on an ongoing journey of healing and wholeness.

Ketamine’s Role in Healing

Given a complete overview of all the necessary components that contribute to powerful and long-lasting results throughout ketamine treatment and psychedelic therapy experiences, does this mean that there are no significant results that can come about in the experiences themselves? 

Not at all.

There are significant psychological and neurological changes that occur during the experiences as a direct result of taking the medicine. These are important drivers of the outcomes that have been realized by clients and the psychedelic medicine studies that have been conducted, and are currently ongoing.

With ketamine in particular, there are a host of beneficial changes that occur in the brain and mood that are helpful in the treatment of certain mental health conditions, and that also make the ongoing integration afterwards more powerful. 

Some of these neurological and psychological benefits of ketamine include:

Increased neuroplasticity 

By increasing the levels of BDNF (brain-derived neurotrophic factor) in the brain through the ingestion of ketamine and some other psychedelic medicines, the brain moves into a more flexible state for the following 3-14 days. This means that new patterns of thought are possible, it can become easier to pick up new habits and behaviors, and embedding new ways of thinking and acting can come easier to an individual. This is incredibly supportive of the integration work to come.

Increased mood regulation 

Clinicians would hope to also see a baseline increase in overall mood and demeanor in the days that follow. A more positive outlook and average emotional state can provide great motivation and reprieve for individuals working with anxiety or depression, perhaps granting them access to emotional states that have been hidden away for some time. There is also a complimentary increase in the ability to regulate moods and emotions, making difficult conversations or major tasks more accessible, which can be critical in realizing long-term, sustained changes. 

New emotions and insights 

There may be the direct experience of new or hidden emotions/insights/experiences that arise throughout an experience that can have significant impacts just from the direct experience itself. Experiences of connection, emotions like joy, or insights around certain patterns of behavior, can be significant catalysts for an individual and can endure for a significant time afterwards.

Improving brain health

Particularly in the case of ketamine treatment, improved levels of mTOR and GABA contribute to increasing the health of the brain’s synapses and neural connections. These areas of the brain can be damaged due to prolonged stress or depression. Improving brain health contributes to cognition, mood regulation, and the ability to enact behavioral change in the long-term. 

These are a few examples of the immediate effects of psychedelic medicines and ketamine that contribute in no small way to the powerful experiences and important results clients see in psychedelic therapy programs.

The Reality of Psychedelic Therapy

As with much of the work and results in the psychedelic therapy world, the reality of these medicines as “magic pills” isn’t so much ‘either/or’, but ‘both/and’. They are both incredibly powerful and beneficial experiences, and they are made that way through a much more comprehensive experiential arc than just the medicine experiences themselves.

There are significant and important components of the preparation, processing, and integration factors that contribute to the results that clients see, and there are significant and important experiences that arise within the sessions, or come about as a by-product of taking the medicines themselves. 

It is by embracing a more holistic view of psychedelic therapy and ketamine treatment that the full power and potential of these experiences are unlocked. Yes, there are incredible results that arise through this work where other combinations of psychotherapy and pharmacology have been unable to. Some examples are enduring smoking-cessation brought about by a single psilocybin session, or in helping an individual heal treatment-resistant depression, These results are real and promising, but they are results that were achieved through the entirety of the psychedelic therapy structure and experience, not simply the medicine experiences themselves.

The Greatest Benefits Are Achieved Through Holistic Treatment

Psychedelic medicines are not magic pills, but the results that psychedelic therapy programs are achieving for clients is remarkable and worth paying attention to. Research being done continues to support the validity of these claims.

There must be a cautious optimism applied in these discussions, to give credence to both the medicine and the programs, and who these experiences are suitable for and who they aren’t. 

With all parties and stakeholders involved taking this more holistic view, the psychedelic medicine world can continue to refine and improve, providing greater healing for clients and replicable, effective protocols for the practitioners and organizations facilitating these experiences.

Any good faith and informed exploration of ketamine and ketamine treatment should include a list of potential side effects that a client may experience. There are both neurobiological and phenomenological side effects that may arise in the short-term immediately after a session, or longer-term through persistent use.

It’s important for practitioners, clinicians, and clients working with this medicine to be informed of these potential side effects, and their frequency and severity. This helps to make informed decisions about moving forward with ketamine treatment and psychedelic therapy programs.

Ketamine is a medication used for a variety of purposes including anesthesia during surgery, pain relief (analgesia), and treatment of mental health concerns, meaning it has the ability to act on multiple areas of the body. When used to treat mental health conditions, it is acting on the brain.

However, during these treatments, ketamine impacts other physiological functions as well. This can result in objective and subjective side effects, even with a single treatment. These effects are sometimes referred to as “body load,” or physical sensations brought on by the ketamine and other similar substances which may be difficult to describe. This article will explore both of these categories of side effects from both a short-term and long-term perspective. Let’s begin by defining what the term “side effect” means.

Defining “Side Effects”

In medical terms, the term “side effect” is used to describe an unwanted or unintended effect of a drug. Although the term is predominantly used to describe adverse effects (mild, moderate, to severe), there are some side effects that can be beneficial.

Using this definition, you can say that the antidepressant and anxiolytic properties are a beneficial side effect of ketamine since its initial intended use was as a surgical anesthetic. Using this example, we can see that not all side effects are negative. However, this article will address the adverse side effects possible from consuming ketamine.

If you would like to explore the positive and beneficial aspects of ketamine treatment for mental health, check out our resources addressing anxiety, depression, and treatment-resistant depression directly.

Side effects can differ in severity, duration, and manner of effect — neurobiological and psychological. Some side effects are simply minor developments that fade quickly after a session, while less common but more severe side effects may require additional attention or care.

Clinical Administration vs. Recreational Use: A Distinction

Before exploring the neurobiological and psychological side effects in more detail, it is important to draw a critical distinction between the method of administration and how this relates to side effect development and prevalence. Namely, the context in which the client is receiving ketamine.

Most of the literature surrounding the side effects of ketamine looks at these effects under the context of habitual recreational use with or without addictive behavior patterns present. These are side effects that can arise from frequent use of unknown quantities, perhaps with increasing amounts of ketamine, for a sustained period of time.

When medications are taken in a manner, dose, or environment other than what is prescribed by a clinician, the potential for adverse side effects increases, as can the severity of side effects.

When working with ketamine, doing so in a structured treatment program alongside trained and experienced clinicians is of the utmost importance. The included protocols are set up to protect client safety, and ensure individuals have the support, care, and guidance that is necessary to work effectively with these medicine experiences.

Side effects are still present in clinical and therapeutic contexts, but the structured support environment is more conducive to modify the treatment plan should side effects arise, if continued therapeutic work is recommended.

If you are currently working within a ketamine treatment protocol or psychedelic therapy program, it is important to inform your care team of any concerns, questions, or comments you have surrounding your experience and the emergence of anything you may consider an adverse side effect. You have a team there to support you, and it’s beneficial to work with their domain expertise and experience throughout these programs.

Short-Term Neurobiological Side Effects

Beginning with the neurobiological side effects of ketamine, there are a number of side effects that may emerge during a treatment session, or in the few hours after a session.

Since ketamine acts on the nervous system as a whole, it is important to block off sufficient time after treatments to allow for recovery. It’s recommended to give your body the space and time it requires to process and metabolize the medicine.

Some short-term neurobiological side effects of ketamine may include:

• Elevated blood pressure and increased heart rate
• Nausea, occasionally with vomiting
• Drowsiness
• Disorientation and confusion
• Headache

There are steps involved in the preparation and post-session suggestions to help manage and mitigate the potential of these side effects as much as possible.

For example, the dissolvable sublingual tablets used in Mindbloom’s treatment protocol are not meant to be swallowed, nor the saliva that they dissolve into. Swallowing the dissolved tablets and saliva greatly increases the potential for neurobiological side effects, which may include increased drowsiness, dizziness, and/or nausea.

Knowing this information is half the battle. If you are aware of the potential for these side effects to emerge, it is much easier to prepare beforehand and be ready for them if they do emerge. Rest and stillness are helpful in dealing with many common short-term neurobiological side effects that do emerge.

As the experience will be unique for each client, it’s important to be informed of side effects beforehand. Equally important is having someone to support and watch out for you during and after the session, and having plans in place that were coordinated with the assistance of a clinical care team to remedy these effects if they do arise. Some individuals may experience multiple side effects, while others may experience few or none at all.

If you have any concerns about this, or feel like you want extra support in the sessions, open this dialogue with your clinical care team so that you feel safe and supported going into the treatment session — an important feature to create safe and powerful experiences.

Long-Term Neurobiological Side Effects

As mentioned before, if you are working with a professional clinical care team, the treatment protocols, including specific session dosages, and frequency of your sessions will help to avoid any long-term adverse side effects.

The side effects listed below have emerged largely in the context of frequent habitual recreational use, with or without associated addictive patterns and behaviors. Ketamine does impact the body, particularly the kidneys, and it is important to be aware of this beforehand.

Some potential long-term physiological side effects of ketamine use include:

• Kidney injury or damage
• Trouble or pain with urinating
• Substance dependence and tolerance
• Baseline increase in heart rate
• Baseline increase in blood pressure
• Respiratory depression
• Possibility of seizures

Given the potential side effects of long-term ketamine use, it is important to follow the prescriptions and protocols of your treatment program, as these are developed and prescribed to safely avoid these long-term effects while still providing effective and therapeutic experiences.

If any concerns or questions emerge throughout your course of treatment, please check in with your care team to go over these in detail. Treatment feedback is important and allows your clinical care team to make informed and safe decisions regarding your program.

Short-Term Psychological Side Effects

Ketamine can also have psychological side effects —those that emerge at the level of emotions, thought patterns, and waking conscious state.

There are both short-term and long-term experiential side effects that may occur as well. Both working with trained professionals in a safe context, and adequate preparation of set and setting help to manage and mitigate the emergence or the severity of potential side effects.

Some short-term psychological side effects that can arise during or just after a treatment session may include:

• Stress from processing emotions/memories
• Disconnection from existing life
• Anxiety, depression, or worsening of these
• Increase in irritability/fragility

As a consciousness-altering agent, ketamine treatment can have a profound and important impact on your mental health. However, if not managed safely and effectively, these experiences can also surface unintended consequences.

If you have a significant emotional experience in the session, it may take some time outside of the planned treatment time to process fully.. This may cause some short-term emotional stress. Experiences that are new to you may occur: out-of-body moments, visual or auditory hallucinations, or disconnection from thoughts and the body. This can be alarming for some.

As you process the experiential information, there may be periods of emotional lability or confusion. If this does happen, work with your support systems, take time to rest, and allow the medicine to metabolize fully. The effects should decrease and resolve as the medication is broken down and exits the body.

Long-Term Psychological Side Effects

Continued or frequent use of ketamine can lead to long-term changes to your brain, resulting in altered cognitive abilities and mental health.

Again, research suggests that these side effects are predominantly seen in the content of chronic recreational use with or without addictive behaviors present, and can be mitigated and managed by working with your clinical care team and taking the medication as prescribed.

Some potential long-term psychological side effects may include:

• Degraded memory recall/storage
• Lowered subjective sense of wellbeing
• Changes in sleep habits

Following the treatment protocols of an experienced clinician should prevent long-term side effects like those mentioned above from occurring. This is because your clinician will likely require periodic appointments to check for efficacy of treatment and possible side effects that you may be experiencing before prescribing more Ketamine.

Having an informed understanding of the medicine, of the potential therapeutic benefits and adverse side effects that exist, and working within your therapeutic container, will all serve to provide safe, effective, and powerful experiences.

How to Manage/Mitigate Potential Side Effects

Like any medicine, ketamine comes with its own associated neurobiological and psychological side effects, some of them healing and welcome, some of them potentially distressing and adverse.

Fortunately, ketamine has been researched for several decades, initially gaining FDA approval in 1970 as a fast-acting anesthetic. Since then it’s uses as an analgesic and its mental health benefits have been studied in depth. It is currently the most well-studied psychedelic medicine available for prescription by a clinician. From these studies a number of best-practices and safety protocols have emerged.

If you have any concerns about the potential side effects that can arise, here are a few steps you can take to help mitigate or manage these:

1. Talk to Your Clinician: This is always the first step. If you have any concerns or questions, bring this up with your clinical care team so that all parties are informed. This is not something you have to, nor should you, figure out and manage by yourself. You have a care team supporting you through these experiences, your safety and addressing side effects is one of the things they are here to help with.
2. Follow the Program Protocols: All of the recommendations, requirements, and procedures that are part of your treatment protocol are there for a reason. Nothing is redundant. Requirements such as not eating a few hours beforehand, having a peer monitor present throughout the experience, and recommendations like preparing yourself physically and mentally beforehand, and setting clear intentions are in place to help provide safe, effective, and powerful healing experiences. Follow the recommendations that your care team provides.
3. Set & Setting: Preparation is important, particularly for powerful healing experiences like these. Taking the time to prepare beforehand, ensuring that you are in an open and welcoming mental space. Make sure that your physical environment is set up to be comfortable and supportive, that you have clear intentions, and are in a state of trust and openness. These all help the process, ensuring you can manage any physical side effects and are well-equipped to handle any side effects that may arise in the sessions.
4. Take Care of Your Health: There is a lot that you can do outside of the sessions themselves to help mitigate or manage the impact potential of side effects. Take care of your physical health in all areas, and welcome and explore your emotions. The more grounded and fit your mind and body are coming in, the more you can receive the medicine and welcome anything that wishes to arise throughout the program.
5. Trust, Let Go, Be Open: A timeless mantra in the psychedelic therapy world, trust that the experience will bring you what you need. Let go of your expectations or requirements for the sessions, and be open to the nature of the experience and to the way the medicine is experienced.

Following These Steps Will Help You Fully Prepare

These steps are not bulletproof guarantees that in following them you will not experience any potential side effects. These steps help you to fully prepare as best as possible, so that you have resources available to you if any of these do begin to arise during or after the dosing sessions.

Work with your team, work with yourself, follow the recommended guidelines, and you will be more likely to have the safe, effective, and powerful experiences that you embarked on this healing journey for.

As explored in some previous resources, ketamine is a unique medicine as it can provide specific biological and phenomenological experiences that lead to its classification as both a dissociative anesthetic and a psychedelic medicine.

Originally synthesized and used in the medical field as a surgical anesthetic, ketamine’s dissociative properties were and remain highly useful in surgical procedures requiring anesthesia. Through ongoing study, an ancillary benefit was noticed — individuals who received ketamine were reporting marked improvements in mental health conditions such as depression and anxiety. This opened a new field of study, which continues to this day, and brought about the introduction of the off-label prescription of ketamine for certain mental health conditions.

In the context of mental health treatment, the dissociative effects of ketamine can be beneficial from both a neurobiological and phenomenological perspective. But what exactly is the process of dissociation? This article explores the definition, use-cases, benefits, risks, and existing classifications of dissociation and its role in the greater context of mental health conditions and treatment.

Ketamine: Psychedelic Medicine or Dissociative Anesthetic?

There is discussion in clinical and psychedelic circles about the appropriate classification of ketamine in context of psychedelic therapy. It was originally synthesized as a dissociative anesthetic, but it’s now increasingly applied as a psychedelic medicine for mental health treatment. What should one make of either of these distinctions?

The classification of ketamine as a dissociative anesthetic is clear and direct. The medical introduction of ketamine was for anesthesia, and it has been used in this way for several decades. All clinics, practitioners, health organizations, and regulatory bodies such as the Food and Drug Administration (FDA) recognize ketamine as a dissociative anesthetic.

It is ketamine’s designation as a psychedelic compound that brings about more discussion. There is a clear argument as to why ketamine can be considered a psychedelic, especially as it’s already an established medicine used in psychedelic therapy contexts.

The Neurobiological Argument

One of the common counterpoints against ketamine’s classification as a psychedelic is that ketamine does not affect the brain in the same way “classical” psychedelic medicines (LSD, psilocybin, DMT) do.

These classical psychedelics are commonly 5-HT2A/B receptor agonists, binding to a specific receptor site in the brain, working on the serotonergic system, and inducing the hallmarks of a psychedelic experience in that manner.

Ketamine does not share the same mechanism of action. It works on N-methyl-D-aspartate (NMDA) receptors and influences the glutamate system. On this neurobiological difference alone, some individuals are inclined to dismiss ketamine’s designation as a psychedelic medicine.

However, when considering the fullness of the psychedelic experience, and when discussing what commonly defines the hallmarks of a psychedelic experience — one that is largely defined by its subjective, phenomenological markers, it seems odd to have the exclusion criteria be solely on the neurobiological mechanisms.

The Subjective / Phenomenological Argument

If you look at the hallmark characteristics of a psychedelic experience — feelings of unity, self-transcendence, distortion of space/time, novel ways of thinking/feeling/experience — they are well within the scope of a ketamine experience. Many clients report having experiences of visions, novel sensations, out-of-body experiences, and other sensations.

If you use this subjective/phenomenological description, ketamine can fit the definition of a psychedelic medicine for use in psychedelic therapy.

What does “Dissociation” Mean?

Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity.

There may be an experience of a “distance” between the sense of self, the thoughts that are arising in awareness, the person they see in memories, or from the physical sensations and presence of the individual’s body.

Separately, there are also dissociative disorders as designated a mental health condition in the DSM, as opposed to a subjective state induced by certain experiences and/or compounds. Dissociative disorders include dissociative amnesia, dissociative fugue, depersonalisation disorder, and dissociative identity disorder. This will be addressed further below.

There are some hallmark subjective experiences that can help determine if dissociation is occurring, and the level of dissociation that has occurred. Some of these phenomenological markers include:

• Feeling like things are in slow motion or seem unreal
• Feeling separated from reality
• Feeling as if looking at things from outside the body
• Feeling like you are a spectator or like you are observed
• Objects looking different
• Colors seeming duller or brighter than usual
• Time speeding up or slowing down
• Seeing things through a fog or having tunnel vision
• Losing track of time or what is happening in the environment
• Feeling as though your body has changed

For an individual who has never had an experience of disconnection like this, the experiences can be challenging at first. But they can also be highly beneficial, giving individuals a momentary glimpse at the functioning of their own psyche and thought patterns, a break from strenuous emotions or trauma, or even a sense of self-transcendence —a feeling of being more than, or out of, the confines of one’s individual body.

What is a “Dissociative”?

Given the aforementioned definition of dissociation, a dissociative is any compound, medicine, or experience that can induce dissociation in an individual, reliably, and according to the subjective phenomena listed above. This state is referred to as dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia.

To measure the state of dissociation and the level of dissociation that was experienced, clinicians and therapists will use a scale to validate and measure the levels of these experiences.

The Clinician-Administered Dissociative State Scale (CADSS) is a tool that clinicians use to measure the degree of dissociation during ketamine infusions. By ranking the extent to which a symptom occurs, the CADSS can assess the psychoactive effects of ketamine. The higher the CADSS score, the more dissociative symptoms a patient is experiencing, and vice versa.

Dissociative drugs can produce visual and auditory distortions and a sense of floating and dissociation (feeling detached from reality) in users. Ketamine is the most prominent dissociative used across medical and clinical environments, though other compounds that induce dissociation do exist.

Part of the promise and potential of ketamine treatment is that at certain levels and dosages for individuals, ketamine induces a dissociated state while the individual maintains conscious awareness. By maintaining consciousness throughout the experience, the individual has the opportunity to raise particular insights, and experience new or powerful sensations or emotions, all of which can be helpful to the individual and the clinical team when working through anxiety, depression, or other mental health conditions.

Benefits of Dissociation/Dissociatives

While some studies have concluded that patients who experience more intense dissociation symptoms during ketamine infusions can have greater or more sustained antidepressant benefits, most have found no correlation between the degree of dissociative symptoms and antidepressant effects.

This references only the neurobiological effects of dissociation. Though even those results are promising, as they indicate the potential of the antidepressant effect of the act of dissociation as induced by a dissociative such as ketamine. The potential of using a dissociative to experience some level of acute and possibly sustained antidepressant effect is promising. Much of the potential of dissociation lies in the work that can be done by the individual and care team during and after the dissociative experience.

In many mental health conditions, recurring, intense, or habitual negative thought patterns are common. No matter the  thoughts —anxious, depressive, or self-negative — the persistence of these ideas, thoughts, and stories often cause clients a level of discomfort. The persistence makes them more likely to continue on and become habitual ways of being.

With a dissociative experience, the individual has the opportunity to create some distance between the thoughts, emotions, feelings, and themselves. With this ”subjective breathing room,” the individual is given the opportunity —perhaps for the first time— to take some space and time to collect themselves. This space allows an individual to look directly at these behavioral patterns, and then return to their lived experience to tackle them with new insights or ways of viewing these things.

Dissociation can also include more positive effects that for someone working with anxious or depressive tendencies can be a catalyst for positive change moving forward. This can include feelings of connection, the sense of being more than just your body, access to new or heightened emotions/insights/lived experiences,.

When the two main potential benefits —the neurobiological antidepressant effects, and the subjective experiential distancing— are combined, it creates a conducive environment for the integration and processing work to begin alongside the individual’s care team. With renewed energy, insights, or emotions, individuals can begin taking the steps to create positive and long-lasting changes in their lives. Especially in areas that were potentially catalyzed, accelerated, or augmented by the dissociative experience itself.

Is Dissociation a Bad Thing?

Dissociation itself is also noted as a symptom related to other mental health conditions. In the aftermath of traumatic events, or chronic exposure to unsafe or threatening situations, the body and psyche as a defensive mechanism may induce an acute, episodic, or sustained state of dissociation to protect the individual from the emotions or traumatic feelings that arise.

The defensive mechanisms of the mind and body may induce dissociation as a protective force. The individual may seem withdrawn, disconnected from their body, aloof or uncertain, and any of the defining dissociative symptoms mentioned at the beginning of this article.

Separately, there is also the dissociative disorder, a specific condition as defined in the DSM — one that is brought about as a defensive protection from the individuals mind and body. Dissociative disorder is a mental health condition, while dissociation is a subjective feature of some medicines and compounds. As is typical within the psychedelic therapy space, the context, content, and nuances included in these definitions and the steps taken to move forward are incredibly important.

Using the dissociative experience, as facilitated by a care team and induced by dissociative compounds, can be a powerful and potent assistant when working through certain mental health conditions like depression and anxiety.

At the same time, dissociative disorders are also a mental health concern outside of clinical settings, and this underscores the importance of working with trained and experienced professionals when embarking on psychedelic therapy programs or individual healing journeys overall.

There is a lot of nuance, the mind and psyche are highly complex and dynamic forces, and working with trained professionals helps to ensure correct diagnoses, correct dosages, and correct experiences to move individuals towards healing and wholeness again.

Conclusion

Dissociation is a highly subjective and highly personal experience. It can be a symptom of other conditions such as major depression, and it is a subjective state that can be induced directly through dissociative compounds like ketamine.

There are a host of potential benefits that dissociation can bring about, from neurobiological antidepressant effects, to subjective reframing and novel experiences to help create long-lasting behavioural change. There are also a host of individual challenges that can emerge if someone is experiencing persistent dissociation on a daily basis — namely being disconnected from their lives, from the beauty of emotions, from the direct vitality of conscious experience.

If you, or someone you know, may be experiencing dissociation, or would like to discuss the potential of working through this together, you can get in touch with our team after taking our survey.

As you embark on a healing journey through ketamine therapy, it’s reasonable to approach treatment with the expectation of seeing positive results. The science and research done on the off-label uses of ketamine have demonstrated a host of positive effects.

So what exactly are these positive effects? What benefits can you walk away from a ketamine therapy program with? 

Each experience for each individual is unique. Some results may be more pronounced for yourself than others —or the reverse. Given that context, there are broad categories of experiences or benefits that emerge which are useful to address and discuss.

The two broad categories are the biological effects and the behavioral effects of ketamine.

Positive Biological Effects of Ketamine

Ketamine is a medicinal compound that is administered through intravenous infusion, intramuscular injection, oral tablets, or nasal sprays. As with any compound taken into your body, ketamine has a host of biological effects on your physical system, or physiology. These changes can occur without our conscious awareness of them, although we can be conscious of their downstream effects on how we feel physically or psychologically.

Regarding its impacts on the brain, Ketamine can be a powerful medicine. It interacts with a variety of neurochemical networks, which act to restore areas in the brain that have been “beaten down” over time by our body’s physiological response to things such as stress. While doing so, it also lays down new neurological pathways. Research is still uncovering more about ketamine’s complex methods of action in the brain, and what this means in the context of treating mental health conditions.

Science suggests that the biological effects are dose-dependent, meaning there is a connection between the effects of ketamine and the amount prescribed.

Below are some of the biological effects of ketamine as a therapeutic medicine that we understand based on current science.

BDNF Upregulation 

Through a series of neurochemical reactions including increasing the level of glutamate transmission while also shifting the balance of glutamate activation from NMDA to AMPA receptors, ketamine upregulates the presence of BDNF in the brain, which helps promote the growth, maintenance, and survival of neurons. This contributes to increased neuroplasticity.

mTOR Upregulation 

Ketamine upregulates a central cell pathway called mTOR, which helps improve synaptic connections and heal damaged synapses. This is significant when understanding that this occurs in key areas of the brain associated with emotional regulation, learning, and memory. Essentially, priming these areas of our brain to go through a psychological healing process.

Global Connectivity 

Stress and depression impact the brain not just on a cellular level but also on a macro level, weakening connections within larger neural networks, such as the prefrontal cortex. Ketamine seems to help improve global connectivity in this portion of the brain and improves the linkages among the subregions, which promotes positive changes in executive function—the ability to control short-term behaviors in favor of self-control, planning, decision-making, problem-solving, and long-term goals.

Subjective Healing Effects of Ketamine

Ketamine’s positive psychological effects can be understood as the surface manifestations of the underlying biological mechanisms that ketamine works on. The biological effects “set the stage” for these sometimes subtle, but longer-term behavioral effects to take root, and rise to the surface where they have the potential to change lives.

These positive psychological effects can also emerge from the psychedelic and dissociative effects of ketamine. It’s able to induce new or novel states of consciousness, surface hidden insights or experiences, and provide space to reflect on important or pivotal aspects of life.

Psychological effects can vary from person to person. Many of them require effective and intentional integration to fully take root, but are essential for providing the long-term, life-changing effects that can happen with ketamine therapy.

Here are some of the positive phenomenological healing effects that can come through ketamine therapy:

• Emotional Regulation: An increased ability to understand and interact with emotions.
• Cognitive Distance: Feeling more ‘space’ or ‘distance’ between external events and an individual’s reaction to them. This allows for more intentional behavioral responses, the rewriting of automatic triggers, and deeper introspection.
• Embodied Feelings: Visceral emotions and feelings returning to the body, potentially some that may have been discarded or forgotten (joy in a depressed person, for example).
• Novel Insights: Ketamine can facilitate crucial insights that when integrated, can provide powerful and significant changes to how the individual views themselves and the world around them.
• New Experiences: New experiences or states of consciousness can provide motivation, inspiration, or understanding of the next steps. This helps to clarify meaning and purpose and catalyze improvements to mood, emotions, and physical experience.

The Life-Changing Session

Beyond the positive benefits of ketamine as a medicine (ie: biologically) and the healing capacity of the felt experience, it is the combination or coupling of these effects that is instrumental for life-changing experiences and results.

When you combine significant insights and experiences with a highly receptive, highly adaptable mind-body dynamic, you have the potential to make progress that endures over time.

This combination creates a space where our brain is primed to heal and gain new insights and perspectives, all while we are going through a phenomenological healing process during our experiences with the medicine.

There are a few additional factors that are important when creating the best possible conditions to facilitate these results:

• Appropriate set & setting: the individual mindset and environment for the session
• Clear intentions or goals for your treatment
• Working with trained and experienced practitioners
• Commitment to the integration phase of treatment

With careful attention around the treatment process and environment, (also referred to as a “container”) formed to do this work, it’s possible to see positive benefits emerge from each session, as well as the collective growth over the course of treatment.

Some experiences with the medicine may be more calming, relaxing, and restorative. They can be seemingly meditative in nature, without any paradigm-shifting epiphanies. 

Sometimes mood doesn’t fluctuate or improve as much as or as rapidly as anticipated. Although it can be challenging to understand why you didn’t receive an immediate substantial relief or what we were hoping for, working with a supportive team around your experiences with medicine can help you identify areas of potential healing and steps toward incremental growth.

Experiences with ketamine as a medicine can vary greatly from person to person, and from one session to the next. This is why working with an experienced treatment team can help you make sense of each experience and come up with an individualized plan to maximize its healing potential.

If you’ve been looking into ketamine treatment, or are currently familiar with the space, you might have noticed there are several different methods of receiving the medicine: ketamine infusions (intramuscular or intravenous), tablets (or “troches”), or nasal spray. 

What isn’t as immediately evident is what the differences are, what the benefits may be, and why you would choose one over the other. Below is a brief history of ketamine treatment, three common methods of administering ketamine, and how each fits into the best course of therapeutic treatment.

A Brief History of Ketamine’s Medical Use

Ketamine’s first FDA-approved use was as a dissociative anesthetic and is used for this purpose in medical and surgical procedures. Ketamine is a special medicine in this class as it does not suppress respiratory rate and is a generally safe tool for anesthesia. It has also been used for years for its rapid acting analgesic (pain reducing) effects from battlefields to emergency care.

To achieve the dissociation and sedation required, doctors needed a direct and effective way to provide and regulate larger amounts of ketamine to the patients. This is where IV and IM injections of ketamine began.

At anesthetic levels, patients often come back from an experience with little to no recollection of what happened while they were sedated. During an invasive procedure this is the preferred outcome. However, when working with mental illnesses, some level of subjective or conscious experience may be preferable, particularly when ketamine’s psychedelic medicinal effects are desired.

IV/IM administration allows dosing of the medicine at amounts that can produce full dissociation and sedation. There is scientific evidence supporting the mental health benefits of dissociation, and more research is being conducted. These are typically the longest sessions, ranging anywhere from 1-3 hours, and are the most expensive, with individual sessions running around $800-1200+USD, with psychotherapy afterward as an available option.

Methods of Administering Ketamine

Ketamine infusions and injections aren’t the only method of delivery used in mental health treatments. Here’s a quick overview of the different methods one can expect when working with ketamine.

Sublingual Tablets or Troches 

Tablets or troches (pronounced “tro-keys”) are compounded tablets from a pharmacy that are absorbed into the brain/bloodstream sublingually, or held in the mouth. Dosing can vary from 10-200 milligrams (mg) per tablet on average, depending on the compounding pharmacy and the order from the clinician.

Tablets are the method utilized by Mindbloom clinicians, allowing for a greater flexibility in treatment based on the client’s response to the medication. Tablets also provide an identical delivery mechanism as IV/IM, but without the risk of infections or introducing harmful agents into the bloodstream — contributing to an increased safety profile.

A secondary benefit is there is a ceiling, an upper limit, to how much medicine an individual can absorb sublingually, making it nearly impossible to take larger doses than necessary.

IV Infusion or IM Injection 

Intravenous (IV) infusions or Intramuscular (IM) ketamine injections have similar effects. The difference is that IV is typically infused into a vein with a bag that drips the substance in while IM is injected directly into the arm with a needle (similar to a flu shot).

Nasal Spray 

Ketamine nasal sprays are a synthesized mist stored in a spray bottle that is applied according to the delivery timeline outlined by the clinician. This is the latest delivery method to gain FDA approval with the introduction of Spravato. 

The bioavailability and desired effect (sub dissociative, sub psychedelic, anesthetic) of each delivery method, which is the proportion of the compound that enters the body’s circulation, is what determines the typical dosing ranges. You can apply the highest doses (several thousand milligrams) with infusions, a mid-range with sublingual tablets (around 1000-1500mgs) and the lowest doses with nasal sprays (

Determining Which Method is Right for Your Ketamine Treatment

It’s important to distinguish the two ways in which ketamine treatments provide therapeutic value, as this will help you make a decision as to which one is right for you, and when.

The Biological Effects of Ketamine

There are the neurobiological effects and benefits when receiving ketamine. Through these effects, we would expect a general improvement in overall mood, an increase in brain-derived neurotrophic factor (BDNF),  and bolstering of neurons that have been worn down over time by the body’s physiological response to things like anxiety and depression.

The biological effects are dose-dependent, and happen regardless of an individual’s subjective experience with the medicine.

Learn more about the neuroscience of ketamine here.

The Subjective Effects of Ketamine

There are also subjective or phenomenological healing effects that ketamine can provide at medium/high doses. These effects include novel ways of thinking, disconnection from thoughts or emotions, dilation of time or space, out-of-body experiences, and more. These experiences vary between each individual and each treatment, but can be essential catalysts for deep transformation when treating mental health conditions such as depression or anxiety with ketamine.

The subjective effects have a ‘sweet spot.’ They need a certain dosage to surface, and can be overtaken by the dissociative or sedative effects at higher doses.

This ideal range for the subjective or phenomenological effects of ketamine is an important point to consider when looking at methods of treatment, and the results you want to achieve. An experienced clinician can help you make the right choice in this regard.

Ketamine’s Role as a Psychedelic Therapy Catalyst

As off-label treatments for ketamine are increasingly researched, ketamine’s subjective and psychedelic effects should be considered.

When looking at long-term, enduring benefits and personal transformation, ketamine’s psychedelic effects play an important role.

Individuals in treatments have the potential to experience more classically ‘psychedelic’ experiences: novel ways of thinking or feeling, immersion in new experiences, time or space dilation, out-of-body experiences, hallucinations, and visual imagery. 

Not to be discounted, these experiences and insights can provide the scaffolding for long-lasting changes, especially if properly integrated back into their lives. 

Which Ketamine Treatment Method is Right for Me?

By Cost

If you’re considering overall cost of treatment:

1. Infusions: Each infusion session can range from $400 to $1000-plus, often sold in 4-6 session packs.
2. Nasal Spray: Monthly nasal spray use can cost $4000-5000 based on recommended dosages. There are some insurance coverage options here to help manage costs.
3. Sublingual Tablets: Depending on the recommended dosage, these can run from $500-1500 per month. Mindbloom offers six medicinal sessions for $89/week billed monthly for three months.

Subjective or Psychedelic Benefits

If you want a compliment of biological benefits and subjective, experiential insights:

1. Infusions: Have the potential to provide a higher degree of dissociation as dissociation is dose dependent and higher doses can be provided via IV or IM.
2. Nasal Spray: Little to no dissociation.
3. Sublingual Tablets: Has the potential to produce mild to moderate levels of dissociation which is generally supportive of a deep meditative state or a trance-like state which can include some psychedelic properties.

When speaking with your clinician or provider, you can use this information to help determine the best method for your unique circumstances.

‍

Ketamine is currently prescribed and used to treat a number of unique medical and clinical situations: from general anesthesia for surgical procedures, to sublingual doses in the treatment of mental health conditions.

Of particular interest is ketamine’s use as an “off-label” medicine for the treatment of mental health conditions. Regarding its applications in medical and surgical procedures, it is so effective and well-supported by medical professionals that the World Health Organization designates it as an essential medicine.

Support for Ketamine’s Off-Label Efficacy

As it was originally approved as an anesthetic in medical procedures, the use of ketamine for therapeutic outcomes in the treatment of mental health conditions are classified as “off-label” use: using a medicine for something other than the original scenario it was approved for.

The existence of off-label uses for ketamine are the first indicator of its efficacy. A potential treatment must demonstrate reasonable and remarkable proof of its ability to treat other symptoms and conditions to be considered for off-label use.

Ketamine is used off-label to treat a variety of treatment-resistant mental health conditions, demonstrating particular efficacy in depression and anxiety treatments.

Ketamine’s Mental Health Use-Cases

Ketamine use in the treatment of mental health conditions is still an emerging area of research and study. More trials are underway to demonstrate the depth and breadth of ketamine’s applications and potential.

There are a few core areas of research underway:

• Ketamine as a treatment for major depressive disorder (MDD) / treatment-resistant depression
• Ketamine as a novel treatment for general anxiety and social anxiety disorders
• Using ketamine to manage bipolar disorder (BPD), obsessive-compulsive disorder (OCD), and substance use disorders (SUD)
• Ketamine as an early treatment for managing suicidal ideation

As more studies emerge, the results are promising: From the rapid onset of results, to long-lasting effects, ketamine as a novel treatment in the mental health space is showing to be highly effective.

Core Benefits of Ketamine Therapy for Mental Health

There are a number of features that make ketamine therapy remarkable and effective as a medicine for the mental health field.

Rapid onset and visibility of results and positive outcomes 

Unlike some traditional pharmacological interventions, which can take up to 6 weeks to begin showing positive outcomes, some clients working with ketamine therapy report seeing results within hours of their first treatment.

Long-tail endurance and durability of its outcomes 

The second core benefit is what is called the durability of the benefits — those that extend beyond just the dosing session or the immediate hours following administration.

Early research has highlighted enduring effects from a single treatment that remain noticeable weeks after the dosing session.

Addresses and heals underlying drivers of the conditions

Along with the immediate mood-regulating effects of a ketamine session, there may be longer-term neurochemical and biological benefits from ketamine.

Some of these benefits may include increasing the presence of brain-derived neurotrophic factor (BDNF) in the brain, which can help create new, healthy neural connections. 

The dissociative and psychedelic subjective experiences ketamine induces can provide new behavioral insights, clarity into life circumstances, and surface deep-embodied emotions or feelings. Integrating and addressing what comes up in ketamine therapy can lead to more resiliency, positive affect, and brighter futures for clients.

It fits into your life 

Convenience is an important factor that makes ketamine therapy a useful and appealing treatment option. 

The experience itself lasts around 90 minutes when using sublingual tablets, so it’s not a full-day commitment for those whose schedules don’t allow.

Because ketamine’s benefits and durability can be long-lasting, you aren’t required to take a pill every day to see benefits. 

Any side-effects are minimal and subside quickly

With programs like Mindbloom, you can receive psychedelic therapy from the comfort of your own home, monitored by a close friend or loved one, while under the guidance of experienced clinicians and highly-trained guides.

The “felt” or physiological effects last around one hour, and short term side effects such as altered sense of time, nausea, restlessness, and elevated blood pressure or heart rate typically subside shortly following the treatment experience.

With a relatively proven and promising efficacy profile for mental health treatment, coupled with the flexibility and adaptability of the treatment programs themselves, ketamine therapy can be a life-changing experience that doesn’t require you changing your life for it. It meets you where you’re at.

What Results Do Clients Commonly See?

The results summary from a 2019 study on individuals with major depressive disorder explains the potential for powerful results:

“There was a significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine. Significant improvement at 1st [hour] of the first dose was seen in depression and anxiety and not for illness severity. There were transient adverse effects observed in some patients which subsided within 1 [hour].”

In more direct terms, this indicates: 

• Significant improvements in depression and anxiety symptoms, and illness severity, lasting at least one month after the last dose.
• Significant improvement noticeable within the first hour of the first dose, which did not make the illness more severe.
• Some adverse effects subsided within the hour.

Ketamine can be a powerful medicine, and a breakthrough therapy for those with depression and anxiety.

Mindbloom clients who respond well to treatment report outcomes across the spectrum:

• Reduction in symptoms for anxiety and depression diagnoses.
• No longer displaying objective symptoms or meeting criteria for mental illness.
• Subjective reports of feeling completely changed or revitalized.

Here’s what one client had to say about their progress:

“I 100% recommend Mindbloom to anyone who has been stuck with anxiety, depression, or stress and wants to try something new. I’ve come to see old problems in new ways and feel like I have a better perspective on the world.” — Mattan G.

Is Ketamine an Effective Mental Health Treatment?

In short, yes! Ketamine is shown to be effective in treating those with depression and anxiety and the corresponding symptoms, and this is backed by research.

Mindbloom will continue developing and providing therapeutic experiences with ketamine. It’s shown to be fast-acting, long-lasting, safe, well-tolerated, and effective. Consult your mental health provider or take the assessment on our website to see if Mindbloom could be a fit for you.

Ketamine can be a powerful tool for mental health clinicians because of its remarkable safety profile across medical and therapeutic modalities. 

In fact, the World Health Organization (WHO) lists it as an essential medicine and advocates for its widespread availability globally. However, like any medication, patients should be well-informed about ketamine’s contraindications and potential side effects, along with alternative treatments available, to determine if ketamine therapy is right for them.

Is Ketamine a Safe Drug?

Ketamine is considered safe when used in a clinical setting under the supervision of medical professionals. We strongly advise against recreational use of ketamine since the strength and quality are uncertain and widely variable (it can be cut with a handful of substances). Further, long-term damage to the body is sometimes seen among recreational users who consume at higher doses or higher frequencies than would be advised in a clinical setting. 

Why Ketamine is Considered Safe

Ketamine was first approved by the Food and Drug Administration (FDA) for use as an anesthetic in the 1970’s. It has been widely used by anesthesiologists during surgeries with young children to aging seniors since. It is used in many socio-economic environments, and continues to be used because it is generally safe, well-tolerated, and effective in what it does.

A factor indicating the safety profile of ketamine as a medicine is that it is used in a variety of medical settings to treat a broad (and growing) number of symptoms and conditions.

Some of these applications include:

• Anesthesia for surgery
• Analgesia for a wide variety of painful conditions, traumas, or procedures
• Combating major depression and anxiety symptoms

Ketamine’s use in a variety of medical and therapeutic indications, with relatively positive safety outcomes, supports its safety profile in many age groups

An important note: Anesthetic dose ranges —those used in surgical procedures— are much higher than those that are used for treating mental health conditions, such as treating depression, anxiety, OCD, and other conditions. When thinking about the safety profile of ketamine at an anesthetic dose, which can be 4-8x and higher a dose used in mental health, it helps us understand how safe ketamine can be in a treatment model like Mindbloom’s.

Is Ketamine Safe for Depression and Anxiety?

With the emergence of science that has validated other therapeutic indications for ketamine treatments (depression, anxiety, OCD, PTSD) more and more clinicians have begun to follow the science and treat conditions with ketamine, off-label. 

This, along with a paradigm shift in emerging mental health treatments, has helped drive ketamine from the hospital into outpatient clinics. Outpatient clinic models vary greatly and you can receive treatment from anesthesiologists, licensed clinicians, and in some settings a psychotherapist paired up with a prescriber.

Results of emerging science continue to be promising. We continue to learn about how ketamine works in the body to treat mental health conditions, and its safety profile in this context. This learning has lead to continued evolution of treatment models that aim to increase access to care (such as in-home treatments) and enhance its therapeutic potential (such as coupling up with therapy).

A true testament to the safety of ketamine is that with professional guidance, it can be taken by clients in their homes. This ensures it’s dosed properly and with proper education around developing a safe environment and mindset. Throughout these sessions, there are few, if any, adverse events that arise —demonstrating the tolerability of ketamine as a therapeutic medicine as well.

Ketamine’s Risk Profile & Contraindications

No medicine available is without risks and contraindications —symptoms or conditions that an individual may be experiencing that indicate treatment may not be suitable. This is why ketamine is a regulated medicine, used in structured procedures and administered by medical professionals. 

Ketamine does not require the use of supplementary tools or procedures such as external oxygen sources, electricity supplies, or large clinical teams — further simplifies the procedures, and this reduction in complexity serves to reduce the potential for adverse effects or events.

Some of the contraindications include:

• Uncontrolled high/low blood pressure, heart problems, glaucoma or intracranial pressure.
• Active and unstable substance use disorder
• Psychotic disorders
• Active mania

There is also potential for adverse events through the dissociative effects of ketamine, such as grogginess, drowsiness, or disorientation leading to an accident or confusion during/after use.

This is why using ketamine as prescribed, in a medical or therapeutic context with trained practitioners, is important. If done in this manner, as has been proven over the past decades, ketamine is a safe and effective medical and psychedelic therapy treatment.

One of the advantages of ketamine as a clinical and therapeutic treatment is that it can lead to desired treatment outcomes within shorter timescales — for some within 24 hours, others after weeks of therapeutic work— while maintaining the efficacy and beneficial effects of longer-acting therapeutic and psychedelic experiences.

There are two ways to address the question “how long does ketamine last?”: How long do the “felt effects” —immediate physiological effects— of the medicine persist in the short-term, and how long do its lasting antidepressant and antianxiety effects persist.

How Long Do the Short-Term, Physical Effects of Ketamine Last?

How long ketamine’s immediate physical effects last depends on multiple factors, with the key factor being method of administration. There are a number of ways ketamine can be received, and each one has its own timing for onset of effects, duration of experience, and noticeable effects after the experience.

The duration of the felt effects or “felt experience” depends primarily on the methods of administration.

Methods of Ketamine Administration

Ketamine is administered, or taken, in the following ways: intravenous (IV) infusion, intramuscular (IM) infusion, sublingual tablets, or intranasal spray. 

Treatment sessions using each of these methods are typically set for one hour, with immediate effects subsiding around one to three hours.

Intravenous (IV) infusion 

IV infusion takes the medicine directly into the bloodstream. It has a very rapid onset, and how long the felt experience lasts is dependent on the half-life of ketamine — the time it takes to be processed in the body and leave its system fully— and other psychological factors. Infusion sessions typically last one hour, but can be extended up to five hours based on clinician’s recommendation.

Intramuscular (IM) infusion 

Intramuscular infusions are administered through a syringe, which is injected into a muscle (usually the shoulder or thigh). This method’s onset typically takes 2-4 minutes, and its full duration ranges from 1-3 hours.

Sublingual Tablets or Troches

Tablets or troches (pronounced “tro-keys”) are another way of receiving the medicine. Mindbloom uses rapid dissolving tablets (RDTs), which are held in the mouth for direct oral absorption and removed after a point of maximum absorption. 

By not swallowing the medicine, the gastrointestinal tract is bypassed avoiding metabolization in the liver, which extends the duration of the experience. If not swallowed, the average onset is around 5-10 minutes, with the dissociative effects lasting for around 30-60 minutes, and a return to physical baseline around 1-3 hours after treatment. If swallowed, half-life is increased and the effects last longer, around 4-5 hours.

Intranasal (IN) Spray 

Intranasal spray options, administered through the nose, are also emerging. There are two types of ketamine-based nasal spray: S-ketamine (esketamine) and R-ketamine (arketamine), also known as “racemic” or “generic” ketamine.

This method’s onset typically takes five to ten minutes, and its full duration ranges from one to three hours.

How Long Does Ketamine Stay in Your System?

As with any compound, it’s easiest to consider this in terms of the half-life of ketamine. A half-life is how long it takes for 50% of the compound to be excreted from the body.

Ketamine metabolizes quickly in the body, with a half-life of around 2.5 hours. This means that after 2.5 hours, 50% of the ketamine has been excreted from the bloodstream. For comparison, coffee has a half-life of five hours. Ketamine’s metabolites can remain in the body for almost two weeks.

Given this, after about 10-12 hours since the initial dosing, a majority of the ketamine is out of your system. This is independent of the subjective experience, which subsides after about an hour.

Overall, this is one of the advantages to work with ketamine: it’s very well tolerated across a large population, it has a fast onset and manageable total duration, and is metabolized and processed through the body quickly as well.

How Long do the Antidepressant Effects of Ketamine Last?

One of the most remarkable aspects of ketamine therapy are the benefits that an individual can experience during, after, and between each dosing session. This is called the “durability” of the experience.

After a single session, it would be reasonable to expect a general improvement in mood/outlook, and increased mental flexibility and openness lasting for about seven days. This can vary from person to person. Some effects are noticeable immediately after the session.

A 2019 study on individuals with major depressive disorder demonstrates the potential for longer-term positive effects:

“There was a significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine. Significant improvement at 1st [hour] of the first dose was seen in depression and anxiety and not for illness severity. There were transient adverse effects observed in some patients which subsided within 1 [hour].”

Given the 1-2 week window of increased openness, flexibility, and general mood brought on by a single session, another opportunity presents itself when “stacking” or adding on multiple sessions through the course of treatment.

Integration’s role in ketamine therapy’s effectiveness

It’s worth noting that ketamine as a compound alone isn’t a “magic pill.” Its short and long-term effects are meant to open an individual up to action and behavioral changes that will help them reach their full potential. Ketamine therapy as a holistic experience promotes setting and working on intentions or goals that promote personal growth. These insights gained are taken with us but the physiological effect may not last.

Mindbloom’s program includes four sessions, spaced 1-2 weeks apart. This treatment methodology is referred to as “stacking.” By continually renewing this general baseline improvement, paired with effective integration work in-between, clients report improvement and maintenance of their baseline moods for many months after completing their last session.

Overall, we can see there are acute effects from a single session that can last for weeks. If sessions are combined into a comprehensive and holistic program, the enduring effects can last for months, or provide enduring and robust baseline improvements.

How Long Do Ketamine Treatments Last?

In general, the subjective experience tends to follow a standard direct dosing arc: An initial period for the effects to come on, a period of full experience with an associated ‘peak’, and a gradual decline back towards normal waking consciousness — though with some lingering physical effects that subside 1-2 hours after the session.

Each individual will have a unique experience, and each session may slightly vary from these exact markers, though the general trend tends to remain the same. Here is a common overview of the experience:

• 0 to 15 minutes: dosing and initial effects begin to arise.
• 15 to 45 minutes: full effect onset, peak of subjective experience.
• 45 minutes to 1 hour: gradual decline back to waking consciousness.
• 1 hour +: residual effects (grogginess, mild dizziness, etc.) begin to subside.

Most treatments are designed to last roughly one hour, with a recovery window of up to three hours.

Clients should plan to have a restful day after a ketamine session, regardless of the delivery method used. It’s helpful to stay with the medicine and the experience rather than jumping back into work or stressful exercise.

If you’d like to learn more about the psychedelic therapy experience, read about how the Mindbloom journey works.