Ketamine therapy

Our approach

At BPA, ketamine treatment is more than simply receiving a medication. We combine the biological effects of ketamine with preparation for the experience itself and thoughtful use of the period afterward, when the brain may be more open to change.

A central part of that process is feeling safe and trusting your clinician, the staff, and the treatment environment.

How does ketamine work?

Ketamine appears to help through several overlapping processes.

1. The medicine has a direct antidepressant effect

Traditional antidepressants primarily affect serotonin, norepinephrine, or dopamine. Ketamine works mainly through the brain’s glutamate system, particularly NMDA and AMPA receptor pathways.

These chemical effects begin soon after the medication is given and can produce antidepressant improvement much more rapidly than conventional antidepressants in some patients.

Ketamine also appears to promote neuroplasticity—the brain’s ability to change, adapt, and form or strengthen neural connections.

2. The ketamine experience itself may create a different perspective

Ketamine temporarily changes the way the brain processes perception, emotion, memory, and thought. Many people experience some distance from familiar patterns of thinking, allowing thoughts or emotions that usually feel fixed or overwhelming to be seen from a different perspective.

One hypothesis is that ketamine temporarily disrupts circuits involved in maladaptive patterns such as rumination, excessive guilt, and persistent feelings of inadequacy.

Some people also experience peace, connection, insight, or a sense of deep meaning. These experiences are not required for benefit, but they can sometimes contribute to a shift in perspective.

3. The period after treatment may offer an opportunity for change

The effects of ketamine do not end when the medication experience wears off.

Research suggests that ketamine can produce a temporary period of increased neuroplasticity and cognitive flexibility. During this time, old patterns may be somewhat less rigid and the brain may be more receptive to new learning.

We encourage patients to use this period intentionally.

That might mean:

• noticing changes in habitual thoughts or reactions
• practicing a new behavior or returning to activities that depression has made difficult
• spending time with supportive people
• journaling, reflecting, or working with a therapist
• practicing mindfulness, movement, time in nature, or other healthy routines
• beginning a small behavior that supports the life you would like to move toward

The goal is not to force change or to interpret every ketamine experience. It is to notice whether there is a little more flexibility and, when there is, use it to strengthen the cognitive, emotional, or behavioral changes you want to make.

Research into how best to combine ketamine with psychotherapy and behavioral interventions is still developing. Early studies are promising, but there is not yet one proven method or schedule for doing this.

Why trust and safety matter

Ketamine temporarily changes perception and can make people feel psychologically and physically vulnerable.

For that reason, we believe one of the most important foundations of treatment is a sense of trust and safety.

Before your first treatment, you will have an opportunity to get to know your clinician, understand what the medication may feel like, ask questions, and talk about anything that might make it difficult for you to relax. We may also suggest simple breathing or body-relaxation techniques to help you feel grounded and open to the experience.

During the session, you are in a private treatment room with trained clinical staff either with you or nearby. You remain conscious and can communicate if you need help, reassurance, or simply want someone present.

Difficult emotions or unfamiliar sensations can sometimes arise. We want you to feel confident that you can experience and explore whatever comes up in your session and to know that you are not doing this alone.

What happens during a ketamine appointment?

Before your first treatment

You meet with one of our clinicians for a psychiatric evaluation. We review your diagnosis, previous treatments, current medications, medical history, and what you hope to change.

We also prepare you for the experience itself and discuss how we can best support you during treatment.

Some patients find it useful to identify an intention for treatment—something they would like to explore or change. This is entirely optional. We encourage patients to hold an intention lightly and to let it go and allow the experience to unfold, being open to and curious about new experience.

You will also need to arrange transportation home after every treatment.

The treatment itself

You receive ketamine in a comfortable private treatment room.

With IM ketamine, the medication is given as an injection into the upper arm.

With IV ketamine, the medication is given gradually through an intravenous infusion. Because the medication is infused over time, the rate and dose can be adjusted during treatment if needed.

Most people recline, close their eyes, and listen to music. We provide eye shades, headphones, music, and blankets, or you are welcome to bring your own.

Clinical staff monitor you throughout treatment and remain available if you need support. We check vital signs and assess how you are responding to the medication.

After the session

Most of the noticeable medication effects resolve before you leave the clinic, but you cannot drive yourself home after ketamine treatment.

We recommend keeping the rest of the day relatively quiet. Many people feel more sensitive to stimulation or more emotionally open for several hours afterward.

You do not need to immediately “figure out” what the experience meant. Over the next several hours and days, we encourage you to notice what feels different and make thoughtful use of the period of increased flexibility described above.

What does ketamine feel like?

The experience varies considerably from person to person and can also vary from one treatment to another.

Many people describe a dreamlike, floaty, or meditative state. You may notice changes in your sense of time, surroundings, or body, and thoughts may feel easier to observe without becoming caught up in them.

Some people experience peace, openness, connection, insight, or emotional distance from problems that normally feel overwhelming. For others, the experience is quiet, relaxing, or relatively subtle.

You remain conscious and able to communicate throughout treatment.

There is no “right” experience and no particular psychological experience you need to have for ketamine to work.

IM or IV ketamine: what is the difference?

Both use the same medication—generic ketamine—but deliver it differently.

There is no single approach that is best for everyone. Your clinician can help you decide which treatment makes the most sense based on your clinical needs, preferences, location, and cost.

BPA also offers Spravato® (esketamine), an FDA-approved nasal form of esketamine that generally has a more standardized insurance pathway than IM or IV ketamine.

What is the treatment schedule?

A typical starting course is:

Initial treatment: About twice weekly for three weeks.

Continuation treatment: About once weekly for several additional weeks.

Maintenance: For patients who benefit, treatments can then be spaced farther apart.

Some people eventually come every few weeks or longer. Others do not need ongoing maintenance.

We try to find the lowest treatment frequency that maintains meaningful improvement rather than continuing on a fixed schedule indefinitely.

How do we know if it is working?

Your clinician will ask about changes in:

• Mood
• Interest and motivation
• Anxiety and rumination
• Sleep
• Energy
• Functioning in daily tasks
• Suicidal thoughts when present
• Relationships and engagement with daily life
• Whether previously difficult behaviors are becoming easier
• How long the benefit from each treatment lasts

We also use standardized symptom measures to help track change over time.

If ketamine is not helping, we do not continue simply because you have started a course. Your clinician will review the response with you and discuss whether to adjust the dose, change the schedule, consider another treatment, or stop.

Ketamine-Assisted Psychotherapy (KAP)

Ketamine-Assisted Psychotherapy (KAP) offers a more supported experience.

In a KAP session, your clinician remains with you throughout the medicine experience, providing support and helping maintain a sense of safety and trust. Rather than engaging in conventional psychotherapy while the medicine is strongest, most people turn inward and explore their internal experience with the clinician’s support.

KAP may also include dedicated preparation and integration sessions before and after treatment. It can be particularly useful for exploring longstanding emotional patterns, relationships, trauma, self-concept, or questions of meaning.

KAP principles inform all of our ketamine care

You do not have to be receiving formal KAP to benefit from this approach.

At BPA, elements of Ketamine-Assisted Psychotherapy inform all of our ketamine and Spravato treatment. Even when a patient is not receiving formal KAP, we emphasize preparation, trust and safety, openness to the medicine experience, reflection on insights that emerge, and thoughtful use of the period of increased flexibility after treatment.

For patients who want more intensive psychotherapeutic support, formal KAP is available on a limited basis with select clinicians.

Is ketamine safe?

Ketamine has been used in medicine for decades. At the lower doses used for depression, most acute side effects are temporary and resolve as the medication wears off.

Common short-term effects can include:

• Dissociation or changes in perception
• Dizziness
• Nausea
• Temporary increases in blood pressure or heart rate
• Fatigue
• Anxiety
• Feeling unsteady or disconnected from your body

We monitor vital signs, mental status, and your overall response before, during, and after treatment.

Ketamine also has potential for misuse, which is one reason treatment at BPA is administered only in a monitored clinical setting and is not prescribed for patients to take home.

Is ketamine FDA approved for depression?

Ketamine itself is FDA approved as an anesthetic. Its use for depression is off-label.

Off-label prescribing means that a medication approved by the FDA for one purpose is being prescribed for another condition based on clinical evidence and medical judgment. This is common in many areas of medicine.

Spravato®, which contains esketamine, is FDA approved for specific depressive disorders.

Learn more about Spravato →

Does insurance cover ketamine?

Insurance coverage for IM and IV ketamine varies.

Because ketamine is used off-label for depression, it generally does not have the same standardized insurance coverage as Spravato.

What does the research show?

Ketamine has been extensively studied as a rapid-acting treatment for depression, particularly treatment-resistant depression.

Randomized trials and meta-analyses show that IV ketamine can reduce depressive symptoms within hours, with benefits measurable from several hours through about a week after a single treatment. A 2026 meta-analysis of 26 randomized trials involving more than 1,100 patients also found benefit after repeated infusions.¹ Because the effect of a single treatment is often temporary, ketamine is usually given as an initial series followed by less frequent continuation or maintenance treatment for people who respond.¹˒²

Ketamine has also been shown to reduce suicidal thoughts rapidly in some patients, although it should not be considered a substitute for emergency or inpatient care when immediate safety is a concern.¹

Major clinical guidelines recognize ketamine and esketamine as treatment options for selected patients who have not responded adequately to several conventional treatments.³

Research is also exploring whether ketamine-induced neuroplasticity and cognitive flexibility can be used to enhance psychotherapy, learning, and behavioral change. The rationale is compelling, but the best timing and methods for doing this have not yet been established.⁴

What happens after you contact us?

The first step is a brief screening to make sure ketamine is a reasonable option to explore and to answer basic questions about treatment and cost.

You then meet with a clinician for a comprehensive consultation.

Together, you decide whether IM ketamine, IV ketamine, Spravato, another treatment option, or no treatment is the right next step.

If you proceed, we develop an individualized treatment plan and follow your response throughout the course rather than using a one-size-fits-all protocol.

Getting started with ketamine

Request an appointment.

We will talk with you about your history, the differences between IM ketamine, IV ketamine, and Spravato, expected costs, and which approach may fit your situation.

Selected references

1. Shim SR, Jeong HS, Bommersbach TJ, et al. Ketamine Infusions and Rapid Reduction of Suicidal and Depressive Symptoms in Major Depressive Episode: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2026;83(7):714–731. doi:10.1001/jamapsychiatry.2026.0612.
2. Marwaha S, Palmer E, Suppes T, et al. Novel and Emerging Treatments for Major Depression. Lancet. 2023;401(10371):141–153. doi:10.1016/S0140-6736(22)02080-3.
3. McQuaid JR, Buelt A, Capaldi V, et al. The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2022;175(10):1440–1451. doi:10.7326/M22-1603.
4. Recent reviews have examined the rationale for combining ketamine-induced neuroplasticity with psychotherapy and cognitive-behavioral interventions; evidence is promising but remains preliminary.