I Expected Hallucinations During Ketamine-Assisted Therapy. Instead, This Happened

This Monday, I had my first ketamine-assisted therapy session. I was so scared and didn’t know what to expect. Various scenarios were running through my brain, often disastrous ones. But in the end, my whole experience was wildly different from my expectations.

I was afraid of losing control. I was afraid of not losing it enough. I was afraid of a “bad trip” because benzodiazepines are traditionally used to end it, and I can’t take them. I was afraid of the feelings I may feel and that I would be helpless against them, without the resources of my rational mind that help process them. I was afraid that I would be unable to talk and say if something bad was happening to me.

It surprised me that thoughts didn’t disappear

In the end, something completely different happened. I didn’t experience an altered state of consciousness. I didn’t experience any hallucinations. I was just lying there, thinking. I was surprised that I was thinking. I thought that conscious thoughts would take a backseat during the whole experience, but there I was, thinking about anything and everything from my blog to my friends, to a protected job I want to take in autumn. 

It was underwhelming at first, really. 

The only slightly psychedelic thing was that shortly after the application of the ketamine, I felt like my lips and fingers were becoming bigger. It was a weird but not uncomfortable sensation. I didn’t feel dizzy, or detached from my body, or sleepy. I was pretty relaxed, especially in the beginning.

So, no big psychedelic effects. There was one thing that was different, though. I was able to clearly see a big fear that seems to permeate my whole life. It occurred to me that it is always there, just suppressed most of the time. It is connected to the fact that I can’t hold down a job. That I don’t have a place in society. And also to the fact that I’m incredibly lonely. I live alone, just with my rats, don’t have a partner, don’t have many friends, and my social phobia makes it difficult to take part in any social activities. 

I was able to experience this fear without it hurting. That isn’t possible for me outside the ketamine session. It hurts so much that I’m not able to think about it much at all.

Usually, when I get close to this fear, my mind immediately pulls away from it. I distract myself, intellectualize it, or simply go numb. During the ketamine session, I could look directly at it. Experience it without pulling back. Examine it.

How ketamine-assisted therapy works

Ketamine-assisted therapy (KAT) combines the effects of ketamine with psychotherapy. The ketamine itself is not the therapy. The neuroplasticity it provides for a week or two after the treatment creates a temporary mental state that can make therapy more effective.

It is used mostly to treat depression, but it proves effective in treating trauma, anxiety, or eating or substance use disorders as well. I chose ketamine for two reasons. One is my persistent anhedonia that still lasts even more than two years after coming off benzodiazepines. The other is my c-PTSD, which is so hard to tackle in regular therapy.

Positive and negative experiences are equally valuable

In one of the preparation sessions, my therapist told me that some people don’t respond to ketamine treatment at all. I already knew that. But she also told me that you can have a positive experience and feel much better afterwards, or you can have a negative one and feel much worse. That freaked me out because I supposed that the worst that could happen is that the ketamine does nothing.

The therapist told me that those two experiences are equally valuable. When you experience a positive effect, you are then left to find ways to connect to that feeling even after the ketamine effect, which lasts for about 10 days, wears off. 

When you have a negative experience, it shows you what you need to work on in therapy. You see your problems more clearly, and there is no hiding from them. She told me that those two outcomes have equally good results after half a year of therapy. 

There is more than one way ketamine can help 

She illustrated this on the possible effects for me: I may experience becoming connected to my body and my emotions, and feel this for roughly ten days after the ketamine session, after which the effects would fade. But I would already remember how it felt, and it would be easier for me to connect to this feeling in the subsequent therapy.

Or, she said, I might experience the things that prevent me from feeling my body and emotions, and it might be distressing. After the ketamine session, I would feel worse, but I would have a clear picture of what I need to work on.

In the end, what happened was just a gentle realization, and she said this was an equally valuable outcome. She said ketamine isn’t a therapy that causes miracles to happen – it just creates the opportunity for a small change that can, in time, lead to big changes. 

Ketamine-assisted therapy and neurodivergent people

Sensory sensitivity 

Neurodivergent people may struggle with sensory sensitivity during the treatment. I didn’t experience this, but after a while, I felt too claustrophobic lying there with a mask over my eyes and headphones over my ears. The therapist said I could remove the mask, and it helped. I didn’t put it back on during the course of the treatment. She said it’s important to keep the headphones, so I did. 

The environment was very sensory-friendly, though. The room felt like a real room, not a medical facility – there was a bed, a carpet, a nightstand… I was told to bring very comfortable clothes, the lights were dim, the music pleasant, and the aroma that permeated the room was pleasant – although he therapits told me to inform her right away if I didn’t like the smell, or anything else. Additionally, I was told to bring anything that would make the room feel more comfortable for me, so I brought a framed photo of Daisy and a memorial mouse plushie that I ended up holding during the whole course of the therapy.

ADHD and autistic experiences with ketamine 

My therapist said that people with ADHD can experience their minds quieting down, which may feel like a relief. Cognitive noise or fragmentation of thoughts can be reduced, leading to the experience of inner peace and quiet.

Autistic people, on the other hand, may experience a temporary release of rigid patterns. They may react to this with either relief or anxiety from the loss of internal structure and control.

For autistic people in particular, the experience sometimes manifests less as bizarre hallucinations and more as increased access to internal experiences that are normally hidden by anxiety, masking, intellectualization, or constant mental activity. Not always, but often enough that therapists who work with autistic clients notice it.

One thing that surprised me is that ketamine didn’t make me less analytical. If anything, I spent much of the session observing my own thoughts and trying to understand what was happening. I wasn’t swept away by the experience. I was studying it. 

Ketamine often works through bodily sensations for neurodivergent people

One thing my therapist explained is that neurodivergent people often experience ketamine differently than neurotypical people. Instead of vivid visions or elaborate inner stories, emotional material may emerge through bodily sensations, emotions, or vague feelings that are difficult to put into words.

This may be related to alexithymia, which is common among autistic and ADHD people. Sometimes the experience only starts making sense afterwards, as the brain gradually translates those sensations into thoughts and insights. That is one reason why the integration sessions and the days following the treatment are considered such an important part of the process.

Worrying about “doing ketamine wrong”

Also, the altered state may be interpreted differently by an autistic or ADHD mind. Neurodivergent people may analyze everything that is happening, worry that we are somehow “doing it wrong” (as I did), or become distressed by the unpredictability.

For the whole time of my experience, I was thinking that maybe I didn’t get enough ketamine for it to really work. I thought I shouldn’t be thinking about mundane things at all. That I should be experiencing something. But I missed the window at the beginning of the session when I could have asked for more ketamine. In the end, I learned that the doctor gave me a really big dose, one that should work well enough even without the additional boost.

At one point, I became concerned that the ketamine wasn’t working because I was still thinking. Everyone talks about profound experiences and ego dissolution, while I was mentally making blogging plans and thinking about job applications. I kept wondering whether I was somehow failing at ketamine. 

You may find it helpful to go into the session with the expectation that:

• You do not need to have a profound mystical experience.
• You do not need to “let go perfectly.”
• You do not need to understand everything while it is happening.
• The treatment can still help even if the session feels strange, confusing, or uneventful.

Many people spend the first session simply learning what ketamine feels like. The therapeutic effects often become clearer after the experience rather than during it.

The evening and the day after

I had an afternoon appointment for the ketamine dosing, and after that, a friend picked me up and rode an Uber home with me because I wasn’t supposed to go home on my own. He stayed a while to talk with me, which helped me big time, because I was feeling really down after the ketamine session. It was really hard to return to my life. 

After he left, I went to sleep, only to find that I felt intense pain lying down, even on my very comfortable bed. Pain meds worked only partially. And I had huge problems falling asleep. It took me several hours. I was scared that the ketamine induced a lasting insomnia (which is one of my biggest fears with the benzo PAWS), but thankfully, the next night I fell asleep just fine.

I took too much of the (non-addictive) sleep medication, though, and was very fuzzy in the morning. I didn’t have the capacity to process any big life changes. Instead, I had to just focus on getting through the day. I drank some caffeine drinks, and it helped a bit, but I felt it also separated me from my feelings somewhat. But the therapist said to rest, and I was resting.

And I had the first integration session on the day after. That was when something interesting happened. 

From desperate to hopeful

The treatment in the Psyon clinic consists of two preparation therapy sessions, the ketamine application itself, and two integration therapy sessions. I have already had one of those. The therapist spread dozens of cards with various pictures and asked me to pick those that felt like I felt before the treatment, during it, and after it. 

For the “after”, I picked a card of a girl sitting in a landscape full of tree stumps with her head in her hands, looking desperate. It was how I felt – I was feeling that I was functioning on my last dregs of strength before the ketamine, and hoped something significant would change, and it didn’t. I also had a big problem returning to my life after the ketamine experience. It felt like it was laid bare in its full awfulness, and I was feeling it in a way I’m usually too numb to feel. 

But when I was talking about the cards with my therapist, I noticed a small detail I didn’t see before. The girl in the picture had a bag full of tree seedlings. She wasn’t succumbing to despair helplessly. She was rebuilding. Planting trees.

It suddenly reframed how I was thinking about the whole experience. It changed it from something that didn’t work enough into something hopeful. 

It’s the beginning, not the end

My anhedonia didn’t disappear, as I hoped. My mental patterns didn’t completely rewrite themselves, as I expected. Instead, something much more subtle happened.

I experienced the ability to look directly at one of the deepest fears in my life without immediately turning away from it.

If you had asked me immediately after the session whether the ketamine worked, I probably would have said, “Not really.”

Now I’m not so sure.

The session didn’t remove my fear. It didn’t make me happy. It didn’t produce any mystical revelations.

What it did do was allow me to look directly at something I’ve spent years avoiding.

And perhaps that’s a beginning.

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