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Let’s start with something easy. Can you tell us a little about your professional background?

I knew I wanted to be a psychotherapist from before I went to medical school, so throughout my training I focused on both the mind and the brain, relationships and science.  When I was in my residency training, I was blindsided by how many of my patients had suffered severe forms of  childhood trauma that I’d mistakenly thought were rare, and by the multifactorial ways that past trauma continued to affect their lives daily, often in ways they didn’t realize themselves.  I learned to be attuned to trauma histories in my patients at the VA and in my private practice.   I’ve found these patients incredibly rewarding to work with and they do get better but often the treatments are long and arduous.  That’s why my jaw dropped when I heard about the results from studies of MDMA, and more recently ketamine, for trauma survivors.  The amount of pain and years of work these medicines can save is going to change the world.

I often hear from people that I stand out in my capacity NOT to induce shame.  There can be no more meaningful feedback for a trauma therapist than that.  They would also say they know I really care about them, and probably also that I can be too direct at times.  I tend to say it like it is, not mince words.

How did you become interested in working with psychedelics?

I think it’s important for mental health professionals to acknowledge that we’ve often had our own challenging therapeutic journeys, and when nontraditional treatments have helped, to honor that too.   Psychedelics have been of enormous benefit to my own growth and healing.

What has been your most meaningful experience in working with psychedelics?

I’ve worked with two patients in ketamine-assisted psychotherapy who had the kind of abuse histories that led to almost everything in their lives one way or another being shaped by the abuse or reactions to the abuse.  They lived in continuous states of re-experiencing trauma, being assailed by overwhelming painful emotions, and/ or completely shutting down.  Ketamine transformed their lives.  Within weeks, they were doing things they hadn’t been able to do for years, or perhaps had never done before.  They stopped trembling all the time– literally.  They stopped thinking about suicide.  They felt hope for the first time they could remember.  I’m in awe of both of them because it wasn’t just the ketamine, it was their bravery and commitment to doing the therapy they did with the help of the ketamine.

What excites you most about the future of psychedelics?

So many things.  Other than short circuiting suffering like I’ve already talked about, I’d say two other things stand out.  One is that psychedelics can bring so much compassion, for ourselves and others.  We can understand and even empathize with those we’ve been angry at or hated.  That’s if we want it.  We always have to work for it.  The other thing is that suffering and illness aside, psychedelics unlock our potential.  The help us become what we can be.  I guess what I’m saying is, everything I value about therapy, psychedelics can facilitate both within therapy and potentially  in other intentional and safe settings.   

What advice would you give to a psychiatrist or therapist just getting started in this industry?

I’ll give the didactic reminders first: Remember that there is no magic bullet.  Nothing works for everyone.  Safety always comes first. There’s no shortcut to becoming a skilled clinician, and no substitute.  However, you’ve got an extraordinary, unprecedented opportunity before you, if you’re learning to work with these awe-inspiring substances early in your career.   Do it responsibly and your work life will be filled with fascination, meaning, and honor of transforming people’s lives for the better.

Enough about work! Let’s try some rapid fire questions.

Where do you live? Proud New Yorker since 1988!🗽 🚕

What’s a perfect afternoon? Reading a good book with a cat in my lap

Describe yourself in two words. Compassionate and intense

Meet Our Clinical Director

By now, you have probably heard quite a lot about ketamine—the new, but not-so-new, medication that is gaining traction and worldwide recognition as a game-changing solution to the mental-health crisis that our world is currently facing. 

In fact, one in every 8 people globally—an estimated 970 million—suffers from some degree of mental illness—and this number is only rising, per data from the World Health Organization (WHO). Considered an “essential medicine” by that very same organization, ketamine just may be the key to unlocking the treatment that can help millions of people living with a myriad of mental health disorders. 

In its essence, ketamine is a dissociative anaesthetic that provides short-acting relief for pain. It has been around since the 1950s and was discovered by Parke-Davis and Company in their Detroit laboratory. They were on the hunt for the ideal anaesthetic and gave ketamine the developmental code name CI-581. The earliest clinical research on ketamine was performed on animals before it was then used on prisoners of war as an alternative to phencyclidine (PCP) for anaesthetic purposes. It was not until the 1970s, during the Vietnam War, when ketamine’s use was extended for the purpose of surgical anaesthesia. 

Ketamine has a wide range of utilization and can be used operatively at both high and low doses. At low doses, it has been shown to be instrumental in treating mental health and pain disorders, explains Mike Cooper, M.D., Psychiatrist and Medical Director at Innerwell. We all have NMDA receptors throughout our brain that play an integral role in both memory and learning. What ketamine does, Dr. Cooper explains, is antagonize these receptors and blocks a neurotransmitter that binds to these receptors, called glutamate. “Ketamine essentially blocks the binding of glutamate to those receptors, which in turn increases activation of a different kind of receptor called AMPA,” he says. “By increasing activation of AMPA you increase the release of BDNF, or brain derived neurotrophic factor, which is a protein in the brain that increases neuroplasticity.”

What is neuroplasticity? Put simply, neuroplasticity is the ability of our nervous system to shift in response to various stimuli, therefore creating new neuronal connections in the brain, explains Dr. Cooper. 

Ketamine is administered through a variety of routes, namely oral, intravenously (IV,) intramuscularly (IM) or intranasally (IN). Here’s a look at how each one works and in which use case one may be preferred over another.  

This is perhaps the least expensive and most straight-forward way to administer ketamine, especially when it comes to treating depressed patients, per research published in The Journal of Clinical Psychiatry. The only downside of dosing ketamine orally is that only about 25 percent of the drug actually reaches systemic circulation. This means that doses may have to be higher to achieve the same results that would be needed if the drug was administered via other methods, such as intravenously. 

In the operating room, ketamine is typically administered intravenously, since there is simply more literature and decades of research supporting this method. It is also how the very first human trial of ketamine infusion was administered. This is often how ketamine infusion clinics prefer to administer their ketamine, according to Dr. Cooper. Research has shown this route to be quite effective, especially when given slowly in a very low dose of 0.5 mg/kg over the course of 40 minutes (http://ketamineinstitute.com/wp-content/uploads/2016/09/Antidepressant-Effects-of-Ketamine-in-Depressed-Patients-Berman-2000.pdf).

Mental health clinics that offer ketamine-assisted psychotherapy sometimes administer ketamine intramuscularly or injected into the muscle, almost in the same way that a vaccine is administered. 

Additional data is accumulating on the intranasal route, which is quite non-invasive and simply involves spraying the medication into the nostrils. In terms of bioavailability, or how well a drug is absorbed in the body, research has shown that intra-nasally is roughly 45 percent, compared to intravenously, which is 100 percent and intramuscularly, which is about 95 percent, according to Dr. Cooper. “These are rough estimates, but they give a general sense of how a practitioner would calculate what dose to give a patient relative to an IV dose,” he says. “So, for instance, if you wanted to give an equivalent dose orally as compared to 90 milligram dose intravenously, you would give 300 mg orally, assuming approximately 30 percent bio available.”

Yes—ketamine is actually one of the safest anesthetics available today, especially in regards to how it preserves the airway reflexes. “You can put someone to sleep with ketamine, but they can still breathe on their own without needing to be connected up to any kind of supplemental oxygen or any kind of airway procedure like an intubation to provide mechanical breathing,” explains Dr. Cooper. This is unique when compared to other anesthetics that put you to sleep. During this process, these anesthetics often suppress a patient’s breathing, which requires them to be intubated in an operating room and provided mechanical ventilation to keep them breathing. With ketamine, on the other hand, the patient continues to breathe even though they're asleep and not feeling pain.

Ketamine is also a very short-acting medication, lasting up to about an hour after its onset. The only real potential downside of ketamine is that it has been shown to increase blood pressure slightly for some patients. Even so, this rise in blood pressure is not to an alarming or concerning degree, notes Dr. Cooper. “While it can increase heart rate a little bit, it is a very physiologically safe medication.”

Ketamine for mental health: the new frontier

While, traditionally, ketamine has been used mainly as an anaesthetic, in the last couple of decades, it has been used increasingly in psychiatry after it was found to be helpful in treating depression in a very rapid manner when given intravenously. Practitioners have been using it off-label to treat depression for a long time, however, a certain form of ketamine, called esketamine, under the name Spravato, was FDA approved in 2019 for the clinical treatment of depression. “It is a nasal spray that must be self-administered by the patient under the guidance of a health professional in a regulated clinical setting,” explains Sam Zand, D.O., Las Vegas-based psychiatrist. “It can now be covered by insurance after 2-4 antidepressant failures.”

Recent reviews published in both Pharmacological Reviews and the Australian and New Zealand Journal of Psychiatry have shown ketamine to be impressively effective in the treatment of major depressive disorder as well as in the treatment of post-traumatic stress disorder. “Trauma becomes stored in the neural circuitry of our body, and ketamine has been hypothesized to increase neuroplasticity and unwire neuroprogrammed stress and trauma,” Dr. Zand explains. 

While other depression medications such as sertraline (Zoloft®), paroxetine (Paxil®), fluoxetine (Prozac®) and citalopram (Celexa®), may take many months to work fully, ketamine has been shown to work as rapidly as after one dose, within 24 hours of the first dose, in fact, notes Dr. Cooper. 

This is perhaps the number one question most patients considering ketamine may have—and it is understandable as to why. This depends on the dose range, according to Dr. Cooper. “At the extreme end of the dose range, ketamine is going to act as a general anesthetic and can put someone to sleep to the point where they're not going to remember the experience and not feel pain,” he says. This is more of how it was traditionally used when it was first discovered. “As you look at the lower doses, say, if you go on the opposite end of the spectrum, where you take a low dose of ketamine, it can be a very relaxed feeling,” he says. The effects of this low dose could be compared to a glass of wine, for example, in terms of that relaxation feeling. 

“Most patients describe the feeling of ketamine as very relaxed and open where they feel comfortable talking and communicating about difficult things in their life,” says Dr. Cooper. “In this low-dose administration, it can be thought of as a psycholytic agent where it lowers ego defenses  to allow patients to talk about aspects of their personality, their life and their memories in a little bit more of an easier way than they can without ketamine.”

In the moderate dose range, ketamine tends to be more like a psychedelic where patients may close their eyes and see beautiful colors, geometric patterns and other shapes, especially when they’re listening to music. They may also notice a distinct shift in their perspective. “They might feel that their sense of self is growing larger, or that they feel more connected to their surroundings or to the people around them, as well as a heightened sense of oneness and connectedness to the world,” explains Dr. Cooper. 

As the dose increases from there, ketamine generates sort of almost an out-of-body experience, where a patient may feel like they're outside looking inward in a very peaceful way. “They feel very much a part of the universe and they can even have these visual experiences of watching the universe being constructed and planets coming into existence and quite metaphysical, extraordinary experiences like that,” says Dr. Cooper. 

The length of time during which ketamine lasts is about an hour long when used for its psychological effects, with only very mild residual effects of the medicine lasting longer than that 60-minute duration period. The official half-life of the medicine, or how long it takes for the medicine in your body to be completely eliminated by 50 percent is an estimated 2.5 hours in adults, per FDA data. 

How a ketamine treatment works depends mainly on the model of treatment. If it is an intravenous ketamine clinic, a patient would go to their doctor’s office, often a psychiatrist. Next, they would be connected to an IV and would receive an infusion of ketamine over the course of an hour or two. There may also be a nurse in position to check in with the patient at frequent intervals. “This type of model doesn't usually involve psychotherapy; it is usually the patient in a clinic room getting an infusion of ketamine, almost like chemotherapy,” explains Dr. Cooper. 

Another model is called ketamine assisted psychotherapy, where the patient undergoes psychotherapy at the same time as they are having a ketamine experience. Often, this type of model kicks off with a preparation session beforehand where the practitioner seeks to learn and understand more of what the patient is seeking assistance and help with. “Part of the initial intake involves setting an intention for the journey, talking about what it is going to be like for them and helping select the music to play to guide them on their way,” says Dr. Cooper. 

This type of ketamine therapy could be provided after they get an intramuscular injection of ketamine, an IV infusion of ketamine, or after they take an oral or sublingual dose of ketamine, according to Dr. Cooper. “The most common route of administration for a patient receiving treatment in the form of psychotherapy is intramuscular injection after which you would lie on the couch in their office and talk about things that come to your mind,” he says. “Often, the psychiatrist will encourage the patient to look inward at their life, put eye shades on, and listen to a music playlist to help guide them on this introspective journey and reflect on their life during the ketamine experience.”

Another type of ketamine-assisted psychotherapy involves the practitioner treating the patient virtually over Zoom. This can allow for a more comfortable experience and may encourage the patient to go more in-depth about their thoughts and past experiences. If a patient chooses to go this route, they would be prescribed ketamine orally in the form of a lozenge or tablet. They would also have a support person or family member present who would be there to help them through potentially difficult aspects of their journey.

During the treatment, the practitioner conducts a medical evaluation that involves assessing the patient's psychiatric history, medical history, and any past experiences with non-ordinary states of consciousness, as well as educating the patient about what the ketamine experience can feel like to them. 

The  first ketamine experience often starts with a very low dose of the drug, which simulates the feeling of drinking a glass of wine—the patient is relaxed and can get comfortable with the medication. “Some patients choose to remain at a lower dose because they find it very therapeutic and can do a lot of good psychological work at this dose,” says Dr. Cooper. “For patients who feel ready to have a bit more of an intense experience, the doctor can carefully titrate the dose over time so the patient can  learn to work with the stronger effects along the way.”

Who would be an ideal candidate for ketamine therapy?

Ketamine is very versatile and there is a great deal of emerging evidence that is showing it to be useful for treating a variety of conditions, especially depression. “Ketamine can be quite beneficial for someone who has depression and has not responded to traditional antidepressant medications like Prozac and Lexapro, or for a patient who's in psychotherapy and has made some progress towards treating their depression and anxiety, but they want to augment their treatment or have a bit more rapid improvement in their symptoms,” explains Dr. Cooper. “Patients who are naturally very introspective and philosophical in general, who would appreciate the kind of inward journey and perspective that they can gain through ketamine, would also be very good candidates for this type of treatment.”

It’s important to recognize that ketamine treatment, while quite extensive and science-backed in its therapeutic abilities, is not for everyone—and determining whether or not it’s right for you is a deeply personal decision that shouldn’t be taken lightly.

If you do decide to try ketamine, it’s also important to recognize that there is no substitute for working with a licensed expert who has been certified and trained in this specialty. Not only can they help prepare you for what to expert and guide you along the journey, but they can also help you better process your experiences and traumas.

If you’re interested in harnessing the power of psychedelics to move beyond what’s been holding you back, sign up and take our patient screener to take the first step towards healing.

Learn about the history of ketamine, the science behind its amazing neuroplasticity-inducing effects, and how it is being harnessed for mental health to help patients heal.

Ketamine 101

What is ketamine? 

How is ketamine administered? 

Is ketamine safe?

What does ketamine feel like? 

How long does ketamine last? 

How does a ketamine treatment work?

Deciding if ketamine is right for you

It’s normal to feel nervous about trying psychedelic-assisted therapy. In the United States, psychedelics are loaded with cultural and political taboos as a result of the War on Drugs. Started in 1971, this government-sponsored campaign published a cascade of negative press against psychedelics, even though medicines like LSD, psilocybin, and MDMA were showing tremendous promise as psychiatric treatments. 

The truth is, like any other medicine, psychedelics do pose risk when they are not taken appropriately. However, the virtue of psychedelic-assisted therapy is that it creates a clinical framework for taking these substances in safe and healthy ways. In general, psychedelics actually have an impressive safety profile. While televised public service announcements in the 1980s and 1990s depicted scary images under the guise of “This is your brain on drugs”, world experts in addiction and public health have repeatedly demonstrated that psychedelics are among the least harmful drugs known. Referring to mushrooms and LSD, professor and drug policy expert David Nutt wrote:,

“It’s virtually impossible to die from an overdose of them; they cause no physical harm; and if anything they are anti-addictive.”

As you can see from this chart published in The Lancet in 2019, legal drugs such as alcohol and tobacco are ranked significantly higher on the ‘drug harm score’ than psychedelic substances like mushrooms and LSD.

Fear around losing control is a common worry amongst first-time psychedelic users. But when taken in safe settings, it is extremely rare for someone to lose control of their senses or sensibilities after consuming psychedelics. You will not take off your clothes and run naked in the street, nor will you have flashbacks or “go crazy” as some media portrayals have suggested. By and large, psychedelic-assisted therapy sessions are gentle, reflective, and meditative in nature. Rather than losing control, people tend to report seeing things clearly and experiencing a sense of profound inner peace.

When taken as prescribed, ketamine is also a safe psychedelic. Furthermore, ketamine has a long safety track record  when administered in surgical settings to adults as well as children as young as 1.5-years old. The World Health Organization has put ketamine on its list of “essential medicines” for its enormous medical potential and low risk profile. Overdosing on ketamine is nearly unheard of in clinical contexts, and the doses that are prescribed for psychedelic-assisted therapy are far below the level that could pose such a risk.

All that being said, signing up for psychedelic-assisted therapy is a major decision. Being ready to take the courageous leap toward wellbeing with the aid of psychedelics is a big step, and it’s very normal to be a bit nervous or scared. At Innerwell, licensed psychiatric clinicians are present at each step of your journey to ensure your experiences are safe and beneficial. 

Whether you're new to psychedelics or just new to ketamine, it's understandable to have some questions. Read on to learn about what you can expect and how to feel confident before your first experience.

What to know if you’re nervous about your first psychedelics experience

Whether you’re about to embark on your very first psychedelic experience with Innerwell or you’ve already done one or two sessions, you’re probably looking forward to reaping the mental-health benefits and alleviation of some of the more debilitating symptoms that you feel have been holding you back in life. 

The good news: Innerwell is here to do just that and was created not only to help set you up for success during your psychedelic experience, but also help you come down from that experience and continue to make gains on your journey towards healing and reflection. 

During each session, which tends to hover around one hour, you can expect the medicine to start taking effect in about 10 minutes. This is especially true if you’re taking the medication orally, which is the most straight-forward way to administer ketamine—especially when it comes to treating depressed patients. Depending on your dose, you can expect the experience to be a little different, notes Mike Cooper, M.D., Psychiatrist and Medical Director at Innerwell. “At the lower range of ketamine, the patient might feel very relaxed, almost like they had a glass of wine, and may find it easier to talk about past experiences, memories and even traumatic aspects of their past that they want to work on in therapy,” says Dr. Cooper. “They might look at things from a different perspective or a new angle and sort of reconsider how they're going about their daily life; maybe thinking about ways of building new habits, healthier habits, making some changes in their life.”

As you get higher up in the dose range for ketamine, the experience can become a bit more psychedelic, which might involve bright vivid colors that might even move with the sound of music. Dr. Cooper points out that at these higher doses it’s even possible to see geometric patterns and different types of imagery that can be really pleasing to the mind. “A person in this dose range may experience a very profound shift in how they're feeling about their life and how they think about themselves as a person, as an individual, and in connection to the world around them,” he says. 

Sessions are usually about two hours in duration to accommodate for the fact that there may be some pre-medication discussions where the therapist might talk to the patient about their intentions for the session and what they hope it will reveal, as well as for a post-session recap after the ketamine has worn off. This gives some time for the patient to fully recover during which they may experience a little bit of grogginess or a little bit of lightheadedness. “Sometimes patients can have a little bit of nausea from ketamine that can linger for half an hour,” adds Dr. Cooper. The potential for these side effects to occur is one of the benefits to having Innerwell so accessible from your own home—there’s no need to drive to and from your session.

What to expect after your session has ended

While the effects of ketamine will certainly have worn off once your session with your psychotherapist has come to a close, you can expect to feel some post-ketamine side effects, as mentioned above. For this reason, it can be helpful to just take it easy. Here are some key dos and don'ts that Dr. Cooper recommends for the rest of the day and week after your ketamine session has ended. 

Assuming your dose was no more than 200 mg, you should not operate heavy machinery or drive for at least four hours. If your dose was between 200-400 mg, you should avoid driving for at least 8 hours, which will pretty much be the remainder of that entire day. If your dose was above 400 mg, certainly do not consider driving the rest of the day at all. 

“Alcohol, especially, tends to dampen some of the integration of the psychedelic  experience into the person's psyche because of its effects on the brain,” says Dr. Cooper. For this reason, he recommends avoiding alcohol the day before, the day of, and the day after a ketamine session. “Sometimes ketamine can be a little disruptive to your sleep the same night that you take the ketamine and this effect can be exacerbated by alcohol or drugs,” he adds. 

Journaling has long been recognized as a self-care technique that can work wonders for improving a person’s mental health. In fact, research has even shown that journaling can help relieve medical symptoms such as high blood pressure as well as anxiety. Dr. Cooper recommends journaling prior to your session to help get you in the right frame of mind to begin thinking about your intentions and what you want to work out during your session. Depending on the intensity of your dose, you might not be able to focus very well on journaling during your actual session. Journaling once the session is over is also encouraged—even up to a day or two afterwards. “Write about any thoughts, feelings, memories, imagery that came up both during your session as well as following,” says Dr. Cooper. He does point out the importance of not feeling pressured to document everything that you experienced down on paper. “A lot of the healing occurs nonverbally, so don’t worry if you don't remember every detail or record every single thought you had during the experience,” he says.

This one can be somewhat inevitable and outside of your control, however, Dr. Cooper emphasizes the importance of being mindful of any potential triggers that you know of and trying to avoid them during the days following your session. “The brain is very malleable after a psychedelic experience due to the fact that the window of neuroplasticity lasts for the next 72 hours after taking ketamine,” says Dr. Cooper. “During this period of time it's a little bit easier to begin integrating new perspectives and thinking about how to build healthier habits in your life, so it’s important to make space for these changes to occur.”

During this extended period of neuroplasticity, when your brain is more malleable, you might consider putting into practice the things you've been wanting to do that you may have been putting off. “For example, if yoga or meditation are activities you’ve been hoping to integrate into your day-to-day, it will be easier for you to start doing these kinds of things within that 72-hour window where neuroplasticity is taking place,” says Dr. Cooper. “It's an opportunity to really shape your life in a bit of a different way.”

Listen to the playlist you heard during treatment

Listening to music, even relistening to the playlist that you heard during your ketamine session, can be quite helpful during the healing process, notes Dr. Cooper. He recommends revisiting some of the songs that were particularly emotionally evocative for you, as this can sort of take you back to the state of mind you were in and help you process some of the topics that came up for you during your session. 

This is a great tip to incorporate in your life every now and then, but especially after a ketamine treatment, per Dr. Cooper. He recommends being mindful of what you’re putting into your psyche via social media, the Internet and any news sources. “There's a lot of negative content out there and the news can be very anxiety-provoking and depressing,” he says. “Be mindful of what you're putting into your mind and your body after a ketamine experience because it's a really opportune time to gain a new perspective on life and more of an optimistic perspective.” All in all, try to be mindful of what information is going into your brain from the external world and focus on the positive energies as opposed to the negative ones. 

This article covers how to set yourself up for success when you're coming down from your psychedelic experience, and what to do afterwards and over the next few days to promote healing and reflection.

Post-Session Care: What to Do Once Your Psychedelic Experience Has Ended

Innewell clients that are on the Individualized Psychedelic Assisted Therapy plan begin with two supervised ketamine experiences. These experiences are under the guided care of a licensed therapist who’s been trained in helping you harness the power of psychedelics for introspection and self-exploration. Your therapist is with you from start to finish during your ketamine experience.

You may be wondering what it’s like to work with a therapist while you’re undergoing a psychedelic experience. In this article, we’re going to break down what to expect and provide tips for interacting with your therapist during your virtual ketamine sessions.

Will I feel like talking during my ketamine experience?

Ketamine is classified as a dissociative anesthetic. When you take ketamine, you will most likely feel calm, quiet, and relaxed. Some people compare taking ketamine to going into a very deep meditation. The experience offers a beautiful opportunity to reflect on your life from a more distanced and less emotionally reactive space. During supervised experiences, your therapist will be on-camera and present with you, and their role is to maintain a safe and supportive environment throughout your experience, enabling deep introspection without fear of judgment. Likewise, their job is not to “watch you” during your session*, but rather to keep a pulse on the energy and shifts that take place as your experience unfolds.

Do I need to talk to my therapist during Ketamine Assisted Therapy?

If there is a story, memory, or thought that comes up during your session, your therapist will be happily ready to listen and help you process it. You may exchange dialogue similar to a typical therapy session while you are in your altered state. 

However, it’s important to recognize that you are not required or expected to talk and engage with your therapist throughout your experience. If you feel like putting on your eyemask and simply listening to the music, that is completely fine. In some cases, clients will not speak at all during a ketamine-assisted therapy session, only opening up once the effects have worn off and their session is complete. In this case, your therapist will honor the quiet space while still being attentive..

The dynamics of communication during ketamine experiences are fluid, and will likely change from session to session. At one particular dose, you might have a highly verbal session, and at another dose, you may prefer more silence.

In summary, there is no “right way” to interact with your therapist during the journey. They are there to support you in whatever way you need. 

What happens after my supervised experiences?

After your first two supervised sessions in the Individualized Psychedelic Assisted Therapy plan at Innerwell, you should start to feel comfortable with how ketamine makes you feel. Likewise, your therapist and psychiatric clinician will be working together with you to ensure you’re safe and at the optimal dose throughout the duration of your program.

Subsequent ketamine experiences are self-guided and followed by an Integration Session with your therapist. Integration sessions allow you to work with your therapist during the optimal time window when your brain is benefitting from the neuroplasticity that ketamine induces.

You will always have access to your therapist and psychiatric clinician throughout your entire journey at Innerwell. We want you to feel comfortable communicating anything that comes up for you, whether it’s an insight, question, or concern.

*You’ll have a sitter at home to make sure you’re safe. Plus, all Innerwell sessions start with a series of safety checks to make sure you’re ready to go.

A must-read for anyone considering the Individualized Psychedelic Assisted Therapy plan, this article discusses what it's like to have a therapist with you while you're undergoing a psychedelic experience.

How do I interact with my therapist during my ketamine experience?

Ketamine is a medication that has historically been used in hospital settings for anesthesia. However, over the past two decades, it’s been studied and utilized as a treatment for mental health conditions. Several studies have demonstrated that ketamine can be helpful in treating anxiety.

Ketamine is thought to work by regulating neurotransmitters in the brain, which may help to reduce anxiety symptoms. Read on for more about how ketamine is being used by psychiatric clinicians to help patients with anxiety.

Anxiety is a normal emotion that helps us deal with danger. It can become problematic when it is out of proportion to the situation or when it interferes with our daily lives. Symptoms of anxiety can include:

Having a sense of impending danger, panic, or doom

There is not one single cause of anxiety. It is often a combination of genetic, psychological, and environmental factors.

Genetic: Anxiety can run in families, so it may be partially due to genetics.

Psychological: Anxiety can be the result of trauma or other stressful life events.

Environmental: Anxiety can be triggered by factors in the environment, such as job stress or relationship problems.

There are a number of different types of treatment available for anxiety. These can include:

Psychotherapy: This can help people learn about their anxiety and how to manage it.

Cognitive-behavioral therapy: This type of therapy can help people change the way they think about and react to anxiety-provoking situations.

Medications: There are a number of different medications that can be used to treat anxiety, such as antidepressants, anti-anxiety medications, and beta-blockers. Psychedelics are a new class of medicine that is being leveraged to treat anxiety.

Relaxation techniques: This can help people learn how to control their anxiety symptoms.

Exercise: Exercise can help to relieve anxiety by reducing stress and improving mood.

What are the benefits of ketamine for anxiety?

There are a number of potential benefits of using ketamine for anxiety treatment. These can include:

Relief from anxiety symptoms: Small studies suggest that ketamine may be effective in reducing symptoms of anxiety.

Rapid onset of action: Ketamine is thought to work quickly, with some people reporting relief from anxiety symptoms within a few hours of taking the medication. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac, on the other hand, can sometimes take several months to effectively treat anxiety.

Long-lasting effects: The effects of a single dose of ketamine may last for a few days or weeks, which is longer than most other anxiety medications.

Increased access to treatment: Ketamine is available as an at-home treatment option, which can increase access to care for people who live in rural or underserved areas.

Reduced need for hospitalization: For people with severe anxiety, ketamine may reduce the need for hospitalization.

What is the evidence for anxiety treatment using ketamine?

A small study published in 2016 in the journal Biological Psychiatry found that a single dose of ketamine was associated with a reduction in symptoms of anxiety and depression in people with treatment-resistant major depressive disorder (MDD).

The researchers noted that the effects of ketamine were not just due to the medication's anesthetic properties. They suggested that ketamine may work by regulating neurotransmitters in the brain, such as glutamate and gamma-aminobutyric acid (GABA), which are thought to be involved in the development of anxiety and depression.

Another small study, published in 2018 in the journal Nature, found that a single dose of ketamine was associated with a reduction in symptoms of social anxiety in people with social anxiety disorder (SAD).

The researchers suggested that ketamine may work by reducing activity in the amygdala, a region of the brain that is involved in the processing of fear and anxiety.

Ketamine for anxiety is still being studied, and more research is being published each year. If you’re considering ketamine for anxiety, talk to your doctor about the risks and benefits.

If you are interested in at-home ketamine therapy for anxiety, you will work with a provider to develop a treatment plan. This usually involves meeting with the provider to discuss your symptoms and create a plan that includes a dosing schedule.

During treatment, you will self-administer ketamine via orally disintegrating tablets. The exact dose and frequency of treatment will be determined by your provider. These tablets are held in the mouth until they dissolve. After ten minutes of swishing, the medicine is either spit out or swallowed. Spitting is recommended for most patients to reduce nausea that is sometimes experienced with ketamine.

For some patients, ketamine is combined with therapy in a process known as ketamine-assisted psychotherapy. KAP usually includes weekly therapy sessions while you are experiencing ketamine, as well as integration sessions that take place after your ketamine experiences. These sessions provide an opportunity for you to discuss your progress and any challenges you are experiencing, and work with your psychotherapist to process your experience. Your provider may also adjust your dose or frequency of treatment based on your response to therapy.

Ketamine for Anxiety

Sitters play an integral part of each ketamine experience. Their presence should create a sense of safety and tranquility. In addition, they are there to ensure that their friend or loved one is safe and well cared for each time they embark on a ketamine experience.

While each person’s journey will be different, here’s how sitter’s can assist before, during and after each ketamine experience.

Be fully available and present on the day and time of your friend or loved ones  ketamine experience.

If your friend or loved one is working with an Innerwell psychotherapist, briefly join the beginning of their Zoom session at the start of the first 2 ketamine sessions (not applicable to self-guided sessions), so the therapist knows you are there and so you can exchange phone numbers.  

Discuss how your friend or loved one would like you to comfort and support them during the session if they appear anxious or in distress. Some people welcome a hand on their shoulder or having someone hold their hand; others prefer to just have someone by their side without physical contact. This should be discussed prior to starting a session.

Maintain a quiet and calm atmosphere including making sure all children, pets, noises and distractions are kept to a minimum.

Be present and aware. Their therapist will need to be able to call or text you to check on them if they have any concerns about their safety or wellbeing. 

Stay within earshot of your friend or loved one in case they need anything. Please do not wear headphones.

Periodically check on your friend or loved one during their experience (yes, poke your head through the door), but do not interrupt their experience to ask if they’re okay unless they look like they’re in significant distress. 

Assist them in moving around the house if needed - such as walking them to the restroom.

Offer tea, water, snacks, fruit, blankets, or any other comforts to help them enjoy a smooth after-care.

Make sure their journal and pen are by their side.

Remain onsite for the entirety of your friend or loved one’s experience. 

Do not leave them alone in their home until they are back to their baseline (i.e., they are able to hold a regular conversation with you; they are able to walk, talk, eat, and drink normally; they display no significant residual effects other than the following: slight intoxication, mild mental fogginess, mild nausea, and/or slightly blurry vision).

Please note, you are not responsible for “guiding” or actively influencing your friend or loved one’s journey in any way. However, you are welcome to offer emotional support when it is solicited.

A: Your friend or loved one will place their prescribed amount of ketamine lozenges in their mouth, hold and periodically swish the medicine in their mouth without swallowing, and then spit out the medicine into a cup after 10 minutes.

A: Ketamine’s effects begin within 5-10 minutes of ingestion, and the psychoactive effects last for about an hour. Feelings of physical imbalance or being “out of it” may persist for a few hours following their dose.

Q: What should I expect from them during the session?

A: Your friend or loved one will most likely be lying down and remain calm and quiet, listening to music while in a mildly dissociated state throughout the experience. However, it is not uncommon to emote in various ways, such as crying, laughing, screaming, squirming or making loud noises. This kind of response is not a need for concern and may be a part of their psychological process. 

A: Physical symptoms such as nausea, drowsiness, and fatigue are common side effects, and should subside within 1-3 hours. Vomiting can occasionally occur if nausea is severe, but will generally subside within 1-2 hours. Your friend or loved one will have been instructed to not eat for 4 hours prior to the start of each medication session (water is OK) to reduce the risk of nausea and vomiting. If the vomiting is continuous and not improving, or if you or your friend or loved one notice blood in the vomit, you should call 911.

Q: What should I do if my friend or loved one appears to be uncomfortable or in distress?

While we encourage you to give them space to experience the highs and lows that can come with psychedelic experiences, if you feel intervention is necessary, there are a few things you can try to help:

Remind them to return to their breath, remain in the moment, and let thoughts pass by

Reassure them that they are safe and that this is a temporary experience

Make sure they are warm and physically comfortable

Place a hand on their shoulder for comfort, or hold their hand if you have previously agreed this is something they would want you to do for reassurance

Q: What should I do in case of an emergency? 

A: Call 911 if you suspect an emergency. Signs of emergency can include complaints of new chest pain, chest pain that travels down their arm, shortness of breath, excessive sweating, severe headache, vision loss, facial drooping, one-sided arm weakness, or slurred speech.

You should also call 911 if your friend or loved one reports any thoughts of suicide or hurting others, or begins behaving in an erratic, paranoid, bizarre, impulsive or physically aggressive manner, or in any other way that is concerningly out-of-character for them.

A: The doses of ketamine that we prescribe do not put anyone at risk of overdose.

If you are interested in learning more about ketamine treatment for mental health, please see our blog post here.

Discover more about the journey you’re on and get techniques and tools to help you heal.

How to Help Others Journey Safely: A Sitter’s Guide

Whether you’re a seasoned psychonaut or having your first psychedelic experience, it is critical to prepare your mind, body, and environment in order to have a safe and fulfilling journey towards introspection and self-understanding.

We’ve put together a guide to help you navigate your psychedelic experience and get the most out of it.

Creating an environment that is conducive for a safe, disruption free psychedelic trip is a crucial step towards having a meaningful experience. Read on to learn how you can prepare your physical surroundings.

Choose an area where you can sit and then lie down, like a couch or bed

Set up ambient mood lighting (e.g. lamps instead of overhead lights)

Surround yourself with cozy blankets and pillows

Make sure all housemates (including furry friends!) do not enter your session space during the experience

Turn on an essential oil diffuser or light an incense stick for a pleasant aroma

Medicine - be sure to double check the dose you should be taking each session

Journal & Pen - this is helpful to keep on hand to jot down notes, questions, or inspiration during or immediately after your psychedelic experiences.

Eyemask - most patients find that wearing an eyemask during their experience helps immensely with immersion and focus.

Blood pressure cuff - this is used for an important safety check before taking your medicine.

Spit cup - spitting out ketamine after 10 minutes allows you to receive the benefits and full effect of the medicine while also minimizing any potential nausea.

Glass of water or juice - this can be helpful to cleanse your palate once you no longer have the medicine in your mouth.

Headphones - for listening to music during your experience. Remember to fully charge them if they have batteries! 

Create distance from work and external responsibilities

Calm the mind with a guided meditation from our library

Avoid any irritating personal conflicts, news, and social media

The Do’s and Don’ts for a Safe Psychedelic Experience

Double-check to make sure your Sitter will be home and present during your experience

Use the restroom immediately before to avoid disruptive bathroom breaks

Plan to spend the rest of your day relaxing and integrating

Take the medicine if your blood pressure is over 160/100*

Drink alcohol or excessive caffeine the day of (tea is okay)

Smoke cannabis or take benzodiazepines on your dosing day

This step-by-step guide walks you through how to prepare your mind, body, and environment for a safe and fulfilling journey inwards with at-home psychedelic assisted therapy.