Does Ketamine Therapy Get You High?

Ketamine therapy often involves high doses of ketamine, but there’s a tendency to distinguish between “therapy” and “getting high” — is that fair?

By J Gordon Curtis Last Updated: February 12, 2024
Last Updated: February 12, 2024

If you’ve looked into ketamine therapy, you’ve likely wondered if it’s the same drug you’ve read about on all those Reddit trip reports. Instead of “tripping,” clinics say participants will “feel an onset of euphoria and a floating sensation,” or something similar.

While we like to pretend ketamine therapy uses an entirely different drug, it certainly does get you high. The true difference — as it is with all drugs — comes down to context.

Ketamine clinics usually emphasize preparation and integration, along with guided sessions. Of course, some forms of ketamine therapy don’t offer a drastic difference in support from recreational use.

Let’s break down what you can expect from the various forms of ketamine therapy and how they set themselves apart from recreational use (if at all).

Will Ketamine Therapy Get Me High?

In short, yes, though this isn’t really “the point” — at least, according to the clinics. Ketamine therapy frequently involves doses that even recreational users consider quite high. 

However, patients can expect preparation, oversight, and integration experience within a therapeutic setting. While this is less common for telehealth clinics, most offer some level of screening beforehand and assistance during the experience — though often a rather insignificant amount. 

There are attempts to differentiate the “high” from ketamine therapy from the recreational one, but this is mostly a concern of stigma. Clinics will sometimes plead the case that it’s not “getting high” within a clinical setting, but it’s hard to see any significant reasoning behind their claims.

The exceptions are clinics that work with below-threshold or very light doses. They claim the option is more of a ketamine “microdose,” where the user won’t feel the effects (get high) but can still (theoretically) benefit.

While studies are not yet conclusive on the long-term implications of microdosing ketamine, it’s likely an unwise practice. Compared to other substances like magic mushrooms or LSD, ketamine’s toxicity makes it a far more dangerous option. 

Serious side effects and health implications related to the bladder and abdominal area are linked to a build-up of metabolites in the system [1]. Metabolites result from your body digesting ketamine, and researchers haven’t looked into the effects of digesting small quantities of ketamine regularly.

Until science can rule out the danger, it’s probably best to steer clear of frequent ketamine use — even in sub-perceptual doses.

Is Ketamine Therapy Similar To Tripping On “Classic Psychedelics?”

Ketamine has some similarities in experience with other psychedelics, with a few distinctions. In addition to the hallucinatory and “psychedelic” elements of ketamine, it also acts as an anesthetic and analgesic — meaning it disconnects the brain from bodily sensations and pain [2].

These effects have led many to call ketamine a “dissociative anesthetic” as opposed to a “psychedelic,” despite ketamine’s psychedelic-like effect. 

The main differentiator comes from ketamine’s action on opioid receptors and two neurotransmitters responsible for inhibition and relaxation: NMDA (N-methyl-d-aspartate) and, to a lesser extent, GABA (gamma-aminobutyric acid).

Together, these are why users report feeling disconnected from their bodies, along with floating and out-of-body sensations. In high doses, this can lead to an experience many describe as “falling into a hole” for a seemingly endless amount of time (or “K-holing”).

Depending on the person experiencing it and how prepared they are for the experience, this can be terrifying or euphoric. 

How Different Forms of Ketamine Therapy Feel

There are a few options for receiving ketamine therapy, with different implications and considerations. The two main options available now are the FDA-approved formulation of Spravato and off-label ketamine clinics.

In the United States and a few other countries, ketamine telehealth options offer mail-order ketamine as well, removing most barriers to obtaining it. In all forms of ketamine therapy, you can expect to feel the “high” of ketamine (outside of microdose regimens), though they occur in different ways.

Before getting into each option for receiving ketamine, here’s a quick rundown of the different routes of administration they might offer:

Form of KetamineConsiderationsBioavailability
Oral (tablets/pills)Passes through the metabolism, which makes efficacy less predictable; poor taste; takes longer to be effective (20–60 minutes)20%-25% [3]
Sublingual (troches/lozenges)Rapid onset (without peaking as high as infusions); more reliable since it doesn’t have to pass through metabolism but still not as effective as IV/IM29% [4]
Intravenous (IV)Rapid onset with a high peak in plasma concentrations of metabolites leading to a higher potential for side effects and adverse reactions; typically administered throughout a 30–60 minute period (meaning you’ll have a needle in your arm that long)90+% [5]
Intramuscular (IM) Single shot into the upper arm, a similar experience to the above in terms of rapid onset and side-effect potential90+%
Intranasal Spray (Spravato)Spray bottle placed in one nostril before pressing on the plunger — by far the most expensive option with a rapid onset and higher bioavailability than some others48% [6]

Taking Ketamine At a Clinic: What to Expect

Most clinics offer an intravenous (IV) or intramuscular (IM) infusion of ketamine directly into the bloodstream. Some also provide sublingual options like troches or lozenges to take advantage of the easier onset.

Typically, clinics will have an introductory therapy session to ensure you’re a good fit for the treatment and then prescribe the course of action they believe is best for you. Often, this will include at least weekly infusions to start, tapering down as needed.

Regardless, you can expect to feel the full effects of ketamine when visiting a clinic and may even find yourself nearing the realm of the legendary “k-hole.” Many practitioners believe the subjective effects of ketamine play a large role in successful outcomes and tailor the dosage to your body weight, experience, and needs.

IV administration drips slowly for 30–60 minutes to extend the experience and prevent a rapid, disorienting onset. Intramuscular, oral, and sublingual doses may be ongoing as well, with re-dosing protocols at different points.

Taking Spravato: What to Expect

Just because the Food and Drug Administration approves of Spravato doesn’t mean it won’t make you feel high. Spravato is a nasal spray containing high levels of esketamine — one-half of the “mirror molecules” that make up ketamine — that patients usually take along with their antidepressant medications.

Note: Treatment-resistant depression is the only approved indication for prescribing Spravato.

The recommended starting dosage for Spravato is 56 mg of esketamine before increasing dosages up to 84 mg. Patients might take up to two doses per week for four weeks before reducing the dosage and/or number of doses.

Each “nasal spray device” has 28 mg, so expect to spray two or three times per session. 

For reference, a strong intranasal dose of ketamine is typically around 60–125 mg, so again, expect to feel the high.

At-Home Ketamine Telehealth: What to Expect

When it comes to ketamine telehealth services, patients are largely on their own. You will usually have an introductory call for 15–30 minutes to determine if you’re a good fit, but the barrier for entry seems low.

After approval, the service will usually mail a kit containing an eye mask, a blood pressure monitor, and 4–12 doses of ketamine. Occasionally, a therapist might be available during some of your sessions, with other clinics offering the option at an additional charge.

While there are certainly worse ways to obtain ketamine than through a telehealth service, you might have to prepare and integrate the experience on your own. This is the biggest thing that sets ketamine therapy apart from recreational use; without it, the benefits are reduced drastically.

Additionally, make sure you have someone willing to stick by you and stay sober throughout the experience. Ketamine’s dissociative effects can make it disorienting, confusing, and dangerous — you don’t want to be in charge of your safety when you can’t feel your body.

Ketamine Therapy vs. Recreational

While the doses of ketamine in clinical settings will certainly lead to psychedelic effects, there is still a significant difference between the recreational and therapeutic use of ketamine. Most of this difference, however, is up to the person taking it — especially when comparing the hands-off attitude of telehealth clinics to recreational use.

The difference is more pronounced within a clinical context, as trained psychological care is an invaluable tool for any mental health concern. Additionally, when using ketamine to address these symptoms, taking it alone can be terrifying and worsen symptoms.

If you feel you are in a healthy place mentally and are willing and informed on the effects of ketamine, intentional “illicit” use could be as effective as hands-off telehealth therapy. While the law considers this a “recreational use” of ketamine, only you can determine your motivations. 

Outside of a clinical setting, ketamine is still an illegal drug and is often contaminated with other substances. Always test your ketamine and familiarize yourself with the laws of your location.

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  1. Chu, P. S.-K., Ma, W.-K., Wong, S. C.-W., Chu, R. W.-H., Cheng, C.-H., Wong, S., Tse, J. M., Lau, F.-L., Yiu, M.-K., & Man, C.-W. (2008). The destruction of the lower urinary tract by ketamine abuse: A new syndrome? BJU International, 102(11), 1616–1622. 
  2. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms—PMC. (n.d.). Retrieved September 26, 2023 
  3. Andrade, C. (2019). Oral Ketamine for Depression, 1: Pharmacologic Considerations and Clinical Evidence. The Journal of Clinical Psychiatry, 80(2), 13517. 
  4. Rolan, P., Lim, S., Sunderland, V., Liu, Y., & Molnar, V. (2014). The absolute bioavailability of racemic ketamine from a novel sublingual formulation. British Journal of Clinical Pharmacology, 77(6), 1011–1016. 
  5. Clements, J. A., Nimmo, W. S., & Grant, I. S. (1982). Bioavailability, pharmacokinetics, and analgesic activity of ketamine in humans. Journal of Pharmaceutical Sciences, 71(5), 539–542. 
  6. Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant. Pharmacy and Therapeutics, 44(6), 340–375.