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Ketamine therapy can feel daunting, especially when you're trying it for the first time. What does it actually feel like during a session? How will your body react? Will you lose control? These questions are normal when considering a treatment that works so differently from traditional antidepressants.

This guide walks you through the complete experience, from your initial screening call to your recovery in the hours after treatment. You'll learn exactly what happens at each stage, what sensations to expect, and how Innerwell's clinical team supports you throughout the process.

By the end, you'll understand how ketamine therapy works at sub-anesthetic doses to promote new neural pathways in the brain's mood circuits, often creating rapid mood improvements within hours. More importantly, you'll know what to expect so you can approach your first session with confidence instead of uncertainty.

What Happens Before Your First Ketamine Session?

Your treatment journey begins with a thorough safety check. After completing a brief online screener, you'll schedule a video consultation with one of our psychiatric clinicians. This screening protects you by ensuring ketamine is safe and appropriate for your specific situation.

During the 15-20 minute call, we'll review your treatment history, current medications, and vital signs. Some conditions make the therapy unsafe right now:

This careful screening ensures the medication will actually help you, not just be another disappointment.

Once you're approved, your first two doses arrive in the Innerwell Box, including:

Skip heavy meals for a few hours to avoid nausea

Create a quiet, dimly lit space where interruptions won't happen

Have a trusted person nearby; they're not there to guide you, just to ensure you feel safe while the medicine works

Take a moment to set an intention. Write down what you hope to understand, release, or discover. This simple step focuses your mind and often shapes the insights that emerge later. When preparation meets intention, you enter treatment ready for the change you've been seeking.

For a complete preparation checklist, see our guide on how to prepare for your ketamine experience.

What Happens During a Ketamine Therapy Session?

1. Right Before Your Session (15 minutes prior)

You'll log into the Innerwell portal and launch an interactive guide that walks you through every step. A brief video check-in with your psychiatric clinician confirms your intention for the session and your baseline blood pressure. You'll dim the lights, choose supportive music, and keep a journal within reach, small details that deepen the therapeutic effect.


When it's time to begin, place the rapid-dissolve tablet under your tongue and let it melt completely. Resist the urge to swallow, because holding the medicine in place maximizes absorption. Most people notice a shift within 15-20 minutes. Your companion provides general support during your session and can help contact emergency services if anything feels off.

The core journey lasts roughly 40 to 60 minutes. In the first ten minutes, you may feel light tingling in your hands or pleasant warmth spreading through your body.

As the medication peaks, many describe a gentle sense of floating, time dilation, or watching thoughts from a peaceful distance, sensations clinicians label "dissociation" that are typically more curious than frightening. Insightful images or memories can surface, so jotting down fragments in real time helps capture material you might explore later in integration therapy.

Around the one-hour mark, the effects taper, letting you reconnect with your surroundings while lingering calm settles in. You remain conscious throughout; at the low therapeutic doses Innerwell prescribes, the treatment stays well within safe, clinical parameters and doesn't trigger the overwhelming experiences people sometimes fear. Our Ketamine 101 guide explains the science behind how these controlled doses work differently from higher recreational amounts.

Once you feel steady on your feet, you'll debrief with your therapist over video. Together, you review blood-pressure readings, discuss any emotional themes, and map out integration exercises such as guided breathing or reflective writing.

Because your treatment happens at home, you avoid IV needles and recovery bays common in clinic-based infusions. Yet you still benefit from licensed oversight, personalized dosing, and rapid medication delivery straight to your door.

What Happens After a Ketamine Therapy Session?

You'll feel a gentle come-down first; most people describe it as mild grogginess or soft, floaty relaxation. These sensations typically fade within one to two hours and resolve within four hours at most. Some patients even feel grounded within 10 to 15 minutes and notice an immediate mood lift that can appear the same day. 

Skip driving, operating machinery, or making big decisions right now. Give yourself space to rest, hydrate, and let everything settle.

The next 24 hours bring mild after-effects for most people: nausea, headache, or fatigue. Dizziness or blurred vision happens less often. These reactions fade quickly and rarely need treatment, but Innerwell keeps a clinical support line open daily for patient concerns and provides guidance on accessing support if anything feels concerning outside of these hours. 

Light meals, extra water, and quiet downtime usually resolve any discomfort.

Capture insights while they're fresh to turn a single dose into lasting change. Jot thoughts in a journal, revisit the integration exercises, or work through the step-by-step integration guide. Your therapist will schedule a debrief, and the Innerwell portal's mood-tracking prompts help you log feelings, patterns, and questions. 

These small actions weave the session's clarity into everyday life, sustaining progress between doses.

Most patients complete their initial treatment in four to eight weeks. Your journey begins with Innerwell's Foundation Plan, eight sublingual doses paired with three psychiatric check-ins and a dedicated therapy session, spread across this timeframe.

This structured approach gives your brain repeated opportunities to build new neural pathways. If you're dealing with deeper or more persistent symptoms, the Extended Plan scales up to 24 doses with five clinician appointments. Our guide on how starting ketamine treatment at Innerwell works walks through each plan in detail.

Sessions typically happen once or twice weekly during this initial phase. Each dose builds on the last, creating cumulative neuroplastic changes that traditional antidepressants can't match.

Once your symptoms show sustained improvement, tracked through both clinical scores and your day-to-day experience, you'll transition to maintenance care. Your clinician adjusts this rhythm based on how you're responding, ensuring you get exactly what you need without overdoing it.

What Are the Potential Side Effects of Ketamine Therapy and How Are They Managed?

Even with careful dosing, you may feel a few bumps along the way. During a session, mild anxiety, a flutter of nausea, or brief disorientation are the most common reactions. 

Your therapist stays online to coach breathing or pause the dose until you regain calm. Once the medicine wears off, light dizziness, a low-grade headache, or fatigue are normal and fade after rest.

Serious complications are rare. Blood pressure can rise, so you check it before and after each dose, and clinicians stand by to advise if numbers spike. "Emergence" agitation, an abrupt, unsettling rush as the drug clears, is unusual at sub-anesthetic doses and resolves quickly with reassurance. Bladder damage appears only in people who use high doses recreationally, not in supervised therapy.

Innerwell emphasizes extra protection through oversight by licensed psychiatric providers, therapists trained in psychedelic therapy (including, but not exclusively through, Fluence), pre-session safety protocols, and robust support systems for patients. The medication itself has been a hospital staple since the 1960s, giving us decades of safety data to draw on.


You now understand how ketamine therapy works, from your first screening call through post-session recovery. Each 40-60 minute session is guided by licensed psychiatric providers with real-time support, and most patients complete initial treatment in 4-8 weeks.

While other providers charge $200+ per session with unlicensed guides, Innerwell's insurance partnerships bring costs down to $54 per treatment. You get licensed therapists and comprehensive clinical oversight at a fraction of the cost.

Ready to take the next step? Start your free mental health assessment, and our clinical team will guide you forward.

Frequently Asked Questions on Ketamine Therapy

You'll feel the medicine working for about 40 to 60 minutes, the period when most of the dissociative effects occur. By 90 minutes, you're usually back to baseline, and any lingering sensations fade within the next hour or so, giving the entire appointment a two-hour footprint from dosing to full recovery. This timeline remains consistent across most patients.

Yes. Acute side effects, grogginess, mild dizziness, or blurred vision typically disappear within four hours, allowing you to sleep normally and return to work the following morning. Just avoid driving or making major decisions until the evening after treatment. Most people find they can resume normal activities without issue.

What if I feel uncomfortable or anxious during the session?

Real-time clinical support is a click away. If anxiety spikes, your clinician can coach you through breathing exercises or other coping skills;, these approaches often help symptoms settle within a few minutes as the session continues. Medication dose changes, when needed, are made gradually over time rather than during a session. Your session companion and 24/7 support line add extra layers of reassurance. The controlled, supervised environment means you're never navigating the experience alone.

Learn what happens during ketamine therapy from screening to recovery. Understand the timeline, session experience, and side effects.

Ketamine Therapy: What to Expect Before, During & After

Introduction

How Long Does Ketamine Therapy Take?

FAQs

Trying to figure out whether you can legally start ketamine therapy can be confusing. One site tells you ketamine is a tightly controlled anesthetic, another promises doorstep delivery, and state maps light up with conflicting rules.

Ketamine has moved beyond the peripheral stigma and out-of-date scepticism. Today, it's a well-researched, proven method for treating depression and other mood disorders. Nevertheless, its status as a Schedule III controlled substance still impacts its accessibility.

Because every state layers its own rules on top of federal law, the path to care changes at each border. This guide breaks down ketamine laws by state to help you understand how it’s regulated. 

Yes, ketamine therapy is legal when prescribed by a licensed medical provider, but as a DEA Schedule III controlled substance, it also carries real abuse potential. Careful regulation is therefore necessary.

Schedule III substances are drugs with accepted medical uses but moderate-to-low potential for physical dependence or high psychological dependence - placing ketamine in the same category as certain steroids and stimulants.

Any clinician prescribing or administering ketamine for therapeutic reasons needs DEA registration, plus meticulous record-keeping. We're talking detailed inventories, security protocols, and documentation down to how vials are stored and counted.

Federal law sets the baseline for ketamine as a Schedule III controlled substance in the United States, and each individual state adds its own layer of regulation. This arrangement impacts treatment accessibility depending on where you live and seek treatment. Three key factors drive the differences you'll encounter:

Corporate Practice of Medicine - states like California, New York, and Texas require physician ownership of medical practices, which limits who can open ketamine clinics.

Medical board oversight intensity - some states issue advisory guidelines, while others mandate detailed consent forms, on-site physician presence, and regular audits.

Comfort with off-label use - certain progressive states may allow nurse practitioners to run infusions under physician protocols or permit at-home sublingual treatments.

The level of caution or freedom a state applies to ketamine therapy impacts both availability and perception of quality: 

Stricter rules can increase costs and limit access.

Flexible rules increase access but can leave patients questioning quality.

The regulatory environment varies dramatically across states, creating distinct environments for accessing ketamine treatment.

*Information presented in this table is intended for general informational purposes only. It does not constitute legal advice. Laws and regulations change and vary, and readers should always seek clarity from their physician or healthcare provider first. 

You can legally access ketamine therapy through telehealth in many states, but the rules are complex and constantly evolving. The COVID-19 pandemic accelerated the adoption of telemedicine, and ketamine therapy expanded alongside it through emergency federal flexibilities for remote prescribing of controlled substances.

While the DEA has never explicitly banned at-home ketamine treatment, state medical boards and corporate practice of medicine doctrines ultimately determine whether remote care can legally operate in each jurisdiction, and how.

The real obstacle is finding providers who actually comply with medical standards and regulations. Some telehealth platforms rush patients through brief online questionnaires, ship sublingual tablets, and call it therapy.

Innerwell takes a different approach by maintaining the convenience of at-home dosing while incorporating clinical rigor throughout the entire treatment process. Treatment begins with a comprehensive psychiatric evaluation conducted by licensed prescribers, not automated questionnaires.

Master's- and doctoral-level therapists guide preparation sessions, provide real-time virtual support during each dose, and offer integration therapy afterward to maximize therapeutic benefits.

What Should You Look for in a Legal Ketamine Provider?

A legal ketamine provider must follow the same controlled-substance regulations that govern hospitals and medical centers. Look for:

Proper licensure verification - the prescribing clinician must maintain active state medical licenses and location-specific DEA registration.

Comprehensive initial evaluation - expect a thorough psychiatric and medical evaluation before your first dose.

Session safety protocols - proper at-home ketamine therapy includes pre-session vital sign checks, real-time virtual oversight from licensed therapists, clear emergency protocols, and guidance on when to seek immediate medical attention.

Detailed documentation - legitimate clinics document every milligram dispensed and maintain consent forms, dosing records, and adverse-event reports.

Ongoing therapeutic support - comprehensive care extends beyond individual sessions through integration therapy and scheduled follow-ups.

Innerwell incorporates these clinical benchmarks into an at-home model without compromising safety standards:

Board-certified psychiatric oversight - our providers conduct thorough video evaluations, write and manage prescriptions under their own DEA registrations, and collaborate with master's- and doctoral-level therapists who guide each treatment session.

Comprehensive care beyond dosing - your personalized care plan includes trauma-informed modalities like EMDR, routine symptom tracking, and direct communication with your treatment team.

Insurance accessibility - partnerships with major insurers help reduce out-of-pocket expenses, making properly regulated care more financially accessible.

We’ve covered how Ketamine therapy is regulated under federal law and explored the state-by-state variations that affect access, from scheduling rules and clinic ownership requirements to telehealth limitations and geographic factors. Displaying those differences side-by-side highlights how state-specific regulation can meaningfully shape your treatment options.

At Innerwell, we believe in bringing clinically sound ketamine-assisted therapy into frameworks that respect both legal regulation and individualized care. Through personalized screening, licensed provider oversight, and accessible at-home protocols, we aim to simplify the pathway to safe, effective treatment, wherever your state falls in its regulatory landscape.

Ready to understand if ketamine therapy might be the right next step for you? Take our free self-assessment.

Complete guide to ketamine therapy laws in all 50 states. Learn federal DEA requirements, state regulations, and telehealth rules.

Ketamine Laws by State: 2025 Guide

Is Ketamine Therapy Legal?

Why Do Ketamine Laws Differ By State?

Ketamine Laws by State (2025)

Can You Get Ketamine Therapy Online?

Start Your Ketamine Journey

Struggling with depression can be isolating, but it feels even harder when your symptoms don’t match what people expect. Sleeping too much, eating more, feeling weighed down, or taking things to heart—these experiences are often dismissed as laziness or sensitivity, leaving you unseen and misunderstood. 

This is the reality of atypical depression, a common yet overlooked subtype that requires its own path to healing.

At Innerwell, we understand how frustrating it is to feel misdiagnosed or minimized. That’s why we offer evidence-based, compassionate care that meets you where you are, helping you move toward relief with clarity and support.

Atypical depression is a specific subtype of depression characterized by mood reactivity (the ability to temporarily feel better in response to positive events) and at least two of four key symptoms: 

Leaden paralysis (heavy feeling in limbs)

These criteria, first formalized in DSM-IV in 1994, distinguish atypical presentations from the melancholic pattern most people recognize.

Despite the label, this subtype is neither rare nor mild. Community surveys place lifetime prevalence around 1–4% of the general population, and analyses of clinical samples show that roughly a fifth to a third of people diagnosed with major depressive disorder meet atypical criteria. 

The condition rarely appears alone, showing higher rates of bipolar spectrum illness, seasonal affective disorder, and anxiety disorders. This overlap compounds its impact on daily life, making accurate diagnosis and tailored treatment essential.

Hidden Symptoms That Often Go Unrecognized

These distinctive symptoms—sleeping too much, eating more, feeling "heavy," bristling at perceived slights, yet perking up when something good happens—don't match the stereotype, so they're easy to overlook. 

Understanding each of these signals helps you recognize patterns and seek appropriate care.


If you regularly clock 10-plus hours of sleep, or even just two hours more than your usual baseline, and still wake up exhausted, that isn't laziness. It's one of the most common atypical features documented in large epidemiological studies. 

Because sleeping in feels voluntary from the outside, friends and even clinicians may chalk it up to poor motivation or inconsistent sleep hygiene. This oversleeping stems from the same neurobiological changes that drive other depressive symptoms, including altered circadian rhythms and disrupted stress response systems.


Classic depression often steals your appetite, but this variant does the opposite. You may find yourself craving carbohydrates, eating late at night, and watching the scale creep upward, sometimes rapidly. 

Clinical literature calls this hyperphagia, and it can lead to significant weight gain during an episode. Because our culture tends to frame weight gain as a lifestyle choice, this symptom is frequently attributed to "stress eating" instead of being recognized as part of a medical condition.


Long before other symptoms become obvious, many people notice a hair-trigger reaction to perceived criticism. This isn't a personality quirk; it's a diagnostic criterion that causes significant social or occupational impairment. 

A forgotten text, neutral facial expression, or delayed email can feel like a personal affront, sparking shame and withdrawal. Over time, the cycle of anticipating rejection and pulling back can devastate relationships and reinforce isolation.


Imagine waking up and feeling as if your arms and legs are weighted with sandbags. That heavy, dragging sensation, known as leaden paralysis, is distinct from general fatigue. 

People describe needing extra effort just to shower or climb stairs. Because blood tests and imaging often look normal, this symptom is sometimes misdiagnosed as a thyroid issue or dismissed outright, yet it represents a core feature of this condition.


Perhaps the most confusing sign is mood reactivity: your spirits briefly lift when something positive happens; a friend's joke, a good grade, an afternoon coffee run. For outsiders, that fleeting smile can seem like proof you're "fine," undermining the seriousness of your condition. 

In reality, the bounce is superficial and short-lived, often followed by a deeper crash when the stimulus fades.

The table below illustrates key differences between atypical and melancholic presentations:

Most of us picture depression as endless gloom, not sleeping 12 hours after demolishing a pizza. That cultural script primes both patients and providers to overlook these features. Primary care visits are short, so clinicians often focus on headline signs like persistent sadness and loss of interest, leaving nuanced questions about sleep length or rejection sensitivity unasked.

Stigma layers on additional challenges. Oversleeping gets branded "lazy," weight gain "undisciplined," and emotional sensitivity "dramatic." When you internalize those labels, you may downplay symptoms or avoid care altogether. Mood reactivity complicates matters further: if you can laugh at memes on Monday, coworkers struggle to understand why you're immobilized on Tuesday.

Diagnostic overlap also muddies the waters. Hypersomnia can masquerade as a thyroid problem, leaden paralysis as chronic fatigue, and rejection sensitivity as an anxiety or personality disorder. Without a full picture, well-meaning providers might prescribe treatments better suited to melancholic presentations, delaying relief.

Recognizing these patterns matters because the right diagnosis directs you to therapies—like MAOIs or rejection-focused interpersonal therapy—that have higher success rates for these presentations. The issue isn't your willpower; it's a treatable medical condition that simply wears a different mask.

Rethinking Treatment: Evidence-Based Options

Atypical depression responds to treatment but not always in the ways you'd expect. Finding the right combination requires understanding how different approaches work for specific symptom patterns: 

SSRIs and SNRIs remain the most prescribed first-line treatments, positioned by recent primary-care guidelines as standard for major depressive episodes of any subtype. They offer solid efficacy with manageable side effects, making them practical starting points for most people.

MAOIs also achieve high remission rates for classic presentations. The challenge is practical: MAOIs require tyramine-restricted diets, vigilant drug-interaction monitoring, and prescribers comfortable with older pharmacology. For many people, an SSRI or SNRI offers an effective, lower-maintenance starting point, with MAOIs becoming the ace card when first-line options plateau.

Therapy works just as well as medication alone. A landmark randomized trial found cognitive behavioral therapy to be as effective as phenelzine, with both approaches producing response rates near 60%. CBT teaches you to identify automatic thoughts, dismantle catastrophic predictions, and schedule behaviors that counter hypersomnia and social withdrawal. When rejection sensitivity dominates your experience, interpersonal therapy zeroes in on role disputes, grief, and boundary setting.

Combined treatment delivers faster, more durable recovery than either medication or therapy alone. The evidence consistently supports dual approaches, enhanced by lifestyle factors like consistent sleep schedules to curb hypersomnia, balanced meals to counter cyclical overeating, and moderate exercise to combat the leaden heaviness that makes movement feel impossible. 

When traditional medications fail, you're left in limbo—sometimes for years. These therapies are changing things for the better.


Ketamine-assisted therapy breaks this pattern by hitting the brain's NMDA receptors, sparking new neural connections that depression seems to have dampened. The process starts with thorough medical screening, then moves to treatment—either in-clinic infusions, nasal sprays, or at-home oral lozenges with remote monitoring through programs like Innerwell's.

The difference is striking: many patients feel mood shifts within hours, not the two-month wait typical with conventional antidepressants. Sessions repeat over several weeks while your care team monitors for temporary side effects like dissociation or blood pressure changes. Because the effects can fade, consistency matters.


EMDR takes a different approach, especially when trauma underlies your condition. You recall difficult memories while following bilateral movements—usually a therapist's finger. This dual attention helps your brain reprocess memories that feel frozen in time, lifting both trauma symptoms and depressive weight. Many describe it as gentler than traditional exposure therapy.


Technology is accelerating these breakthroughs through digital psychiatry tools that analyze your genetics, symptom patterns, and smartphone data to predict which medications you'll actually tolerate. Mood-tracking apps catch subtle fluctuations in sleep or rejection sensitivity that signal when you need a medication adjustment or booster session.

These approaches prioritize speed over the old "wait and see" model. Whether it's ketamine's rapid neural reset, EMDR's trauma resolution, or AI cutting through medication guesswork, recovery shouldn't require endless patience when effective tools exist today.

Innerwell's Integrative Approach to Healing Atypical Depression

Navigating these complexities requires a multidimensional approach, and Innerwell offers comprehensive services designed to meet diverse patient needs. With a team of licensed therapists and psychiatrists specializing in mental health, we provide evidence-based treatments, including at-home ketamine therapy under clinical oversight—showing a remarkable 69% reduction in symptoms for patients.

EMDR is available for those whose condition coexists with trauma, alongside more traditional therapeutic options. Cost and accessibility advantages include insurance coverage, making these treatments more accessible compared to typical out-of-pocket expenses. Clinical rigor through evidence-based protocols under licensed provider guidance ensures high standards of care, while the collaborative model enriches the treatment experience through a synergistic approach.

Outcome data highlights effectiveness: 60% reduction in anxiety symptoms and 87% of patients noted improvement within just four weeks. From initial intake to personalized treatment plans, the patient journey is thoughtfully designed to support recovery. This integrative approach emphasizes holistic healing, ensuring patients receive comprehensive, effective care tailored to their unique circumstances.

Combine the right treatment with self-compassion, and you create the foundation for genuine recovery. Take Innerwell's free mental health screener to explore personalized, stigma-free treatment options today and move toward relief you can feel—and trust.

Atypical depression looks different from classic depression. Learn its signs and how Innerwell supports recovery with tailored, evidence-based care.

Therapy

Ketamine Therapy: What to Expect Before, During & After

Ketamine Laws by State: 2025 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