Understanding
Ketamine Therapy
A science-based overview of what ketamine is, how it works in the brain, which conditions it treats, and what makes it safe in a clinical setting.
What Is Ketamine?
Ketamine is a dissociative anesthetic with a long track record of safe use in medical settings. First synthesized in 1962 and approved by the FDA in 1970 as an anesthetic, it has been on the World Health Organization's List of Essential Medicines since 1985.
In recent decades, researchers discovered that ketamine has powerful, rapid-acting antidepressant effects — a breakthrough that has transformed treatment options for people with conditions that didn't respond to traditional medications.
In 2019, the FDA approved esketamine (Spravato), a ketamine-derived nasal spray, specifically for treatment-resistant depression and major depressive disorder with suicidal ideation — marking a new era in psychiatric medicine.
Quick Facts
How Ketamine Works in the Brain
Unlike conventional antidepressants that target serotonin or dopamine, ketamine works through an entirely different pathway — one that can produce rapid results.
NMDA Receptor Blockade
Ketamine blocks NMDA receptors — the "locks" that regulate glutamate, the brain's primary excitatory neurotransmitter. This blockade sets off a rapid cascade of downstream effects.
Glutamate Surge
The blockade causes a controlled surge in glutamate activity, which activates AMPA receptors and triggers the release of BDNF — a critical brain growth protein.
Neuroplasticity
BDNF stimulates the growth of new synaptic connections in areas of the brain associated with mood regulation — essentially "rewiring" circuits damaged by chronic depression or trauma.
"Ketamine is the most important discovery in antidepressant treatment in the last 50 years."
— Dr. Carlos Zarate, National Institute of Mental Health
Six Decades of Medical Use
Ketamine has one of the longest and most thoroughly documented safety records of any anesthetic in modern medicine.
See Our ProcessSynthesized by Calvin Stevens
Developed as a safer alternative to phencyclidine (PCP) for use as a battlefield anesthetic.
FDA Approval as Anesthetic
Approved for human use and widely deployed during the Vietnam War due to its safety profile in field conditions.
WHO Essential Medicine
Added to the World Health Organization's essential medicines list — a designation reserved for the most effective and safe treatments.
Antidepressant Effects Discovered
Landmark Yale study demonstrates rapid, powerful antidepressant effects in patients with major depression — sparking decades of research.
FDA Approves Esketamine (Spravato)
The first new antidepressant mechanism approved in over 30 years, specifically for treatment-resistant depression.
Growing Clinical Evidence
Hundreds of clinical trials and real-world studies continue to expand our understanding of ketamine's therapeutic potential.
Delivery Methods Compared
Ketamine can be administered several ways. We use sublingual lozenges — prepared by a licensed compounding pharmacy and shipped directly to you — so treatment happens in the comfort of your home.
| Method | Onset | Duration | Bioavailability | FDA Status |
|---|---|---|---|---|
| Sublingual Lozenge ★ What we use — at-home, compounding pharmacy |
15–30 minutes | 45–75 minutes | 25–35% | Off-label |
| IV Infusion Requires in-clinic administration |
1–2 minutes | 45–60 minutes | 100% | Off-label |
| Intramuscular (IM) Requires in-clinic administration |
5–10 minutes | 30–45 minutes | 93% | Off-label |
| Intranasal (Esketamine) Spravato — in-office only, REMS program |
20–40 minutes | 2–3 hours | 40–50% | FDA Approved |
Safe Under Proper Medical Guidance
Sublingual ketamine has a strong safety record when prescribed by qualified clinicians and used responsibly at home. Here's what you should know.
What to Expect During a Home Session
- Mild dissociative or "floaty" sensation at therapeutic doses
- Altered perception of time, color, or sound — temporary and manageable
- Sessions take place in your own home at a scheduled time
- A trusted support person present with you is strongly recommended
- Full effects typically wear off within 45–75 minutes of dissolving the lozenge
Common Temporary Side Effects
- Nausea (mitigated with pre-treatment anti-nausea medication)
- Dizziness or lightheadedness — resolves quickly after infusion
- Transient increase in blood pressure and heart rate
- Vivid dreams or unusual perceptions during the session
- Mild fatigue the day of treatment
- No driving for 24 hours following treatment
Who May Not Be a Candidate
- Active or poorly controlled psychosis or schizophrenia
- Uncontrolled hypertension or certain heart conditions
- Active substance use disorder (evaluated on a case-by-case basis)
- Certain thyroid conditions
- Pregnancy
- Current use of certain medications (full screening required)
What Ketamine Is Not
- Low addiction risk at clinical doses
The therapeutic dose is far below amounts associated with recreational misuse. - Not a cure
It is a treatment that can meaningfully reduce symptoms and improve quality of life. - Not unguided
Every protocol is prescribed and reviewed by a licensed clinician. - Not a replacement for therapy
Working alongside a therapist can deepen and extend the benefits.