How to talk to your patients about Ketamine Therapy

Stephanie Karzon Abrams, Clinical neuropharmacologist | Clinical Director Mystic Health | Founder, Beyond Consulting | Research Director, Microdosing Collective 501c3

A 6-step framework for clinicians.

Raising the ketamine therapy conversation with a patient can feel challenging. This guide gives you the framework to start it, sustain it, and close it with a referral.

1. What Isn't Working 

Reframe treatment resistance as a signal. Patients need to hear that the current path can have a ceiling — not that they need more patience. 

Say: 

“We've tried a few different approaches, and I want to be honest: the response isn't what I'd hope for. That tells us clinically that your depression may not be primarily serotonin-driven — which means the medications we've been using are working on the wrong mechanism. I'd like to talk about something that works differently.” 

2. Explain the Mechanism Simply 

Glutamate, not serotonin. New synaptic connections, not mood adjustment. 

Patients can benefit from learning about a model. The key shift: SSRIs work on serotonin; ketamine works on glutamate — the brain's primary excitatory system, involved in learning and synaptic plasticity. This is why it can work when SSRIs haven't. 

Say: 

“Ketamine blocks a receptor that gets overactive in depression, and triggers the brain to rapidly form new synaptic connections — structural changes, not just a mood adjustment. That's why patients often feel a shift within hours, not weeks.” Here you might talk about how SSRIs have an onset delay, and ketamine does not. So when fast relief is necessary, ketamine can be a good option.

3. Address the Psychedelic Context Directly 

Name it before they do. 

Ketamine's cultural associations — dissociation, altered states, tranquilizer — are in the room whether you name them or not. Naming them first signals clinical confidence and removes the sense that you're selling something. 

Say: 

“Ketamine is considered a psychedelic — it does produce altered states, or a dream-like state, and that's part of how it works. It's been used in anesthesia medicine for over fifty years and is on the WHO essential medicines list. But ketamine therapy is sub-anesthetic, much lower doses. The dissociative experience is the doorway through which therapeutic work becomes possible.” “Think of it as creating the space you need to navigate your challenges more clearly.”

4. Go Beyond Symptom Reduction 

Ketamine opens access to meaning-making and existential material that oral antidepressants don't reach. 

The neuroplastic or  critical learning window following a ketamine session — 24 to 72 hours of heightened brain malleability — is real and therapeutically significant. For patients whose depression is entangled with grief, identity disruption, or existential questions, this is often the most clinically meaningful dimension. You can read more about critical periods here: https://ictr.johnshopkins.edu/news_announce/study-shows-psychedelic-drugs-reopen-critical-periods-for-social-learning/And here: https://www.nature.com/articles/s41586-023-06204-3

Say: 

“Ketamine doesn't just reduce symptoms. It creates a window of access to things that are hard to reach in standard therapy — grief underneath the depression, beliefs about oneself that haven't shifted, questions of meaning. That's not guaranteed for everyone, but it's a real part of what this treatment can offer.”

4. Responding to Common Objections 

Cost, fear, stigma, efficacy doubt — address each one without dismissing it. 

Patient says… 

You say…

"It's too expensive." 

Spravato is covered by most major insurers when criteria are met — sometimes at a standard copay. IV and IM ketamine are cash-pay, but financing is available, and insurance can cover your medical consultation. Also consider the ongoing cost of treatment that isn't working.

"I've heard it's addictive." 

At clinical subanesthetic doses, in a supervised setting, addiction risk is not significant for patients without prior substance use disorder. That concern applies to recreational use — not to what we're discussing.

"I don't want to lose control." 

The dissociative experience is temporary, monitored, and — for most patients — much less frightening in reality than in anticipation. You are in a clinical setting with a provider present throughout. The dosing is personalized so you can begin low so you can dip your toe into the feeling first. 

"What if it doesn't work?" 

Response rates for ketamine in TRD are 60–70%, versus under 50% for antidepressant augmentation at this stage. If it doesn't work, that's clinical information too, and we can try something else. 

5. Make the Referral Easy 

Offer them a next step, not just information. 

Patients leave most clinical conversations with new information and no action. The referral moment is where this work is lost. Close specifically: a name, a number, your implicit endorsement. 

Say:

“I'd like to refer you to [CLINIC NAME]. They're physician-led, integrative, compassionate,  they work collaboratively with me. They also offer a free discovery call. I can also be part of your process in collaboration with their team.  If you want to move forward, I can send a note so they have context when you reach out. Is this something you're willing to try?” 

If your patients or clients are in the Los Angeles area, get in touch with Mystic Health to learn more!

Mystic Health
info@mystic.health | (310) 550-1006
www.mystic.health
2901 Wilshire Blvd, Suite 105, Santa Monica, CA 90403