Ketamine Therapy Myths and Facts: What You Should Know

You've probably encountered conflicting information about ketamine therapy. One source calls it a party drug. Another warns about addiction. A third claims it's a miracle cure. If you've been researching treatment-resistant depression, these contradictions make an already difficult decision harder.

You're not alone. Millions of people with depression don't respond adequately to traditional antidepressants, and many of them are trying to separate fact from fiction about alternatives like ketamine.

The bottom line: Most of what circulates about ketamine therapy is outdated, incomplete, or applies to recreational use rather than supervised medical treatment. When administered properly, ketamine is an evidence-based option with response rates often in the 40–70% range. It works through a completely different mechanism than traditional antidepressants, and that difference matters.

What Is Ketamine Therapy?

Ketamine therapy involves administering controlled doses of ketamine under medical supervision to treat depression, anxiety, PTSD, and other mental health conditions. The doses used are subanesthetic, far lower than those used for surgical anesthesia or recreational purposes.

Two main clinical approaches exist. FDA-approved esketamine (Spravato) is a nasal spray requiring healthcare provider observation and 2-hour post-administration monitoring through REMS protocols. Off-label racemic ketamine is delivered via IV, intramuscular injection, or sublingual tablets.

Clinical guidelines describe ketamine-based therapies for treatment-resistant depression, typically defined as inadequate response to at least two adequate antidepressant trials. Ketamine isn't a first-line treatment. It's an option when other approaches haven't worked.

How Does Ketamine Work Differently?

Traditional antidepressants like SSRIs target serotonin. They require 4–8 weeks to work because therapeutic effects depend on gradual changes in receptor sensitivity.

Ketamine operates through a fundamentally different system. It targets NMDA receptors in the glutamate system, producing antidepressant effects within hours to days. The speed matters.

Stage 1: Releasing the brake. Ketamine blocks NMDA receptors on inhibitory brain cells, removing the neurological brake that normally suppresses activity in mood-regulating circuits.

Stage 2: The glutamate surge. With the brake released, your brain releases glutamate, its primary excitatory neurotransmitter. The glutamate surge activates AMPA receptors.

Stage 3: Growth factor release. AMPA activation triggers release of Brain-Derived Neurotrophic Factor (BDNF), a protein essential for neuronal growth.

Stage 4: New connections form. Studies suggest ketamine rapidly promotes synapse formation in mood-related circuits, which may underlie its fast antidepressant effects.

For someone living with treatment-resistant depression, this mechanism can mean feeling functional again within days instead of waiting months for another antidepressant trial.

What Are the Most Common Myths About Ketamine Therapy?

Myth #1: "Ketamine is an opioid"

Fact: Ketamine is not an opioid. Johns Hopkins confirms it works through NMDA receptors in the glutamate system, not opioid receptors. The confusion may stem from ketamine's use as an anesthetic, but it has a completely different mechanism and risk profile than opioids like morphine or fentanyl.

Myth #2: "It just gets you high and masks symptoms"

Fact: This theory has been "debunked" according to Mayo Clinic. Ketamine produces measurable neuroplastic changes that outlast any acute effects. Brain imaging studies show ketamine promotes new synaptic connections in mood-regulating regions. These are structural changes, not just symptom masking.

Myth #3: "Ketamine therapy is highly addictive"

Fact: A scoping review of 65 studies found no misuse or dependence in professionally supervised treatment for treatment-resistant depression. Context matters: medical doses, clinical oversight, and structured protocols fundamentally change the safety profile compared to recreational use. Ketamine is classified as a Schedule III controlled substance, meaning it has recognized abuse potential, but supervised medical treatment is different from recreational use.

Myth #4: "Effects are only temporary"

Fact: Single doses often produce effects lasting 1–2 weeks in people who respond. Maintenance protocols can extend benefits over a year or more for some. The duration varies by individual, but "temporary" doesn't mean "brief."

Myth #5: "Ketamine causes permanent brain damage"

Fact: This concern comes from studies of heavy recreational abuse at high doses over extended periods. Research at therapeutic doses has generally not found evidence of persistent cognitive decline. Medical ketamine uses controlled doses in supervised settings, a fundamentally different exposure pattern.

Myth #6: "At-home ketamine is unsafe or unregulated"

Fact: The FDA has warned about compounded ketamine products used without proper medical oversight. But at-home ketamine with appropriate clinical supervision, including psychiatric evaluation, dosing protocols, monitoring, and integration support, is a legitimate treatment model. The key is choosing a provider with licensed clinicians and comprehensive safety protocols, not minimal screening and follow-up.

Myth #7: "Ketamine is a quick fix"

Fact: Ketamine isn't a one-and-done cure. Most protocols involve 6–8 sessions over 2–3 weeks for initial treatment, followed by maintenance sessions as needed. Many people who respond see noticeable improvement within the first few sessions, but a substantial minority don't respond even after a full induction series. Lasting benefit often requires combining ketamine with therapy to translate neuroplastic changes into new thought patterns and behaviors.

What Are the Benefits?

Clinical trials demonstrate substantial efficacy for treatment-resistant populations:

• Response rates often in the 40–70% range, depending on protocol
• Rapid onset within 24 hours of first dose in many cases
• In one inpatient trial, JAMA research reported 44% remission rates with adjunctive ketamine infusions
• Significant reduction in suicidal ideation demonstrated in randomized controlled trials according to Nature research

In a large NEJM trial of nonpsychotic treatment-resistant depression, ketamine achieved a 55% response rate compared to 41% for electroconvulsive therapy.

Not everyone responds. Some people complete a full treatment series without meaningful improvement. But for many who haven't found relief elsewhere, ketamine represents a genuinely different approach.

What Does Improvement Actually Look Like?

Clinical trials measure symptom reduction on standardized scales. But what does it feel like in practice?

People often describe it as the volume turning down. The constant noise of dread or emptiness doesn't vanish entirely, but it quiets enough to function. You might notice you can get out of bed without the usual negotiation. A conversation with a friend doesn't feel like performing. Activities that once brought some pleasure start to register again.

Small tasks that felt insurmountable become manageable. The mental fog that made concentration difficult starts to lift. You might find yourself looking forward to something for the first time in months.

The experience is less about euphoria and more about remembering what a baseline sense of functioning felt like before depression made you forget.

What Are the Risks?

According to the FDA label, dissociation, dizziness, nausea, temporary blood pressure increases, and sedation are among the most common adverse reactions of ketamine therapy. Most dissociative and blood-pressure-related effects occur around dosing and typically resolve the same day.

Other considerations:

• Bladder effects: Long-term heavy recreational use has been associated with bladder problems. At therapeutic doses with appropriate monitoring, this risk is much lower, but providers should track any urinary symptoms.
• Blood pressure: Temporary increases during treatment require monitoring, especially for people with cardiovascular concerns.
• Dissociation: The dissociative experience during treatment can feel unsettling for some people, though many find it tolerable or even helpful for processing difficult emotions.

Proper screening, monitoring, and follow-up substantially reduce these risks. The key is working with a provider who takes safety seriously, not one focused on minimal oversight.

Who Should Not Use Ketamine Therapy?

Careful screening matters. Ketamine therapy may not be appropriate for people with:

• Uncontrolled hypertension or significant cardiovascular disease
• Severe liver impairment
• Active psychosis or a history of psychotic disorders
• Unstable substance use disorders
• Pregnancy or breastfeeding

If any of these apply, you'll need specialist evaluation before considering ketamine. A thorough screening process protects you and ensures treatment is both safe and appropriate.

Why Does the Therapeutic Approach Matter?

Ketamine promotes neuroplasticity. New synaptic connections form in mood-regulating brain regions. But that neuroplasticity window is most valuable when you use it intentionally.

The medication opens a door. Therapy helps you walk through it.

Integration sessions help you process insights from the treatment experience and translate them into concrete behavioral changes. Clinical research suggests ketamine therapy may work better and have more durable benefits when combined with psychotherapeutic support.

Some providers just deliver ketamine with minimal oversight. Others build therapeutic support into every step. The difference matters for how long your results last.

How Innerwell Does Ketamine Differently

Innerwell delivers at-home ketamine therapy paired with licensed psychotherapist support. This isn't medication dropped off with minimal supervision. It's a complete program built around the idea that the therapeutic relationship matters as much as the medicine.

Licensed clinicians, not unlicensed guides. Every session is overseen by Master's or Doctoral-level licensed therapists with specialized training through partnerships like Fluence Training.

Therapeutic support built in. Innerwell includes preparation sessions before treatment and integration therapy afterward to help you process insights and translate them into lasting changes.

At-home comfort. Treatment happens in your own space, removing the logistical burden of clinic visits while maintaining clinical rigor through telehealth monitoring.

Insurance partnerships. Costs as low as $54 per treatment with insurance coverage in California and New York, compared to $400–$1,200 per session at many IV clinics.

In Innerwell's internal outcomes tracking, people report a 69% reduction in depression symptoms and 60% reduction in anxiety symptoms after 10 weeks, with 87% seeing improvement within four weeks.

The Bottom Line

Most misconceptions about ketamine therapy stem from conflating recreational misuse with supervised medical treatment. The clinical evidence tells a different story: ketamine is an evidence-based option that may help when traditional antidepressants haven't worked.

Not everyone responds. Maintenance protocols matter. Medical supervision is essential. But for many people with treatment-resistant depression, ketamine represents a genuinely different approach worth considering.

If you're wondering whether ketamine therapy might be right for you, take a free assessment to explore your options.

Frequently Asked Questions

Is ketamine therapy legal?

Yes. FDA-approved esketamine (Spravato) is fully legal for treatment-resistant depression with mandatory safety protocols. Off-label racemic ketamine is also legal when prescribed by licensed physicians, though it lacks FDA approval for psychiatric use.

What does the dissociative experience feel like?

Most people describe it as mild to moderate: feeling floaty, dreamlike, or detached from your body. Effects peak around 40 minutes and resolve within 2 hours. True hallucinations are uncommon at therapeutic doses. Many find the experience tolerable; some find it helpful for processing emotions.

How many sessions will I need?

Most clinical protocols use 6–8 sessions over 2–3 weeks. Many people who respond notice change within the first few sessions, but a significant minority don't respond even after a full series. Maintenance frequency varies from weekly to monthly based on individual response.

Will insurance cover ketamine therapy?

Coverage varies. FDA-approved esketamine has growing insurance coverage. Off-label IV ketamine often requires out-of-pocket payment, with many clinics charging $400–$1,200 per session. Innerwell has insurance partnerships in California and New York, with treatment costs as low as $54–$75 per session. Self-pay plans and HSA/FSA funds are also available. Learn more about costs.

Can I drive home after treatment?

No. Dissociative effects begin within 5–10 minutes and persist for about 2 hours. Plan for transportation and allow the rest of the day for recovery. Do not drive or operate machinery on treatment days.