What Are The Biggest Misconceptions About Ketamine Therapy?

What Are The Biggest Misconceptions About Ketamine Therapy?

Despite ketamine therapy being a safe and legal treatment for PTSD, anxiety, and depression, there are still many misconceptions about ketamine due to its recreational use. Even as ketamine treatment is gaining traction around the world, finding a doctor or medical professional willing to discuss the treatment is not always an easy task.

So what are some of the most common misconceptions about ketamine, and what is the reality?

Ketamine has been used in professional medicine since 1966 for a variety of anesthetic purposes. Even though it’s been used in practice for over 50 years, we still lack a full understanding of how the drug effects our bodies.

More recent studies have unlocked insight into how ketamine affects the brain, highlighting its effectiveness as a treatment for a range of mental health issues.

Misconceptions About Ketamine

One of the first things people often think about when they hear ketamine is a “k-hole,” which is an extreme dissociative state common with recreational use of the drug. However, in a professional setting, the dosage of ketamine administered for therapeutic purposes is controlled and much lower than the amount used recreationally. This, paired with medical supervision and guidance, dramatically reduces the risk of a “k-hole.”

It may seem surprising, then, that this dissociative effect of ketamine is exactly what makes it so beneficial as a therapeutic tool. Paired with conventional therapy, the dissociative state helps many patients lower mental barriers, allowing them to freely address underlying issues or see problems in a new light.

To further understand the misconceptions of ketamine, physicians from ketamine clinics provide their opinions and experience — helping quash some perceptions about the drug.

Dr. Dan Zimmerman – Acheron Psychiatry

A big misconception about ketamine therapy, or KAP, is that, compared with other therapies, the healing is passive and automatic, i.e., that healing comes from what the ketamine does to you. That is not accurate.

Healing in KAP derives from how you engage with the ketamine and the precious window of mind-opening it enables. Like any type of “real” therapy, KAP involves respect, patience, openness, and attentiveness; effortful work; and a somewhat difficult hermeneutics of doubt, especially given the unconscious resistances that hold onto their (deeply irrational, archaic) fear of any kind of deep change.

Even though the psychedelics effect is not infrequently bedazzling, a neat and novel experience — even a peak experience — it only can have true clinical value in the context of a proper mindset. That mindset is a mind humbly endeavoring to know itself with the assistance of the therapy, and in the case of KAP, therapy enhanced by medicine.

All of that being said, it is impressive what ketamine can do by lowering defensiveness, and enhancing openness and the objectivity of the observing ego. It may be said to meet the curious self-inquirer halfway, if not three quarters of the way.

Patients who are “good at” conventional therapy — curious, insightful and appropriately humble about their ability to know themselves in the absence of clinical dialectics — often become phenomenal patients in KAP.

However, if you lack much in the way of reflective capacity, curiosity, and insightfulness — ie, are unequipped to do the work of therapy — you unfortunately are unlikely to substantially benefit from KAP in the long run, even when a strong placebo effect is initially observed, or even when depression or anxiety symptoms are transiently relieved.

— Dr. Dan Zimmerman, Co-Founder and Psychiatrist at Acheron Psychiatry

Dr. Christopher Romig – ARK Integrative Medicine

A common misconception people have about ketamine therapy is that it is addictive.

Ketamine has been used as an anesthetic for decades, and there is no evidence that it is addictive when used under medical supervision. The dosage that is administered in the infusions is considered minimal and does not produce the effects that a higher dosage would.

Minimizing the addictive potential of ketamine can be done by controlling the delivery of all ketamine medications, as well as by carefully monitoring for individual tolerance to the medication.

Therefore, it is essential to use ketamine only as prescribed by a qualified healthcare professional in a medical setting to minimize the potential for abuse or addiction.

Healthcare professionals should carefully monitor patients during and after treatment to ensure their safety and well-being.

— Dr. Christopher Romig, Owner, Founder, and Medical Director of Ark Integrative Medicine

Dr. Mike Cooper – Innerwell At-Home Ketamine Therapy

Ketamine’s categorization as a “dissociative anesthetic” or “dissociative psychedelic” is well known. Unfortunately, dissociation tends to have a negative connotation, especially for patients with significant trauma histories. The dissociation experienced during a ketamine journey is actually quite different from the dissociation experienced as a symptom of PTSD, however.

Most patients report the dissociation effect of ketamine to be quite pleasant and even euphoric. It creates a space for patients to view themselves, their lives, and their places in the world in a new light. They learn that it’s possible to be less attached and encumbered by the mental and physical anguish that is omnipresent in their daily lives. It’s an opportunity to redefine their relationship to their bodies and their environments.

Ketamine’s dissociative properties make it uniquely therapeutic, as the psychological healing experienced during a journey mirrors what is happening on a biological level with neural circuits involved in learning, mood, and pain.

— Dr. Mike Cooper, Medical Director of Innerwell At-Home Ketamine Therapy

Dr. Mark Leeds – The Mood Center

There is a misconception that ketamine-assisted psychotherapy is not essential for the best short-term and long-term results. Some ketamine clinics tell patients to go get talk therapy on their own, but this often leads to them either not getting therapy or going to a therapist who is unfamiliar with ketamine integration therapy. Onsite psychotherapy is essential for getting the most out of ketamine infusion treatment.

— Dr. Mark Leeds, Consulting Physician at The Mood Center

Dr. James Simonson – Integrative Psychiatry of Oklahoma

I think there are several misconceptions regarding Ketamine therapy for mental health that are pervasive. One of the most common things I encounter in our clinic is the idea that ‘ketamine will fix me and I won’t have to do any thing else but show up.” Ketamine is a very powerful tool in the modern treatment of mental health; however for long lasting effects, we feel that directed psychotherapy should be used in combination. Patients can have a range of experiences from a comforting, dissociative state to a full ego dissolving transcendent psychedelic experience.

During any of the experiences, patients can gain insights and perspective on themselves which benefit from discussing and exploring with a professional trained specifically to help them navigate these insights. Recent studies have highlighted the importance of the combination of ketamine and psychotherapy versus either tool used alone.

Oftentimes a “bad trip” is nothing more than a challenging experience that confronts the patient with the reality that the persona they have lived for years is merely a result of their brain developing defense mechanisms as a result of overwhelming emotional pain caused by a past trauma. These can be overwhelming and scary if the patient has to navigate them alone.

In our clinic, we never leave patients alone during their Ketamine experiences and provide aftercare that is needed to help process these experiences.

— Dr. James Simonson, Owner and Founder of Integrative Psychiatry of Oklahoma

Dr. Susan M. Gillispie – Wholistic Health

We have all heard that Ketamine is a horse tranquilizer, and you are correct. Like many medications we use in human medicine, it is also used in Veterinary medicine. If you have pets, you have given them antibiotics such as amoxicillin, tetracycline, etc. These are also used in human medicine.

Other people ask about the illicit use of Ketamine. Unfortunately, it is used recreationally and in much greater amounts than therapeutically. Many drugs that are prescribed to patients have found their way to the streets, such as Xanax, Percocet, morphine, fentanyl, as well as many others. Ketamine is no different.

I also get questions about “K-Hole” and ketamine. This is when someone takes a high dose of ketamine to achieve a detachment from reality which can lead to hallucinations.

Ketamine used in a clinical setting is a low dose to achieve disassociation but not at the level that promotes hallucinations, and is for a short time of 20-30 minutes in a well-controlled setting to ensure patient safety.

— Dr. Susan M. Gillispie, EdD, MSN, BSN, RN, APRN, Founder of Wholistic Health

Dr. Steven Radowitz – Nushama

One of the biggest misconceptions about ketamine therapy is the ‘ketamine cure’—it is not a panacea. Psychedelic therapy is a tool to open the door and show what is possible, but it’s up to the person to do the integration work for lasting change.

While 70-80 percent of our members find significant improvement, we believe 10 percent of progress is related to the molecule, 10 percent of it is diagnosis, and 80 percent of the work happens with preparation and integration.

Every Nushama session is accompanied by integrators, supporting members to set preparation intentions, and glean key insights from their journeys to integrate. Sustaining the mental health benefits involves integrating key takeaways into their daily lives.

To support this process, we offer year-round programs like breathwork and sound. We encourage a daily practice like meditation, journaling, and gratitude, and other lifestyle changes that make a person overcome the ‘dis-ease’ in their life and bring it into alignment.

— Dr. Steven Radowitz, Chief Medical Officer and Co-Founder at Nushama

Dr. Marcel Green – Hudson Mind

A common misconception about ketamine is that its benefits are purely experiential. When, in fact, ketamine activates significant physiological changes in the brain. We know that major stress and depression can change the composition of a brain, weakening synaptic connections that make it more difficult for regions of the brain to communicate.

Low-dose ketamine treatments restore these dormant neural circuits by triggering the production of Glutamate, which in turn, promotes BDNF, a protein that encourages neuroplasticity in the brain.

Many patients do experience dissociative ketamine journeys that can be immensely helpful in uncovering subconscious insights. But only focusing on the dissociative feelings of ketamine — and ignoring ketamine’s impact on the brain’s biology — ultimately undervalues this powerful antidote to major depression.

— Dr. Marcel Green, Psychiatrist at Hudson Mind

Dr. Abid K. Nazeer – Advanced Psychiatric Solutions

Here are some common misconceptions about Ketamine that I encounter frequently discussing the treatment with patients.

a. Ketamine treatment will start showing benefits immediately.

Once you start the initial induction series of ketamine infusions, yes, it is possible to start seeing benefits very quickly. Particularly, when it comes to resolution of suicidal thoughts, you may find relief within a few hours of your first treatment.

However, it is possible for someone to start noticing improvements and benefits at any point during the 2- or 3-week induction phase. Most common infusions after which you start to notice improvements are the 3rd or 4th infusion. In some cases, a late response can be seen after the 5th or even the 6th infusion. It is more likely to have a delayed improvement if someone is taking high dose benzodiazepines, or in higher age groups where there has been a longer period of rigid thinking.

Ketamine causes “neuroplasticity”, the formation and repair of neuronal transmission highways in your brain. Doing one treatment will only fix a few “potholes” but the cumulative effect of completing a series of ketamine treatments is as if you are repaving the entire highway. There is a building momentum over the initial series that builds with each successive treatment.

It is important to remain optimistic and patient, understanding that there might be ups and downs over the course, but everything can still feel much better by the end of it. We commonly notice that loved ones may notice the benefits before anyone else. They can identify small positive changes in behavior in the patient which are indicators that he or she may be starting to respond. It’s understandable that one loses hope quickly if nothing feels better after two treatments, especially when there is a long history of failed past treatments.

I try my best to manage expectations and also encourage patients to start changing their internal identity and shed the belief that they will always be suffering from their mental health diagnosis.

b. It doesn’t matter where and how you receive ketamine treatment, it’s all the same.

Ketamine is a powerful treatment that should be used carefully in appropriately screened patients and as part of a larger comprehensive treatment plan. Most ketamine clinics do not have a psychiatrist involved, or even a psychotherapist on staff. The primary clinician is assuming care of complicated treatment resistant individuals with depression and anxiety but is not specialized or trained to do so.

For some patients, they may still be able to improve with purely being administered the medication, but for many others there is a need for a more robust approach.

There is an advantage to going to a clinic for ketamine treatment that can also offer multiple synergistic treatments such as transcranial magnetic stimulation, provide guidance and management of psychotropic medications, offer ketamine assisted psychotherapy, and provide a support structure overall. Not only is it safer from a psychiatric standpoint, but it also leads to better outcomes and less fragmented care. In these settings, ketamine is not being relied upon solely to help the condition, but rather as just one of many tools in the toolbelt.

c. I won’t need to be on my anti-depressant medications any longer if ketamine treatments help.

Though it is true that effective ketamine treatment can help someone to taper off of their anti-depressants, it is not the likely outcome. If someone has a treatment resistant condition that has led to taking multiple medications, and has a long history of failed treatments, the chances are higher that he or she would need to maintain on the medications in conjunction with ketamine maintenance.

We prefer to not adjust the psychotropic medications immediately before or during the induction course. This can confuse our assessment of how well or not well the ketamine is working. Once we have determined how long the ketamine will exert benefit and figured out the “maintenance interval”, then a proper medication treatment plan is made. If ketamine does not provide a longer lasting benefit, let’s say under 6 weeks, then we do not attempt to taper off any current antidepressant medications.

If they have a longer maintenance interval, then we taper one by one and monitor closely. If the person starts to need more frequent ketamine treatments because of tapering off the antidepressants, it might be best to stop tapering and maintain at the lowest effective dose.

Certain kinds of conditions and medications that treat them, such as stimulants for ADHD or mood stabilizers for bipolar disorder mania prevention, will still be needed as ketamine does not directly improve those conditions.

d. Ketamine treatment will lead to worsening addictions.

Very often, I hear patients verbalize their hesitancy to consider ketamine treatment due to fear it will cause them to develop or worsen an existing addiction. Most of the literature supports ketamine’s efficacy in treating substance use disorders. Ketamine can help lower alcohol use, diminish sedative or opioid withdrawal symptoms, and decrease cocaine use.

While it is true that utilizing ketamine on a more routine basis at higher doses can lead to physical and psychological dependence, that is not proven to be the case when ketamine is given in a supervised medical setting and especially when paired with psychotherapy.

For these reasons I have concerns with any sort of home ketamine treatment or off-label prescribing of ketamine troches or nasal sprays for home maintenance treatments.

— Dr. Abid K. Nazeer, M.D. FASAM, Founder of Advanced Psychiatric Solutions

What To Know About Ketamine Treatment

Ketamine is becoming an increasingly popular therapy option for those with treatment-resistant mental health conditions. Because of this, you may be eager to explore the potential benefits it may have for you.

However, it’s important to regard ketamine therapy as a tool to help you work on conditions — and not as a panacea or cure-all.

Remember to seek professional guidance and administration of ketamine by a clinic. To explore if ketamine therapy may be beneficial for you, contact a local clinic and discuss your options with a doctor and mental health professional.

Healing Maps Editorial Staff

Healing Maps Editorial Staff

View all posts by Healing Maps Editorial Staff

The Healing Maps Editorial Team has decades of experience across all facets of the psychedelic industry. From assessing studies and clinic research, to working with clinician's and clinics, we help provide data-backed information to psychedelic-curious individuals across the globe.

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Comments (1)

  • Alice Carroll
    September 6, 2023 at 2:39 pm Reply

    Thanks for explaining that proper control of the dosage is also crucial when it comes to undergoing ketamine treatment. I’m interested in looking for a good doctor to consult about that because my brother might need it in the future. He has been experiencing chronic pain for some time now.

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