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6 Reasons Why Ketamine Therapy May Not Be Working For You

Ketamine therapy may prove effective when all other options have failed. Numerous studies confirm the healing potential of ketamine; however, there are circumstances where ketamine therapy may fall short of a miracle. Fortunately, many of these reasons can be attributed to a lack of knowledge and preparation rather than innate biochemical and patient-specific factors. Healing from ketamine therapy takes foresight, careful planning, and hard work. Additionally, healing isn’t always linear, and an appreciation that the medicine builds upon itself over time is key to sticking through some ups and downs.

Today, we are going to discuss six potential reasons why ketamine therapy may not be working for you. Furthermore, we will point out how to avoid pitfalls, be okay with doubt, and embrace the journey, however pleasant or challenging it may be for you.

1. Inadequate preparation for ketamine therapy

Much like an athlete who takes time to practice, strategize their moves, and plan for a win, preparing for a ketamine therapy is a key step in the process of healing. Preparation involves conducting your own research and truly understanding the medicine's potential benefits and risks. It's crucial to find the best ketamine clinic that aligns with your intentions and goals; a healing facility that provides a safe and comfortable environment is key. It's best to understand the ketamine process in its entirety, along with the work that is involved in addition to receiving the medicine. Someone considering ketamine therapy should take an introspective view of themselves, asking why ketamine and why now? Fear, doubt, and disappointment can be avoided by doing this groundwork and asking questions. Next, it’s time to utilize your support system and build a team. This could involve finding a therapist or a loved one with whom to discuss your ketamine therapy experiences. Insights, motivation, or new ideas are common after a ketamine infusion; thus, it can be beneficial to discuss these with someone, integrate your ketamine experiences to make changes in thoughts, behaviors, and ultimately plans for positive change.

2. Poor attention to the big picture

The medicine alone will more often than not have beneficial effects, and sometimes immediately. However, poor attention to aftercare and your lifestyle will likely result in short-lived effects from ketamine therapy. The ‘big picture’ includes what you do in your everyday life to foster good health – sleep, nutrition, exercise, stress-reducing practices, social support, etc. At some point, the ketamine infusions will end, so it is important to understand that ketamine can act as a catalyst for change, often described as a reset, to set you on a new, healthy path. However, those who repeat the same unhealthy patterns are likely to expect the same results. Now is the time to start new healthy habits and routines, change who you choose to share your time with, or the environment if it proves to be detrimental to your mental health and healing. There exists a vulnerable period during and after ketamine therapy. During this time, the mind may be more susceptible to injury and necessitates rest and protection. After ketamine therapy, the ‘mental tissue’ is delicate and requires a protective and nurturing environment.

It is crucial to acknowledge the potential for negative indoctrination in this vulnerable period, coupled with the risk of returning to toxic environments, such as chaotic lifestyles or abusive situations, post-treatment. This has the potential to cause additional harm, as you may be more impressionable and can be adversely affected by negative experiences during this sensitive period.

3. Lack of commitment or follow-through

Trust the process and understand how ketamine may work for you. Ketamine is unlike other medicines, where you may feel the effects immediately and with time, it wears off. Ketamine builds upon itself, and the benefits of the medicine continue throughout the series of infusions over time. Ketamine causes neuroplasticity and neurogenesis, which takes hours to days to cause real structural changes in the brain. Additionally, there are different types of responders, with some people feeling the benefit of ketamine after one or two infusions, while others may require more, such as five or six, until they feel exponentially better. Patients are encouraged to lean into the experience, not give up too soon, and allow themselves to have grace and patience throughout the entire ketamine therapy experience, especially if their infusions are challenging.

4. Unrealistic expectations of ketamine therapy

It’s normal to have some doubt or to start the ketamine therapy process with high expectations. Ketamine therapy does not compare to any other form of therapy; it is a truly unique and special form of healing. Oftentimes, patients have suffered for years from depression or other mental illnesses, so expecting an overnight transformation and complete relief of symptoms is unrealistic and a recipe for disappointment. Goals are often achieved when taken in ‘bite-size’ fashion. Set small and obtainable goals rather than something grandiose. Be specific (e.g., “I will go for a 10-minute walk daily” vs “I plan to exercise more”).

A person is shown intently focusing on a small, intricate detail - represented by a tiny flower or puzzle piece - through large, elaborate glasses, which are sharply in focus. The background, intended to depict the 'big picture,' is a vast, blurry, and undefined landscape, symbolizing the overlooked broader context and the person's obliviousness to it
Zoomed In, Tuned Out: Missing the Forest for the Trees

5. Using the wrong form of ketamine and/or being in the wrong setting

Not all routes of administration of ketamine are the same or equally effective. Oral ketamine is a potentially less effective form of ketamine with a delayed onset of antidepressant effects. Oral ketamine is only 20% bioavailable, and nasal ketamine isn’t much better with a bioavailability of 40%. This implies that much higher doses may be required to have an effect compared to intravenous ketamine, which is 100% bioavailable. Intravenous ketamine allows for lower doses and poses a lower risk for side effects or adverse reactions. Additionally, oral and nasal ketamine have a less predictable response and consequently experience (i.e., the dose is dependent on the rate of absorption and other patient-specific factors). Intravenous ketamine is the superior route of administration, with the medical provider having complete control, precision, and appropriate dosing specific to your individual needs. Finding the optimal dose with the most therapeutic potential can be somewhat of a guessing game with oral and nasal forms of ketamine, while IV ketamine allows for ease of finding the appropriate dose and maximizing the benefits.

Don’t underestimate the importance of set and setting. The environment and attention to where, when, how, and with whom you choose to undergo ketamine therapy are critically important. Find someone you trust and feel comfortable with because your mindset during the administration of this medicine can have a significant impact on the experience and efficacy. You can expect positive effects of ketamine and therapy when you are comfortable with your surroundings and caregivers.

6. Non-responders and medicine interactions

Patients should be carefully screened during their initial consultation for contraindicating medical conditions or medications that may interact or make ketamine less effective. Some medications have the potential to reduce the effectiveness of ketamine treatments, including benzodiazepines such as Xanax and Lamotrigine (Lamictal). Taking these medications does not exclude you from pursuing ketamine therapy, although it does require a specific plan with your prescribing physician and the ketamine clinic provider. With proper direction, sometimes these medications can be held on the day of and after infusions to lessen the potential for interactions and reduced effectiveness of ketamine treatments. Therefore, patients are encouraged to speak with their doctor about holding their doses of these specific medications.

Ketamine therapy is not a guarantee. Approximately 10-15% of patients do not respond to ketamine therapy. It's important to understand that while the majority of patients will respond favorably to the medicine, there is a possibility that ketamine therapy will not be effective for you.


Ketamine therapy can be a powerful and life-changing tool for healing, although there are reasons, albeit most are avoidable, why this form of therapy may not work. Ideally, this list helps you understand some limitations and provides guidance on how to avoid potential pitfalls. Understand that there are other forms of mental health therapy, and be sure to ask your ketamine therapy provider if this is right for you. Set yourself up for success by doing the due diligence of proper preparation, and don’t be afraid to seek advice or guidance from people you truly trust!

Tags: anxiety, best ketamine clinic, depression, fibromyalgia, generalized anxiety disorder, healing, integration, iv ketamine, ketamine, ketamine assisted psychotherapy, ketamine infusion, ketamine therapy, mental health, mental illness, pain, psychedelics, PTSD, san luis obispo, set and setting, suicide, therapy

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