Most people who reach out to us about ketamine have heard the word somewhere. A friend who did it. A podcast. An ad on Instagram promising relief in days. What they usually have not found is a plain explanation of what actually happens, what the evidence does and does not support, and who should not be doing this at all.
What ketamine assisted therapy is
Ketamine assisted therapy, often shortened to KAP, pairs a low dose of ketamine with psychotherapy. The medicine is one part. The therapy around it is the other part, and the two are not separable in this model.
Ketamine is a dissociative anesthetic that has been used in medicine since the 1970s. It is a Schedule III controlled substance, which means it is legal to prescribe and also carries recognized potential for misuse. In the last two decades, researchers began studying its effects on depression and found something unusual: relief that arrived in hours rather than weeks, in some people who had not responded to anything else.
That finding is what built the field. It is also where honesty matters.
Where ketamine actually stands, medically and legally
Ketamine is FDA approved as an anesthetic. It is not FDA approved for depression, PTSD, anxiety, or any other psychiatric condition. When it is used for those purposes, including in our practice, that use is off label.
Off label prescribing is legal, common, and well established across American medicine. It is not a loophole. But it does mean something specific: the FDA has not evaluated ketamine for these uses and has not determined that it is safe and effective for them. There is one exception. Esketamine, sold as Spravato, is a related compound approved in 2019 for treatment resistant depression. That is a different medication delivered under a different protocol.
The research on ketamine for depression is genuinely promising and still developing. The research on ketamine combined with psychotherapy specifically is thinner, and studies to date have mostly been small, open label, or retrospective. Larger controlled trials are underway.
We tell people this before they decide anything. If a provider describes ketamine to you as safe and effective, proven, or a breakthrough cure, that is a marketing claim rather than a clinical one, and it is worth noticing who is willing to say it.
How the medicine is given
There are several delivery routes. In our practice, ketamine is administered by a prescribing medical provider as an intramuscular injection in the upper arm.
Other models use intravenous infusion, sublingual lozenges, or nasal spray. The route changes onset, duration, and intensity, and it also changes what kind of monitoring is appropriate. It is worth understanding which route a provider uses before you commit, because it shapes the entire experience.
One route deserves a specific caution. Several telehealth companies mail compounded ketamine lozenges for use at home with little or no monitoring. The FDA has issued warnings about compounded ketamine products, noting that use without a provider monitoring for sedation, dissociation, and changes in vital signs may put patients at risk. Compounded products are also not FDA approved, meaning their safety, effectiveness, and quality have not been evaluated. We do not work this way and we would encourage anyone considering an at-home subscription model to read those warnings first.
What the process actually looks like
Ketamine assisted therapy is not an appointment. It is a sequence, and the dosing session is just a part of it.
Consultation and treatment planning. If you are not already working with us, or if it has been more than a year, this comes first. Roughly forty five minutes. We look at your history, your current medications, what you are hoping for, and whether this is the right moment for your nervous system. Some people leave this session having decided not to proceed, or to wait. That is a legitimate outcome.
Medical screening. The prescribing provider conducts their own evaluation independently. This covers cardiovascular health, blood pressure, psychiatric history, current medications, and substance use history. This is a medical decision made by a medical provider, not a therapist.
Preparation sessions. One to three sessions, typically one to one and a half hours each. This is where we talk about what you want from the experience, what you are afraid of, what music you want, what happens if something difficult comes up, and how you will get home. Preparation is not a formality. In our experience it is the strongest predictor of whether a dosing session goes well.
The dosing session. Around two hours. More on this below.
Integration sessions. This is where the therapeutic work happens. Whatever surfaced during dosing gets made sense of, connected to your life, and worked with. Ketamine can loosen material. Integration is what turns loosened material into change. Skipping this step is the most common way people spend a great deal of money and end up where they started.
What happens in a dosing session
You arrive. We settle in, review intentions, and take your vitals. The prescribing provider administers the injection.
Effects begin within a few minutes. Most people lie down with an eye mask and music. The experience varies widely. Some people describe visual imagery, some describe a sense of distance from their usual self, some describe strong emotion arriving without a story attached, some describe very little.
I stay in the room the whole time. The approach is largely inner directed, meaning I am not asking questions or steering. I am tracking you, adjusting music, offering a hand or a word if you want one, and being a steady presence. If something difficult surfaces, I am trained to work with it, including with Brainspotting, EMDR, or IFS if that is what the moment calls for.
The strongest effects last roughly forty five minutes to an hour. Afterward there is time to come back, drink water, and begin talking if you want to. You cannot drive. You will need someone to take you home.
Who this is not for
This is the section most sites leave out.
Ketamine assisted therapy is not appropriate for everyone, and there are conditions where it carries real risk. These include uncontrolled high blood pressure and certain cardiovascular conditions, a history of psychosis or certain presentations of bipolar disorder, pregnancy, some liver conditions, and active substance use involving ketamine or other substances. Certain medications interact with it.
Beyond the medical contraindications, there are timing questions. Someone in acute crisis, someone without stable housing or support at home, someone with no one to drive them, or someone who cannot commit to integration sessions may be better served by doing other work first. Dissociation is worth particular thought. For people who already dissociate readily, a medicine that produces dissociative states requires careful consideration rather than enthusiasm.
Our screening is deliberately conservative. If we tell you no, or not yet, it is not a judgment about you.
Risks and side effects
During and shortly after a session: nausea, elevated blood pressure and heart rate, dizziness, blurred vision, disorientation, and psychologically difficult experiences. Nausea is common enough that we plan for it.
Longer term concerns center on frequent or high dose use, including bladder and urinary tract problems and potential for psychological dependence. This is one of the reasons a structured, spaced protocol with real clinical oversight matters, and one of the reasons unlimited at-home access concerns us.
What it costs
Preparation and integration sessions run one to one and a half hours and are priced at the standard hourly rate of $200. A ninety minute session is $300. Dosing sessions are two hours at $400. The initial consultation and treatment planning session is $150. Medical costs from the prescribing provider are separate.
Insurance generally does not cover this directly. If your plan includes out of network benefits, we can provide a superbill and you may be eligible for reimbursement. Thank You Life is a nonprofit working to reduce financial barriers to psychedelic therapy, and Healing in the Margins is a local nonprofit providing funding for LGBTQIA+ and BIPOC individuals.
What to ask any provider
Who is in the room during dosing, and for how long. How many preparation sessions are included. What integration looks like and whether it is included or extra. Who does the medical screening and what their credentials are. What happens if something difficult comes up in session. What their training is specific to ketamine, not just to therapy generally.
If the answers are vague, keep looking.
For what it is worth, my own answer to that last question is that I have guided over six hundred hours of ketamine assisted therapy sessions, and I train other therapists and medical providers to do this work, including a twelve week foundations and facilitation cohort for clinicians.
Frequently asked questions
1. Is ketamine assisted therapy legal in Tennessee?
Yes. Ketamine is a Schedule III controlled substance that can be legally prescribed by a licensed medical provider. Its use for psychiatric conditions is off label, which is a legal and common practice in medicine.
2. How many sessions will I need?
It varies. Many people do a series of dosing sessions spaced over several weeks, each with preparation and integration around it. This is determined in treatment planning, not in advance.
3. Will I be unconscious or out of control?
No. Doses used in this setting are well below anesthetic doses. You remain able to communicate. Most people can speak if they want to and remember the session afterward.
4. Can I do this if I am on antidepressants?
Often yes, but it depends on the specific medication. This is evaluated by the prescribing provider during medical screening.
5. What if I have tried ketamine at an infusion clinic already?
That is worth discussing. The experiences are structured differently, and prior experience with infusion does not necessarily predict how this will go for you.
If you are considering ketamine assisted therapy in Nashville, the next step is a conversation, not a commitment. You can complete our client prescreen or email our Client Care Coordinator at Admin@TraumaTherapyNashville.com.
Melanie Reese, LMFT, is a Certified Clinical Trauma Professional and Certified Brainspotting Consultant in Nashville with more than fifteen years of experience as a trauma therapist. She has guided over six hundred hours of ketamine assisted therapy sessions and trains therapists and medical providers in ketamine assisted therapy through Groundwork Trauma Education. She has guest lectured at Vanderbilt School of Nursing on psychedelic assisted therapy in clinical practice and offers trainings to help therapists support clients in preparation and integration of non-ordinary experiences.
Medically reviewed by Nora Cheney, MSN, APRN, PMHNP-BC.
Learn more about our ketamine assisted psychotherapy services, our approach to trauma and complex PTSD, and Brainspotting.