Innerwell combines personalized guidance from licensed therapists with cutting-edge psychedelic medicine. Now serving patients in Arizona, California, Colorado, Connecticut, Florida, New Jersey, New York, Ohio, Oregon, Utah, Texas, Virginia, Minnesota and Washington State. || Innerwell Reflections

Innerwell Reflections

Reflections

Find a Clinician by State

Find a Psychiatrist

Find a Therapist

Find Ketamine Treatment

Find EMDR Therapy

EMDR

Ketamine Treatment

Psychedelic Integration

psychiatry

therapy

arizona-mental-health

california-mental-health

colorado-mental-health

connecticut-mental-health

Delaware

florida-mental-health

georgia-mental-health

idaho-mental-health

illinois-mental-health

iowa-mental-health

Kentucky

maine-mental-health

massachusetts-mental-health

michigan-mental-health

minnesota-mental-health

montana-mental-health

Nebraska

nevada-mental-health

new-hampshire-mental-health

new-jersey-mental-health

new-york-mental-health

north-carolina-mental-health

ohio-mental-health

oregon-mental-health

pennsylvania-mental-health

tennessee-mental-health

texas-mental-health

utah-mental-health

vermont-mental-health

virginia-mental-health

washington-mental-health

wisconsin-mental-health

 Personalized Mental Health Support from Wyoming Specialists

About

Refer a Patient to Innerwell

Work With Us

Reviews

Why Innerwell

Contact

Affiliate Program

Ketamine for Depression

Ketamine for Anxiety

Ketamine for PTSD

Ketamine for Postpartum Depression

Welcome! What service are you primarily interested in?

Innerwell Privacy Policy

Terms & Conditions

Innerwell Telehealth and Informed Consent

Page Not found. It's okay, we all get a little lost from time to time.

KBS, Inc. and its affiliates (“Innerwell”) provide a platform that connects medical professionals with individuals. Innerwell does not control or direct the activity of the medical professionals providing care through the platform. Innerwell does not provide medical advice and nothing on the platform should be considered medical advice.

Ends soon: 15% off all new plans with code OCT15

About 50% of patients don't respond to their first antidepressant. Ketamine therapy offers a different mechanism of action—one that works through novel brain pathways and can produce results within hours instead of weeks, but that doesn’t mean ketamine therapy is right for everyone. 

Ketamine therapy requires true treatment resistance, tolerance for dissociative side effects, commitment to ongoing therapy work, and access to qualified providers. Whether it's right for you depends on your specific clinical profile, practical circumstances, and readiness to engage.

This guide walks you through seven decision-making questions. By the end, you'll have a better idea of whether ketamine therapy is worth pursuing for your situation.

Important: This information is educational, not medical advice. Only a licensed professional who knows your complete medical history can determine if ketamine suits your situation.

Why You’re Considering Ketamine Therapy

Many people exploring ketamine therapy have already tried standard treatments. Some experience success, while others enjoy brief moments of improvement that fade. Others see no change at all.

The mental weight of wondering whether things will ever improve can be exhausting. You may be researching ketamine therapy because you’re looking for something different, but you’re right to be cautious. It’s essential to cover the basics before diving in. 

Ketamine therapy has produced meaningful results for many people with treatment-resistant depression and anxiety, but it's not a universal solution. It requires proper medical oversight, realistic expectations, and integration into a broader mental health plan.

7 Questions: Is Ketamine Therapy Right for Me?

These seven questions cut through the marketing claims and provide the framework needed to determine if ketamine therapy aligns with your individual situation.


1. Are Your Depression or Anxiety Symptoms Truly Treatment-Resistant?

Treatment-resistant depression or anxiety means standard options no longer work. In practical terms, you cross that threshold after trying at least two different antidepressants, each at therapeutic doses for six to eight weeks, without meaningful relief according to Mayo Clinic guidance. 

You're not alone: around one-third to one-half of people with major depression don't improve after their first antidepressant.

Before labeling symptoms "treatment-resistant," clinicians must confirm that you meet criteria for Major Depressive Disorder. The DSM-5 framework requires five or more specific symptoms—persistent low mood, loss of interest, changes in sleep or appetite, or recurrent thoughts of death—present during the same two-week period, severe enough to disrupt work, relationships, or daily functioning.

Have you completed at least two full courses of antidepressants at prescribed doses?

Taken each medication consistently for six weeks or longer?

Tried evidence-based therapy like CBT for at least eight sessions?

Addressed medical conditions like thyroid problems?

Are you using alcohol, cannabis, or supplements that might interact with medications?

Recognizing true treatment resistance ensures you don't leap to advanced therapies prematurely, and spares you the frustration of repeating approaches that won't help. If you've exhausted these options, ketamine therapy might be a good next step to explore with your healthcare provider.


2. Will Ketamine Therapy Match Your Expectations?

Ketamine works through a completely different pathway than traditional antidepressants by blocking the brain's NMDA receptors and triggering a surge of glutamate that sparks new neural connections. This is why many people notice a shift in mood within hours.

Clinical research shows IV ketamine produces significant antidepressant effects within hours to days for many patients with resistant depression. Esketamine nasal spray acts almost as quickly, while oral or sublingual lozenges build more gradually over the first few sessions.

Rapid relief doesn't mean universal relief. Roughly one in five patients feels a minimal change after an initial series, and even strong responders may need periodic booster doses. Your diagnosis, metabolism, concurrent medications, and delivery method all shape response.

The advantage of ketamine therapy is the faster feedback loop: instead of waiting a month to see if a medication helps, you'll know within a session or two whether ketamine is working. If it isn't, you can pivot without losing another season to trial-and-error.


3. Can You Access Ketamine Therapy and Commit to the Treatment Format?

Ketamine therapy comes in several forms, each with different time commitments, costs, and accessibility requirements. Understanding what's actually feasible for your situation matters as much as clinical fit.

Oral sublingual tablets offer the most flexibility, avoiding needles and clinic appointments entirely. At-home programs like Innerwell ship pre-measured tablets, a digital blood-pressure cuff, and a dosing guide directly to your door. 

Intramuscular (IM) injections step up the clinical involvement slightly, requiring quick clinic visits or mobile services. Effectiveness and costs fall between IV and oral options, but you'll need access to a provider offering this format and reliable transportation to appointments.

Nasal sprays (FDA-approved esketamine) require two-hour supervised clinic visits where you'll spray the medication under nurse observation. You'll need reliable transportation and a clinic within a reasonable distance.

Intravenous (IV) infusions represent the most time-intensive option, requiring in-clinic visits lasting several hours with continuous vital-sign monitoring. If you live far from specialty clinics or can't take multiple half-days off work, this option becomes impractical regardless of its clinical benefits.

The practical reality: The question isn't which format is "best" in the abstract; it's which you can actually access and sustain over the course of treatment.


4. Do the Risks and Requirements Align With Your Health Profile?

Ketamine is a potent medication, even at the low doses used for mental health care. Before committing to treatment, you need to understand both the common side effects most people experience and the medical conditions that make ketamine unsuitable.

Floating sensation, lightheadedness, or shifts in perception

Dissociation, which typically fades within an hour

Dizziness, nausea, or brief blood pressure spikes

Long-term risks deserve careful consideration. Repeated high-dose or unsupervised use can cause bladder inflammation and, rarely, elevated liver enzymes. Because ketamine is a controlled substance, reputable clinics monitor for any signs of dependency or misuse.

Conditions that make ketamine unsuitable:

Uncontrolled high blood pressure or serious heart disease

Medications that raise blood pressure or significantly affect brain chemistry

Quality programs build safety into every step—medical screening with labs when needed, real-time monitoring during treatment, mandatory recovery periods, and follow-up calls checking for lingering effects. 

Ask yourself: Are you willing to experience temporary dissociation and other mild side effects? Do you have any medical conditions that would rule you out as a candidate? Can you commit to safety protocols like monitoring your blood pressure and having a clinician available during sessions? 

If the answer to any of these is uncertain, ketamine therapy may not align with your current health profile or comfort level.

5. Are You Ready to Commit to Integration and Ongoing Therapy?

Ketamine works best when paired with structured psychotherapy. If you're expecting a medication you can take passively without additional therapeutic work, ketamine therapy probably isn't the right fit.

Research shows that ketamine-assisted psychotherapy deepens insights and extends the antidepressant benefit far beyond what the medication alone provides. 

Scheduling therapy sessions within 48 hours of dosing

Blocking out time for journaling or reflection

Working with your therapist to translate insights into actionable changes

Continuing your existing therapy and medications

Innerwell's model involves coordinated care with licensed psychotherapists, psychiatrists, and specialized clinicians. Patients receive personalized dosing guidance, telehealth support, and integration resources through the Innerwell app—but you still need to show up for the work.

The reality: If you're not willing to commit to regular therapy sessions, journaling, and active integration work, ketamine therapy likely won't produce the lasting results you're hoping for.

Ketamine therapy costs vary dramatically depending on delivery method and insurance coverage. 

IV infusions typically require the largest financial commitment. They are considered "off-label" for psychiatric use, so most insurance plans decline payment. Expect $400–$800 per infusion out-of-pocket.

Nasal spray costs between $900–$1,200 per session at list price, but insurers are far more willing to cover it because it carries FDA approval for treatment-resistant depression. 

At-home sublingual programs are often the most affordable option, and pair ketamine with tele-psychiatric supervision at $81–$125 per treatment.

Your deductible status and whether the provider is in-network

Which format (if any) your plan covers, and what prior authorization requires

Total out-of-pocket costs for your first 2-3 months of treatment

Whether payment plans or financial assistance programs are available

The bottom line: Financial stress undermines treatment outcomes, so honest assessment of affordability matters as much as clinical fit.

7. Can You Identify a Safe and Qualified Provider?

The difference between safe, effective ketamine therapy treatment and a risky experience comes down to provider quality—and knowing what questions to ask before you commit.

Licensed psychiatrists and prescribing clinicians on staff

Licensed therapists trained in ketamine integration

Published patient-outcome data, like remission rates and symptom reductions

Documented safety protocols, including pre-treatment screening, real-time vital-sign monitoring, and post-session observation

Transparent pricing and insurance guidance upfront

Responsive patient support staffed by clinicians

Innerwell was designed around patient-first care. Every treatment pairs a board-certified psychiatric prescriber with a licensed therapist, and outcome data from thousands of sessions drives continuous protocol refinement.

Who will supervise my sessions, and what are their credentials?

How many patients does each clinician manage per day?

What happens if I experience a medical or psychological adverse event?

How will you help me integrate insights into daily life?

The reality: If you can't find a qualified provider in your area or through telehealth platforms, ketamine therapy may not be a safe option for you right now.

Ketamine therapy isn't universal. It requires the right clinical profile, financial resources, commitment to therapy, and access to qualified care. 

You now have a framework to evaluate whether ketamine therapy aligns with your situation. You know if you're truly treatment-resistant, whether the timeline and success rates match your expectations, which formats you can access, if the risks fit your health profile, whether you're ready for integration work, if you can afford treatment, and how to identify qualified providers.

Innerwell combines licensed psychiatric care with therapist-guided integration and at-home convenience. Our patients see a 69% reduction in depression symptoms and a 60% reduction in anxiety symptoms after ten weeks. Board-certified prescribers and licensed therapists work together on every treatment plan, with telehealth supervision and safety monitoring built into each session.

Ready to find out if you're a candidate for ketamine therapy? Get started here.

Wondering if ketamine therapy is right for you? Answer 7 helpful questions about resistance, costs, and risks to decide if it's the right fit.

Is Ketamine Therapy Right for Me? 7 Questions To Ask Yourself

Introduction

Your Next Steps Towards Ketamine Therapy

Two different people can take identical doses of ketamine treatment and have completely different experiences. One might feel profound relief that lasts for days, while the other notices effects that fade within hours. The difference is biochemistry.

Your body transforms ketamine through liver enzymes, genetic variations, and other factors that make your response uniquely yours. This metabolism determines how quickly the medication converts into active compounds, how long therapeutic effects last, and how intensely you experience treatment.

This article explains how your body processes ketamine, what factors influence that processing, and how clinicians use metabolic insights to personalize treatment.

Metabolism is the set of chemical processes your body uses to break down substances. These reactions, which happen primarily in your liver, convert what you consume into forms your body can use or eliminate.

When you take ketamine, liver enzymes transform it into breakdown products called metabolites. Many remain therapeutically active and contribute to your treatment experience. This transformation determines how long ketamine works, how intensely you experience its effects, and how your body clears it away.

Your unique processing system—shaped by genetics, health, medications, and lifestyle—means you'll respond differently than others.

The four phases of pharmacokinetics—Absorption, Distribution, Metabolism, and Elimination— shape how your body processes ketamine.

Absorption: Ketamine enters your bloodstream through different routes, and the method matters. Intravenous (IV) delivery sends the medication directly into circulation for rapid absorption. Oral consumption takes longer because the medication must pass through the liver first.

Distribution: Once in your bloodstream, the medication travels throughout your body, including to your brain, where it produces both therapeutic and psychoactive effects. 

Metabolism: In your liver, a family of enzymes called cytochrome P450—particularly CYP3A4, CYP2B6, and CYP2C9—converts ketamine into norketamine and other compounds. These breakdown products shape how long the effects last and what they feel like.

Elimination: Finally, your body clears out ketamine and its breakdown products, primarily through urine. With a half-life of approximately 2-3 hours, you can predict roughly how long the medication stays active in your system.

The metabolic journey doesn't end with initial liver processing. The primary compound, norketamine, retains some psychoactive effects, though it's less potent than ketamine itself. 

Norketamine continues undergoing transformation to form hydroxynorketamine, believed to contribute to antidepressant effects. Dehydronorketamine is another byproduct, though its role is less understood and less potent.

Ketamine actually exists as two mirror-image forms called R-ketamine and S-ketamine. This racemic mixture means your body processes two chemically similar but distinct molecules, each with its own metabolic pathway and therapeutic properties.

Researchers continue to investigate how exactly these compounds contribute to therapeutic benefits, with hydroxynorketamine showing particular promise in ongoing investigations.

How Does Slow Or Fast Metabolism Impact Ketamine Treatment?

Your liver's speed in breaking down ketamine shapes the intensity, duration, and even the safety profile of each session. 

When liver enzymes work slowly, ketamine and its active compound norketamine stay in your bloodstream longer. This extends symptom relief but also intensifies dissociation and can cause short-term spikes in blood pressure or heart rate.

Fast processors face the opposite challenge. They clear the medication quickly, which means the antidepressant benefits might fade sooner. This often prompts clinicians to increase the dose or shorten intervals between sessions.

Metabolism speed is key to determining treatment dosage. For example, at Innerwell, we review your medical history, current medications, and how you respond to early treatments, then fine-tune your regimen based on what your body tells us. This personalized approach can help patients achieve significant improvements in depression and anxiety scores. 

Slower processors hold onto ketamine and norketamine longer, raising the chance of lingering dizziness, nausea, or elevated blood pressure, especially true for people with liver or kidney impairment. 

Fast clearance rarely causes danger, but it can leave you underdosed—risking disappointment rather than harm.

By measuring, monitoring, and adapting to your unique pace, clinicians keep benefits steady and side effects manageable, and keep each session effective and safe.

What Makes Some People Process Ketamine Differently?

Three main factors shape how quickly or slowly you break down the medication, and understanding them helps your clinician dial in the perfect dose.

Genetics & liver enzymes: Your liver's cytochrome P450 system runs on enzymes built from your DNA. One common variant, CYP2B66, slows the main metabolic pathway that converts ketamine to norketamine. People with this variant often show higher blood levels and longer-lasting effects from the same dose. 

Health, age & lifestyle: Your current health determines your metabolic rate. For example, kidney disease slows elimination, older age naturally reduces liver blood flow, and hormonal changes—pregnancy or menopause—can shift enzyme activity. Daily habits count too; even poor sleep affects your metabolism.

Other medications & substances: Since the same CYP system processes dozens of medications, metabolic interactions happen frequently. Strong inhibitors like fluoxetine, macrolide antibiotics, or even grapefruit juice can raise medication levels, intensifying both therapeutic and dissociative effects.

It's critical to share your complete medication list—prescriptions, supplements, and recreational substances—before treatment. A few minutes of honest disclosure prevent dosing complications and keep your sessions both safe and effective.

Does the Method of Taking Ketamine Change How It Works?

How ketamine enters your body shapes everything that follows—from the speed of relief to which metabolic pathways dominate. 

First-pass processing is when the liver processes anything you swallow before it can circulate throughout your body. Non-oral routes, like IV injections, either bypass or limit this metabolic step, delivering more unchanged ketamine and producing a different balance of active compounds.

IV injection bypasses your digestive system entirely, minimizing early metabolic conversion and achieving nearly 100% bioavailability. 

Intramuscular injection also achieves high bioavailability (approximately 93%) with rapid absorption and limited initial metabolism.

Intranasal sprays deliver 45–50% bioavailability by absorbing through nasal blood vessels, offering a middle ground for patients who need clinic oversight but prefer to avoid needles.

Sublingual lozenges dissolve under your tongue and absorb through oral blood vessels, bypassing most of the liver’s first-pass metabolism, achieving around 24-32% bioavailability. 

Swallowed tablets or capsules provide around 20% bioavailability because they must travel through the gut and liver first.

Innerwell uses oral sublingual lozenges because they strike a practical balance of accessibility and effectiveness: convenient for at-home dosing and potent enough to achieve therapeutic blood levels.

Lozenges trigger proportionally more metabolic conversion to norketamine, which can extend relief but may reduce the immediate dissociative experience. Faster routes feel stronger, peak sooner, and fade quicker, while slower routes build gently and linger longer. 

How Does Innerwell Adjust Treatment to Your Metabolism?

At Innerwell, we account for your individual metabolism through comprehensive assessments and personalized treatment plans that evolve with your responses.

The process starts during your medical screening, where you'll share liver and kidney history, current prescriptions, and supplements. This allows clinicians to spot CYP inhibitors or inducers that could affect how you metabolize ketamine. 

Once treatment begins, every session becomes a data point. You'll log how quickly the lozenge took effect, the depth of dissociation, and how long mood relief lasts.

Real-time notes flow into the Innerwell portal, where your prescriber tracks metabolic patterns. Maybe your fluoxetine regimen is slowing ketamine clearance, or you metabolize the medication so quickly that benefits fade by day two. 

Follow-up appointments translate those insights into careful dose adjustments or timing tweaks, keeping blood levels within the therapeutic window described in pharmacokinetic studies.

This feedback loop, guided by licensed psychotherapists and psychiatric providers, helps patients achieve meaningful reductions in depression and anxiety symptoms.

Making Your Ketamine Treatment Work for You

Your body's metabolism determines how ketamine works for you. Genetics, liver enzymes, health conditions, medications, and lifestyle all influence how quickly you process the medication. When you understand these factors, you can work with clinicians to optimize your results.

At Innerwell, we translate metabolic science into personalized treatment through comprehensive screening, real-time tracking, and continuous adjustments. Our approach helps patients achieve meaningful improvements in depression and anxiety by honoring their unique biology.

Ready to explore treatment designed around your metabolism? Start with our Initial Screening.

How do I know if I'm a fast or slow metabolizer? 

Your response to early treatments provides key clues. If effects fade quickly or you need higher doses for relief, you may be a fast metabolizer. If effects linger longer or you experience intense dissociation at standard doses, you may metabolize more slowly. Your clinician tracks these patterns to adjust your protocol.

Can my metabolism change during treatment? 

Yes. Changes in other medications, health conditions, stress levels, and even sleep patterns can shift how quickly you process ketamine. This is why ongoing monitoring and dose adjustments matter—your metabolism isn't fixed.

Learn how your body metabolizes ketamine, why it matters for treatment, and what affects processing speed, administration routes, and dosages.

Reflections

Is Ketamine Therapy Right for Me? 7 Questions To Ask Yourself

How Does Your Body Metabolize Ketamine? A Complete Guide

Atypical Depression: Recognizing Hidden Symptoms and Rethinking Treatment

Rethinking ADHD: A Multimodal Path to Focus & Balance

Preventing Trauma Before It Starts: The Future of Resilience-Based Mental Health

The Invisible Trauma: How Neglect Shapes the Brain — and How We Heal

Preventing Trauma Before It Starts: The Future of Resilience-Based Mental Health