Ketamine is a highly regulated drug in the U.S. and there are good reasons behind it. In certain studies, ketamine has shown great promise in helping with anxiety, treatment-resistant depression, PTSD, and OCD. However, there are some risks related to ketamine therapy you should know about.
We will discuss the risks and side effects of ketamine, some better therapies, and why regulation is important to prevent mishaps from happening.
Short-Term Side Effects of Unregulated Ketamine Treatment Explained
Ketamine is a drug that works as a dissociative anesthetic. This means it can cause physical, mental, and emotional changes. The effects of ketamine usually begin about 30 minutes after the dose.
Depending on whether you take IV ketamine, lozenges, intranasal spray (Spravato), sublingual tablets, or as an intramuscular injection you may feel:
Dissociation
This is a mental health symptom where a person feels disconnected from their thoughts, feelings, or sense of identity. It can cause people to feel detached from reality, often as a response to stress or trauma. This sense of detachment from one’s body or surroundings is sometimes described as an “out-of-body” experience or entering a “K-hole”.
Euphoria and Relaxation
Euphoria or relaxation is a common side effect of ketamine, where users might feel intense feelings of happiness, calmness, or a sense of well-being. This can occur due to ketamine’s effects on the brain’s neurotransmitter systems.
Hallucinations
Hallucinations are a potential side effect of ketamine. In these cases, users may have distorted perceptions of reality. For example, they might see, hear, or feel things that aren’t actually there. This happens because ketamine affects brain chemistry and how the senses process information.
Confusion and Disorientation
Confusion and disorientation are side effects of ketamine, causing users to feel mentally unclear or unable to understand their surroundings. This can lead to difficulty focusing, recognizing people or places, and maintaining coherent thoughts during or after use.
Impaired Memory
Impaired memory is a side effect of ketamine, where users may experience difficulty recalling recent events or information. This occurs due to ketamine’s influence on the brain’s memory centers, leading to short-term memory disruptions during or after use.
Agitation
Agitation is a potential side effect of ketamine, where users may feel restless, irritable, or anxious. This can lead to increased physical movement, nervousness, or emotional distress, often as a result of ketamine’s effects on the central nervous system.
But, if you have taken a higher dose or been given one from your prescriber (MD, DO, NP, or PA), you may feel certain physical effects, such as:
- Numbness and analgesia: Reduced sensitivity to pain, which increases the risk of accidental injury. People may not be aware at first, but the numbness should subside within 4 hours of their first ketamine dose.
- Drowsiness or sleepiness: A strong urge to sleep or feeling very tired is quite common after taking ketamine. As the medication is strong and in certain doses acts like an anesthetic, this is a very mild side effect.
- Dizziness and blurred vision: Difficulty focusing or maintaining balance can be a risk associated with ketamine. Though not that common, people should feel normal after a few minutes.
- Slurred speech: Trouble speaking clearly just after your session has ended can be a thing. To make sure it’s nothing serious, observe yourself for 15 to 20 minutes intensely.
- Nausea and vomiting: There are ketamine therapy side effects that are common like nausea. If ketamine is given on a full stomach, it can result in the risk of choking.
- Increased heart rate and blood pressure: While temporary, cardiovascular stimulation and high blood pressure can be risky if someone has underlying causes, make sure to screen patients thoroughly before giving them the option of ketamine therapy.
- Loss of coordination: Initially, your motor skills can get worse. This is the reason why everyone who undergoes ketamine therapy is given some rest before they are allowed to go home.
Tip: If you ever feel like even after your ketamine session is over you aren’t feeling normal, you should immediately contact your clinic back for further direction.
Long-Term Risks of Ketamine Therapy
There has been a history of ketamine abuse. Even if most people might be using the drug in moderation or clinical settings, there can be some long-term risks as well. This is especially true for people who abuse or are addicted to the drug and support misuse. These chronic and high doses can affect multiple body parts.
Some long-term effects researched have been:
Urinary Bladder Damage
The bladder has been researched to suffer heavily from ketamine use. There are 3 ways in which the bladder can be damaged:
- Ketamine-associated cystitis: A high dose of ketamine can cause chronic inflammation, ulcers, and scarring of the bladder wall. This can cause symptoms like frequent urination, pelvic pain, blood in urine, and incontinence.
- Reduced bladder capacity: Due to other symptoms as explained below, the bladder capacity can reduce significantly. Severe cases may require surgical help (e.g., bladder removal).
- Kidney damage: The bladder is not the only organ that is affected due to ketamine. Kidneys also face major damage due to which urinary reflux and kidney infections can become common. As a result, kidneys can be permanently damaged with bladder dysfunction.
Organ Damage
There are selective organs in our body that can metabolize drugs to keep the body functioning. Two organs that do so are the liver and kidneys. Because of more toxins in the blood, the liver and kidneys may take direct damage and have reduced function.
Also, high heart rate and blood pressure can cause cardiovascular issues and risk of heart failure. However, people who still may choose to continue taking ketamine in high doses may face compromised respiratory function because of the combination it has commonly with other depressants.
Nasal and Injection-Related Harm
Even though Spravato is not available over the counter, people find ways to abuse street versions of such medications. People who continue to use ketamine through nasal passages in powder form can get erosion of their nasal walls.
This can limit their sense of smell completely. Also, injection use can make skin infections worse, vein damage, and endocarditis (heart valve infections), ultimately making the patient very critical.
Yet, some ketamine side effects are worse. This has been observed in patients who don’t refrain from drug usage and continue to abuse it. These are some psychological side effects of the drug:
- Memory loss: Short-term and long-term memory deficits.
- Attention and executive dysfunction: Difficulty concentrating, planning, or problem-solving.
- Mood disorders: Depression, anxiety, and personality changes.
- Psychosis: Hallucinations, paranoia, and schizophrenia-like symptoms in predisposed individuals.
- Flashbacks: Recurring dissociative episodes even after finishing.
- Reduced gray matter volume: Observed in brain regions linked to memory and emotion.
- Impaired white matter integrity: Disrupted communication between brain areas.
These are quite serious risks and side effects that affect people who chronically use ketamine. This is NOT common to see in people who take regulated therapies. Although, if you want to be informed enough, you should talk to your healthcare provider or prescriber about the risks.
How Safe Is Ketamine Therapy Compared to Other Treatments?
Regulated ketamine therapy is much safer than using it on the street. Even among medical options, ketamine-assisted psychotherapy (KAP) is the safest.
This is the comparison you should look for:
| Feature/Aspect | IV Ketamine | KAP (Ketamine-Assisted Psychotherapy) | Oral Ketamine |
| Administration Route | Intravenous (100% bioavailability) | Usually sublingual (30% bioavailability) or intramuscular (93%); paired with psychotherapy | Oral (16–24% bioavailability) |
| Setting | Medical clinic, continuous monitoring by professionals | Clinic or therapist office, therapeutic “set and setting,” integration support | At home or clinic; less monitoring |
| Onset & Duration | Rapid onset (minutes); short duration (40–60 min) | Varies by route (IM: rapid, sublingual/oral: slower); session includes therapy before, during, and after | Slower onset (15–30 min); longer, gentler experience |
| Efficacy | Most research-backed for severe depression, acute suicidality, PTSD; 70% response in TRD | Emerging evidence suggests enhanced and longer-lasting benefits when combined with therapy | Promising for depression, but less robust and less predictable than IV; similar efficacy in some studies |
| Bioavailability | 100% | IM: 93%, Sublingual: 30% | 16–24% |
| Dosing Control | Precise, can be started/stopped instantly; dose fully delivered to brain | Moderately precise (IM/sublingual); oral less precise | Least precise; subject to digestive variability |
| Safety | Highest, continuous medical monitoring, immediate assist possible | Moderately high—therapist present, but less medical monitoring | Lower—risk of missed side effects, no immediate help |
| Side Effects | More likely to cause transient dissociation, nausea, headache, drowsiness | Similar to IV or oral, but may be mitigated by therapeutic support | Fewer headaches/drowsiness than IV, but more GI side effects (nausea, variable absorption) |
| Dropout Rate | Higher (54.8% in one study, possibly due to intensity or side effects) | Lower than IV alone; therapy may improve tolerance and completion | Lower (26.7% in same study) |
| Convenience | Less convenient (requires clinic visits, IV placement) | Moderately convenient (clinic/office visits, but more supportive environment) | Most convenient (can be taken at home) |
| Cost | Highest (multiple clinic visits, medical staff, equipment) | High (therapy, medication, integration sessions) | Lower (fewer clinic visits, no IV setup) |
| Best For | Acute/severe depression, suicidality, rapid symptom relief, treatment-resistant cases | Patients seeking lasting psychological change, those who benefit from therapy integration | Maintenance, long-term use, those unable to access IV/clinic care |
Ketamine-assisted psychotherapy is a great way to approach ketamine-based treatments. The biggest factor is the safety and the guided integration which makes it great for people to understand all their feelings better.
Also, as regulated ketamine therapy like KAP doesn’t encourage or even prevent chronic ketamine use, individuals affected by individuals can reverse their urinary symptoms. They can also expect to partially recover from cognitive limitations as well.
Why Regulating Ketamine Therapy Is Important for Patient Safety?
Regulating ketamine therapy is crucial to protect patients from potential misuse, side effects, and addiction. When given in safe medical places, ketamine can be safe and effective. If no one watches the treatment, patients face more risks, especially from unqualified providers or at-home treatments.
Proper regulation also ensures consistent treatment standards, informed monitoring, and ethical care delivery. It helps prevent long-term problems, supports safe dosing, and encourages data collection to track outcomes and improve safety protocols over time.
Key Reasons for Regulation:
- Prevent misuse, dependence, and unmonitored use
- Ensure qualified professionals administer the treatment
- Reduce risks of side effects like hallucinations and confusion
- Monitor long-term physical and psychological health impacts
- Address safety concerns with unregulated ketamine clinics
- Encourage national data collection for better outcomes
- Support integration into broader mental health care plans
Considering All of the Facts..
Ketamine therapy is one of the better therapies you can come across for your mental health issues. When all else fails, ketamine-assisted psychotherapy has shown great results so people can consider safer options.
Regulated treatments, like ketamine-assisted psychotherapy (KAP), offer a safe, guided approach. While unregulated use can lead to serious ketamine therapy side effects and long-term harm.
Choosing regulated care not only improves mental health outcomes but also reduces the risks of misuse, addiction, and physical difficulties often seen in unmonitored or chronic ketamine use.
Get KAP Sessions That Are Transforming and Freeing!
If you are looking for safe, regulated, and professional ketamine-assisted psychotherapy options, you can reach out to the Ko-Op.
We practice mindful ketamine therapy that can help you get closure about your mental struggles. You can choose between solo or group ketamine assisted psychotherapy sessions in Philadelphia.
Our program provides:
- Clinically Supervised, Evidence-Based Treatments
- Safe Dosing in Calm Environments
- Solo or Group Healing Options
- Mindful Integration with Licensed Therapists
You can get connected to us for a consultation here.
And, if you are a therapist, you can join our 6-week nationwide virtual training on KAP that can help you learn:
- About KAP as Client and Clinician
- Embodied Training Through Real Sessions
- Guided Prep, Dosing, and Integration
- Weekly Peer Discussions and Connection
- Firsthand Insight Into What Works
To learn more about our program, you can click here.
