Verified by 
Key points
- Change is upon us: Psychedelic treatments are increasingly accepted as promising new options.
- Unfettered innovation without consideration of patient safety could lead to reckless practices.
- We must gain clarity around how to deliver psychedelic medications in a way that will be safe and responsible.
There’s a new buzz in the field of mental health care: Psychedelics are coming. We stand at the brink of change: Psychedelic treatments are increasingly accepted as promising new options.
Yet as the recent veto by California Governor Gavin Newsom shows, there are some who urge restraint until clarity is gained around how to deliver psychedelic medications in a way that will be safe and responsible.
As a provider, I have had a front-row seat in the use of psychedelic medicines as part of integrative medicine and trauma-informed psychological care.
Currently, the only legal psychedelic medicine is ketamine, a dissociative anesthetic that has psychedelic properties. As I mentioned in a past post, “ketamine is not God,” a “psychedelic” medicine is one that “reveals” (the meaning of “delic”) the psyche (psyche).
There are several ways to administer ketamine, including by intramuscular injection, nasal spray, lozenge, and IV infusion. My practice provides ketamine infusion for two reasons. First, the dosing can be precisely controlled, and, second, we can intervene if a patient begins to suffer in an unproductive, psychologically damaging way.
So, what I share, about what to expect, refers to ketamine infusion exclusively.
Before the first ketamine infusion, we provide support to help patients prepare, physically, mentally, and emotionally. This includes setting an “intention.” In the work of ketamine therapy, across various organizations, intention-setting is critical. Intentions set a therapeutic framework and container for the inner psychological work to follow.
On the day of an infusion, patients sit down with a provider to go over any remaining questions and review the process. Just before an infusion treatment session begins, patients are given the opportunity to share the intentions they set for themselves.
The treatment is essentially pain-free. Other than a small prick while starting the infusion line, patients tell us they feel no pain and may even enjoy the experience. Once they receive the IV and the ketamine starts to be slowly administered, patients spend the next 45 minutes exploring their unique psychological landscape. This is where ketamine takes effect in “revealing” the intricacies of the psyche.
At the start of the infusion, there may not be noticeable effects, but as the infusion progresses, many patients may encounter a feeling of “lightness” or “floating,” which for some feels like a “weight being lifted off their shoulders.” Others describe it as a dream-like state with a floating, calm sensation, and some patients report visions of colors, shapes, and images. Each person’s experience can be quite different and can vary from infusion to infusion. We provide ketamine only in the clinic, where patients are monitored by qualified, licensed medical professionals who are prepared to treat any unpleasant side effects during the procedure.
Generally, within 15 minutes of completing the infusion, patients tell us that they feel grounded again in the present time and space and that their thinking is clear and present-focused. In most cases, peoples’ awareness and thinking will generally be clear within minutes of finishing an infusion session, but as a standard precaution, we ask patients to avoid driving home after a ketamine treatment session.
Three common effects just after a ketamine IV infusion are dizziness, temporary disorientation, and fatigue. Feeling lightheaded or disoriented after the treatment is normal, and this typically resolves quickly. Some people feel tired or fatigued after the treatment, and, if they do, this should resolve after a nap. Some patients experience an immediate return of energy to what is considered their norm. We recommend that patients build in time to rest after each session. The infusion experience can vary from session to session, so patients may feel tired after some but not all of their sessions. This is normal.
As with all treatments, the outcome of ketamine treatment sessions varies. Some patients notice an immediate improvement in symptoms, and, for others, symptom relief comes over time and may not be felt until the fourth, fifth, or sixth infusion session.
A successful outcome can show up in several different ways:
• Having a clear head
• Having a quieter mind
• Experiencing improved mood
• Feeling increased interest in activities you once enjoyed
• Noticing improved sleep.
We encourage patients to honor how their body responds to treatment and try to avoid pressuring themselves into feeling something that may not feel authentic for them.
Following any biological mental health treatment, we repeatedly emphasize that aftercare is important. My colleagues and I strongly advocate for combining ketamine infusions with trauma-informed integrative talk therapy. By meeting with our patients for an integration session the day after each infusion, we support patients’ potential for transformational change during the short window of time that immediately follows such treatment.
In this “window of transformative potential,” integration therapy is essential. While ketamine may help reveal the psyche, the critical healing work of making meaning of what surfaces happens during integration sessions.
Our work is collaboration between medical and mental health providers, through an integrative, cross-disciplinary team effort. We believe this new model for care will give patients the best possible outcomes. We believe it's time to innovate, but that innovation must balance cutting-edge treatment and patient safety.
