What Are the Different Types of Ketamine Treatment?

You can’t read about mental health treatment right now without reading something about ketamine or psychedelics—but you may wonder what part of the experience makes it so effective.

"Ketamine treatment is actually a spectrum of services which include the use of ketamine as a psychiatric pharmaceutical, the use of ketamine as a lubricant for the psychotherapy process, and the use of ketamine to induce mystical-type experience," says Raquel Bennett, PsyD, and founder of the Ketamine Research Institute.

If you are considering this treatment, you might want to learn more about the different treatment philosophies to determine which one best aligns with your goals.

But none of these approaches is superior to the others, says Bennett. "It is important to give the patient what they need at that moment in time."

Ketamine As Medicine

At the very core of ketamine treatment is the fact that it is a medical treatment with impressive results in treating mental illness. And to some providers, that's it.

In this biochemical model, mindset and physical environment (known in the psychedelic community as "set and setting") are largely ignored. A patient is seen as a passive being receiving medication. Ketamine's dissociative properties are seen as side effects rather than tools for insight.

Some of this approach comes from Dr. Stanislov Grof’s work. Grof, a Czech psychoanalyst, pioneered a format that modern sessions use today where patients will largely go inward to experience ketamine on their own. His work informed the protocol usually used today in ketamine clinics, providing patients with an eye shade and music as they experience the ketamine journey. 

How It Works

A psychiatrist typically administers this approach through ketamine infusions. However, people with co-occurring pain issues or disorders may receive treatment from an anesthesiologist who can help them manage physical side effects, too. Usually, dosing is below a full psychedelic level.

Therapy is typically done separately, either with a therapist from the treatment team administering the ketamine immediately following administration or with a patient’s outside therapist. As with traditional antidepressants, ketamine is most effective when combined with psychotherapy.

“Ketamine by itself,” says Bennett, “appears to relieve the symptoms of certain kinds of depression. However, the effect is temporary, and there is a risk of creating ketamine addicts if no new skills are acquired.” 

Ketamine-Assisted Psychotherapy

The psychotherapeutic model—also known as ketamine-assisted psychotherapy—uses ketamine as a kind of lubricant for the therapy process, putting an emphasis on talking through and emotionally processing one's feelings during the ketamine treatment.

Insights that might be gained from psychotherapy alone are typically deepened in this type of approach, and both the added neuroplasticity and the interruption of the typical conscious state create room for one to form new insights into their situations.

Salvador Roquet, a Mexican therapist, originally developed this approach. Roquet discovered that below-anesthetic doses of ketamine led to significant changes in psychological functioning that could facilitate more openness faster in therapy. Although some of Roquet’s methods were extreme and controversial, he is still considered one of the pioneers of using ketamine with psychotherapy.

How It Works

In ketamine-assisted psychotherapy, the patient may feel some degree of an altered mindset, but the dose is kept low enough so that they can still articulate their ideas and participate in intentional self-reflection. The ketamine may be given in methods ranging from intramuscular injections to oral lozenges to nasal spray to IV. 

Someone may revisit material they have discussed before but might experience a perception shift or commitment to behavioral change not previously available to them.  In one study, a participant described his experience with KAP as an “amplification” of his regular talk therapy. 

Ketamine Used Psychedelically 

People can reach beautiful, dream-like states on psychedelics, having visions and hearing messages while in a state of expanded consciousness. (In fact, a psychedelic experience may be the closest psychoactive experience to a dream, according to research.)

A psychedelic approach or philosophy to ketamine emphasizes its dissociative and psychedelic properties and uses the medicine to intentionally create a profound and temporary altered state of consciousness.

A higher dose (usually administered via intramuscular injections) and more dramatic experience are typically the goals in these experiences, and people usually report more vivid dream-like visions.

How It Works

Unlike in the biochemical model, setting is important in the psychedelic model. Some clinicians may use ceremonial objects in their offices to create an experience already meant to elevate from everyday life.

Some research shows that how much of the dissociative/psychedelic effect is reached relates to how much change or relief is experienced. A higher score on the Clinician-Administered Dissociative States Scale after 40 minutes correlated with improvement on the Hamilton Depression Rating Scale at both 230 minutes following ketamine and seven days later.

While psychotherapy is not done concurrently with this type of experience, integration is a key part of the protocol. Through integration work, one can take the insights gained from their psychedelic experiences and process their meanings, as well as devise how to incorporate the insights into their daily lives through changes in thought patterns or behaviors.

However, Bennett writes that the "full psychedelic experience" is not for everyone. It may be too overwhelming for some. It is best for people who already have some degree of ability to observe their own mind and some interest in existential exploration.

A Word From Verywell

While ketamine treatment can be incredibly helpful for many people, it is not a panacea, nor is it a cheat code to bypass self-inquiry. Only embark on this type of treatment if you are truly ready for it and have assessed the precautions with your healthcare provider.