Ketamine is a legal, safe and effective medicine used to treat a variety of mental health conditions, including depression, anxiety, and PTSD. Ketamine has rapidly acting antidepressant and mood enhancing effects, which can begin to take effect within one to two hours after treatment and last for up to two weeks. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.

Key Players in the Brain NMDA receptors: The “gates” that usually keep certain brain pathways fixed in place. They regulate how strongly memories, emotions, and habits are held. NMDA receptors are like compacted soil that keeps old, established roots in place, making it hard for new plants to grow.​ GABA and GABAergic interneurons: GABA is a calming neurotransmitter, and these interneurons act like traffic controllers. They prevent the brain from becoming overstimulated, keeping signals in balance. GABAergic interneurons are like the gardeners who trim and maintain balance so one plant doesn’t overwhelm the rest.​ AMPA receptors: These receptors “receive” signals that encourage growth and connection between brain cells. AMPA receptors are like sprinklers watering areas where new seeds are trying to grow.​ BDNF (Brain-Derived Neurotrophic Factor): This is like a natural fertilizer for the brain, helping neurons sprout new branches and strengthen connections. What Happens in the Brain Over Time During the session: The soil loosens (NMDA quiets), giving space for new perspectives to emerge.​ Immediately after the session: The sprinklers turn on (AMPA activates), helping new connections take shape. The brain enters a more flexible and “teachable” state, which makes therapy especially effective.​ Within 72 hours of the session: BDNF (fertilizer) levels rise, fertilizing the brain’s new connections. This is often when people notice increased clarity, creativity, or relief from old emotional burdens.​ Within two weeks of the session: With therapy and integration, the new neural “plants” have begun to take root. Clients may notice lasting changes in mood, perspective, and behavior.​ Long-term: With repeated care, the brain’s garden can be reshaped for long-term effects. Old patterns lose their grip, and healthier, more adaptive pathways grow stronger. This creates enduring improvements in resilience and emotional wellbeing.

Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, nasal spray, and sublingual lozenges. Journey Clinical only prescribes ketamine as a sublingual lozenge via a rapidly dissolving tablet using the “swish and spit” method. The tablet is placed under the tongue and will cause salivation. Clients then swish the saliva in their mouth for a short period of time (determined by the medical provider) and this is how the ketamine is absorbed. The saliva is then spit out and the mouth rinsed with water. The absorption rate is estimated to be about 15-30% using the “swish and spit” method.

The effects of ketamine, which most clients find pleasant, last for approximately 45 minutes. These effects can make clients feel “far from” their body and facilitate shifts in perception that can often feel expansive in nature. Motor and verbal abilities will be reduced, so most clients lay in a comfortable position during the experience. Once these effects subside, the remainder of our appointment is spent giving space to process and discuss the experience. While it may feel hard to articulate what happened during the experience, clients believe the insights gained are clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the Ketamine experience. Clients have reported experiencing benefits such as improved mood, reduced anxiety, or relief from depression for weeks or months afterward.

Ketamine temporarily enhances the brain's flexibility, initiating a surge of neuroplasticity that can last up to two weeks after the KAP dosing session. Neuroplasticity is the brain's ability to reorganize and form new neural connections in response to learning, experience, or injury. During the integration period, the connections a person actively engages such as exploring emotions in therapy, practicing self-compassion, or adopting new thought patterns become stronger. Conversely, unused rigid patterns, like self-criticism or trauma loops, may begin to diminish. Benefits of KAP do not solely take place during the dosing session and it is important to leverage the brain's newfound flexibility to foster lasting change.

Maximizing the benefits of KAP involves actively engaging in integration practices following your sessions. This period is crucial for solidifying the insights gained and fostering lasting change. Strategies to enhance integration include journaling, practicing mindfulness and meditation, accessing therapeutic support, connecting with others, spending time in nature, and lifestyle adjustments like regular exercise, balanced nutrition, and adequate sleep. By actively participating in these practices, clients can help ensure the changes initiated during KAP sessions are sustained and integrated into daily life.

Ketamine is often described as a “psychedelic-adjacent” medication. While it does produce altered states of consciousness at therapeutic doses, it works through a different receptor system (NMDA antagonism) than classic psychedelics like psilocybin, LSD, or MDMA. During KAP, these altered states are used intentionally alongside psychotherapy to support healing.

Research on ketamine for OCD is emerging and shows promising, but preliminary results. Some studies suggest ketamine may rapidly reduce OCD symptoms, but more evidence is needed to confirm long-term effectiveness. Beyond OCD (and depression, anxiety, and PTSD), KAP is being researched for various conditions, including chronic pain and substance use disorders. Studies suggest ketamine may provide short-term pain relief in conditions like neuropathic pain, fibromyalgia, and migraines. Additionally, preliminary studies suggest ketamine may aid in reducing cravings and preventing relapse in individuals with substance use disorders. While these applications are promising, ketamine’s use for these conditions is still being researched and it is essential to consult with a qualified healthcare provider to determine its appropriateness for specific situations.

Eligibility for KAP depends on your medical and mental health history. Generally, adults with treatment-resistant depression, anxiety, PTSD, or other qualifying conditions may be candidates. Those with unstable medical conditions, uncontrolled substance use disorders, and contraindicated psychiatric disorders are likely not eligible for KAP. These may include uncontrolled hypertension, uncontrolled glaucoma/pressure in the eye, severe breathing problems, ketamine allergy or sensitivity, active ketamine use disorder, acute mania or mixed state, history of primary psychotic disorder, or other unstable medical conditions. A thorough medical and diagnostic evaluation is required to ensure safety and determine if KAP is appropriate for you.

Coverage for ketamine treatments varies widely by state and insurance plans. Most state Medicaid programs do not currently cover ketamine for mental health conditions because they are considered off-label. However, most of the therapy sessions during the KAP process may be covered by Medicaid or other insurance companies. Additionally, Journey Clinical can help clients submit out-of-network claims. Clients are encouraged to check with their insurance provider or Journey Clinical regarding their specific benefits.

• Paradigms of Ketamine Treatment ()by Raquel Bennett, Psy.D. for MAPS • Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy ()-() research study by Jennifer Dore et al, 2018 • Ketamine for Depression and Mood Disorders ()by Erica Zelfand, ND for Townsend Letter • Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression ()b()y goop • Ketamine Assisted Psychotherapy with Jonathan Sabbagh of Journey Clinical ()- Psychology Talk Podcast