Is Ketamine Therapy Safe?
Ketamine has been used safely as an anesthetic in medical settings for over 50 years. Its safety profile at anesthetic doses is well established. At the lower, sub-anesthetic doses used in ketamine-assisted psychotherapy, the risk profile is substantially reduced — and serious adverse events are rare in properly screened patients.
Safety in KAP is achieved through three mechanisms: rigorous screening before treatment, physician presence throughout sessions, and continuous vital signs monitoring. Dr. Rosenbach conducts all sessions personally, in your home, with medical equipment on hand.
Ketamine is not an experimental drug. The FDA approved esketamine (a derivative) for treatment-resistant depression in 2019. Racemic ketamine — the form used in KAP — has been used in psychiatric practice for decades, with a robust and growing evidence base.
During-Session Side Effects
These effects are expected, transient, and resolve as the medication wears off:
Dissociation
ExpectedA sense of detachment from your body or surroundings — the core therapeutic mechanism of ketamine. This is intentional, not a complication. Intensity varies by dose and individual. Dr. Rosenbach adjusts dosing based on your response.
Nausea
UncommonNausea occurs in a minority of patients, usually mild and brief. Fasting before the session reduces this risk significantly. Anti-nausea medication can be administered if needed.
Elevated Blood Pressure
Expected, MonitoredKetamine transiently raises blood pressure and heart rate in most patients. Vital signs are monitored throughout every session. Patients with uncontrolled hypertension are screened out before treatment.
Perceptual Changes
ExpectedVisual or auditory alterations, abstract imagery, altered sense of time. These are part of the psychedelic experience and are prepared for during pre-session work. They are temporary and resolve fully.
Emotional Intensity
VariableDifficult emotions or memories may surface. This is often therapeutically valuable. Dr. Rosenbach provides grounding support throughout. Preparation sessions specifically address psychological readiness for this.
Increased Salivation
UncommonA minor anticholinergic effect that occurs in some patients. Generally not distressing. Can be pre-treated with a common medication if needed.
After-Session Effects
Fatigue
Most patients feel pleasantly tired after the session. Rest is recommended. This typically resolves after a night's sleep.
Emotional vulnerability
A period of emotional openness or sensitivity in the 24–48 hours following the session. This is actually therapeutically useful — many patients find this window ideal for journaling, reflection, and integration work.
Cognitive fogginess
Mild cognitive effects (difficulty concentrating, slower processing) can persist for a few hours. This is why driving is prohibited on session day.
Mood improvement
Many patients notice a lifting of depression beginning within hours to 24 hours post-session. This is the intended therapeutic effect.
Continuous medical monitoring throughout every ketamine session
Long-Term Risks: Context Matters
Concerns about ketamine's long-term effects largely arise from studies of recreational ketamine use — frequent, high-dose, unsupervised consumption. In a clinical KAP context, the risk profile is very different.
⚠️ Bladder damage (ketamine cystopathy)
Associated with chronic recreational use (daily or near-daily use). In therapeutic protocols with infrequent sessions, this risk is extremely low. No cases of bladder damage have been reported in clinical KAP protocols.
⚠️ Cognitive effects
Chronic recreational use can impair memory and executive function. Therapeutic doses used infrequently show no persistent cognitive impairment in clinical studies.
⚠️ Psychological dependence
The risk of misuse in a therapeutic context — with physician oversight and infrequent sessions — is very low. Dr. Rosenbach screens for substance use history and monitors carefully.
Screening Criteria: How Safety Is Ensured
Before any patient receives ketamine, Dr. Rosenbach conducts a comprehensive evaluation covering medical history, current medications, psychiatric diagnosis, cardiovascular health, and substance use history. Patients with the following are typically not approved for KAP: