Is Ketamine a "Magic Pill" Treatment?
Psychedelic and ketamine therapy are becoming common topics in common culture and public parlance more and more each day. For good reason, continued research and clinical studies show positive results when these medicines and compounds are used to treat a variety of mental health conditions.
Combined with the existing safety and efficacy profiles of ketamine, and the supportive reports of clients who have completed ketamine treatment, it’s easy to herald these experiences, programs, and medicines as “wonder drugs.”
This is compounded when legendary figures in the space such as Stanislov Grof, responsible for thousands of early studies on LSD psychotherapy, submit claims like “...psychedelics, used responsibly and with proper caution, would be for psychiatry what the microscope is for biology and medicine or the telescope is for astronomy.”
These are big, bold statements, and there are solid arguments in support of this across academic research, clinical studies, and real client experiences. However, it’s easy for ketamine and other psychedelic medicines to develop a sort of “halo effect” as a magic pill that can cure whatever is ailing you. All you need to do is show up and take it, right?
This “magic pill” moniker has its downsides. It diminishes the importance of ”Set and Setting” and adequate experience, preparation and integration, and overstates the long-lasting impact of the psychological benefits that ketamine and psychedelic medicines can and do provide.
All of the additional components of safe and effective psychedelic therapy —the clinicians/practitioners, the therapeutic containers they are taken within, the ongoing individual evolution of personal narratives and challenging habit change— can be just as significant to realizing powerful results and experiences in individual sessions and throughout the entire programmatic arcs of these experiences.
Defining the “Magic Pill”
At a first look, it’s easy to derive the essence of what is meant when someone says that ketamine, psychedelic medicine, and psychedelic therapy is a “magic pill.”
Given that the method of administration for many of these compounds is in a pill or other easily ingestible form, it’s easy to make the assumption that all an individual needs to do is show up, take a psychedelic medicine, and be magically cured of existing ailments.
Psychedelic medicine is being explored as a treatment everything from treatment-resistant depression, to major anxiety challenges, OCD, substance abuse problems, and a host of other mental health conditions. Since traditional treatment modalities typically require months to years to see improvements, psychedelic medicines can seem like a “magic pill” treatment in comparison.
It is true that there are impressive and substantiated results throughout the clinical and therapeutic worlds of the profound potential and promise of psychedelic medicines. However, the myopic view of narrowing down psychedelic therapy to solely the physiological effects of ingesting psychedelic medicines can do more harm than good to individual clients. This view also can negatively affect the emergence of psychedelic medicine as a whole as it moves into maturity.
As with anything that is oversimplified, this “magic pill” designation leaves out important nuances, steps of the process, and the small refinements that are critical and necessary components in helping clients heal, integrate, and enjoy powerful experiences in the sessions and throughout the program.
What Gets Left Out of the “Magic Pill” Conversation
There are many essential components of any reputable psychedelic therapy protocol that are left out in the definition of psychedelic medicines as “magic pills”.
Some critical aspects of the experience include:
Working alongside trained and licensed practitioners/clinicians throughout the psychedelic therapy process is an essential factor in the results that a client may realize throughout the process. Practitioners and clinicians facilitate the initial intake ensuring client safety, titrate or adjust doses effectively, and help explore the results and begin the integration process.
Preparation and intention
Preparing the individual's mindset and physical space they will have their experience in (also referred to as ”Set & Setting”), as well as clearly defining personal intentions for embarking on these experiences, have a massive influence in the experience an individual has. This is entirely antithetical to the notion of the magic pill as something you just “show up and take.”
Processing and Understanding Experiences
It is possible that many dormant or novel emotions, insights, and experiences may arise throughout a psychedelic therapy session. It is not a given that it will be immediately understandable and actionable by a client once they have completed the session. The purpose or importance of some of these insights/experience may not be obvious until they have been carefully unpacked in the integration process, or with the assistance of the practitioner and/or licensed therapist.
Although there can be significant experiences that have immediate and long-lasting effects on the individuals, this is not always the case. Presenting psychedelic medicine experiences as if no additional processing work is necessary afterwards —that an individual just emerges from an experience “:completely changed for the better, forever”— is simply not true. Giving clients this expectation going into the experience can make the reverberations more difficult or strenuous.
Building off the last point, there may be a significant integration process afterwards, as the individual begins to take the lessons and emotions from the medicine session and enact and embody them in their life back at home. This process can take days, weeks, months, or years to fully realize, and some lessons or next steps may not have clearly defined end dates at all.
Though there can be significant and powerful healing done immediately within the sessions, as one would hope for the individual, the reality is that enduring and significant personal change from psychedelic therapy often has a long-tail of integration work that accompanies it. This should be known and communicated to clients before they undergo an experience, so that they are clearly aware that the medicine experiences themselves are but the first step on an ongoing journey of healing and wholeness.
Ketamine’s Role in Healing
Given a complete overview of all the necessary components that contribute to powerful and long-lasting results throughout ketamine treatment and psychedelic therapy experiences, does this mean that there are no significant results that can come about in the experiences themselves?
Not at all.
There are significant psychological and neurological changes that occur during the experiences as a direct result of taking the medicine. These are important drivers of the outcomes that have been realized by clients and the psychedelic medicine studies that have been conducted, and are currently ongoing.
With ketamine in particular, there are a host of beneficial changes that occur in the brain and mood that are helpful in the treatment of certain mental health conditions, and that also make the ongoing integration afterwards more powerful.
Some of these neurological and psychological benefits of ketamine include:
By increasing the levels of BDNF (brain-derived neurotrophic factor) in the brain through the ingestion of ketamine and some other psychedelic medicines, the brain moves into a more flexible state for the following 3-14 days. This means that new patterns of thought are possible, it can become easier to pick up new habits and behaviors, and embedding new ways of thinking and acting can come easier to an individual. This is incredibly supportive of the integration work to come.
Increased mood regulation
Clinicians would hope to also see a baseline increase in overall mood and demeanor in the days that follow. A more positive outlook and average emotional state can provide great motivation and reprieve for individuals working with anxiety or depression, perhaps granting them access to emotional states that have been hidden away for some time. There is also a complimentary increase in the ability to regulate moods and emotions, making difficult conversations or major tasks more accessible, which can be critical in realizing long-term, sustained changes.
New emotions and insights
There may be the direct experience of new or hidden emotions/insights/experiences that arise throughout an experience that can have significant impacts just from the direct experience itself. Experiences of connection, emotions like joy, or insights around certain patterns of behavior, can be significant catalysts for an individual and can endure for a significant time afterwards.
Improving brain health
Particularly in the case of ketamine treatment, improved levels of mTOR and GABA contribute to increasing the health of the brain's synapses and neural connections. These areas of the brain can be damaged due to prolonged stress or depression. Improving brain health contributes to cognition, mood regulation, and the ability to enact behavioral change in the long-term.
These are a few examples of the immediate effects of psychedelic medicines and ketamine that contribute in no small way to the powerful experiences and important results clients see in psychedelic therapy programs.
The Reality of Psychedelic Therapy
As with much of the work and results in the psychedelic therapy world, the reality of these medicines as “magic pills” isn’t so much ‘either/or’, but ‘both/and’. They are both incredibly powerful and beneficial experiences, and they are made that way through a much more comprehensive experiential arc than just the medicine experiences themselves.
There are significant and important components of the preparation, processing, and integration factors that contribute to the results that clients see, and there are significant and important experiences that arise within the sessions, or come about as a by-product of taking the medicines themselves.
It is by embracing a more holistic view of psychedelic therapy and ketamine treatment that the full power and potential of these experiences are unlocked. Yes, there are incredible results that arise through this work where other combinations of psychotherapy and pharmacology have been unable to. Some examples are enduring smoking-cessation brought about by a single psilocybin session, or in helping an individual heal treatment-resistant depression, These results are real and promising, but they are results that were achieved through the entirety of the psychedelic therapy structure and experience, not simply the medicine experiences themselves.
The Greatest Benefits Are Achieved Through Holistic Treatment
Psychedelic medicines are not magic pills, but the results that psychedelic therapy programs are achieving for clients is remarkable and worth paying attention to. Research being done continues to support the validity of these claims.
There must be a cautious optimism applied in these discussions, to give credence to both the medicine and the programs, and who these experiences are suitable for and who they aren’t.
With all parties and stakeholders involved taking this more holistic view, the psychedelic medicine world can continue to refine and improve, providing greater healing for clients and replicable, effective protocols for the practitioners and organizations facilitating these experiences.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom® clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety