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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.

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Peer Treatment Companions play an integral part of each ketamine experience, and having a Peer Treatment Companion present for every ketamine experience is a requirement for treatment at Innerwell. 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 Peer Treatment Companions can assist before, during and after each ketamine experience. Please print these instructions and keep them on hand during your loved one’s ketamine experiences.

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

If your friend or loved one is working with an Innerwell psychotherapist, briefly join their Zoom sessions at the start of their ketamine sessions (not applicable to self-guided sessions), so the therapist knows you are there and 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. If your loved one is undergoing a therapist-guided session, 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 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 (approximately 2-3 hours). 

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 ketamine session (water is OK) to reduce the risk of nausea and vomiting. 

Here’s what you should do if your friend or loved one starts to vomit:

If they’re alert and awake enough to walk, assist them to the bathroom and keep their head above the toilet or trash can.

If they’re too groggy to walk to the bathroom with assistance, help them sit up and hold a large bowl or trash can in front of them in case they continue to get sick.

If they’re too sedated to sit up, move them into the recovery position so they will not choke on their vomit. 

1. Raise the arm that is closest to you above their head. Prepare to roll them towards you.

2. Gently roll them toward you, guarding their head from hitting the floor. The head should rest in front of the arm, not on it.

3. Tilt the head up to maintain their airway. Tuck their nearest hand under the cheek to help maintain head tilt and raise the face off the floor.

If you are worried about your friend or loved one, call 911, especially if you can't awaken them to the point that they can talk to you. Furthermore, If they’re vomiting continuously and not improving, or if you notice blood in the vomit, 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, there are a few things you can do 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 if my loved one is having a psychologically challenging experience, or is having difficulty processing their experience after it ends, emotionally or otherwise?

A: If you or your loved one would like someone to talk to during a psychologically and/or emotionally challenging psychedelic experience, you can contact the Fireside Project by calling or texting 62-FIRESIDE. They’re open every day from 11:00 am - 11:00 pm PST. Their Psychedelic Support Line is staffed by rigorously trained, compassionate, supportive volunteers from diverse backgrounds who listen deeply and from a place of non-judgment. 

If your loved one doesn’t need to talk to someone immediately during or after a challenging experience, remind them that they can reach out to their psychiatric clinician and/or therapist at Innerwell to discuss their experience. They can contact their clinicians in the Innerwell Portal (located in the Care Team section of the Support tab). Innerwell’s Member Support team can also be reached during business hours by calling (909) 679-3482 or emailing care@helloinnerwell.com.   

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

A: Call 911 if you suspect an emergency. Signs of an emergency [such as a heart attack or stroke] can include complaints of new chest pain, chest pain that travels down the left 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. 

The 988 Suicide & Crisis Lifeline also provides 24/7, free and confidential support for people in distress, as well as prevention and crisis resources for you or your loved one. For crisis counseling, please call or text 988.

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 Peer Treatment Companion's Guide

How to Help Others Journey Safely: A Peer Treatment Companion’s Guide

Ketamine therapy is gaining significant attention in mental health treatment as a breakthrough option for conditions resistant to traditional medications. Unlike conventional antidepressants that target serotonin, ketamine works through different neural pathways, offering rapid symptom relief—often within hours rather than weeks. This alternative approach shows particular promise for treatment-resistant depression, anxiety disorders, PTSD, and chronic pain conditions, with success rates of 60-70% in patients who haven't responded to standard treatments.

Innerwell offers expert-guided ketamine therapy for mental health—discover our Innerwell ketamine programs.

Ketamine therapy involves using ketamine, a medication traditionally used as an anesthetic, to treat mental health conditions. First developed in the 1960s and approved by the FDA as an anesthetic in 1970, ketamine has a long history of safe use in medical settings. Its unique properties allow it to induce anesthesia while maintaining respiratory function, making it valuable in emergency and surgical settings.

In the early 2000s, researchers discovered ketamine's rapid antidepressant effects, leading to its off-label use for mental health conditions. Off-label prescribing—using FDA-approved medications for non-approved purposes—is common and legal in medical practice when supported by scientific evidence.

What sets ketamine apart from traditional psychiatric medications is its mechanism of action. While conventional medications primarily target serotonin, norepinephrine, or dopamine systems, ketamine affects the glutamate neurotransmitter system.

As an NMDA receptor antagonist, ketamine may disrupt patterns of negative thought and behavior associated with depression, explaining why it works quickly—often within hours—compared to traditional antidepressants that take weeks to show benefits.

These are the mechanisms of action that affect the brain:

The primary mechanism of ketamine's action is as an antagonist of N-Methyl-D-Aspartate (NMDA) receptors. These glutamate-activated ion channels play a crucial role in excitatory neurotransmission in the brain. Ketamine blocks the NMDA receptor channel in its open state, preventing ion conductance and altering glutamate signaling.

This blockade is particularly potent in certain receptor subtypes. GluN2C/D-containing NMDA receptors appear more susceptible to ketamine's effects compared to GluN2A/B-containing receptors. This differential sensitivity contributes to ketamine's unique profile of effects.

Beyond its immediate effects on neurotransmission, ketamine enhances neuroplasticity and synaptogenesis. It increases the production of brain-derived neurotrophic factor (BDNF), a protein that promotes the growth and differentiation of new neurons and synapses.

This enhanced neuroplasticity may explain why ketamine's effects can persist beyond its immediate presence in the body. It potentially "resets" dysfunctional neural circuits involved in depression and other mood disorders.

While ketamine blocks NMDA receptors, it also paradoxically increases glutamate release in certain brain regions. This leads to activation of AMPA receptors, another type of glutamate receptor. This AMPA receptor stimulation triggers molecular cascades that promote synapse formation and strengthen neural connections.

The complex interplay between NMDA receptor blockade and downstream glutamate signaling appears central to ketamine's antidepressant effects.

What Conditions Does Ketamine Therapy Treat?

Ketamine has been proven effective for several conditions, including:

Treatment-Resistant Depression—For patients who haven’t responded to at least two antidepressants, ketamine offers fast relief—helping most of them experience significant improvement, sometimes after just one session.

Major Depressive Disorder (MDD)—Effective not only for treatment-resistant cases but also for broader MDD, with 50–70% response rates and rapid symptom relief.

Anxiety Disorders (GAD, Social Anxiety, PTSD)—Emerging research supports ketamine for anxiety, especially PTSD. Ketamine-assisted psychotherapy (KAP) may deepen emotional processing and introspection.

Bipolar Depression (Not Mania)—Can reduce depressive symptoms in bipolar disorder when carefully managed alongside mood stabilizers to prevent mania.

Obsessive-Compulsive Disorder (OCD)—Some evidence suggests ketamine may quickly reduce obsessions and compulsions by targeting glutamate pathways, though results can vary.

Chronic Pain (CRPS, Migraines, Fibromyalgia)—Ketamine’s pain-relieving effects may benefit chronic pain conditions, especially when depression and pain overlap.

Types of Ketamine Therapy: How is Ketamine Administered 

Ketamine is administered through a variety of routes, such as:

Intravenous (IV) infusion is the most common and well-studied method for ketamine's psychiatric use. Typically, doctors administer a dose of 0.5 mg/kg over about 40 minutes, though dosages may range from 0.1 mg/kg to 0.75 mg/kg depending on patient response and clinical needs.

IV administration provides 100% bioavailability, allowing for precise dosage control and rapid onset of effects. This method requires a clinical setting with medical supervision throughout the infusion.

Intramuscular injections involve administering ketamine directly into a muscle, typically the deltoid or thigh. This method offers rapid absorption similar to IV, though with slightly more variable bioavailability.

IM ketamine is useful when IV access is challenging and provides a practical alternative while maintaining the supervision and safety of a clinical setting.

Sublingual ketamine involves dissolving a lozenge or troche under the tongue, allowing the medication to be absorbed through the oral mucosa. This method offers lower bioavailability (approximately 30%) than IV or IM routes but can be more convenient for maintenance treatments.

Some providers prescribe sublingual ketamine for at-home use between in-office treatments, though this practice varies widely based on provider protocols and patient factors.

Intranasal Esketamine (Spravato®) — FDA-Approved

Esketamine (Spravato®) is a nasal spray formulation of the S-enantiomer of ketamine that received FDA approval in 2019 for treatment-resistant depression. It's administered in a certified healthcare setting with strict monitoring protocols.

It's important to distinguish ketamine from esketamine (Spravato), a related compound with FDA approval for treatment-resistant depression. Both work through similar mechanisms, but esketamine comes as a nasal spray with standardized protocols defined by FDA guidelines.

Oral ketamine tablets have the lowest bioavailability (approximately 20%) due to extensive first-pass metabolism in the liver. This route typically requires higher doses to achieve therapeutic effects.

Some clinics prescribe oral ketamine for at-home maintenance treatment, though this is less common than other methods due to the limited bioavailability and variable absorption.

Rapid Symptom Relief (Hours to Days, vs. Weeks for SSRIs)

Ketamine's most remarkable benefit is its rapid effects, delivering significant symptom relief within hours or days, unlike traditional antidepressants that typically take weeks to work.

For patients in crisis, this quick response can be life-changing and potentially life-saving, particularly for those experiencing suicidal thoughts or severe functional impairment.

Supports Neuroplasticity and Emotional Flexibility

Ketamine promotes neuroplasticity—the brain's ability to form new connections and reorganize itself. This enhanced flexibility may help patients break free from rigid thought patterns and develop healthier cognitive processes.

The neuroplasticity effects may contribute to lasting benefits beyond the immediate drug effects. By promoting the growth of new neural connections, ketamine potentially helps "rewire" dysfunctional brain circuits associated with depression and anxiety.

May Help Break Negative Thought Patterns and Rumination

Many patients report that ketamine helps interrupt persistent negative thinking and rumination. The dissociative experience can provide psychological distance from entrenched thought patterns, offering a new perspective on problems.

This cognitive flexibility can create a window of opportunity for implementing therapeutic techniques and developing healthier thought patterns.

Effective for People Who Haven't Responded to Traditional Treatments

For treatment-resistant depression—defined as failure to respond to at least two adequate trials of antidepressants—ketamine offers hope when other options have failed. Studies show approximately 60-70% of treatment-resistant patients experience significant improvement after ketamine treatment.

This effectiveness in otherwise treatment-resistant cases represents one of ketamine's most important clinical contributions.

Can Accelerate Breakthroughs in Therapy (Especially with Integration Sessions)

Ketamine-Assisted Psychotherapy (KAP) combines ketamine administration with psychotherapy, potentially enhancing the therapeutic process. The altered state ketamine induces can facilitate deep introspection and emotional processing, allowing patients to engage with their thoughts and feelings in new ways.

Many clinicians report that patients can achieve therapeutic breakthroughs more quickly when ketamine sessions are paired with skilled psychotherapy, particularly psychedelic integration therapy that helps process insights gained during ketamine treatments.

Potential Benefits for Suicidal Ideation Reduction

Research shows 55% of patients receiving ketamine experienced a ≥50% reduction in suicidal thoughts within a day. This quick action contrasts sharply with traditional antidepressants, which carry FDA black box warnings about potentially increasing suicidal ideation, particularly in young adults.

This rapid anti-suicidal effect represents one of ketamine's most clinically significant benefits, potentially creating a window of safety during which other therapeutic interventions can be implemented.

Risks and Side Effects of Ketamine Therapy

Common Short-Term Side Effects (Dissociation, Nausea, Dizziness, Increased Blood Pressure)

During and shortly after ketamine administration, patients commonly experience:

Dissociative effects (feeling detached from reality or one's body)

Perceptual disturbances (visual or sensory changes)

These effects typically resolve within hours after treatment, but can be distressing for some individuals. The dissociative experience, while therapeutically valuable for some patients, may be challenging for others, particularly those with a history of dissociative disorders.

Less Common but Serious Risks (Misuse Potential, Bladder Issues with Long-Term High Doses)

The long-term risks of repeated ketamine treatments for psychiatric conditions are still being studied. Concerns include:

Potential for Tolerance or Dependence: While ketamine administered in controlled medical settings appears to have low abuse potential, there are concerns about psychological dependence with repeated use.

Urological Effects: Chronic, high-dose ketamine use has been associated with urinary tract problems, including a condition known as "ketamine cystitis". However, this appears rare at the doses used for depression treatment.

Cognitive Effects: Some studies suggest potential concerns about cognitive effects with long-term use, though research at therapeutic doses is limited.

Who Should Not Use Ketamine Therapy (Contraindications: Active Mania, Psychosis, Certain Cardiovascular Issues)

Ketamine therapy is not appropriate for everyone. Key contraindications include:

Uncontrolled hypertension or serious cardiovascular disease

Patients with a history of psychosis or schizophrenia are typically not considered good candidates for ketamine therapy due to the risk of exacerbating psychotic symptoms. Similarly, ketamine's potential for abuse makes it a cautious choice for individuals with a history of substance use disorders.

The cardiovascular effects of ketamine—primarily increased blood pressure and heart rate—necessitate caution in patients with cardiovascular conditions.

Healthcare providers typically implement several safety measures:

Comprehensive screening and informed consent in ketamine therapy before treatment

Continuous monitoring of vital signs during administration

Careful dose adjustment based on individual response

The FDA has issued specific warnings regarding ketamine products, emphasizing that the drug is safe only when administered in a healthcare facility under supervision. This highlights the importance of proper medical oversight during treatment.

What to Expect During a Ketamine Therapy Session

Pre-Treatment Screening and Medical History Review

Before beginning ketamine therapy, you'll undergo a comprehensive evaluation to determine if you're a suitable candidate. This typically includes:

A thorough review of your medical history

Assessment of current symptoms and previous treatments

Screening for contraindications such as uncontrolled hypertension or certain psychiatric conditions

Discussion of your goals and expectations for treatment

Baseline vital signs and possibly laboratory tests

This screening is essential for safety and helps predict whether ketamine therapy is likely to benefit you.

Setting the Intention: Importance of Mindset and Environment ("Set and Setting")

Many providers emphasize the importance of "set and setting"—your mindset and the treatment environment—in shaping the ketamine experience. You may be encouraged to:

Develop clear intentions for your treatment

Practice relaxation techniques to prepare mentally

Consider what aspects of your condition you hope to address

Create a comfortable environment with elements like eye shades and calming music

This preparation can enhance the therapeutic potential of ketamine and help manage the dissociative effects.

What Happens During a Session (Duration, Monitoring, Dissociative Effects)

When you receive ketamine therapy, especially via IV infusion, you can expect:

Discover how ketamine acts on glutamate pathways to deliver fast symptom relief—often within hours—for depression, PTSD, anxiety, and chronic pain.

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How to Help Others Journey Safely: A Peer Treatment Companion’s Guide

Ketamine 101

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