Combining psychotherapy with low doses of ketamine is becoming a more common option for treating severe depression and post-traumatic stress, especially for people who face a lot of trauma in their work such as firefighters, police officers, and military members.
Ketamine is best known as an anesthetic that doctors have used for decades. At low doses, given together with guided therapy, it can change how people remember and feel about their traumatic experiences.
This has led some clinicians to try ketamine-assisted psychotherapy for patients who have not improved with usual treatments.
First responders face a high and repeated burden of trauma. Small studies and surveys suggest that police officers and other emergency workers often see hundreds of disturbing events over a career, far more than the average person.
Rates of depression, burnout, and suicide are higher in this group than in the general public. For many of those people, traditional therapies—talk therapy, standard antidepressants, or time-limited programs—do not always help. That gap has pushed clinicians and clinics to try new approaches, and ketamine has moved quickly into that space.
Ketamine causes a dissociative state: people may feel separated from their body or their usual thoughts and emotions. At high doses it is used as an anesthetic in hospitals. In smaller doses it can have rapid effects on mood.
Research starting from animal experiments and early human trials showed surprising and often fast relief of depressive symptoms after a single low dose.
These results led to development of esketamine, a related drug approved by the U.S. Food and Drug Administration in 2019 as a nasal spray for treatment-resistant depression. Other forms of ketamine are still approved only for anesthesia; when used for mood or trauma they are prescribed off-label.
But the science is still catching up with practice. A number of researchers caution that clinical use of ketamine, especially outside tightly controlled research settings, is ahead of the evidence for long-term safety and effectiveness.
Large, high-quality trials are still limited for some questions, such as whether ketamine reliably helps people with post-traumatic stress disorder (PTSD) over the long term, and which kinds of psychotherapeutic support work best alongside the drug.
The regulatory landscape adds to the uncertainty. There is no single federal standard that spells out how to dose ketamine for psychiatric use, how to train providers, or how to run safe clinics.
As a result, more than a thousand private ketamine clinics have opened across the country, offering a wide range of services, from supervised infusion in medical settings to at-home kits sold online. The U.S. Food and Drug Administration has warned about at-home ketamine treatments. State rules vary, and oversight can be inconsistent.
Safety matters. Side effects include nausea, temporary rises in blood pressure, breathing problems at higher doses, and disturbing psychological experiences. Because the drug can open traumatic memories, people may be retraumatized if a session is not properly guided by a trained mental health professional.
That is why many experts argue that ketamine treatment should be paired with skilled psychotherapy and careful clinical monitoring, not offered as a quick shot of medicine alone.
Clinicians who support ketamine-assisted psychotherapy argue it can be especially helpful for first responders. Some therapists report that ketamine can reduce the emotional intensity of traumatic memories and help people engage with psychotherapy more deeply and quickly than usual.
Practitioners describe the drug as lowering emotional defenses, helping people access painful memories without being overwhelmed. Sessions typically last a few hours, with the drug’s main effects present for under an hour, and patients are supported before, during, and after the dose.
Despite this promise, cost and access are barriers. Many insurers do not cover ketamine-assisted psychotherapy, and a single IV session can cost more than a thousand dollars.
That makes it hard for many first responders and others who might benefit. Some public systems, like the Department of Veterans Affairs, provide ketamine treatments in select cases, but coverage is uneven.
Public perception is another hurdle. In communities and among some officers, ketamine is known as a street drug or a party drug, which makes acceptance of medical use harder. Without clear guidance from employers or police departments, many first responders are unsure whether to try it or how it would be viewed by colleagues and supervisors.
In reviewing the current state of evidence, several points stand out. The strongest findings show that low doses of ketamine can produce fast relief from depressive symptoms in some patients, often within hours or days. Evidence for ketamine’s role in treating PTSD is promising but less definitive.
There is limited long-term data. Safety and quality of care depend heavily on how treatment is delivered: whether psychotherapy is integrated, how clinicians are trained, and how follow-up is handled.
The market’s rapid growth and variable regulation raise risks of inconsistent care and potential harms. More rigorous, longer-term studies are needed, with careful measures of mental health outcomes and harms, and comparisons between ketamine plus psychotherapy versus psychotherapy alone.
Analysis: For first responders with severe depression or PTSD who have not improved with standard care, ketamine-assisted psychotherapy may be a reasonable option to consider in specialized, well-run programs.
Key safeguards should include clear clinical protocols, trained staff, psychological support before and after dosing, and monitoring for adverse effects. Policymakers and healthcare systems should push for stronger evidence through controlled trials and for consistent standards of practice and training.
Insurers should consider covering evidence-based ketamine services to improve access while systems are built to ensure safety. Until we have more data, caution is sensible: ketamine can help some people quickly, but it is not a magic cure and must be used carefully.
If you care about mental health, please read studies about cannabis use disorder linked to increased risk of mental diseases and some mental health drugs can cause rapid weight gain.
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