Managing your mental health amid everyday tasks like paying bills, caring for loved ones, and enjoying your hobbies can feel downright impossible. And if you neglect your mental well-being long enough, you may find yourself struggling. Ketamine therapies are at the forefront of mental healthcare, particularly for treating conditions like treatment-resistant depression. When traditional tools fail, ketamine can offer an alternative to those who may need it
The catch, though, is that ketamine-based interventions are often conducted in clinical settings. If you’re thinking about utilizing ketamine, but are unable to do so in-person with world-class clinicians, you may consider unguided ketamine therapy.
But before you take the plunge, you need to have a sense of the risks and benefits of embarking on a psychedelic voyage without a guide.
Let’s set the table. Ketamine may have some psychedelic properties, but it was originally developed in the ‘60s as a sedative. As it happens, its “dissociative anesthesia" also induces a mild, dreamlike state, during which the mind is more pliable than usual.
Under the hood, using ketamine dampens NMDA receptors in the brain’s glutamate system. Research tells us that those receptors become overactive during times of chronic stress or anxiety.
“Unguided” therapy refers to undergoing a ketamine experience without direct instruction or assisted supervision. Crucially, unguided also doesn’t mean standalone. Ketamine is often implemented as an adjunct therapy alongside other interventions.
In fact, esketamine (nasal ketamine, known as Spravato) often requires patients to also take an oral antidepressant in cases where the sufferer exhibits suicidal ideation or other red-flag symptoms.
In practice, most unguided ketamine sessions take place in clinics, where a provider administers the drug before leaving the patient alone in a comfortable, serene setting.
Unguided ketamine therapy doesn’t mean you’re treating yourself, but it does mean there won’t be someone sitting beside you, talking you through it.
While research generally shows that combined interventions improve treatment outcomes, working in-person with a provider or sitter isn’t practical for everyone who needs help. Unguided ketamine therapy provides a workaround and comes with some unique benefits.
Solo voyages with ketamine almost always cost less than guided experiences. This shouldn’t be a surprise; ketamine has come a long way from being a sedative turned party drug. Administering ketamine as an acute treatment, and maximizing the critical hours that follow, takes real expertise.
While costs vary significantly, some sources identify guided treatments as costing up to $1,000 per session. You can find unguided services for far less than that, usually ranging between $50 and $300.
Here’s the reality: Some who suffer from mental health ailments can’t physically access the treatments they need.
People with severe depression may not have the agency to get themselves to a clinic; those with serious anxiety may not be able to handle medical environments. At-home, or without eyes-on, therapies are an essential workaround for individuals at their most vulnerable.
Unfortunately, ketamine is still a drug, and unsupervised drug use of any kind comes with risks. For unguided ketamine therapy specifically, it’s not all upside.
The mild reality-distorting effects of ketamine, coupled with the “emotional kinetics” happening in your mind, can easily be overwhelming. You may have to contend with strong, unexpected feelings, not all of which are positive.
Having a sitter present helps ground the experience, especially if they’re trained in psychedelic navigation. Any clinic or telehealth service you work with will have safety levers to pull if you put yourself in harm’s way physically, but you will be left to contend with a possibly stormy emotional situation yourself.
Then there are the physical safety risks. Ketamine can be spatially disorienting, increasing your risk of falls or at-home accidents. You can also fall into a “k-hole” if you administer the wrong dose.
Errant dosing is more likely than you think - a report discussed by Psychiatric Times in 2023 showed that more than half of at-home ketamine users have taken more than their assigned dosage, either accidentally or on purpose.
When we think of therapy, we picture two people in a calm, serene environment, slowly unpacking and mending deep traumas and gleaning productive insights. All that emotional labor isn’t usually something you can tackle alone.
Before you embark on a solo voyage with unguided ketamine therapy (or another psychedelic), you need to perform a cost-benefit analysis.
The biological effects of ketamine - think back to the NMDA receptors in your brain - work whether there’s someone in the room with you or not. The neuroplastic window can last for hours or days afterward.
But some experts have emphasized the importance of pairing ketamine therapies with integrative support, so as to avoid an incomplete treatment. While ketamine does provide acute relaxation and relief, for best results you’ll need to put in the work afterward as well.
Integration, or practices that help you sort through your insights and make sense of the voyage, can be helpful for getting the most value from psychedelic therapies. Qualified stewards or sitters know how to steer you in the right direction.
Absent a guiding hand in the moments after you come down from ketamine, proper solo integration practices are even more important. Your options range from meditation to journaling, but you should never finish a psychedelic stint and return to business as usual.
If you’re about to set sail on a ketamine voyage, there’s some prep work you need to do beforehand. Taking a bit of extra time to set the mood can enhance your experience.
Ketamine therapy experiences last between 30 minutes and 1 hour. To prepare the environment for the session, set the room to a comfortable temperature, draw shades to limit harsh lights, or grab an eye mask. Slow, low, ambient music can help you relax, but it isn’t required.
As for using other forms of technology, it may be wise to play it safe and limit unnecessary external stimulation. Research is conflicting, but some data point to digitally-assisted therapies as being potentially hazardous to the treatment.
Put simply, at-home ketamine therapies may require interaction with a screen for video calling or similar purposes, but idle smartphone usage while under the drug’s effects probably isn’t doing you any favors.
If you’re doing at-home ketamine therapy, you should have a trusted friend readily available. They don’t need to join you in the room, but it’s a non-negotiable safety rule.
That said, ketamine experiences aren’t typically intense or chaotic. In clinical settings, you mostly sit idle in a chair or on a couch and let your mind wander while a staffer waits nearby, but out of sight.
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