Everyone online seems to have one of two opinions about ketamine:
• Ketamine is a miracle cure.
• Ketamine is just a legal way for people to do drugs.
Neither is true.
I’ve worked with ketamine for eight years—as both a prescribing clinician and psychotherapist—and the reality is much more nuanced than these extremes.
Let me be clear: I have seen ketamine save lives. I’ve worked with people who struggled with depression their entire lives. They had lost relationships, jobs, and all hope that anything would help them. I’ve also seen it provide relief from addiction, prolonged grief, and PTSD. It is a powerful treatment. Full stop.
Like many new treatments in medicine, ketamine is often heralded as a cure requiring little more than showing up and receiving the medication. In my experience, it’s not that simple. I have never seen ketamine alone, in the absence of psychotherapy or intentional engagement by the participant, meaningfully resolve depression, anxiety, trauma, or addiction inthe long term.
It’s more realistic to say ketamine is a catalyst rather than a cure. It can create the conditions for profound change, but maintaining those gains usually requires continued effort.
This distinction matters because I’ve also seen the harm that comes from overselling any treatment. When someone is told a treatment will “fix” them and it doesn’t, they often conclude that they are the problem—that they’re beyond help or that “nothing works for me.” For people who have already tried multiple treatments, that loss of hope can be devastating. Setting realistic expectations from the beginning helps prevent this.
How effective is ketamine?
The research consistently shows that approximately 50–70% of patients respond and 25–45% achieve remission after a typical treatment course of four to eight ketamine sessions.
A few definitions are helpful to understand here:
• Response is a meaningful change, with symptoms improving by at least 50%.
• Remission means symptoms become minimal or absent over mid to long-term follow up.
• Relapse means symptoms return after an initial improvement.
In other words, someone can respond to ketamine without being forever cured. While feeling better for a few days or weeks is valuable—especially for someone in a severe depressive episode—it isn’t the same as lasting recovery. I think we would all agree that a short-term effect then backsliding into severe depression is hardly miraculous.
Compared to other therapies for treatment-resistant depression(TRD), ketamine is better or equal in its efficacy. For mild to moderate depression, traditional antidepressants produce remission in about 30% of patients, with success rates declining after multiple medication trials. Ketamine, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT) all have comparable response rates for TRD, though each comes with its own benefits, risks, and practical considerations.
What about relapse?
This is the part that rarely makes the headlines. Many people relapse if stopped before completing a series and/or without maintenance, which is why maintaining treatment and participating in ongoing psychotherapy are often recommended. In the medical model, i.e. ketamine without psychotherapy, the majority will require maintenance treatments – ongoing ketamine administration spaced out anywhere from once a month to every few months.
However, we’ve seen that by adding psychotherapy the time between doses can be extended and often can be stopped altogether.
For milder symptoms or acute issues, the treatment can be less intensive and relapse is less likely. Most research is ontreatment-resistant depression, but clinicians in practice over the past few decades have seen that ketamine can reliably help shift many symptoms related to chronic stress, trauma, and global nervous system dysfunction.
Ketamine doesn’t work on the same timeline for everyone. Some people experience dramatic improvement within hours of their first treatment, while others don’t notice meaningful changes until their third, fourth, or even sixth session. I’ve seen patients feel absolutely nothing after several treatments before experiencing a significant breakthrough later in the series.
Research can tell us about probabilities, but not about how a unique individual will respond. This is why it’s very helpful to work with a trained therapist who can help unpack your history and goals and help you decide whether ketamine treatment may be worth a shot for you.
So, is ketamine worth it?
In my opinion, absolutely—but only if we are honest about what it can and cannot do.
If your goal is rapid relief from severe depression or suicidal thinking, ketamine is one of the most effective treatments we have. If your goal is long-term remission, trauma resolution, or sustained recovery from addiction, the medicine is only one part of the process.
It’s worth repeating that ketamine’s benefits aren’t limited to depression. In clinical practice, many people seek treatment because they feel emotionally stuck, trapped in repetitive patterns of thinking or relating, chronically anxious, overwhelmed, or unable to access a sense of purpose in their lives. While the research is strongest for treatment-resistant depression and is growing for PTSD, anxiety, and addiction, we know that ketamine reliably increases neuroplasticity—the brain’s ability to form new connections.
During this window, many people describe being able to step outside their usual perspective, see long-standing problems differently, or access emotions that previously felt out of reach. One or two sessions may provide meaningful insight, renewed motivation, or a shift in perspective, but lasting change rarely comes from insight alone.
Without intentionally practicing new behaviors, strengthening healthier relationships, and integrating what was learned, the brain often returns to familiar patterns.
Ketamine can open the door to change, but it is our repeated choices afterward that help keep it open. Psychotherapy, preparation, integration, healthy relationships, sleep, exercise, and other lifestyle changes help translate that window of opportunity into lasting improvements.
Ketamine isn’t a miracle cure, but for many people, it can be the catalyst that finally makes lasting change possible.