Ketamine-Assisted Therapy
Medically supervised ketamine treatment, sometimes paired with psychotherapy.
What is it?
01What is ketamine?
Ketamine is a dissociative medicine first developed as an anaesthetic in the 1960s. It has been used in hospitals and emergency medicine for decades because it can produce anaesthesia and pain relief while preserving breathing and cardiovascular function differently from many traditional anaesthetics.
At much lower doses, ketamine has a very different effect.
Rather than producing full anaesthesia, it can create an altered state of consciousness characterised by changes in perception, distance from ordinary thought patterns, emotional openness and sometimes a feeling of observing yourself or your life from a new perspective.
Over the past two decades, ketamine has attracted enormous interest in psychiatry because of its ability to produce rapid antidepressant effects, sometimes within hours rather than the weeks typically associated with conventional antidepressants.
Ketamine-assisted psychotherapy, often shortened to KAP, combines ketamine with psychological support or psychotherapy before, during or after the medicine experience.
The emerging idea is that ketamine may create a temporary period of greater psychological flexibility, while therapy helps someone work with what becomes accessible during that period.
A brief history of ketamine
Ketamine was developed in 1962 by chemist Calvin Stevens while researchers were searching for a safer alternative to the anaesthetic phencyclidine, or PCP.
It entered clinical use later that decade and became widely used in surgery, emergency medicine, battlefield medicine and veterinary medicine.
For many years, ketamine was thought of almost entirely as an anaesthetic and pain medicine. That changed dramatically around the turn of the twenty-first century.
In 2000, researchers published a small but landmark study showing that a single low-dose intravenous infusion of ketamine could produce rapid antidepressant effects in people with depression. [5]
Subsequent studies found similar effects in people with treatment-resistant depression, including individuals who had already tried multiple antidepressants without sufficient improvement. [6]
This changed the direction of depression research.
Until then, most antidepressant development focused heavily on serotonin and related neurotransmitters. Ketamine acts primarily on the brain's glutamate system, particularly the NMDA receptor.
Its rapid effects suggested that depression might be influenced through entirely different biological pathways.
What may it help with?
02What is ketamine being used for?
Treatment-resistant depression
This is where the strongest evidence sits.
Ketamine has repeatedly demonstrated rapid antidepressant effects in people whose depression has not responded adequately to conventional treatments.
Unlike many antidepressants, which can take several weeks to begin working, ketamine can produce measurable improvement within hours or days.
Different treatment models exist, including intravenous ketamine, intramuscular or subcutaneous administration, oral or sublingual preparations and intranasal esketamine, which is one component of the ketamine molecule.
Some protocols involve several treatments over a period of weeks rather than a single session.
For many people, the challenge is not whether ketamine can produce an initial improvement but how to sustain that improvement. This is one of the reasons psychotherapy and integration are becoming increasingly important areas of research.
A 2026 review of ketamine combined with psychotherapy brought together 72 studies across depression, PTSD, obsessive-compulsive disorder, addiction and eating disorders. Results were generally positive, but only 11 were randomised controlled trials, and the two studies that randomly assigned psychotherapy didn't find it added benefit. Treatment approaches varied considerably, and better-designed trials are still needed. [4, 7]
Rapid reduction in suicidal thinking
One of the most remarkable findings in ketamine research has been its ability to reduce suicidal thinking rapidly in some people experiencing severe depression.
In one randomised controlled trial involving people with major depression and significant suicidal thoughts, 55% of participants receiving ketamine achieved at least a 50% reduction in suicidal ideation after 24 hours, compared with 30% receiving the control medication. [8]
A review combining individual results from 10 studies found that a single dose of intravenous ketamine reduced suicidal thoughts within a day, with effects lasting up to a week. [9] This rapid response is one of the reasons ketamine has generated such interest within psychiatry.
Rather than waiting weeks to see whether a medication will work, there may be circumstances where meaningful improvement occurs very quickly.
Anxiety and PTSD
Ketamine-assisted psychotherapy is also being explored for anxiety and post-traumatic stress disorder.
The evidence here is not as established as it is for depression, but early studies and real-world treatment programs have reported improvements in anxiety and PTSD symptoms.
A retrospective study of 235 people treated with ketamine-assisted psychotherapy across three private practices found reductions in depression and anxiety, although it had no comparison group. [10]
For trauma work, the dissociative effect of ketamine may sometimes help people approach painful memories or emotions from a degree of psychological distance rather than feeling completely immersed in them.
This is one reason the therapeutic relationship and integration can matter so much.
Addiction
Ketamine presents an interesting paradox.
It is a medicine with known misuse and dependence potential, yet researchers are also investigating whether it may help treat certain addictions when delivered within structured therapeutic programs.
A recent systematic review examining 14 studies involving 551 participants found promising results across alcohol, cocaine and opioid-use disorders, including reductions in craving and improvements in abstinence in some studies. The studies were small and few were randomised, so the researchers described these benefits as preliminary. [11]
Research combining ketamine with psychotherapy has been particularly interesting because the altered state may create an opportunity to examine behaviours, triggers and beliefs surrounding addiction.
But this is one area where context matters enormously.
Ketamine can itself become compulsively used. Chronic misuse has been associated with dependence, tolerance and significant physical consequences, particularly bladder and gastrointestinal problems.
For someone with a history of addiction, that dual reality is worth understanding and taking caution.
How does it work?
03What happens in the brain?
Ketamine works very differently from classic psychedelics such as psilocybin or LSD.
Its primary action involves blocking NMDA receptors, which form part of the brain's glutamate signalling system. This appears to trigger a cascade of downstream effects involving pathways associated with synaptic growth, learning and neuroplasticity.
Researchers are particularly interested in signalling involving AMPA receptors, BDNF and mTOR, all of which play roles in how brain cells communicate, adapt and form new connections.
This has led to the idea that ketamine may temporarily create a more flexible state in which established patterns of thought and emotion become less fixed.
The subjective experience can also be important. At therapeutic doses, people may experience a sense of distance from ordinary thoughts, a change in perspective, vivid imagery, emotional release or a feeling of observing their life without being completely caught inside it.
For someone experiencing depression, that temporary separation from entrenched negative thinking can sometimes feel profound.
What does the evidence say?
04What we are learning
Ketamine has challenged one of psychiatry's longest-standing assumptions: that antidepressant treatments necessarily take weeks to work.
Its ability to produce meaningful changes in mood within hours has fundamentally changed how researchers think about depression and the brain.
It has also helped shift attention towards glutamate, neuroplasticity and the possibility that psychological states may be more changeable than we once believed.
The strongest evidence remains in treatment-resistant depression, with important research also exploring suicidal thinking, PTSD, anxiety and addiction.
Perhaps the biggest question now is not simply whether ketamine works. It is how best to use the window it creates.
Medicine, therapy, integration, behaviour and environment may ultimately prove far more powerful when they work together than when any one of them is used alone.
What does a session or practice look like?
05What does ketamine-assisted therapy actually involve?
Ketamine-assisted therapy varies significantly between clinics and practitioners.
Some services provide ketamine primarily as a medical antidepressant treatment, while others intentionally combine the medicine with psychotherapy.
Treatment often begins with preparation sessions where the participant discusses their history, current challenges and intentions for treatment and develops trust with the therapeutic team.
The ketamine session itself is considerably shorter than LSD or MDMA-assisted therapy.
Depending on the dose and method of administration, the main altered-state experience may last approximately 40 minutes to 90 minutes, with additional time afterwards for recovery and reflection.
Many people wear an eye mask and listen to carefully selected music while focusing internally. The experience can range from gentle relaxation and emotional openness to significant dissociation, vivid imagery, altered perception of the body and a temporary loss of the ordinary sense of self.
For some people, the experience feels dreamlike. Others describe seeing their life, relationships or problems from a distance that allows a different perspective to emerge.
Ketamine versus ketamine-assisted psychotherapy
There is an important difference between receiving ketamine as a medication for depression and participating in ketamine-assisted psychotherapy.
In a medical model, the primary therapeutic mechanism may be considered pharmacological: the medicine creates biological changes associated with antidepressant effects.
KAP adds another layer. The altered state itself becomes part of the therapeutic work.
A therapist may help someone explore emotions, memories or insights that arise during the session and then work with those experiences afterwards.
Researchers are increasingly studying whether psychotherapy can help make ketamine's antidepressant effects more durable.
One small open-label study of 16 people with treatment-resistant depression combined four ketamine infusions with a 10-week course of cognitive behavioural therapy. Two of the eight people who responded to ketamine had relapsed eight weeks after their last infusion. The researchers saw this as a possible sign that therapy can help sustain improvement, but the study had no control group and larger trials are still needed. [12]
A small 2026 study of 46 people receiving esketamine injections found higher remission rates by the end of treatment when structured psychotherapy was added (78% compared with 35%). The groups weren't randomly assigned, and there was no meaningful difference between them six months later. [13]
This is an evolving area of research, but it reflects something we return to repeatedly across The Mental Wealth Hub: the altered state can be important, but what happens around it may be equally significant.
What might someone experience?
Ketamine experiences are highly individual.
People commonly describe:
- feeling detached from their body or ordinary identity
- watching thoughts rather than being consumed by them
- vivid imagery or dream-like experiences
- emotional release
- feelings of peace or spaciousness
- changes in the perception of time
- insights about relationships, behaviour or life experiences
- a temporary quietening of repetitive or depressive thinking
- a glimpse of the part of yourself that depression can hide, which can bring hope.
At deeper doses, some people experience what is sometimes called a K-hole, a profound dissociative state involving a strong sense of separation from the body and ordinary reality. This is not a great feeling.
In therapeutic environments, the dose and experience are generally intentionally managed rather than pursued for intensity.
For people who have lived for years inside relentless depressive thinking, even a temporary experience of mental quiet or psychological distance can feel significant.
Why preparation and integration matter
Ketamine can create very rapid changes in mood and perspective, but those changes do not automatically become lasting behavioural change.
Preparation helps someone understand what they want to explore and creates trust with the therapist or treatment team. Integration provides space afterwards to make sense of the experience.
This might involve psychotherapy, somatic work, journalling, changes in behaviour, examining relationships or environments, and consciously reinforcing healthier patterns during the period after treatment.
Researchers are particularly interested in whether ketamine temporarily increases neuroplasticity, which raises an important therapeutic idea: if the brain is temporarily more receptive to change, what we practise and reinforce during that period may matter.
Risks and considerations
06A note about ketamine and addiction
Ketamine requires a slightly different conversation from many of the other medicines featured on the Hub. When administered within controlled clinical programs, research has generally found low rates of misuse or dependence. A 2026 systematic review found minimal evidence of craving, dose escalation or misuse among patients receiving ketamine or esketamine within appropriately monitored psychiatric treatment. [3]
Outside structured treatment environments, however, ketamine can become addictive.
Repeated recreational or compulsive use can lead to tolerance, craving and dependence, and heavy long-term use has been associated with serious bladder, urinary and gastrointestinal problems.
This becomes particularly relevant for people who already have a history of substance dependence.
Interestingly, ketamine is simultaneously being investigated as a treatment for addiction, particularly alcohol, cocaine and opioid-use disorders.
It is therefore not as simple as saying ketamine is either addictive or an addiction treatment.
Both can be true.
The setting, frequency of use, therapeutic structure, personal history and relationship with the medicine all matter.
Access in Australia
Ketamine is already a legal prescription medicine in Australia and is listed as a Schedule 8 controlled medicine.
Its traditional approved uses involve anaesthesia and related medical applications, while racemic ketamine is also prescribed off-label in some specialist psychiatric settings for treatment-resistant depression.
Esketamine, marketed as Spravato, is a nasal spray developed specifically for depression. Since 1 May 2025, it has been subsidised on the Pharmaceutical Benefits Scheme (PBS) for adults whose depression hasn't improved after trying at least two different antidepressants. It's given under supervision at certified treatment centres, alongside an oral antidepressant, so ask your doctor or psychiatrist whether you're eligible and where it's offered near you. [1, 2, 14]
Rules for prescribing other forms of ketamine, a Schedule 8 medicine, are set by each state and territory, so access depends on where you live and on your treating team.
This makes ketamine very different from MDMA, psilocybin or LSD.
It already sits within mainstream medicine, while the therapeutic use of altered ketamine states alongside psychotherapy is continuing to evolve.
Questions to ask a practitioner
07Ketamine treatment can look very different from one clinic to the next, so it helps to understand exactly what is being offered before you begin.
- Qualifications and experience: Who prescribes, and what experience does the team have with ketamine treatment for mental health?
- Which treatment: Which form of ketamine are you recommending, and why? Am I eligible for PBS-subsidised esketamine?
- Screening and suitability: What medical and psychological screening is included? How do you consider my blood pressure, current medications and any history of substance use?
- Consent and preparation: What will you explain before I agree to treatment? Is preparation included, and how do we agree on what support feels okay during the session?
- During the session: Who monitors me during treatment, and can I talk with someone about what comes up?
- Emergency procedures: What happens if I feel unwell or very distressed during or after a session? When is it safe to go home, and when can I drive again?
- Integration and ongoing support: What psychological support is included before and after sessions? Do you offer somatic or body-based approaches?
- Length of treatment: How will we decide how long treatment continues, and how do you watch for any signs that I am starting to rely on it?
The right team will welcome your questions and help you feel informed at every step.
Founder’s Insight
Ketamine-assisted therapy was helpful for me during periods of depression. What stood out was how quickly it could shift the heaviness. There were times when I felt caught inside depression and ketamine created a temporary sense of distance from it, it gave me a glimpse into my true self and hope that the period of darkness will eventually shift. For me, that was incredibly valuable.
But ketamine is also the psychedelic-assisted therapy I would personally approach differently if someone has struggled with addiction. I have experienced addiction in my own life, and I think it is important to acknowledge that ketamine can feel good, can provide relief very quickly and can become something a person wants to return to repeatedly.
That does not take away from its therapeutic potential. I found it genuinely helpful for depression.
But for anyone with an addictive personality or history of substance dependence, I believe the relationship with ketamine deserves particular awareness and honesty. There is something very different about using a medicine intentionally within a structured therapeutic process and beginning to rely on that medicine as the place you go whenever you want to escape how you feel.
For me, that distinction matters. Ketamine can be incredibly helpful when used intentionally with strong therapeutic support and integration, but it is equally important to stay aware of your relationship with the medicine and whether it is supporting healing or becoming something you rely on for relief.
You’ve read about it. Now what can you actually do?
You don’t need to have the perfect plan. Choose the next step that feels most useful for where you are right now.
Always speak with a qualified health professional before starting something new. If you are struggling right now, find immediate support.
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This is educational information. It is not a recommendation that this approach is right for you. Always speak with a qualified health professional.
