Our Guide

ketamine therapy guide

Here, we comprehensively cover ketamine in mental health.

To start, please listen to this conversation regarding the guide’s content while you read on…

Next, explore Mad Scribbler’s 7-year journey as a walkthrough and primer below. The guide summarizes the site’s extensive content into a 10-minute read.

Navigate deeper topics using the TOC (≡) and the hyperlinks below, which lead to detailed information with studies, citations, and sources.

Listen by clicking play above each section, which works on most devices. If it isn’t on your phone, try PC. There may be delays to start and during reading as the text is sent to an AI in the cloud to be processed. Please wait a bit.


● Introduction

This site grew from a comprehensive guide on Reddit (r/therapeuticketamine), which u/madscribbler has maintained for several years. The post proved immensely popular with those starting therapy. However, as more was learned about ketamine, the post’s 44000-character limit restricted what could be said.

At this point, collaborators reached out regarding turning the guide into a resource website, which is the site you see today.

We strive to reflect current research and cover the therapy fully. We take great care to cite our sources throughout.

Provide feedback if anything you read conflicts so we can update if necessary.

Below I address questions for those exploring, beginning, or looking to get more out of their treatment. I edit the guide with things we learn, so it’s continually evolving.

In r/KetamineTherapy we are pinned to the top of the sub.

Share us in r/therapeuticketamine under the guidelines per our Community page (along with other subs in our community page or ketamine-related subs), and with friends.

Please also share it with your providers, as many providers use us as a primer for their patients (including Dr. Pruett & Team (at Taconic).

Providers use Request to be Added to Directory.

Please take a moment and give us a quick Provider Rating. We annotate our directory with this feedback for the benefit of others.

We would like to see the site grow even more. If you find it useful, please pass us along to others you know we can help.

Ask questions in the comments, and I’ll incorporate the answers here and respond.


● Authors

This combines personal experience over six years on the therapy, hundreds of conversations with others on Reddit subs, and research where it is available. Without fail, others take issue with some of what’s said here, so I attempt to call out contrasting viewpoints where criticism has been raised.

I specialize in AI and cognitive computer architecture based on neurobiology, neural networks, and big data.

My wife is a doctor specializing in neurological patients, traumatic brain injury & spinal cord injury at a renowned hospital in the discipline.

My provider specializes in ketamine therapy, and I’ve participated in many studies. I’ve been an active member of the ketamine Reddit scene for many years. We recommend you join this sub where we interact the most—r/KetamineTherapy (as we are unrestricted there). Also, join r/therapeuticketamine for community support and a large group of people to relate to.

Multiple site content collaborators all have extensive experience with ketamine therapy, too.


● Resources

We recommend you listen to primarily instrumental music, with very few words, and to make sure any words that are included be positive, uplifting and congruent with a safe, healthy mind space. If you are looking for a good session playlist that will promote a healthy and safe trip, use our curated playlist Ketamine Saved Me (on Spotify).

Education is key in getting the most out of your therapy, and the podcast Ketamine Insights (also on Spotify) has great content on the most recent topics, and new episodes are published frequently. The hosts are well versed in ketamine therapy and bring a lot of good topics up for discussion. When you have time, give it a listen. For an episode where I was interviewed, click “It was a revolution for my psyche”, Rob’s journey to mental health.


● TOC

Below are the sections of the guide linked directly. You will jump straight to what you select. Keep reading below if the first time to the guide.


● Symptoms vs. Results

I am BP1, with psychotic features. I struggled with persistent bipolar one depression, which did not respond to SSRIs, constant (daily) ideation with extensive planning, and complex psychological issues such as self-persecution complex and complex PTSD.

One trigger resulted in PTSD maladaptive behavior that would trigger another, which then triggered again until the first trigger was reached again. Round and round it went. This resulted in significant mood instability, anger at inappropriate times, paranoia, a general suspicion of others being out to get me, inferring hidden agendas, and a feeling of complete hopelessness. I undermined my successes through self-persecution because I subconsciously didn’t feel I deserved them.

I was choosing untrustworthy people to surround me, which led to many traumatic life situations, making them worse and worse over time.

I would ruminate on negative thoughts, situations, and feedback in a cycle of unhealthy self-talk. I saw the world through a very unhealthy lens, reinforcing all the fear and paranoia. I couldn’t feel joy or happiness, for those led to self-defeat, so I was wired entirely wrong.

I’ve been on ketamine for six years. I have had 100% remission of rumination, depression, ideation, CPTSD, and almost all trigger situations non-stop. Ketamine has rebuilt my healthy synapses, neurons and relocated dendrites, so I can happily cope with life and now view the world through an objective lens showing love, support, compassion, and acceptance of me and who I am today.

Ketamine improves cognition, memory, and mental flexibility, so damage caused by depression has been healed completely. This results in mental clarity and an overall ‘lighter’ feeling. Depression was a heavy blanket that weighed me down, unmotivated. Hard to start and harder to finish. Ketamine made my mind quieter; I no longer cycle on intrusive thoughts. I am no longer obsessed with suicide. I no longer ruminate. Look to this page to see how ketamine improves the default mode network in our mind, quieting it and taking away cyclic or impulsive thoughts completely—the inner narrator quieted in my mind, which feels tranquil.

I love life and live every minute. I feel joy and happiness now, and I’m very content almost all of the time. These past six years have been the best of my life.

I knew ketamine was working for me with the first dose (no more ideation after the first dose). The depression lifted in the first few doses. Once the healthy synapses grew, I reinforced them. As I was triggered, I broke down trauma underneath and differentiated it from my new reality, rewiring them to no longer fire. Six + years in, I’m a completely different person that loves life in every way, and ketamine has been so successful I don’t feel like any other treatment is needed to feel better.

Being bipolar, I maintain a mood stabilizer, antipsychotic, stimulant, and sleep med, but I no longer need recreational drugs and several prescriptions I used to take.

It takes ketamine time to regrow synapses and relocate dendrites depression and PTSD Maladaptation creates. So, like many, I did feel worse before I felt better.

See: Feeling Worse When Starting Treatment

Emotional processing is complicated, significantly before the depression lifted and the new synapses developed and grew strong. They’re like muscles, and they need exercise to grow strong. So, the therapy was complex emotionally at first, and I cried a lot. Profuse sobbing. It was so cathartic though. To release all that lifted the weight of the world from my shoulders.

So, in summary, ketamine lifts rumination, depression, and ideation completely, and words can’t describe how good that feels. Incredible feeling. It also restructured my brain to appreciate these things and come healthily to the world.

I’m so happy now, consistently happy and healthy.

It’s why I wrote the guide and built the site. Ketamine made such a difference for me I’m getting the word out to everyone that it can help.


● Treatable Mental Illnesses

Ketamine is indicated for treating Bipolar 1 & 2, rumination, depression (such as major depressive disorder and treatment-resistant depression), PTSD & CPTSD, substance abuse, persistent anxiety, intrusive thoughts, Alzheimer’s & Dementia, Autism (ASD), ADHD, Borderline Personality Disorder, Panic Disorders, suicidal ideation and self-harm, and OCD. Most of the benefits are reported by patients and doctors, so few studies exist to prove out benefits, although more come out every day. We’ve taken great care to cite our sources across the site and add new content every week.

Spravato has been proven effective and is FDA-approved for treatment-resistant depression (TRD) only (in clinical trials). Racemic ketamine is off-label for mental health purposes.

While ketamine has a long history as an anesthetic and painkiller, I don’t cover chronic pain or anesthesia in the guide. There is a supplemental page on neuropathic pain here. We are focused mainly on the use of ketamine therapeutically, be it do it yourself or through a provider.

Ketamine is not considered the first line of defense, so some mainstream healthcare guidance is to try first-line antidepressants first. Given how effective ketamine is, I would use it as the first option, but the medical community is conservative.

If other antidepressants haven’t worked or cause unwanted sexual side effects (which is common), or you want to go straight to the best option IMHO, explore ketamine.

Ketamine has been proven in treatment-resistant depression, which requires multiple antidepressants to be tried first to indicate by most evidence-based practices. Do not self-diagnose. Only do diagnosis through a qualified health provider.

See: Treatable Mental Illnesses


● Effectiveness by Mental Illness

This is the result of our 30-Second Survey, current as of the end of last week. This is patient-reported effectiveness.

If you haven’t completed the survey, it takes less than 30 seconds. It is very helpful for us in various ways, providing the results below and evidence to use in media to overcome ketamine’s stigma. Ketamine for mental health regularly gets poor press coverage.

In the survey, we identify non-responders as they reported scores lower than or equal to two stars or less for overall effectiveness. The non-responders skew the overall scores downward so pay attention to the number in each category. The resulting effectiveness % is calculated using those who responded and scored higher vs. those who did not respond.

Categorically, we’ve observed that there is a direct correlation between the time on the treatment and the patient’s success. The longer someone has been treated, the higher they tend to score on the survey. This underscores the need to stick with it even when you feel worse at first for the best results.

Effectiveness Rating Legend

Amazing

Highly Effective

Effective

Partially Effective

Ineffective

Not Rated (No Submissions Yet)

Survey Results

Overall Effectiveness of Ketamine Therapy

135 Surveyed, 15 Ineffective (88% Effective)

Average Months on Treatment

10 Months

Major Depression Disorder (MDD)

86 Surveyed, 10 Ineffective  (87% Effective)

Mood Instability

54 Surveyed, 7 Ineffective (88% Effective)

Suicidial Ideation

51 Surveyed, 7 Ineffective (86% Effective)

ADD/ADHD

34 Surveyed, 8 Ineffective (76% Effective)


PTSD/CPTSD

58 Surveyed, 7 Ineffective (88% Effective)

Triggers

41 Surveyed, 6 Ineffective (85% Effective)

Treatment Resistant Depression (TRD)

58 Surveyed, 7 Ineffective (88% Effective)

Anxiety

78 Surveyed, 8 Ineffective (90% Effective)

Intrusive Thoughts

53 Surveyed, 11 Ineffective (79% Effective)

Rumination

58 Surveyed, 9 Ineffective (84% Effective)

Substance Abuse

27 Surveyed, 2 Ineffective (92% Effective)

OCD

15 Surveyed, 3 Innefective (80% Effective)

Personality Disorders

14 Surveyed, 3 Ineffective (78% Effective)

Panic Disorders

35 Surveyed, 4 Ineffective (88% Effective)

Psychosis

4 Surveyed

Anger

11 Surveyed, 1 Ineffective (90% Effective)

Schizophrenia

4 Surveyed

BP1

7 Surveyed

BP2

14 Surveyed, 1 Ineffective (92% Effective)

Autism

9 Surveyed

Alzheimer's

4 Surveyed

Thank you; every submission adds weight to our collected evidence!


● Treatment Center

Treatment is done via ketamine clinic often, and telemedicine is an alternative. There are practices everywhere that specialize in ketamine.

Search Google for ‘ketamine providers near me’ or ‘ketamine telemedicine providers.’

Our site hosts a comprehensive provider directory, with a matrix by state in our Providers by State page.

With a clinic, expect a $350ish consult fee. Most do IVs, often $300ish to $700ish each, and standard practice is 6 to 8 IVs administered over two to three weeks. Telemedicine and some clinics also do troches (sublingual lozenges). Troches, by comparison, are $75-$90 for the equivalent of 4 IVs.

See: Optimal Dosing Frequency

More costs can be found in costs by route of administration.

Make sure your treatment center believes in patient education and patient self care. It’s key to know the dosages you are being given, and at what frequency.

Ketamine increases anesthesia tolerance across the board – so if one were to be in an ER, and about to undergo surgery they’d need to tell the ER what dose of ketamine they take, and at what frequency for the anesthesia to be adjusted appropriately (upward).

As I understand it, worst case scenario is you could be in emergency surgery and not sufficiently sedated – iow, sedated enough to be paralyzed, but not sedated enough to be unconscious. And then experience the surgery.

Which is unlikely I’m sure, but I know when I went in for a colonoscopy and gave them my doses and frequency they doubled the anesthesia. So definitely a remote possibility.

Many patients share the guide with their providers, and as a result are able to have more in-depth conversations with their providers about their course of treatment, the potential side effects, and other related concerns. Be sure you choose your provider carefully, and that you are well informed and educated about your treatment, and related protocols.


● Administration

See: ROAs – Routes of Administration

See: Treatment Information

The clinic can administer ketamine using varied routes of administration. Most often used are IVs, but there are IM injections, nasal spray, troches (aka lozenges), pills, rapid dissolve tablets, suppositories, transdermal, and nebulization. Telemedicine often uses troches or rapid dissolve tablets as they ship better.

Typically, an IV series is done over two to three weeks, with injections Monday, Wednesday, and Friday, over two/three successive weeks, for example. This initial series of 6-9 (typically) infusions are called the “loading doses“.

I started with troches, did them for two months, then did my IV series of 6. I use a local provider overseen by a psych specialized in ketamine. I know many choose telemedicine, and there are several viable alternatives, however, do your research, as several get many bad reviews for poor support during the treatments. If we see enough negative feedback about a provider, we will annotate our provider directory to call that out.

At first, in my treatment, I found troches preferable to IV. No injection was involved. I could do them as I saw fit, go as deep for as long as I liked, and ensure I had a quiet, safe space for the experience. It’s essential to be in a safe space with limited (no) interruptions (outside of a friend/therapist, perhaps). Still, while you’re under the influence, you’re vulnerable, and avoiding trauma is essential (I’ll go into that more below).

Do not mix ketamine with water, like a bathtub, hot tub, or pool. Cognition can take a break while under ketamine, and drowning is a risk. Instead, find a comfy recliner, couch, or bed. It is anesthesia, and you will fall unconscious if the dose is too high.

Another reason I preferred troches to IV is because clinics do o2 stats and blood pressure checks, which negatively interrupt the experience – so you’ll be knee-deep in childhood trauma, and a nurse will bug you. Not ideal. If this is your provider’s practice, ask them to limit their interactions to before and after the dose is administered and has been completed. My practice changed its standard operating procedure for everyone upon this request.

In the IV series, dosages are increased over the series to promote higher dissociation. This can be done with troches. However, heed the warning above, and please read carefully about the dosing below because more is not always better.

With IV administration, you can request magnesium alongside, which increases the effect and reduces hangover.

Ketamine can cause nausea in some people, so they can also administer Zofran, an antinausea drug.

You can supplement it with magnesium glycinate using troches or other non-IV methods. It is highly bioavailable and comes without the laxative effect of magnesium l-threonine. 400mg. An early morning dose on the day of your ketamine is recommended, although magnesium is good to take at 400mg daily.


● Bioavailability

Different routes of administration have differing bioavailability levels, which translates to more highly effective doses at lower comparative ketamine doses, which can help prevent bladder harm, covered last in the guide. More detail there.

With troches, try and keep the saliva in your mouth, under your tongue, as much as possible. Ketamine is more bioavailable when absorbed through 1st pass digestion via mucosal membranes. See Spit or Swallow Oral? When you swallow, ketamine goes through second-pass digestion via the liver, giving you more of a hangover (dull headache and fatigue for 1-2 days afterward) and increasing bioload over other approaches. Given we all have a natural swallow reflex, troches are bound to end up in the stomach to a degree regardless. But if you hold the spit in your mouth as long as possible (ideally 45-min, to 1-hr) and then spit the ketamine out, you’ll have little hangover compared to swallowing.

Generally, oral administration of ketamine has a relatively low bioavailability, typically around 20%. This is due to the extensive 2nd-pass metabolism in the liver, where a significant portion of the drug is metabolized before it can reach systemic circulation.

Some patients have reported that their oral mucosa will be affected by troches and RDT’s, causing inflammation and potential shedding of the inner lining of the cheek. This, like the bladder, will heal completely over time.

In regards to tooth enamel:

  • Ketamine is acidic, with a pH of 3.5-5.5. Acidic substances below the critical pH of enamel (5.5) can erode enamel over time.
  • However, the limited contact time with low concentrations used therapeutically is unlikely to cause significant enamel erosion.
  • One study found no difference in salivary pH after intravenous ketamine administration. No clinical studies have directly evaluated the effects of long-term therapeutic ketamine use on dental enamel.
  • Proper oral hygiene practices should prevent any minimal erosive effects of therapeutic ketamine use.

Overall, while more research is needed, there is no strong evidence currently that therapeutic ketamine under proper medical supervision degrades or erodes tooth enamel to a significant degree, especially with short-term use.

The nasal is even better at 1st pass digestion than under the tongue (more mucosa), resulting in a higher bioavailability than sublingual.

Intranasal administration of ketamine, by way of comparison, has a higher bioavailability of around 45-50%. This is because intranasal administration allows the drug to be absorbed directly into the bloodstream through the mucous membranes in the nose, bypassing metabolism in the liver.

You may want to consider getting a nasal dispenser. This can lower the risk of bladder damage, covered last in the guide. See Vitality Medical to Buy a Nasal Dispenser.

Racemic rapid dissolve tablets and racemic troches can be placed into warm saline, dissolved, and dispensed nasally with this device.

The suppository also has higher bioavailability than the sublingual due to more mucosa. Here, follow the same protocol to prepare RDTs or troches and inject rectally with a rectally appropriate syringe.

Suppositories generally avoid first-pass metabolism like nasal, IV, and IM. Suppositories can have variable absorption depending on the specific formulation and individual differences in absorption in the rectal mucosa. It is generally thought to be higher than oral, however.

So, all that said, always involve and follow your provider’s guidance in any variation to your prescribed treatment plan, including formulations and route of administration. Discuss any changes with them, and get approval to try a given technique. You need to understand your provider’s protocol for such approaches and protocols for infection mitigation.


● Half-Life

The half-life of ketamine is 2.5 hours. Ketamine takes down fine motor controls, making driving, operating machinery, and other tasks requiring coordination difficult.

If pulled over or in an accident and tested immediately after dosing – for example, immediately after an IV, you will be given a DUI. Ketamine can be a false positive for PCP.

Waiting 24 hours to drive brings the ketamine down to nearly non-existent levels.

If doing in-office administration, we recommend a designated driver. Many providers require this.

Here are the key points about the half-life and driving recommendations for ketamine used therapeutically:

  • Ketamine has a relatively short half-life of around 2-3 hours. This means that after 2-3 hours, the plasma concentration of ketamine is reduced by half.
  • However, the psychoactive effects of ketamine typically last 45-90 minutes when used at therapeutic doses. The effects wear off gradually.
  • Ketamine is metabolized into norketamine with a longer half-life of around 12 hours. Norketamine is also psychoactive and can prolong the effects.
  • Most guidelines recommend waiting 24 hours after using a therapeutic dose of ketamine before driving or operating heavy machinery. This allows time for the drug and metabolites to be sufficiently cleared from your system.
  • Some experts say waiting 12-16 hours may be sufficient based on the short half-life, but 24 hours is a more conservative timeframe given the presence of active metabolites and individual variability in response.
  • The effects of ketamine vary significantly between individuals based on factors like body size, liver function, other medications, etc. It’s best to be cautious when judging your ability to drive safely after ketamine.
  • If you must drive sooner than 24 hours, be careful and attentive. Have someone else drive if you notice lingering effects like sedation, slowed reflexes, coordination issues, or altered judgment. Please don’t take any risks when it comes to driving safely.

In summary, a 24-hour wait is recommended after a therapeutic ketamine dose, but if driving sooner, take every precaution and avoid driving if any effects persist. The clearance time can vary.


● Experience

See: Non-Ordinary States of Consciousness

See: Disassociation

See: Subjective Experience

See: Preventing Panic

See: The Transformative Power of Ketamine

Reports of experience range from trivial effects to profound insight into trauma and unhealthy mental patterns, complete in-situ deaths, and reincarnations (rebirths/near-death experiences), communing with higher consciousnesses, and a complete loss of comprehension/cognition. Some report reality collapses to a single infinite point, then rebuilding based on Mandelbrot fractals (this can be the experience associated with a k-hole). Generally, however, the experience of ketamine is described as ineffable.

This is dose-related. There are benefits to various states of dosing, which I will cover next.

To start, ketamine disables the perineuronal net, a protective system in the brain dealing with trauma. This is one of its greatest strengths, as by disabling the net, the mind becomes adaptable to how trauma is stored and the stimulus-response patterns of triggers. This comes with some risk, though, as when new trauma occurs within the window wherein the net is down, the trauma won’t be processed as normal, and the effects of that are unknown. Due to this, my advice is to avoid traumatizing yourself with the experience itself.

Disassociation is accomplishable via a moderate dose, so there is no need to wipe out your cognition (anesthetic dose) or ‘ego-die/khole‘. Some report therapeutic value in ego-death levels, and some research indicates reset of brain circuits and neural networks at those doses can be therapeutic. I have dosed at elevated levels and found benefit in understanding myself spiritually, yet there is some risk to my sanity. Know, however, that those doses are not required for ketamine to be effective, and they can be traumatic if you aren’t prepared for them.

Again, my guidance is to start low and work up. Trauma processing is best when your ego is present and lucid, which is lower doses than ego death. Start low and work up to it if you want to go as far as ego death. As you’ll see below, though, many of ketamine’s therapeutic aspects do not require this.

Ketamine at high doses recycles neural networks/resets brain circuits (aka neural fragmentation), so you may be out of it for a bit. Do not let it concern you — it’s a natural and transient part. Try not to go this high, but know it happens, and nothing to worry about. For more about this, you can read this Sheep on K for a good study. Research has shown the human brain doesn’t behave precisely similarly, but it should give you the gist.

Brainwaves of sheep collapsing after ketamine is administered. This shows that the mind “resets” after a dose of ketamine, and this is hypothesized to create the near-death experience some get.

See even more of Ketamine’s Action in the Brain.

Note that the flatlining of brainwaves shown is hypothesized to create a Near Death Experience (NDE) for some while undergoing the experience.

Again, trauma processing only requires a moderate disassociated dose. This keeps you mentally intact but opens memories from suppressed traumas and will surface the issues your mind needs help with. At these doses, ketamine exposes suppressed memories, triggers (stimulus/response), traumas, and thought patterns for modification. This is how it most effectively treats PTSD & CPTSD. At these doses, the recall on ketamine will be near perfect.

Dissociation provides new perspectives on problems, memories, and triggers — and each time you take ketamine, the view differs. This will give you much to think about and work on.

Do not try to make your mind focused. It will prove difficult. Trauma is processed in the background; you need not work on it consciously. You can, though, and as you understand triggers better, you can target them intentionally and rewire them to fire appropriately.

Ketamine collapses neural networks/brain circuitry and some brainwaves in no particular order and to varying degrees while enhancing other neural networks/brain circuits/brainwaves. This is a highly active field of study, with imaging of all nature being produced, and the terms are broad because there isn’t consensus on the exact mechanisms here.

See: Brainwave Changes

As a result, ketamine is unpredictable in that the same two doses will rarely have the same effects. Each time you take ketamine, the subjective experience and the nature of the trip will vary – some trips will be more vital and more profound, while others may not even induce visual or any mental effects. Each time you take ketamine results in a new point of view, however, and part of that variability is thought to stem from the variations in these collapses and resets. Again, theoretical.

Like many, I did feel worse before I felt better. Processing trauma was brutal, and I cried non-stop for a couple of days after each dosing for the first eight or so.

See: Feeling Worse When Starting Treatment

By starting with troches, I had already begun the formation of the new synapses and dendrites found in a healthy brain. I had pre-processed a lot already going into the IVs, so my IV series was anti-depressive and healing.

Those starting with IVs build the new synapses and dendrites with the first dose, and the growth happens 12-72 hours after a dose. In the beginning, the newly formed structures are weak and need a lot of reinforcement. The series of 6 IVs gives them lots of time to build out, and what you do during your series can affect how well they build out, and like a muscle, they need exercise. Do everything you can to be healthy. Therapy, yoga, walks, meditating, bonding with loved ones, processing emotions, letting them come and go. Learn mindfulness. This is key, and being present now is what gets rid of triggers.

Now is different than then. Always remember that.

Often people who are in the first few IVs wonder, “Is this even working for me” “I’m discouraged. This is my last hope, and I need it to work for me”, and “Am I doing it wrong?”. No, you’re not. It takes time to regrow and adapt to using the new neural networks. You can’t force it, and there are no ‘mistakes’ you can make that will change the course of action.

In the first few doses, a lot of pent-up emotion is released, and you don’t have healthy neurons online to cope quite yet. So, it’s discouraging for some. It’s common Feeling Worse When Starting Treatment. They are processing many emotions, are still depressed, and wonder if they should continue therapy. It’s expensive and makes them feel like crap, so why keep doing it?

That is when you need to keep going because your brain is still healing, and the depression hasn’t lifted yet. Keep with it, and as your mind recovers, you’ll feel better. At a minimum, do the first 6 IVs, but it might take more, and in my case, I went to monthly boosters and did that for three years to reinforce the synapses and to remain open for processing.

Even though the first few doses may be difficult emotionally, your ideation (should you have any) will be removed with the first dose, so you won’t want to end your life. If you continue to ideate after the first dose (which happens rarely), it’s a sign of cyclic ideation caused by depression and may take a while longer to resolve as your networks build.


● Transliminal Space

The term “transliminal” itself is derived from Latin, where “trans-” means “across” or “beyond,” and “limen” means “threshold.” So, “transliminal” in this sense is to be interpreted to mean “beyond the threshold.” In a psychological context, this refers to experiences or states of consciousness that go beyond ordinary, everyday awareness.

Transliminal space is the boundary between awake and in a dream state at the edge of anesthesia. It can seem as if you exist solely of mind alone in the void and of a completely separate and transiently invisible physical body.

There are theories that transliminal space, at moderate doses, is a sweet spot for deep introspection and is the most therapeutic level. I cover doses below in more detail, but in my experience, when transliminal, I feel I’m merged with the higher mind and that it’s teaching me more from which I can grow – if in no other way than a much deeper understanding of myself.


● Near Death Experience (NDE)

Many people who k-hole see that event as a near-death experience. This can feel like an in-situ reincarnation. An NDE is characterized by the following:

It’s important to note that not everyone with a near-death experience will experience all of these elements, and the experience can vary greatly from person to person. The interpretation of these experiences can also be influenced by a person’s cultural and personal beliefs.

  1. Out-of-Body Experience (OBE): This is often the first element of an NDE. The person feels as though they have left their physical body and are observing events from a detached perspective.
  2. Tunnel Experience: Some individuals report moving through a dark tunnel or void, often towards a source of light.
  3. Feelings of Peace and Joy: Many people report feelings of profound peace, love, and joy during an NDE. They often lose all fear of death.
  4. Light: Individuals often report being drawn towards a bright light. This light is often described as being of unearthly brilliance and warmth.
  5. Encounter with Others: Some people report encounters with deceased loved ones or spiritual beings. These beings often communicate with the individual, offering comfort or advice.
  6. Life Review: Some individuals experience a rapid, panoramic playback of their life or portions. A sense of profound understanding or insight often accompanies this.
  7. Reluctance to Return: Many individuals who experience an NDE are reluctant to return to their physical bodies and earthly life. They often report a sense of disappointment when they revive or are resuscitated.
  8. Transformation: After an NDE, individuals often report profound changes in their attitudes, beliefs, and values, including a decreased fear of death, an increased sense of purpose and self-worth, and a greater concern for others.


● Out of Body Experience

An out-of-body experience (OBE) is a phenomenon in which a person perceives the world from a location outside their physical body. This experience can vary greatly from person to person, but there are some common elements that many people report.

  1. The feeling of Separation: The individual often describes a sensation of being able to view their physical body from an external perspective, as if they have separated from their body and are observing it from a distance. This is often described as looking down on their body from above, but the perspective can vary.
  2. Altered Perception of the Environment: The environment during an OBE may appear similar to the normal physical world but with subtle differences. Some people report that the world seems more vivid, with colors appearing more vibrant. Others describe the environment as being dreamlike or surreal.
  3. Sensations: Various physical sensations may be associated with OBEs. These can include feelings of floating or flying, spinning, or rapid movement. Some people also report a sensation of vibration or buzzing as they separate from their body.
  4. Emotional Responses: The emotional response to an OBE can vary widely. Some people find the experience exhilarating or profound, while others may find it frightening or disorienting.
  5. Return to the Body: The return to the body is often described as a quick or instant process. Some people report a sensation of being pulled back into their body, while others describe simply finding themselves back in their body without a clear transition.

It’s important to note that OBEs are often associated with altered states of consciousness, such as near-death experiences, deep meditation, psychedelic substances, or certain sleep states. However, they can also occur spontaneously without any apparent trigger. The exact cause and nature of OBEs are still subjects of ongoing research and debate in the scientific community.


● Super-Hearing

Ketamine disables the perceptual filters your mind uses to filter out background noise. So, when you’re on ketamine and not listening to something like music, you may hear sounds you have tuned out automatically all the time, like the furnace or air conditioning.

Take this as an opportunity for your ketamine self to be kind to your future self. If doing at-home treatment, find all the little rattles and creaks while on ketamine, and your life will be far quieter around you afterward.

For example, I found chattering glass vases when the air conditioner was on. I appreciate the difference now that low-level background noise is gone, having silenced it.


● Neurological Growth
● Improved Cognition
● Neural Plasticity

See: Brain Changes

See: Neural Networks

See: Neural Plasticity

See: Cognitive Improvement

See: Memory

See: Perineuronal Network

See: Neurogenesis

See: Synaptogenesis

See: Dendrite Remodeling

Ketamine has been shown to improve cognition (memory, processing speed, and cognitive flexibility) across correlated studies. For 24-72 hours after a dose, there may be reductions in cognition – however, after seven days, there are marked, measurable improvements over baseline.

Ketamine promotes (at least) three mechanisms through which your brain changes and heals: Neurogenesis, synaptogenesis, & dendrite relocation, regrowth, and extension (aka remodeling).

Neurogenesis –

Ketamine appears to increase the proliferation and development of new neurons from neural stem cells. It does this primarily by activating the mTOR (mechanistic target of rapamycin) pathway, which stimulates synaptogenesis and growth of new dendrites on developing neurons. Ketamine also seems to increase levels of BDNF (brain-derived neurotrophic factor), an important neural growth factor. The most prominent growth occurs in the hippocampus.

Synaptogenesis –

Research shows that ketamine rapidly increases synaptogenesis in the prefrontal cortex and hippocampus. It does this in several key ways:

  • Ketamine increases brain-derived neurotrophic factor (BDNF). BDNF supports long-term potentiation – the strengthening of synapses based on patterns of neural activity. BDNF facilitates synaptic plasticity.
  • Ketamine also activates the mTOR pathway. mTOR signaling promotes the translation of synaptic proteins needed to produce new synapses.
  • The new synapse formation induced by ketamine occurs via the rapid synthesis of synaptic proteins like PSD-95, glutamate receptors, and synapsin. This leads to increased density and function of synapses.
  • Ketamine also increases the number of mature mushroom-shaped dendritic spines, the sites where synapses form. This further enables synaptogenesis.

Dendrite Relocation, Regrowth, and Extension (Remodeling) –

  • Ketamine increases brain-derived neurotrophic factor (BDNF) levels, which promotes dendritic remodeling and motility. BDNF activates pathways that allow dendritic spines and branches to become more mobile.
  • The increased dendritic mobility induced by ketamine leads to elongation and branching of dendrites. This allows dendrites to sample a greater area to form new synapses.
  • Ketamine also rapidly increases the turnover of dendritic spines, with the loss of certain spines and the growth of new ones. This reorganizes the dendritic network.
  • Advanced microscopy techniques have shown dendritic spines redistributing within 30 minutes of ketamine treatment in rodent models.
  • The new dendritic configurations allow neurons to form novel circuits and increase synaptic connectivity.

Inducing rapid relocation and rewiring of dendrites, ketamine can quickly remodel communication between neurons in brain regions involved in depression. This may help “reset” circuits that have become dysfunctional, restoring neural plasticity. The reconstitution of neural networks via dendrite reorganization is likely a key mechanism underlying ketamine’s robust and sustained antidepressant effects.

Note that Spravato has not shown the same effect. Again, this implies not rebuilding synapses as effectively, but speculative and not proven through research.

Neural plasticity opens during a dose and persists up to 72 hours afterward. Neural plasticity means your mind is open for conscious modification, and it’s as if your conscious and subconscious can discuss things and come to terms with one another.

Decide to change, accept, and love something; it will become solidified in your mind after the window closes. For instance, you can quit a substance and wake up the next day, not craving it.

The uses of this are manyfold, experiment and surprise yourself!

There is limited research available, but ketamine is also remarkably similar and thought superior to modern treatments for Alzheimer’s as well. Out of five hypothesized pathways for Alzheimer’s, ketamine shows improvements in four and uncertain effects in a fifth.

One of the leading theories in Alzheimer’s is that the dendric spines become complex and, as a result, require expensive metabolic processing. Ketamine reforms dendric spines, making them leaner and more efficient and attaching them to new locations on the synapses. This reduces the metabolic expense of the dendrite and is theorized to act as a precognitive agent against Alzheimer’s. I’ll add more info here as studies proceed.

See Alzheimer’s Disease for more recent updates here.


● Metacognition

Ketamine installs metacognition in that you’ll have a new voice in your head of an inner moderator. It will monitor your interactions and will let you know when you’re in triggered situations so you can resolve those triggers interactively. It will recognize when you are triggered, so you can take those situations into ketamine sessions and work through their underlying pattern. You then will take time to differentiate your new reality from the reality that caused those triggers. Then, in the window of neuroplasticity 12-72 hours post-session, you reprogram yourself to become immune to those circumstances in the future.

It takes time and practice, but this increased capability of your mind to recognize and work through this is called metacognition. Metacognition means greater self-awareness of your mental state, thoughts, and emotions.

Do not be alarmed by this new self-awareness; you will grow into it.