Why Ketamine is a Psychedelic, and Why it Matters

As you explore the field of psychedelic therapy and psychedelic medicine, you may come across the question as to whether ketamine is rightly classified as a “psychedelic.”

This question becomes  important as ketamine treatment as a psychedelic therapy option rapidly expands. What’s more important, however, is what this classification lends to the overall discussion around psychedelic therapy modalities as mental health treatment options.

Discussion around Ketamine as a “Psychedelic” Medicine

Ketamine’s classification as a psychedelic is largely a semantic and subjective discussion as of this writing. Clinical, academic, bioethical, and commercial entities largely disagree on the formal definition of “psychedelic.”

Those skeptical of ketamine being classified as a psychedelic typically defer to the definition of a “classical psychedelic,” which refers exclusively to hallucinogenic compounds that work primarily on the serotonergic 5-HTA2 receptors in the brain. This group includes psilocybin (found in psychedelic mushrooms) and lysergic acid diethylamide (LSD). In comparison, ketamine acts on the brain’s glutamate systems and NMDA receptors. More on the neuroscience below.

Those who support ketamine’s classification as a psychedelic cite its neurobiological (physical) and phenomenological (mental characteristics) similarities to classical psychedelics. They also point to the similarity in client outcomes through various psychedelic therapy modalities in clinical research, despite a difference in neurological mechanisms of action.

Ketamine isn’t alone in this discussion. The compound 3,4-methylenedioxymethamphetamine (MDMA) is another non-classical psychedelic with research-backed medicinal applications and FDA approval-tracking. MDMA has also been shown to lead to positive mental health outcomes, especially in patients with post-traumatic stress disorder (PTSD).

Why it’s Important Ketamine is Recognized as a Psychedelic Medicine

Recognition of ketamine as a psychedelic is larger than semantics: It’s about increasing access to psychedelic therapy and improving mental health outcomes for clients.

Aside from COVID-19, the mental health crisis is the second leading public health crisis in the United States. According to the U.S. Substance Abuse and Mental Health Administration (SAMHA), 21% of U.S. adults experienced mental illness in 2020. This statistic represents one in five adults, or around 53 million people.

Psychedelic medicine research indicates positive results for an increasing number of mental health conditions and their symptoms, such as:

• Mood disorders (depression, major depressive disorder, bipolar disorder)
• Anxiety disorders (generalized anxiety disorder, social anxiety disorder)
• Trauma disorders (PTSD)
• Substance Use disorders (alcohol use disorder, substance use disorder)
• Suicidal ideation
  

“We know through research that all psychedelic compounds exhibit different felt experiences and neurobiological impacts, even classical psychedelics within their own category,” Dr. Leonardo Vando, Mindbloom’s Medical Director says. “What’s most important are the tremendous outcomes psychedelic medicines like ketamine, and FDA approval-tracked compounds like MDMA and psilocybin, are providing to clients living daily with mental health challenges.”

So while “psychedelic” remains a blanket term, with most agreement centered around what qualifies as a “psychedelic experience,” the importance of these classifications becomes less important in the face of the outcomes they provide.

What is a Psychedelic Experience?

Origins of the term “psychedelic”

The term "psychedelic" was originally coined by English psychiatrist Humphry Osmond in a letter addressed to Aldous Huxley back in the 1950’s.

It is a combination of the Greek words "psyche" (mind) and "delos" (to reveal). This gives us the common definition of psychedelic as "mind-manifesting."

When combined, the “psychedelic” experience is a direct, embodied experience of how an individual’s mind works. This sets the foundation for the deeply introspeive potential that these compounds and experiences have to offer individuals.

Hallmarks of a psychedelic experience

Psychedelic experiences often provide individuals unique insight, emotions, or experiences of why and how they are the way that they are. They discover where patterns of behaviors emerge from, how they relate to themselves, others, and the world, and the current state of who they are at the time of the experience.

There are several factors that have emerged in psychedelic medicine as being hallmarks of a psychedelic experience. While everyone’s experience is unique and will vary based on the individual and each separate session, these hallmark characteristics are a powerful frame to use when gauging whether a certain compound or experience can be considered psychedelic.

Ineffability

A classic hallmark of the psychedelic experience is that it is difficult, if not impossible, to adequately put the experience into words. Words and linear language do not seem to describe the fullness of the experience, and this fundamental ineffability is a sign of a psychedelic experience.

Novel Experiences/Insights 

The psychedelic experience can provide or induce novel experiences, emotions, insights, revelations, or connections that were not previously known, understood, or embodied as reality.

Ego Dissolution 

A distinct trait of the psychedelic experience is the dissolution of the sense of being an isolated, separate Self —an ego.

Timelessness

Another overlap with the mystical experiences, psychedelic experience can often bring about a sense of timelessness, that the experience is taking place outside of time.

Higher-Order Reality

A sense of "seeing True Reality" or a higher order reality than what is commonly available in ordinary waking consciousness. A distinct feeling that whatever is experienced as being almost "hyper-real."

3rd Person Perspective

Psychedelics and their mind-manifesting nature can often bring about a third-person perspective: a sense of looking back at yourself and your psyche as if from a detached observational position. It is this perspective that helps include the novel insights, emotions, or understandings that can arise in psychedelic experiences.

A point worth noting is that from the original definition of a psychedelic experience, this experience is not strictly limited to a class of compounds, or dependent upon the ingestion of a specific substance. There are many experiences, and perhaps life itself, that can be classified as psychedelic under these definitions.

For the purposes of categorizing different medicines, compounds, and experiences as psychedelic, these six hallmarks of the experience are a useful starting point.

If you have experienced ketamine treatment yourself, or know someone who has, you may notice that the ketamine experience often includes several of these characteristics as part of the experience. It is this subjective, experiential reality of the ketamine experience that is the strongest argument in favor of classifying ketamine as a psychedelic medicine. 

Ketamine’s Effects as a Psychedelic Medicine

Phenomenological Similarities

Referring back to the classical hallmarks of a psychedelic experience, ketamine treatment is able to reliably and effectively induce many, if not all, of these indicators within a single session.

From the ineffability of the experience to a distorted sense of time, space, or self-identity, and from ego dissolution to the noetic quality of accessing a new, but familiar space rich with information, the individual ketamine experience shares nearly all of the classical hallmarks of a psychedelic experience. 

Neurobiological similarities

While not only limited to the phenomenological, or mental, characteristics, ketamine has several neurobiological similarities with the classical psychedelics (psilocybin, LSD). This gives support to the classification of ketamine as psychedelic.

This is a point that often surfaces in the discussion of whether ketamine should be or can be considered psychedelic. While the classical psychedelics have their mechanism of action based in the serotonin system, acting on 5HT2A and other receptors, ketamine works within a separate system in the brain: the glutamate system and the NMDA receptors.

It is this different mechanism of action that is often used to convey that ketamine isn’t a classical psychedelic. Though the mechanism of action is separate, you can still note that the neurobiological outcomes remain similar across the various psychedelic compounds. 

Research shows increased levels of neuroplasticity in the days after a session, increased communication across disparate regions of the brain, and a lessening of activity in the Default-Mode Network (DMN) in the brain. These neurobiological impacts are powerful levers in the transformative potential in psychedelics and exist in the ketamine experience, as well as in other FDA approval-tracked compounds like MDMA, not just the classical psychedelic compounds. 

While there is a difference in the specific neurobiological mechanism of action, we see that the end results are similar. Moreover, given the subjective and experiential nature of the psychedelic experience, it is the phenomenological similarities that give stronger credence to the claim that ketamine can and should be classified as a psychedelic compound.

These phenomenological similarities of the experience, paired with similar neurological outcomes and impacts, both contribute as major supporting points to the discussion that ketamine is, and must be, considered a psychedelic medicine and be included in the clinical repertoire of psychedelic therapy modalities. 

Is Ketamine a Psychedelic?

Yes. Based on the hallmarks of psychedelic experiences, the neurobiological, phenomenological, and linguistic definitions provided above, it is fair to say that ketamine is a “psychedelic” medicine.

Though ketamine treatment has its origins as a dissociative anesthetic, it has quickly become the primary medicinal application of psychedelic medicine. With the right set and setting, preparation and integration, and safe, effective dosages, can be truly and completely psychedelic. It encompasses the totality of a psychedelic experience.