Ketamine has psychedelic, dissociative, pain relief, and anesthetic properties. Ketamine has been historically used in surgical settings, including pediatric surgery, due to its excellent safety profile. It is not a central nervous system depressant, which means it does not slow the consumer's heart rate or breathing. It has also been used successfully in managing acute and chronic pain conditions due to its analgesic (pain relief) properties.
In the last two decades, ketamine has been increasingly applied at sub-anesthetic doses as an off-label treatment for chronic and treatment-resistant conditions, including depression, post-traumatic stress disorder, anxiety, and other psychiatric diagnoses. It shows promise for treating other compulsive issues such as substance use disorders, eating disorders, and obsessive-compulsive disorder. In very high doses, ketamine anesthetizes the patient, putting them in a dream-like, fully out-of-body, unconscious state. Anesthetic doses are very high and should not be used in therapy settings.
You can schedule a free consult with me here. During the consult, we talk about your intentions, goals, and expectations. If we're a good fit, we'll start with a 90-minute intake evaluation which looks at the biological, psychological, and social factors in your life. We continue with 55-minute sessions that are much like regular therapy sessions and designed to prepare you for ketamine. This includes somatics, meditation, and talk therapy techniques.
To receive ketamine injections, the most convenient prescriber is Dr. Joey Nichols, MD. You can schedule an appointment with him at Canopy Family Care for the required medical evaluation, which is a separate appointment from your sessions with me. We share an office space for easy access. The medical evaluation can be done at any time but must happen before ketamine is provided.
If you prefer ketamine lozenges, you can bring your own into my office along with your prescriber's contact information.
Each ketamine appointment is two hours unless you opt for a longer three-hour session. Pricing information is at the bottom of this page.
Thanks to ketamine's strong safety profile and long history of use as a surgical anesthetic, it is safe for most people at the lower doses we use in therapy. It is prescribed off-label for depression, anxiety, and PTSD. While ketamine is safe for many people, some are not a good fit for ketamine-assisted therapy.
Prior to receiving ketamine, you will undergo medical and psychiatric evaluations. These evaluations are to protect you from adverse medical events induced by ketamine interacting with your body, mental health condition(s), and medications you might take. This process helps us reduce unwanted health risks, but neither I nor the medical professional evaluating you can guarantee a risk-free experience.
I do not offer ketamine therapy to pregnant or breastfeeding mothers.
I do not work with individuals who have:
> A primary dissociative disorder
> Active hallucinations
> Unstable angina (chest pain/heart disease)
> Current and uncontrolled mania or mixed episode
> Uncontrolled hyperthyroidism
> Increased intracranial pressure
> Liver disease
> Previous allergic reaction to ketamine
> History of cystitis or other bladder issues (Unless you have received approval by a urologist)
Ketamine causes an increase in blood pressure comparable to what occurs during exercise. If your heart is not healthy enough for vigorous exercise, you must be on blood pressure medication and have a stable blood pressure in order to safely take ketamine.
The exact way ketamine works in the brain is still under investigation. However, scientists believe it enhances neuroplasticity and neurogenesis by “combing” through or detangling clusters of nerves that have become clustered together through repetitive behaviors and thoughts.
The neural connections associated with compulsive behaviors, obsessive thinking, ruminating, depression, anxiety, hypervigilance, and PTSD symptoms are opened up and able to reconnect with other neurons again. By detangling these clusters of neurons, the availability of new connections help us get “unstuck.” Ketamine can help us get symptom relief and assist in healing from them completely. However, ketamine alone does not create the change. The 1-3 days after a ketamine session are the optimal time to initiate new patterns, for example, changes to self-talk, diet, exercise, or creative projects.
The ketamine experience is often characterized by the relaxation of ordinary concerns and usual mindset. This tends to lead to a disruption of negative feelings and preoccupations. This interruption, and the exploration of other possible states of consciousness, can lead to significant shifts in overall well-being.
At lower doses, people typically experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. This dose range supports somatic and talk therapy techniques. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience enhanced feelings of empathy and connectedness in this dose range. This state may also support verbal processing as it relaxes our usual defenses. For some, lower doses are more appropriate and support a more traditional therapeutic process focused on talking about uncomfortable topics, listening with fresh perspective, and building a relationship.
Medium and high doses are more likely to produce psychedelic, dissociated states that are largely internal, non-verbal journeys, though some people are able to vocalize at higher doses. Body sensations are greatly diminished, but some clients may have strong physical sensations as they process big emotions. Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological and possibly spiritual growth, and promoting a positive change in outlook.
Sensory effects of ketamine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, vivid imagery, and changes in visual, tactile, and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar music may not be recognizable. It is possible to temporarily forget things we ordinarily remember, such as our phone number. One hour might feel like two or three hours.
Some people report transpersonal experiences, which can be perceived as bizarre or frightening. Others might describe them as pleasurable, joyful, or fascinating. Even frightening experiences can be of great value. Having a difficult experience does not mean you had a “bad trip.”
Crying, heavy breathing, shaking, and other signs of emotional processing are normal. Ketamine (and therapy in general) works best when we allow these experiences to happen, trusting our body’s wisdom. I am trained and experienced in providing stability for those moving through difficult states. You will receive psychotherapeutic support and ongoing guidance for working through and integrating journeys.
The effects of ketamine typically start a few minutes after dosing. Journeys typically last about an hour. We give extra for these sessions to settle in and prepare beforehand, and to reorient and begin processing the experience afterward. Each ketamine appointment is 2 hours minimum, with an option to add one more hour at the time of scheduling. You may be offered a second dose some time after the first. You are under no obligation to accept this offer. If you are unsure or silent, a second dose will not be provided. If you are experiencing intense fear or unmanageable feelings, or are incapable of consenting, another dose is not appropriate.
While a range of experiences may occur, it is difficult to predict how you may respond. Low doses are recommended for first-time consumers to gauge sensitivity and promote your safety.
Clients who release their sense of expectations tend to have a smoother experience.
Many people see significant results after six sessions. A minimum of three sessions with ketamine is strongly recommended to begin seeing improvement. Results vary depending on the client's physical health, psychological condition, commitment to integration activities, social resources, and other environmental supports.
I work with people who are entirely new to psychedelics, people who journey with psychedelics on their own, and everyone in between. Many clients who seek ketamine therapy have a therapist already, and others are exploring therapy for the first time.
Interested clients must be 18 years or older, meet medical and psychiatric safety requirements, and be able to attend in-person sessions in Takoma Park, Maryland. Required psychotherapy sessions can take place in-person or virtually. Clients located in Maryland, DC, and Virginia can be seen virtually.
Ketamine sessions may take place weekly, every other week, or monthly.
Several psychotherapy sessions without ketamine are required before ketamine is administered. For some, this might be two sessions. For others, more time will be needed. At least one psychotherapy session is required in between each ketamine session to support integration and determine whether ketamine is still appropriate.
If you would like to receive an intramuscular or subcutaneous injection, the most convenient option is to see Dr. Joey Nichols, MD at Canopy Family Care. We share an office space in Takoma Park, Maryland. You can visit him for the initial medical evaluation, which is separate from my psychiatric intake process, to recieve the prescription. This appointment can take place any time before or after you begin seeing me for therapy, but the medical evaluation must take place before the first time you receive a ketamine injection.
If you prefer to use oral lozenges during your appointment, you may get a prescription from the prescriber of your choice and bring that into my office for sessions. The cost on your end is variable depending on the cost of the doctors' visits and the prescription itself. More information on cost is at the bottom of this page.
Ketamine can result in a number of benefits, and there are now many studies demonstrating its efficacy. However, there are no guarantees and results vary. Results are also dependent upon your engagement with preparation and integration. The time you spend preparing and processing journeys in between sessions are just as important as the journeys themselves. Ketamine makes changing thoughts and behaviors easier, but that also requires commitment.
Journeys with psychedelic drugs like ketamine are contextual, which means their effects – and whether or not you see lasting impacts – are dependent on many factors including the dose, the environment, your personal needs, how you engage with preparation and integration, the extent of your trauma history, and the setting in which you live your daily life in between journeys.
Lasting improvement, especially for serious or chronic conditions, generally occurs after six or more sessions. I strongly recommend committing to three sessions, to start. Ketamine is most effective as part of a holistic strategy that includes diet, exercise, mindfulness, social-emotional development, and other therapeutic support.
Ketamine may not permanently relieve any condition you are experiencing. If your symptoms respond to ketamine, you may still choose to be treated with other medications and ongoing psychotherapy to reduce the possibility of symptoms returning. You may decide you want additional ketamine sessions or other therapies. If you are not seeing any benefits after 6 sessions with ketamine, I will suggest seeking support through another modality. We can continue to see each other for therapy without ketamine, or I may refer you to someone better equipped to support you.
The doctor who performs your medical evaluation will ask if you are taking certain medications or using certain substances that interact with ketamine. I will also follow up with these questions during our intake. Please be specific and honest about which medications you are taking. This is to protect you from unpleasant and potentially dangerous health reactions.
Substances that increase sedative and/or nauseating effects of ketamine: Alcohol, opiates/opioids, benzodiazapenes, muscle relaxers, benadryl, gabapentin, and other nervous system depressants.
Substances that reduce the antidepressant effectiveness of ketamine: Benzodiazepines, GABAergic agents, opioid agonists, calcium channel blockers, antipsychotics, NSAID pain relievers, Lamictal, St. John’s Wort, Rifampin
Substances that may increase the experiential intensity of ketamine: Clarithromycin, Erithromycin, grapefruit juice.
Information on ketamine’s interaction with other medicines is becoming more accurate with time. I update this page regularly with the latest information.
Injections are sent into the shoulder muscle (intramuscular/IM) or under the skin (subcutaneous) on the back of the arm. IM takes effect rapidly and goes away rapidly. At low doses, the come-up and come-down are lower intensity. Medium and higher doses produce a more rapid and significant change in perception, often leading to an out-of-body dreamstate. Subcutaneous injections take effect and dissipate more gradually than IM, but more rapidly than lozenges.
Lozenges are taken orally and usually at a much lower dose. The dose takes effect and goes away more gradually than injections.
Not currently. I prefer injections and lozenges over IV infusions for use in therapy for a few reasons. First, IV limits the client's comfort in terms of mobility if they want to move around. Second, IVs can be anxiety-inducing for people with medical trauma. Also, the machinery involved in the infusion creates sounds that can be disrupting or jarring to the ketamine experience. Injections and lozenges seem to be more accessible for a wider range of people.
Ketamine has an extensive record of physiological safety and has been used at much higher doses for surgical anesthesia, without respiratory depression or other serious side effects, for many years. However, as with any other medicine, there are potential risks and side effects to consider. The most common physical side effect is a short-term increase in blood pressure, pulse, or heart rate, which may be a risk to those with heart disease, and can be misinterpreted as anxiety.
Other possible effects are temporary and include dizziness/lightheadedness, immobility, impaired balance and coordination, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to hear or to feel objects accurately including one’s own body, headache, anxiety, nausea, vomiting, and diminished awareness of physical functions such as respiration. These effects are transient and resolve as the active phase of the medication ends (generally within 4 hours).
Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction or cystitis in some individuals. During intake, I will ask you to elaborate if you have a relationship with ketamine (and other substances) outside of the legal therapeutic context. If your relationship with ketamine outside our sessions becomes problematic, we will continue our sessions without ketamine until your relationship with ketamine and related health concerns have stabilized.
Ketamine can bring to light challenging dynamics, painful feelings, or repressed experiences. It is your responsibility to consult with medical professionals to weigh the risks of your existing conditions with the risks and benefits of ketamine.
In some cases, ketamine’s dissociative quality can be dysregulating to clients’ protective systems, activating a “backlash” in defenses. This can look like symptoms intensifying after experiencing a bit of relief, devaluing the experience, lasting dissociative symptoms (sometimes up to 1 week), confusion, suicidality, flashbacks, uncomfortable/unusual somatic sensations (i.e. shaking), vomiting, and more. Although these side effects are rare, they are possible.
Some unpleasant reactions are, counterintuitively, evidence that healing is taking place. The protective barriers around the underlying trauma may have been removed by the ketamine, which can show up as dysregulation. After our session(s), if you experience unusual or unpleasant physical and emotional side effects like the ones listed above, please reach out to me immediately. I will help you as best as I can and refer you to an outside professional if I am not able to adequately support you.
People with chronic pain may experience a temporary and rapid resurgence of chronic pain as the medicine wears off. Stretching, body work, and warm baths before and after are helpful.
Please make the time and space before and after to prepare and integrate, both during our required sessions and on your own. Having a support system of friends, family, professionals, and other community to lean on when possible can make this work safer for you. If you do not have access to community support, please let me know so we can explore your options.
Psychiatric Evaluation/Intake. This is a one-time fee.
$225 (1.5 hours)
Medical Evaluation, for those seeking injections. This is a one-time fee. If you are looking for IM, the most convenient option is to do this with Dr. Joey Nichols, MD, who shares an office space with me. Schedule an appointment with Canopy Family Care. If you prefer to use lozenges, the medical evaluation will take place with the prescriber of your choice.
$249 (1 hour)
Required Prep and Integration Sessions (without ketamine). The number of prep and integration sessions varies and depends on many factors, including the person's age, trauma history, and social and emotional resources. These sessions typically look like my regular psychotherapy sessions. Some people are ready after three prep sessions. Others see me for a few months before trying ketamine.
$150/session, 55 minutes.
Ketamine-Assisted Therapy Sessions w/ Intramuscular Injection (IM)
$485 total for a two-hour psychotherapy session with an intramuscular injection (IM) of ketamine. This includes guided practices (including meditation) beforehand, trained therapeutic support for the entire session, ketamine administration, and onsite medical supervision during the appointment.
Three-hour sessions are available upon request for an additional $175. More time is added to the beginning and end of the session for psychotherapy, meditation, art, body work, and other activities to support the ketamine experience.
Ketamine-Assisted Therapy Sessions w/ Oral Lozenges
The cost for a two-hour ketamine session using lozenges is $350. Onsite medical supervision is available by request for an additional $175. Medical supervision is required for clients with higher risk health complications including compromised immune systems and severe allergies.