Psychedelics and Bipolar Depression: A Therapist’s Year of Ketamine Treatment
When I began exploring ketamine treatment for my bipolar depression in 2023, I was following a strong pull of intuition. Other treatments had begun revealing their limits, and I was drawn to the increasing availability of at-home dosing sessions for a different approach to mental wellness.
My interest was rooted in ketamine’s proven benefits for treatment-resistant depression, a category of depression that does not improve after trying at least two well-established treatment methods. For me and many others with Bipolar Type II, depression comprises the majority of our days compared to periods of hypomania. I was seeking relief from this darker side of the spectrum, with its gnawing negative self-beliefs and distorted thinking patterns that made life challenging.
I located a well-reviewed psychiatrist who worked with me to prescribe an appropriate dose, dosing frequency, and educated me on creating a nurturing set and setting for each at-home dosing trip. As with any promising treatment, I longed for the ketamine to work, but had to see through trial and experimentation to determine its efficacy for my body. I also continued taking my other medications.
In reflecting on my year of using a psychedelic for treating chronic mood disorder, I can say wholeheartedly that the process was well worth it. I consistently discovered profound insights made possible by synaptic growth, gained a wider perception of myself and of the world, felt the loosening of self-judgments, and was able to experience nervous system renewal that supported real lifestyle changes.
Ketamine’s Psychedelic Potency
Ketamine’s primary mechanism is increasing activity of Brain Derived Neurotropic Factor (BDNF), a protein that controls nerve cell health. Its levels in the brain shape our synaptic plasticity, mood regulation, and capacity for learning. BDNF in turn interacts with the amino acid glutamate, which is released in greater amounts in the prefrontal cortex. This is how ketamine is able to address issues of atrophy and abnormalities in the prefrontal cortex that are tied to depression.
Unlike organic psychedelics such as psilocybin (magic mushrooms) or ibogaine, ketamine is a man-made compound of the arylcyclohexylamine drug class that was synthesized in 1962 to be used as an anesthetic. In the 1970s researchers discovered that subanesthetic doses of the drug had fast-acting antidepressant effects for patients with mood disorders.
As a dissociative anesthetic, ketamine has psychoactive and hallucinogenic effects. It is embraced as an entheogen (a portal to the “god within” like other plant medicines) that provides a sense of ego dissolution, out-of-body experience, and even spiritual or mystical revelation. It ushers in a profound non-ordinary state of consciousness (NOSC) that temporarily alters the user’s perception, thought, and feeling, enabling new perspectives to emerge.
Indeed, from a psychological perspective, ketamine can inspire spontaneous insight and discovery through accessing formerly unconscious material.
Mental Health Benefits
A growing body of research has demonstrated ketamine’s effectiveness in treating forms of depression, and studies are exploring its uses for anxiety, bipolar disorder, OCD, substance addiction, and PTSD. It is accessible via IV infusions at ketamine clinics, at-home sublingual dosing, and as the FDA-approved nasal spray Spravato.
The complementary field of ketamine-assisted psychotherapy encourages sourcing a therapist to guide your dosing journey. They can facilitate preparatory sessions for intention-setting, and integration sessions for reflection afterwards. Providers and psychedelic therapy advocates emphasize that ketamine’s temporary effects and insights need to be actively integrated into daily life in order to maximize lasting benefits.
As with most profound experiences, ketamine trips have the most impact when there is conscious effort made to apply self-discoveries toward healthier behaviors. I chose to do my integration work independently, relying on my therapist perspective and capacity to reflect deeply on inner experiences.
My Trip Experiences
I started each dosing session with a gentle intention setting, identifying a mental challenge or a personal issue to bring to mind. These were held loosely so that unconscious material could flow naturally. My primary goal was to be present to each stage of the unfolding experience. I would create an inviting setting in my home with ambient music or a sound bath recording playing quietly in the background, and then lie in a comfortable position for the duration of the trip. On my dose these lasted roughly 2 hours.
Once the sublingual troche had dissolved and the medicine began its work, my perceptual field would gradually change. The flow of time would feel gentler as I settled into a resting state. Physical tension and the ache in my chest would abate, making me feel more inhabited in my body. Colors, textures, and other senses would take on a softer, more relaxed quality, and I was able to breathe more deeply. This nervous system rebalancing felt effortless, and I soon came to recognize it as the baseline state of my body without the presence of depression and chronic stress.
Neurologically, my brain was building stronger neural memory of what regulated, non-depressed conscious awareness felt like. New synaptic pathways were being created, and my brain was reconnecting with reward circuits in a way that felt both otherworldly and also familiar.
Psychologically, I was entering a flow state that allowed me to move more easily through mental and emotional blocks. The dissociative effects of ketamine enabled me to reflect on difficult or traumatic memories with greater emotional distance and regulation, making them easier to move through.
Post-Trip Integration
Integration after a trip is a highly creative process where contemplating new beliefs about oneself or the world can lead to artistic expression, more mindful living, and lasting lifestyle changes. Beyond supporting mental health, the process can have profound impacts on mind, body, spirit, lifestyle, and even relationship wellness.
My integration focused on unpacking spontaneous insights and connections I had made while in the altered state. In the following days I would reference notes I had made during sessions as prompts for further reflection. This time period was important due to the temporarily increased neuroplasticity and malleability of my thought patterns.
Even during sessions, spontaneous insights would often arise and I would suddenly know what to do in a difficult life situation, as self-judgment dissipated and empowered action felt attainable. Sometimes this would lead to sending a delayed message or initiating some communication that I had been avoiding. It felt as if my executive functioning was more fully online, allowing me to take values-focused action with greater confidence.
Most significantly, over the course of several months I gained the clarity and energy to leave an emotionally and psychologically abusive relationship of several years. This decision was driven by my increasing understanding of my attachment wounds and relationship trauma history, and how they had been distorting my self-beliefs and standards.
Notably in some sessions there were no profound discoveries, only relaxing sensory experience. And some bursts of sensation left only fading impressions, leaving me to trust in the wise timing of my unconscious mind.
In alleviating depression symptoms and supporting prefrontal cortex functioning, the trips consistently helped me to reconnect more deeply with my authentic self. I was gratified to see how reliable my inner healing intuition was once the mental noise and self-doubt had been cleared away.
No Magic Bullet
While ketamine is an established evidence-based treatment, expectations for its benefits must remain realistic. I found it effective as an adjunct treatment alongside other medications, and my psychiatrist helped me navigate potential interactions between the two.
Most importantly, the Psychedelic Harm Reduction and Integration (PHRI) clinical model emphasizes that ketamine and other psychedelics must not be viewed as a “magic bullet” for alleviating suffering. In other words, passive receptivity is insufficient.
Instead, users must be active participants in their own healing process. For example, ego dissolution is often experienced as the softening of self-narratives, release of psychic defenses, and loosening of rigid beliefs. This experience is profound, but without integration into new mindsets or behavior changes, benefits are unlikely to last.
As therapists would say, the desirable state to trait change that jumpstarts new ways of being is not automatic. Psychological growth requires whole-person investment and also attunement to pacing needs. Oftentimes challenges like unprocessed anger or grief, fear of secondary loss (e.g. loss of identifying as a depressed person), and pushing for major lifestyle changes too quickly must be addressed in order to experience a lasting breakthrough.
A Few Safety Considerations
Before starting treatment I researched whether ketamine had potential to be chemically addictive. As with any substance, an individual’s history of addictive tendencies or behavior should be taken into account. But when ketamine is used in controlled therapeutic environments at relatively low doses (in comparison to recreational use), its addictive potential is low.
Research has shown that in comparison to hard drugs, ketamine does not promote the neural adaptation that renders drugs physically addictive. However, it is possible to develop psychological dependency, and heavy long-term use leads to higher tolerance and often use of increasingly higher amounts.
A larger safety concern for me was the limited amount of literature on longer-term impacts of ketamine on the body. As of 2025, research has verified the safety of ketamine treatment up to durations of six months. While there are anecdotal reports of individuals continuing treatment for years and experiencing benefits with minimal side effects, substantive research is lacking. This lack of clarity informed my decision to stop treatment after a full year.
Conclusion
For those committed to the organic process of psychological growth, the therapeutic use of ketamine offers profound opportunities for reconnecting with your intuition, true self, and fundamental sense of aliveness.
If you are considering ketamine treatment for a mood disorder, I would highly encourage working with the most affordable, reputable psychiatrist and therapist providers that meet your needs. Whether via a local clinic or through telehealth, you deserve to receive dedicated support from the very start of your psychedelic therapy journey.
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