What Is Ketamine Therapy? Everything You Need to Know

If you asked someone about ketamine a decade ago, they’d likely give you one of two answers—that it’s a party drug famous for its hallucinogenic effects or an anesthetic used in surgical procedures. Ask that same person today and they might bring up ketamine therapy instead—and how it can treat a range of mental health conditions like depression, anxiety, and PTSD.

Don’t get me wrong: Ketamine therapy isn’t exactly new (scientists have been investigating its mental health effects since the ’9srcs). But there’s no denying that it’s seen a surge of interest in recent years. Ketamine clinics—or treatment centers that offer infusions of the drug—have popped up all over the country, not to mention on our screens and in our social circles. Maybe you googled it after Jen Affleck swore it saved her marriage on The Secret Lives of Mormon Wives or when a friend gave you a play-by-play of their trippy-sounding but life-changing session.

So what’s the deal with ketamine therapy—what is it, how does it work, and does it live up to all the hype? The short answer: It’s complicated. We spoke with two psychiatrists below to get the low-down on the treatment. Here’s what they want you to keep in mind.

First, what do people mean by “ketamine therapy,” anyway?

I called up Gerard Sanacora, PhD, MD, a professor of psychiatry at Yale Medicine who’s been researching ketamine for years, and posed this very question. His response: “It really depends on who you ask.”

To understand why that is, a bit of history: Ketamine was approved by the FDA as a surgical anesthetic back in the ’7srcs. Soon after, doctors noticed it had a calming effect, which eventually inspired researchers to investigate whether a lower dose could help with depression. (Spoiler alert: It did!) And because the FDA only regulates the sale, distribution, and advertising of drugs—not how doctors and patients use them—its stamp of approval opened the door for ketamine to be prescribed for off-label use today…say, as treatment for all sorts of mental health concerns, Dr. Sanacora explains.

Why does that matter? Well, all this off-label stuff means that there aren’t as many rules and frameworks for how ketamine is prescribed and administered as you might think. So these days, you have the option to seek anything from an infusion from a reputable healthcare system for severe depression to eating disorder treatment from a specialized boutique advertised to you on Instagram. You might also see a counselor for ketamine-assisted psychotherapy and work through your trauma while you trip. Or get a prescription over telehealth and take it from the comfort of your own home to ease up creative block. As Dr. Sanacora told me, it’s a bit of a free-for-all out there.

The point is, not only could “ketamine therapy” refer to a few different treatments currently available, but your experience may also vary a lot depending on your provider. So keep that in mind as we dive into these next couple of questions.

What happens during ketamine therapy?

Medically speaking, ketamine therapy is administered several ways. The first route is via an injection—a.k.a. IV ketamine. (When access to that is limited, clinicians may opt for intramuscular, or IM, ketamine, typically an injection in your arm.) An IV infusion session usually lasts about 4src minutes and reputable facilities should monitor you for at least an hour afterwards, says Dr. Sanacora—but is that actually happening? It’s hard to say, he says, given that lack of oversight and guidelines.

There’s also a nasal spray called esketamine. While the drug isn’t pure ketamine, but rather a component of it, it’s similar enough that it often gets lumped under the ketamine therapy umbrella. However, unlike the off-label ketamine treatments we’ve discussed, esketamine was actually approved by the FDA in 2src19 to treat depression and comes with its own set of strict guidelines, Dr. Sanacora explains. To get it, your healthcare provider must first conduct a stringent evaluation to make sure the benefits outweigh the risks for you; then, you self-administer the spray and your provider monitors you in-office for two hours.

Less common—and more frowned upon in the medical community—is oral ketamine, Christina Ni, MD, a psychiatrist with Mindpath Health, tells SELF. It can be prescribed in the form of lozenges or tablets by any doctor (and in some cases even a nurse practitioner or physician’s assistant), but Dr. Ni notes that we don’t know as much about its effectiveness as we do intranasal and IV ketamine. Not to mention, it’s compounded (which the FDA has issued warnings against), so the quality may be questionable. Lozenges are also less likely to be taken under the supervision of a doctor, meaning you might be on your own in the case of any adverse reactions and medical emergencies, Dr. Ni points out. (More on that in a bit.)

As for what happens after ketamine is administered: Like with many drugs, other effects vary from person to person—and they’re often hard to describe. Typically, you’ll enter a dissociative, hallucinogenic state after about 2src minutes after its administered. You might feel like you’re detached from your surroundings or observing yourself from outside of your body, explains Dr. Ni. Some people feel nothing at all—or on the other end of the spectrum, feel horrible and panic. “Most people just say, ‘Well, that was weird,’” Dr. Sanacora says.

After the high passes, the effects often linger. A lot of people start to feel less depressed within a couple hours. Others notice mood improvements within a couple days; many within two weeks. Some even perceive changes in how they view themselves or the world. Unlike, say, an SSRI—which increases mood-regulating serotonin—ketamine targets another neurotransmitter, glutamate, which is more concerned with helping the brain change and adapt. Over time and with repeated treatments, these newly active neurons help the brain rewire itself, says Dr. Ni. This, in turn, disrupts and restructures negative thought patterns and perceptions that may have become automatic—for example, the intrusive thought that no one likes you or that you’re not good enough.

So how effective is ketamine therapy, really?

That depends on what you’re using it for—and, as mentioned above, providers have the leeway to prescribe it outside its evidence base. The research, by and large, shows that ketamine (both the IV and nasal spray) can be incredibly effective for treatment-resistant depression (which is defined as depression that didn’t improve with at least two types of standard antidepressants) along with people with major depressive disorder who have severe suicidal ideation (as in, they have both intent and a plan in place). “I have no doubt that this has really changed peoples lives for the better,” Dr. Sanacora says.

But beyond depression? “We know very little,” he says. Some studies suggest ketamine therapy (the IV form) may also be useful for bipolar disorder, PTSD, OCD, and even Parkinson’s disease—but the research has been mixed. “It’s still quite experimental when used for these other conditions,” says Dr. Sanacora.

That’s not to say the infusions, sprays, and tablets can’t be effective for other mental health conditions or even concerns like marital troubles—we just don’t have enough data to fully understand if and how it works or what the effects might be, according to Dr. Sanacora. (His best guess is that the evidence will ultimately show the drug does benefit some of these conditions like PTSD.) But Dr. Ni’s current take? “More research is needed before we start using it for all those things.”

That said, if there’s one consistency Dr. Sanacora’s noticed, it’s that people’s expectations play a big role in how well the treatment works. If you expect to feel better, there’s a better chance you will, he says.

Is ketamine therapy right for you?

You’re probably used to us reminding you that you should always talk to a doctor you trust whenever considering new treatment, but when it comes to ketamine therapy, this piece of advice should not be overlooked. In the right person, the drug can, as Dr. Sanacora says, be life-saving. But it can also be dangerous when given to the wrong person. “There are some pretty significant risks,” says Dr. Ni—which is why the medical community largely agrees it should be set aside for severe cases of depression, not mild to moderate ones.

What are said risks? First, ketamine can raise your blood pressure and heart rate so if you have a history of stroke, heart attack, or cardiovascular issues, you should avoid it. That said, blood pressure can even skyrocket in people without these risk factors, says Dr. Ni, creating a medical emergency (this is why she believes at-home lozenges and preloaded, self-administered syringes are just too risky).

Ketamine can also impair cognition, perceptions, and decision-making, and in some, trigger psychosis (so it’s often a no-go in those with a history of schizophrenia or related conditions). And because the drug may impact the health of the fetus, pregnant people should hold off. There’s also the potential for addiction, adds Dr. Ni (which is considered moderate to low as a Schedule III substance). Plus, some evidence—much of which, it’s worth noting, was gathered on recreational use, not medical—suggests long-term ketamine use may impair brain function, injure the liver, and damage the bladder.

Lastly, consider the commitment. While some people may only need one infusion every couple of months or even years to reap the benefits they’re after, others have to keep up with weekly sessions before tapering down to biweekly or monthly treatments. Dr. Ni suggests asking yourself if you’re willing and able to carve out the time (and money) to regularly visit a doctor to sustain the benefits.

How to be smart—and safe!—if you’re interested in ketamine

As SELF previously reported, a good place to start is the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3) directory, as members of this organization pledge to uphold standards of practice and ethical principles when providing health care services.

Whether you’re eyeing an IV ketamine clinic, want to ask a doctor about esketamine, or perusing a telehealth company, there also are a few red flags to look out for. First, ketamine therapy should never be given as a standalone treatment, says Dr. Sanacora, so avoid places that give you ketamine and send you on your way without follow-up. Same goes for brief consultations and quick scripts. Even if you discover your needs are short-term, you want it to be part of a comprehensive treatment plan with oversight from a trained medical professional.

You also want to make sure the facility takes serious safety precautions, says Dr. Sanacora. Find a team that closely monitors how you respond to the drug and ensure they have a procedure in place in case you have an adverse reaction. It also doesn’t hurt to look out for providers who have undergone specialized training, such as through the International Society for the Study of Trauma and Dissociation (the gold standard, Dr. Ni tells me), so they’re prepared in the rare event ketamine triggers severe dissociation or psychosis.

None of this is to deter you! It’s just to help you make an informed decision. Ketamine therapy—like anything in the field of medicine—has its pros and cons that need to be heavily considered before diving in. But depending on your needs, it could be a legit option for finally feeling the relief you need.