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Expert Insights: The Benefits and Risks of Ketamine Therapy
Ketamine-based treatment is being used in some psychiatric settings, particularly for treatment-resistant depression, but its benefits, risks, and evidence base differ by condition. States of Mind spoke to Dr Justin Jaques, a ketamine-therapy provider at Journey Clinical, about how he uses ketamine in practice and what patients should consider before pursuing treatment.
Ketamine therapy has been found to provide significant relief for mental health conditions such as depression within three to six months. Evidence for anxiety, PTSD, and substance use disorders is more limited and still evolving.
Traditionally used as an anaesthetic, ketamine has also been studied for rapid short-term reduction of suicidal ideation in some depressed patients, although the durability and broader implications of this effect remain under investigation.
For some people, especially those with treatment-resistant depression, standard treatments do not bring sufficient relief, which is one reason ketamine has attracted interest.
So how does ketamine help people, and what are the considerations and risks to keep in mind before considering ketamine as an option for mental health?
Ketamine therapist and addiction counsellor Dr Justin Jaques tells States of Mind that he has seen marked improvement in some clients’ mental health following therapy, and shares some of the key considerations and risk factors to keep in mind — particularly for those with a history of substance misuse, including the importance of screening and supervision.
NB: The views in this interview reflect one clinician’s experience and should not be taken as a summary of guideline consensus. Evidence is strongest for treatment-resistant depression; evidence for PTSD, anxiety, and addiction is less established. Suitability, supervision, and regulation vary by jurisdiction and treatment model.
You have been working in mental health care for a number of decades — how has ketamine assisted therapy changed the way that you approach mental health treatment?
As well as ketamine therapy, I also deliver psychedelic-assisted therapy with psilocybin, so I have seen the two different approaches.
They both do similar things by increasing neuroplasticity. I find that ketamine is tolerated a little easier, but it also really creates neuroflexibility for the next few weeks, which means you can deliver some very good therapy in that time frame to help people change the way that they think.
As we get older, we get really hardwired in unhelpful ways, such as all-or-nothing thinking, jumping to conclusions, and catastrophizing.
I can help somebody look at a new problem in a different way.
I think that’s the hope of these types of treatments — instead of years of therapy where nothing is changing, it is a potentiating effect that lets me really get some more accelerated work done in a shorter amount of time.
Currently, the research coming out on ketamine suggests that we can often get a definite mood change.
For somebody who is a procrastinator, or is depressed or anxious, where we have been using SSRIs, all the tools, the exercise, sometimes ketamine can be the trick to really help somebody have three months to six months of remission and relief.
Based on the different types of protocols, often it’s the eight- or twelve-session journey model, where we see a positive effect for six months.
For somebody who’s been struggling with chronic depression, anxiety or addiction issues, that can be vital.
Before working with ketamine, did you have any professional concerns that have since changed after seeing how ketamine can help people?
When I think about my profession and my career, such as doing prolonged exposure therapy, it can be very difficult for people; it’s painful — I make them go into memories.
Having a tool that can really help with that has been a game-changer.
I think people often drop out of therapy when they start to do trauma work, because it’s just so hard and so painful, so psychedelics give us another way to approach that.
There have been other positive developments in mental health care, such as neurofeedback, but in terms of efficacy, ketamine is good.
The other thing about ketamine is that it is a very inexpensive medicine.
I think, for me, the social justice implications of expanding access, especially in America, where our insurance-based model really keeps people poor, are so important for people who don’t have employer-sponsored insurance.
I think it’s a new door where we’re going to be able to help people heal faster and more efficiently, utilising the medicine.
Also, when it comes to psychedelic therapy, the timeframe can be the hardest piece. With ketamine, you can do it in a short window, and there are very few psychedelics that can do that.
Even with psilocybin, you need five or six hours, which is not cost-effective. People also have very full lives, so finding the time to do six hours of therapy is really hard.
Based on your clinical experience working with ketamine therapy, what kind of mental health conditions have people seen to benefit most from ketamine therapy?
The three majors that I really treat as a generalist — anxiety, depression and trauma.
I also work with a lot of special forces, first responders and military populations, and it’s really good for burnout.
A recent case that I’ve been working on was a paramedic firefighter who has been doing it for 40 years, and we’ve been able to turn the burnout down and increase their resilience. The way they described it is that they feel “more like themselves”.
They are now able to be at work. The other aspect of burnout is anger and rage. It is really hard when you’re burned out, and you have a lot of PTSD based on trauma. Now, they have become friendlier, kinder, and more compassionate toward their co-workers.
I think for first responder populations and the military, it’s going to be another game changer, because they go through so much, and treating PTSD or secondary trauma is really hard.
Are there any conditions or patients that don’t respond well to ketamine therapy?
Humans are so complex. Everyone responds differently to ketamine — some people don’t respond as much, and there’s a rare population who don’t respond at all.
Other important factors would be conditions such as psychosis and psychotic disorders. You have to be really careful, as a rule, for example, if you’re somebody who has delusions, hallucinations, that can be a rule out.
We also have to be really careful with what we call “Cluster B personality disorders”. Sometimes putting somebody under psychedelics can make those worse.
Equally important is to take medical conditions into account. You have to have a good heart rate and good blood pressure, for example.
NB: Careful psychiatric and medical screening is important before ketamine treatment. Particular caution may be needed in people with psychosis, mania risk, significant personality pathology, uncontrolled hypertension, cardiovascular disease, or active substance-use problems.
What cognitive or emotional changes do patients report — and how important is integration as part of the therapy process?
For some people, they have a more intense brain experience and go outside themselves.
Others have a more body-based experience. It can be very emotional and bring up difficult things, but it can help you feel your feelings. It can help you think in new ways. It can help you gain the insight that you’re looking for, which is why setting an intention before you start is important.
I think integration is vital because, currently, people can access IV and nasal ketamine experiences, and even sublinguals, where they are able to go to a ketamine clinic, and there’s no preparation, there’s no integration.
I think the integration, which is the psychotherapy of it, where we are making those changes and working with a collaborative psychotherapist that helps you look at things differently, is so important to have lasting change.
From a cognitive-behavioural perspective, the way we think affects how we feel and how we behave. If we don’t change those thinking patterns, if we don’t look at that and the problems in our life, it’s probably going to go back to that, because you’re going back into the environment that you came from.
You are within a system, and it’s going to want you to go back to where you were, so you really need the integration and the therapy to help really make lasting change.
What are the risks or side effects of this treatment that people should understand before they consider pursuing it?
I think the risks are that when you take ketamine in an unsupervised way and you’re not doing it in a psychedelic way.
I think the risk for addiction in this case is probably high, and we’ve seen fatalities where people are taking ketamine. This is because one of the biggest problems we have currently is that, when giving somebody a controlled substance to take without proper supervision, medical professionals do not have control.
If people are using take-home ketamine from a company that sends it to you, there’s going to be a risk because we can’t monitor that.
I would say to really make sure that you’re working with a reputable company that is using a psychedelic model, and it has therapy as an integration piece.
I think that significantly lowers the risk of any kind of addiction, even if you have an addiction history.
NB: Risks and side effects can also include dissociation, sedation, nausea, dizziness, transient increases in blood pressure, distressing psychological experiences, and, with repeated exposure, concerns about misuse and urinary symptoms. Take-home or unsupervised models may pose additional risks due to limited monitoring.
Looking ahead, where do you see ketamine therapy or other psychedelic-assisted therapies fitting into future mental health care?
Psychiatry has had poor tools for so long, and then we had the war on drugs, and we stopped all the great psychedelics research.
Now, I think they’re going to be so common and integrated due to all of the studies that are now coming out showing their benefits for conditions such as anxiety and depression; it is mind-blowing.
My vision is that having these better tools is going to really help with trauma, depression, and anxiety. I think it will create a robust mental health toolkit with many options for people, which will be a game-changer.
I see them as an integral part of the future of mental health.
My worry is that people see psychedelics as a panacea, but they are just one part of a solution for mental health. You still have to do the therapy, you still have to do the hard work, but I think it’s really going to help people do that work by opening up to different ways of thinking and healing.
Expert Board Member
This is a relevant and accessible interview on a timely topic, and it offers readers a clear sense of one clinician’s perspective on ketamine therapy. Its strengths are readability, practical focus, and an appropriate balance between potential benefits and important cautions, making it a useful contribution to a complex and evolving area of mental health care.
