Ketamine therapy: What it’s used for, how it works, and side effects
Reviewed by Susan Radzilowski, MSW, LMSW, ACSW
Written by
therapist.com teamLast updated: 01/29/2025

What is ketamine therapy?
The term “ketamine therapy” is generally used to describe two different forms of treatment: ketamine infusion therapy and ketamine-assisted psychotherapy.
Ketamine infusion therapy involves administering a fast-acting medication called ketamine through an intravenous line (IV) for the treatment of psychiatric disorders.1 Ketamine-assisted psychotherapy (KAP), on the other hand, is a therapeutic approach that combines the administration of ketamine with psychotherapy.2 In KAP, ketamine is usually administered through alternative routes, such as a nasal spray, rather than intravenously.
Originally used as an anesthetic for surgery and emergency trauma situations, ketamine is now sometimes used as a treatment for depression and other conditions that haven’t responded to other treatments.3,4 Some researchers believe that ketamine can help people with various mental health conditions when its psychedelic properties are combined with psychotherapy.5
Is ketamine therapy legal?
Ketamine is a Schedule III controlled substance in the United States that’s legal for medical use under the supervision of a licensed healthcare provider.6 While it’s only FDA-approved as an anesthetic, clinicians can legally prescribe it “off-label” for a variety of health conditions.7 “Off-label” simply means using an approved drug for an unapproved purpose.8
What is ketamine therapy used for?
Ketamine-assisted psychotherapy (KAP) has been trialed as a treatment for multiple conditions, including:9
- Chronic neuropathic pain
- Opioid tapering (gradually reducing the dose of opioid medications over time)
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Attention-deficit/hyperactivity disorder (ADHD)
- Substance use disorders (SUD)
KAP is an emerging therapy, and further research is needed to determine exactly how effective it is in treating various conditions. It’s important to remember that it is generally considered only after traditional treatments have failed, rather than as a first-line therapy.
If you’re experiencing mental health challenges, consider reaching out to a qualified healthcare provider or licensed mental health therapist. They can evaluate your specific circumstances and medical history and determine what form of treatment might be appropriate for your needs.
How does ketamine therapy work?
In ketamine-assisted psychotherapy, ketamine is administered in subanesthetic doses.10 Although administering ketamine through an IV is most common when it’s used for anesthesia, in KAP it may be injected into the muscle tissue, taken orally via under-the-tongue tablets, or sprayed into the nasal cavity.11
During treatment, clinicians may adjust ketamine dosages to achieve various states of consciousness.12 Dosages and frequency of administration may vary, and psychotherapy may be provided before, during, or after ketamine administration.
Types of psychotherapy that have been used in conjunction with ketamine include:13
- Cognitive behavioral therapy (CBT)
- Mindfulness-based interventions (MBI)
- Motivational enhancement therapy (MET)
- Exposure therapy
- Existential therapy
- Functional analytic psychotherapy (FAP)
The number of psychotherapy sessions may be as few as one or extend to multiple sessions over several weeks or months. Ketamine’s role in enhancing psychotherapy is still being explored. It’s likely that it works through multiple mechanisms, which include:14
- Increasing brain plasticity
- Triggering emotional experiences
- Reducing psychological defenses
- Improving patient engagement
Although the effects of ketamine tend to be felt quickly, scientists still don’t know exactly when or how ketamine boosts the brain’s ability to form new connections or all the biological factors involved.15 More research is needed to understand the timing and mechanisms, and to determine the best way to integrate psychotherapy sessions into the treatment.
Does ketamine therapy get you high?
Ketamine can produce psychedelic effects, including feelings of dissociation, altered perception, and euphoria.16 In KAP, these altered states are considered therapeutically beneficial. The dissociative experience may help patients gain new perspectives on their problems and process difficult emotions, particularly when guided by a licensed clinician.
What does ketamine therapy feel like?
During KAP sessions, patients often report feeling disconnected from their environment and feeling a different awareness of their own body and reality.17 Many describe a dreamlike or “spaced out” state. Some people have reported feeling strange, spacey, woozy, floating, and loopy. It often leads to dissociation and altered understandings of reality.
Ketamine is a controlled substance that must be prescribed by a healthcare provider. It has potential side effects and related risk factors and should only be taken under supervision.
Additionally, patients are unable to drive themselves home after KAP sessions due to the effects of the treatment. This requirement for transportation may pose another barrier to accessing care.
Does ketamine therapy work?
Ketamine-assisted psychotherapy combines two proven treatments for psychological disorders—medication and talk therapy—potentially offering better results than either alone.18
While ketamine alone can provide temporary relief from mental health conditions and pain, integrating it with psychotherapy may extend these benefits. Like psychedelics such as MDMA and psilocybin, ketamine could enhance therapy by increasing awareness and providing profound insights that lead to lasting psychological changes.
One small study looked at using KAP in a group setting to treat 10 frontline healthcare workers who were experiencing symptoms of burnout, PTSD, depression, and anxiety during the COVID-19 pandemic.19 Treatment involved six weekly sessions at a private clinic. The results showed significant improvements in participants’ average scores for PTSD (59% reduction), depression (58% reduction), and anxiety (36% reduction) following treatment.
While more research into KAP is needed and ongoing, early results like these look promising.
Ketamine therapy side effects
According to a safety and tolerability study involving more than one hundred KAP patients, both under-the-tongue and intramuscular injection forms of ketamine were generally well-tolerated.20 No significant adverse events were reported, but side effects included:
- Dissociative effects: Ketamine can induce dissociative or psychedelic experiences, which are sometimes labeled as side effects. These experiences can be unsettling if not properly integrated, but are also considered part of the therapeutic process.
- Elevated blood pressure: A significant portion of sessions (49.16%) reported elevated blood pressure post-session, though this was generally transient and manageable.
- Nausea and vomiting: Nausea occurred in 12.05% of sessions, and vomiting in 2.52% of sessions.
- Headache and dizziness: Headaches were reported in 3.35% of sessions, and dizziness was noted in a few instances.
Other side effects include blurred vision, slurred speech, and mental confusion.21 Most side effects should resolve shortly after treatment. It’s advised that you refrain from driving, operating machinery, caring for others, or making critical decisions until at least the day after your session. Consider seeking help from a trusted friend or family member to monitor and spend time with you following treatment.
Who is not a good candidate for ketamine therapy?
People with certain preexisting conditions may not be good candidates for ketamine therapy. Ketamine may negatively affect some patients with cardiovascular disease, liver disease, ocular hypertension, or a number of other conditions.22
Ketamine also interacts poorly with certain medications. Some studies have been done on the pharmacodynamic interactions between ketamine and other drugs, but more research is needed.23 If you pursue any form of ketamine therapy, your health care provider should take a thorough history and ask about any medications you’ve been prescribed.
Because ketamine is associated with dissociative side effects, people with a history of dissociative disorders or psychosis may not be well-suited for KAP.24 The dissociative effects may make their symptoms worse. As it stands now, electroconvulsive therapy (ECT) may be a better option for patients with depression that has psychotic features.25
Before starting ketamine therapy, candidates should undergo thorough medical and psychological screening by licensed clinicians and health care providers to ensure they’re suitable candidates. This typically includes reviewing medical history, current medications, and previous forms of treatment. Providers may also assess your support system and ability to integrate the therapeutic experiences.
Seeking ketamine therapy treatment
Ketamine should only be administered in controlled medical settings under professional supervision. Concerning trends have emerged, including unsupervised home use through compounded prescriptions and unregulated cash-only clinics.26 These practices pose significant safety risks and don’t follow proper medical protocols. Without a licensed provider carefully managing your use, risks could include fatal overdose, injury from lost pain sensation, and amnesia, just to name a few.27
Ketamine therapy should only be done under the supervision of a licensed provider. To ensure safe and effective treatment, you should:
- Research clinics thoroughly
- Work only with licensed medical and mental health providers
- Choose facilities with medical oversight and emergency protocols
- Confirm the clinic follows proper screening procedures
- Ask about integration support and follow-up care
- Consider the full treatment protocol, including preparation and integration sessions
- Discuss treatment goals and expectations with qualified healthcare providers
Is ketamine therapy covered by insurance?
KAP may be partially covered by insurance, but you should check with your insurance company for specific coverage details.28 Some insurance plans may cover the therapy sessions, but not the ketamine medication itself.
If you’re interested in KAP, consult licensed healthcare providers who follow established medical protocols. Visit our directory to find licensed mental health professionals in your area that can help evaluate your eligibility and create an appropriate treatment plan.
Sources
1 https://psychiatry.uams.edu/clinical-care/interventional-psychiatry/ketamine-infusions/
2 https://pubmed.ncbi.nlm.nih.gov/30917760/
3 https://publichealth.jhu.edu/2024/what-to-know-about-ketamine/
4 https://pubmed.ncbi.nlm.nih.gov/31612847/
5 https://pubmed.ncbi.nlm.nih.gov/30917760/
6 https://www.rosalindfranklin.edu/research/centers/research-support-offices/environmental-health-and-safety/controlled-substances/
7 https://publichealth.jhu.edu/2024/what-to-know-about-ketamine/
8 https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label/
9 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
10 https://pubmed.ncbi.nlm.nih.gov/38362026/
11 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
12 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
13 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
14 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
15 https://pmc.ncbi.nlm.nih.gov/articles/PMC8190578/
16 https://pmc.ncbi.nlm.nih.gov/articles/PMC4961540/
17 https://pmc.ncbi.nlm.nih.gov/articles/PMC7755908/
18 https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
19 https://www.tandfonline.com/doi/full/10.1080/02791072.2023.2186285/
20 https://pubmed.ncbi.nlm.nih.gov/37256163/
21 https://healthcare.utah.edu/hmhi/treatments/ketamine-assisted-psychotherapy/
22 https://www.ncbi.nlm.nih.gov/books/NBK539824/
23 https://pubmed.ncbi.nlm.nih.gov/34170315/
24 https://pubmed.ncbi.nlm.nih.gov/37224232/
25 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/prediction-of-electroconvulsive-therapy-response-and-remission-in-major-depression-metaanalysis/259FD7600E652E9D272481FC6D87F4F9/
26 https://publichealth.jhu.edu/2024/what-to-know-about-ketamine/
27 https://americanaddictioncenters.org/ketamine-abuse/overdose-dangers/
28 https://healthcare.utah.edu/hmhi/treatments/ketamine-assisted-psychotherapy/
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.