First synthesized as an anesthetic in 1962, ketamine is used recreationally as a psychedelic and has become a popular nightlife drug, including in queer spaces. In powdered form, the drug is often passed around crowded dance floors and afterparties, where bumps offer bursts of dissociation and euphoria. But over the past two decades especially, the use of ketamine under medical supervision — or “ketamine-assisted therapy” — has been researched as an intervention for multiple mental health conditions, most notably treatment-resistant depression.
Ketamine’s effects on the brain have long made it a powerful tool in medicine. Ketamine has been used as an anesthetic since the 1970s, and following a surge of studies in the early 2000s, is now being used by doctors as a potential treatment for a range of diagnoses. In addition to its use as an intervention for depression, recent studies have also investigated its effects on bi-polar disorder, posttraumatic stress disorder (PTSD), anxiety, eating disorders, addiction, and more. Ketamine is only FDA approved as an anesthetic, however, so any use of ketamine for mental health treatment is still considered off-label, meaning that it is used for a different purpose than intended.
Several experts who spoke to Them say that they have seen promising outcomes using ketamine to treat some of the most common mental health conditions often faced by LGBTQ+ people. And many queer people who have experienced ketamine treatment say it has helped them overcome mental obstacles that other interventions couldn’t. While ketamine abuse in recreational settings has shown to be a risk in the queer community, medical-supervised use of ketamine for mental health treatment is a promising avenue warranting further study.
Other psychedelics, like MDMA and psilocybin (the psychedelic compound found in mushrooms), have also been studied for potential therapeutic use, and advocates are now pushing for the FDA to approve a range of psychedelic treatments for mental health. Although psychedelics are generally not considered highly addictive, some users can develop a tolerance for ketamine or abuse it. What does it look like to use ketamine in a medical setting? Why would LGBTQ+ people be interested in pursuing it? And what does it feel like?
Below, find answers to some common questions about ketamine-assisted therapy. Please note that mental health treatment with ketamine should be done in consultation with a medical provider. Consult a doctor with any questions about ketamine-assisted therapy or to determine if it might be beneficial to you.
What is ketamine-assisted psychotherapy (KAP)?
Before we get into how ketamine-assisted therapy can help queer and trans people, let’s walk through what it is. Ketamine assisted psychotherapy (KAP) refers to the use of ketamine to help treat a number of mental health conditions.
There are several different ways that KAP can be administered. Infusions, in which ketamine is administered via an IV, take place under medical supervision. Patients generally receive three to six infusions over the span of about two weeks. Often used in cases of treatment-resistant depression, infusion is the most studied form of ketamine therapy.
KAP can also be administered in conjunction with talk therapy, including sessions before and after treatment to prepare for and integrate its effects. Spravato, a nasal spray that includes one of the twin compounds contained in ketamine, was approved by the FDA in 2019 for treatment-resistant depression, when taken in conjunction with an antidepressant.
Ketamine can also be administered in oral lozenges that are held under the tongue. The FDA advises that all forms of ketamine treatment should be administered under the supervision of a health care provider.
How does ketamine-assisted therapy work?
Ketamine influences a neurotransmitter known as glutamate, which plays a key function in brain communications. Research is still ongoing, but ketamine’s therapeutic function is often framed as an opening of the mind to different ways of thinking. The effects of KAP are often described as a feeling of reorientation in the mind.
“In the days following ketamine experiences, the brain will be more plastic,” says Clare McBee, LICSW, a Boston-based provider who specializes in LGBTQ+-affirming psychotherapy. “There’s an interesting window to continue to apply what we’ve been doing in their therapeutic work.”
Marc T. is a 59-year-old trans client of McBee and has undergone KAP twice in a treatment setting. Marc had long been working to manage anxiety, depression, and complex PTSD associated with his formative family experiences, and reached a point where he felt “stuck in rigid ways of thinking about myself,” he tells Them. “KAP helped loosen that up in a way that 22 years of talk therapy hadn’t.”
“It shook me free and helped me break the rules in my head. All of who I am is against every rule I ever grew up with,” he says. For Marc, that meant letting go of self-judgment and accepting his queer identity in a different light.
“I felt better about saying that I don’t have to fit the norms out there, or be like any other trans guy,” Marc says. “I’m more comfortable with where I am than I ever really was.”
Who is ketamine-assisted therapy for?
Providers and patients say they’ve turned to KAP in the face of stalled progress with therapeutic alternatives. “Usually my clients who choose to pursue KAP are stuck in their treatment process, with symptoms that they can’t seem to get beyond,” says McBee.
KAP can be a promising intervention for many of the mental health challenges faced by LGBTQ+ people in particular. “Queer people often come to treatment with a complex landscape of shame, from internalized homophobia, transphobia, oppression on a collective level, or rejection, abandonment, or messages of pathologization from their families of origin,” McBee tells Them. When a patient’s journey through reckoning with shame and trauma reaches a roadblock, McBee says that KAP can help shift their perspective and encourage a change in thinking.
For McBee, a good candidate for KAP would demonstrate a willingness to explore and potentially face unknown parts of themselves, and have realistic expectations that the treatment isn’t a cure-all. Ideally, they also show commitment to doing both preparatory sessions and integration, or continued talk therapy to unpack and synthesize their experience afterward. Feeling safe and supported with providers is key, especially for queer and otherwise marginalized people to allow themselves to be vulnerable with this kind of treatment.
“Folks from our community have issues with the medical and mental health fields because of the inherent heteronormativity or the lens towards whiteness,” says Courtney Watson, LMFT, founder of Doorway Therapeutics, a mental health clinic in Oakland, CA, that specializes in providing services by and for LGBTQ+ and BIPOC people.
“It’s really important to know there are providers you’re not going to have to explain things to, who aren’t going to misgender you or subject you to microaggressions,” Watson tells Them.
What does ketamine-assisted therapy feel like?
The sensory effects of ketamine treatment vary depending on the dosing, with higher amounts leading to psychedelic experiences or hallucinations. Patients who’ve received ketamine infusions have reported feelings of enhanced perception and dissociation, or experiencing a view of themselves from the outside. Patients have also reported improvements in mood, reduction in suicidal ideation or other depressive symptoms, along with increased motivation, socialization, and activity.
For Aaron C., a 37-year-old who was diagnosed with bi-polar II, ketamine infusions have helped him treat the periods of depression associated with the condition.
“I was at a last straw with my depressions and how long they were lasting,” Aaron tells Them. “I was at a point where I felt the medication I was on wasn’t working.”
Aaron started with eight infusions over a two-week period, with visits to a clinic where he received an IV, relaxing in a chair with music and an eye mask. “I’m on this journey that feels like a movie that’s constantly in motion,” says Aaron, adding that the psychedelic effects can be hard to describe. He has seen himself from a distance and moved through scenes that helped him see his past and present in an altered light. “It changes your perspective and brings you out of your head and body.”
The resulting impact on his mental health has been profound. A week or so after the initial sessions, his depression seemed to lift, and he felt motivated to resume activities he usually enjoys, like taking a bike ride and cooking, for example, rather than feeling too drained to leave the couch. Now, he goes in for maintenance infusion sessions every four months or so.
Are there risks associated with ketamine therapy?
Ketamine treatment in a clinical setting carries few immediate risks, though there are conditions related to high blood pressure that a physician should screen for before prescribing it. There are also risks for people with schizophrenia or with bi-polar disorder who are experiencing a manic episode, as ketamine can exacerbate psychosis.
The controls placed on KAP make the abuse of prescribed ketamine difficult, but providers would still want to proceed with care when working with patients who have a history of addiction. “If someone has specifically abused ketamine in the past, we want to be really thoughtful about preparation and how they can relate to it as medicine in a therapeutic context,” McBee says.
As the treatment is relatively new, and involves a substance with its own cultural associations, stigma can be another challenge.
“There’s a lot of stigma, especially around ketamine infusions, which caused me to do my own research because I wanted to make sure I feel safe,” Aaron says, noting that the information he uncovered ultimately helped him feel the treatment was right for him. “I’ve learned that it’s good to be open about it. It helps people around me feel okay about having their own mental health problems and that we should all take steps to deal with them.”
Who can access ketamine-assisted psychotherapy?
If you want to start ketamine-assisted psychotherapy, the first step is finding a provider in your area that administers KAP, which you can locate by parsing through databases on platforms like Psychology Today and the American Society of Ketamine Physicians, Psychotherapists, and Practitioners. Once you find a practitioner who performs KAP, they’ll likely have an evaluation session to make sure the treatment is the right fit for you.
Aside from the FDA-approved nasal spray, most costs associated with ketamine-assisted therapy are not covered by insurance, though advocates and providers are working to change that. Clinics may offer group therapy sessions for preparatory and integration work to help reduce individual costs. They may also develop partnerships with nonprofits that offer financial assistance.
“When we think about those who are most marginalized in society, insurance will benefit some, but it’s not going to benefit all,” says Watson, who also started a nonprofit called Access the Doorway to help fund KAP treatment for queer and BIPOC patients of Doorway Therapeutics.
What’s the future of psychedelic-assisted psychotherapy?
The therapeutic use of psychedelics is a rapidly expanding field of research and practice, with many queer practitioners and organizations touting its efficacy in treating mental health conditions often experienced by LGBTQ+ people. And while KAP is relatively new, the concept of pursuing psychological healing through psychedelics is ancient.
“Our ancestors have engaged in healing through altered states of consciousness for thousands of years,” Watson says, adding that colonization and other systems of oppression resulted in mind-altering substances being demonized and made illegal. “Many of us view this as coming back to an old way of healing and integrating it into the psychotherapeutic format.”
As research continues into the therapeutic potential of psychedelics, queer practitioners and patients are at the forefront of using them to address chronic mental health challenges in the community. “The world makes it harder for us just to be who we are,” Watson says. “For the places where we reach an impasse, ketamine-assisted therapy can help us move beyond that.”
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