What If I Have A ‘Bad Trip’ at a Ketamine Clinic?
Last reviewed and updated: June 22, 2026.
Key Takeaways
| Prevention | Set an intention; learn what dissociation feels like; develop a grounding technique; avoid alcohol/cannabis before; share trauma history with provider |
| During a difficult experience | Slow breathing; signal staff for reassurance; remember it is time-limited (resolves within 60 min of infusion end); move toward curiosity rather than resistance |
| KAP | Ketamine-assisted psychotherapy — therapist present in the room during infusion; available at growing number of clinics; ask specifically if this is offered |
| You can always stop | Infusion can be slowed or stopped at any time; ask this explicitly before your first session |
| After the session | Integration therapy (processing what emerged with a therapist) is associated with better long-term outcomes; not all clinics offer it; many refer to integration specialists |
My partner shot a sidelong glance at me as we pulled up to a giant, stunningly modern house in Mar Vista before my first ketamine experience.
“You got this?” He asked.
“I got this,” I replied — a little nervous, but hiding it with a smile and a quick thumbs up.
I grabbed my bag and stepped out of the car before I lost my nerve. As I struggled to unwedge a giant tote full of blankets, medication, and sunglasses out of our tiny Mini Cooper, I heard a small, strong voice call my name.
“Sylvie! You made it!”
I turned around to see Maggie, my ketamine therapy concierge, hop out of the house to give me a hug and welcome me inside.
“We’ll take good care of her!”
She called back to my boyfriend, ushering me inside. He gave her a slight smile and took off as I stepped inside, heart pounding slightly. We were thinking the same thing: This was either going to be an incredibly therapeutic, transformative experience… or I was about to get initiated into some sort of painfully hip, new-age L.A. cult, never to be seen again.
Luckily, it was the former.
I met Dr. J* through a friend of a friend. He was a doctor building a ketamine therapy clinic in Los Angeles who wanted to talk about content strategy and media. I’m a creative director at an internal media agency.
Maggie, Dr. J. and I immediately connected over a Google hang, and a few weeks later, Maggie asked me if I wanted to get in on a “friends and family” offer with Dr. J at a reduced cost. All of this in exchange for writing up a thorough review of the process, my experience, and offering any thoughts as they refined everything for a wider circle of clients.
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Although I’ve dabbled in psychedelics over the years (mostly mushrooms, with a light smattering of… other substances), I had never done ketamine. I had also never done therapeutic drugs under the supervision of a doctor or therapist. I was instantly intrigued by the offer, but also a little wary: I would be in an unfamiliar environment with unfamiliar people; what if I had a “bad trip?”
So far, my psychedelic experiences were incredibly positive, and mostly involved the following:
- Giggling with friends until our sides and mouths hurt from laughing
- Watching a Joshua Tree breathe in and out
- Taking a magical dip in a friend’s pool
I decided I was familiar enough with meditation and breathing techniques, my own set and setting, and drugs in general that the potential rewards outweighed the risks.
I replied “Yes! Very interested!” to Maggie, and we set a date.
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The Pre-Session Before My Ketamine Experience
My pre-session process included filling out two relatively extensive intake and consent forms, as well as reading a bunch of material provided by Maggie/Dr. J (and, of course, doing my own frantic Redditing/Googling. I didn’t sign up for this because I’m the picture of mental stability!).
The consent form covered all the usual medical stuff to be expected — do I have a history of high blood pressure? Which medications am I taking? Am I currently under the care of a doctor?
The intake form was a little more broad, asking about my experiences with psychedelics, as well as my intentions and what I wanted to explore during the session.
I also had a 45-minute pre-session video call with Dr. J, where we went over my form and discussed my physical + mental health history, as well as any questions I had.
I learned that there are a few ways of administering ketamine.
One is nasally, through a spray containing esketamine — which is similar to, but not exactly ketamine. This is the only treatment currently available as a prescription (e.g., covered by some insurance companies) as a treatment for treatment-resistant depression.
However, Dr. J said he wasn’t as impressed with the clinical efficacy of esketamine, and preferred sublingual ketamine (via a lozenge that dissolves in your mouth), IV ketamine, or an intramuscular injection.
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Based on the fact that I mainly wanted to use the session to address some general depression and existential fears, he recommended an IM injection based on my weight. Dr. J also prescribed me an anti-nausea medication to take the morning of the ketamine experience, which I immediately clocked as a huge benefit to doing drugs with a doctor. What a perk!
As the date of my treatment grew closer, I got weirdly nervous. I say “weirdly” because I’ve never felt that nervous about trying something new, but the clinical setting and all the preparation going into it was getting in my head.
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One of the documents Dr. J sent me recommended journaling about my feelings, and something I kept reading over and over was about not trying to have any expectations about the trip. Just let the medicine take you where you need to go, and all that hippie stuff. Hmmm.
The problem with this was that I had a lot of expectations about this session.
I’ve struggled with major depression since I was a teenager. In my twenties, I learned that my grandmother had to be institutionalized at one point for her depression, which made total sense to me. Although I’ve never been committed, I’ve self-medicated with alcohol and other destructive/impulsive habits.
Whether it was spending thousands of dollars and countless hours on a therapist and psychiatrist’s couch, or trying tons of medications, from Ativan to Zoloft, this was my previous treatment method. I also developed a crippling, existential fear of death my senior year of college.
Whatever you do, dear reader, please do not take an astrophysics class and then Google “eventual heat death of the universe” after several college-grade bong rips. That interfered with my REM cycle so much that I had to go to a sleep clinic.
Over the past few years, I’ve done a lot of hard work on myself to help address some of these feelings. I quit drinking (and am still “California sober”), run as a hobby, pour energy into my own creative pursuits versus getting bogged down at my day job, practice mindfulness, and eat more vegetables.
I still think medication is great, and you can’t out-GOOP mental illness, but, for me, those things help.
Still, sometimes, in the small hours of the morning, even after a 10-mile run and a lovely dinner with my partner and a candlelit bath, I get so anxious about death that I feel like I’m hurtling 100 mph towards a brick wall.
Or I feel an itchy blanket of malaise wash over my brain, dampening my neural connections and pulling over an ugly, damp blanket of depression over my serotonin receptors.
Could ketamine therapy help those small fires I couldn’t stamp out with any other tool in my toolbox?
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What My Ketamine Experience Was Like
Back to the Mar Vista manse. I stepped inside an airy entryway and Dr. J greeted me warmly.
After a few minutes of chitchat, Maggie left and we stepped into a small dark room with a bolster-type pad on the floor with a pillow and lit candles. I admitted I was feeling a bit nervous.
“That’s normal,” Dr. J. said gently.
He handed me a pair of wireless headphones and an eyemask, and asked me to make myself comfortable on the bolster.
“I’ll be sitting right here during your treatment, making sure you’re supported and taking a few notes. If you ever feel like you want some grounding, you can put your hand out to your side like this” — he demonstrated — “or on your shoulder, and I’ll come touch your hand or shoulder for a moment.”
I nodded and laid down.
“Whenever you’re ready, you can sit up, and I’ll inject you with the medicine in your arm. Then you just lay back down, and let the experience happen.”
I sat up quickly, wanting to get things started before I chickened out. He gently touched my arm, and, before I could even feel the injection, he said I could lie back down. I put the headphones and eye mask on… waiting.
Within 30 seconds, my body felt slightly warm and tingly in that “coming up” way that most psychedelics feel (for me, at least). I felt the medicine wash over me in waves, and practiced some calming breathing techniques — like an astronaut about to blast off into space.
Suddenly, I saw a billowing, giant tent over me — I was in some sort of prehistoric desert yurt. From there, I moved through a strangely organic, visual experience: I was at the top of an overcast mountaintop, seeing into eternity.
I was a tiny piece of kelp in a giant seaweed forest that towered thousands of miles above my head. It felt like I was inside a human blood cell. I was laying under massive ferns blowing over me.
The experience made me feel dazzled and child-like; as if I was on my first ride at Disneyland.
At one point, I started thinking about how weird it is that we have teeth, and laughed out loud. I also felt a headrush so intense — not unpleasant, but intense — that I put my arm on my shoulder for Dr. J’s support. He gently grasped my shoulder, grounding me, and I let go.
You know that scene in The Two Towers where Gandalf defeats the Balrog and goes through time and space, living a lifetime in Middle Earth years as he’s reincarnated into Gandalf the White? That’s the closest comparison I can make about my ketamine experience without sounding like a Burner who’s been at the Playa for one too many days.
My actual ketamine experience lasted about 45 minutes, but it felt so timeless — in a weirdly relaxing way. I had the overwhelming feeling that, although we’re different, we’re all from the same source, and to that source we’ll return.
Cheesy, I know, but very moving when you’re feeling that deep in your being.
I realized I shouldn’t be sad about myself or people I love dying. After all, it’s a miracle that we’re sharing this space and time together at all, and something to be grateful for. Besides, we’re all extensions of the same Thing. And one day, we’ll all be back at that source together.
I slowly came out of my ketamine-coaster, feeling fresh and vulnerable.
Dr. J. carefully welcomed me back to reality, encouraging me to rest for a few minutes and to take things slowly. He handed me two pages of notes where he had jotted down the time and what I had been doing — laughing, moving my legs, breathing rhythmically.
To this day, I have no idea what I did with those notes.
I stepped outside, where my partner was waiting. Everything was so bright. I warned him that I wasn’t up for talking in the car. However, I made sure to emphasize not to worry; the result was a positive, very powerful ketamine experience. We drove home and I saw the world like my brain had just taken a bracing, icy, fresh breath.
The Post-Session After My Ketamine Therapy
When I got home, all I wanted was a Sweetgreen salad and sleep.
I became acutely aware of how much I hated my phone; how unhappy that small rectangle made me. I didn’t look at it all night, and picked it up much less often over the ensuing weeks.
I felt as though my brain was a forest, with relatively healthy trees, but an insidious undergrowth of anxiety and depression I couldn’t quite get to. Ketamine was like a weed whacker for those nasty, overgrown vines, blowing them out of my system and giving my brain a hard reset. This feeling lasted for weeks, and even months, after my treatment.
I’m coming up on eight months since my session. Although the benefits aren’t as acute, the realizations I had during my ketamine experience ring true and sound. They’re a comfort to me when I get a little frazzled, when my jerk of a brain wants to conjure up thoughts like “everyone you love will die and be gone forever one day.
Two days after my session, I had an “integration session” with Dr. J. This is a necessary (and important) part of taking the experience and contextualizing it for everyday life and reality.
What I said during that session still feels true today: We are all different, but we are all One. God, I’m really sounding like an L.A. denizen now, aren’t I? If my New York friends find this piece, I’m never going to hear the end of it.
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Is Ketamine Treatment For You?
I’m not sure if ketamine treatment is right for everyone with anxiety and depression. Dr. J said the patients who had the most difficulty with it, in his experience, had trouble letting go of control. So it’s wise to take that into consideration before signing up for a session.
Me? I’m making decisions and am in control all day: At work, in my creative pursuits, at home. It felt nice to hand the reins over to a medication that blasted me off to the Moon (and beyond).
I also valued the opportunity to take this medicine in a space where I wasn’t partying with friends. Hell, that would only make me worry about their respective trips, instead of my own. It felt intentional, safe, and supported from the beginning.
Sure, some nerves are normal. But if you come into contact with a practitioner that gives you a bad feeling, it’s best to steer clear. It’s why it’s important to research a bit before starting ketamine therapy.
Overall, my ketamine experience was a 10/10, and I would do again as part of my mental health regimen. Preferably with a kind doctor who lives in a Mar Vista mansion.
*Using euphemisms for Dr. J & Maggie. Although everything was legal and run by certified medical professionals, the clinic is still in the development phase. I don’t want to inundate them with new clients/questions.
Difficult Ketamine Experiences in 2025: What Good Clinics Now Do
Clinical understanding of difficult ketamine experiences has matured considerably since this article was written. Here is the updated picture of how well-run clinics approach challenging sessions and what you can expect from the standard of care.
Preparation is now recognized as the most important factor. The field has largely moved away from treating ketamine infusions as purely pharmacological interventions — something you receive passively — toward a preparation-and-integration model closer to psychedelic-assisted therapy. Leading clinics now offer structured pre-treatment consultations that address: what a dissociative experience feels like and what to expect; intentions-setting; breathing and grounding techniques to use during the infusion if anxiety arises; and explicit permission to signal the medical team if you need support. Research consistently shows that people who enter ketamine infusions with clear intentions, realistic expectations, and some preparation for the dissociative state have significantly better outcomes and fewer difficult experiences than those who enter cold.
Ketamine-assisted psychotherapy (KAP) has become more widespread. The integration of a trained therapist into the ketamine experience — sitting with you during the infusion, not just meeting before and after — is now available at a growing number of clinics. In KAP protocols, a therapist is present in the room during the session, able to provide reassurance, grounding, and support if distressing content arises. This significantly changes the risk profile for difficult experiences: you’re not alone in the room with a nurse monitoring vitals, you’re in the presence of someone trained to hold therapeutic space. If managing psychological difficulty during the session is a concern for you, explicitly asking whether a clinic offers KAP versus standard IV infusion protocol is an important question when evaluating options.
What to do if you have a difficult experience. If distressing thoughts, imagery, or feelings arise during a ketamine session: (1) Use your breath — slow, deliberate breathing activates the parasympathetic system and can reduce the intensity of fear responses even while dissociated. (2) Signal the staff — you can always ask the nurse or therapist present to talk to you, touch your hand, or adjust lighting. A reassuring voice is often enough to reorient. (3) Remember it is temporary — ketamine infusion effects resolve completely within 45–60 minutes of the end of the infusion; even very distressing material is time-limited. (4) Don’t fight it — attempting to suppress or resist distressing imagery often intensifies it; moving toward curiosity (“what is this showing me?”) is often more effective than avoidance. Post-session, integration support — journaling, talking with the clinical team, or a therapist — is the standard recommendation for processing what emerged.
Frequently Asked Questions
How common are bad trips at ketamine clinics?
Truly distressing experiences — what most people would call a “bad trip” — are relatively uncommon in clinical ketamine settings compared to recreational use. The clinical setting itself provides significant protective factors: medical supervision, a controlled environment, pre-session preparation, and the knowledge that staff can intervene if needed. That said, ketamine’s dissociative and psychedelic properties mean that unexpected, strange, or emotionally difficult experiences do occur. The most common difficult experiences include: intense dissociation that feels disorienting rather than pleasant, emergence of anxiety or fearful thoughts, unexpected emotional material (grief, difficult memories), and rarely, a sense of ego dissolution that feels threatening. These experiences are typically manageable with support and rarely require medical intervention beyond reassurance.
Can you stop a ketamine infusion if you’re having a difficult experience?
Yes — ketamine infusions can be slowed or stopped at any time. If you are having a genuinely distressing experience and want the session to end, telling the clinical staff will result in the infusion rate being reduced or the IV being stopped. Because ketamine has a relatively short duration of action (effects typically resolve within 30–60 minutes after the infusion ends), even a difficult experience is time-limited. In practice, most distressing experiences resolve with reassurance and support without stopping the infusion — but the option to stop is always available, and a good clinic will make this clear before you begin. You should ask this question explicitly during your pre-treatment consultation: “What will you do if I’m distressed during the infusion?”
What should I do to prepare to reduce the chance of a difficult experience?
The most evidence-based preparation steps are: (1) Set a clear intention — knowing what you want from the treatment creates a psychological frame that guides the experience. (2) Learn what dissociation feels like — understanding what to expect from ketamine’s effects (feeling detached from your body, time distortion, unusual perceptual effects) makes these less alarming when they happen. (3) Develop a grounding technique — a simple breathing pattern, a phrase, or a mental image you can return to if you feel overwhelmed. (4) Avoid recreational substances before treatment — alcohol and cannabis in the days before can destabilize the psychological baseline. (5) Discuss any trauma history with your provider — ketamine can surface emotional material, and providers who know your history can offer better support and help you prepare.
What is integration therapy after ketamine and why does it matter?
Integration therapy refers to therapeutic work — typically sessions with a therapist — in the days and weeks following a ketamine treatment, aimed at making sense of what emerged during the experience and applying any insights to daily life. Difficult or unusual experiences during ketamine sessions often contain emotionally meaningful content; integration therapy provides a structure for processing this rather than simply setting it aside. Research on psychedelic-assisted therapies more broadly has consistently found that integration is a key factor in long-term outcomes — people who engage with post-session integration maintain benefits longer than those who treat the infusion as a standalone pharmacological event. Not all ketamine clinics offer integration therapy, but increasingly many refer patients to therapists with psychedelic integration experience.
