Understanding Ketamine Safety and Addiction Risk in Depression Treatment

You may have landed here because depression, anxiety, or trauma keeps tightening its grip no matter how many pills you swallow or how many therapy sessions you attend. If so, you are not alone. At least 30% of people with depression in the United States and Canada are estimated to meet the criteria for treatment-resistant depression. Yet when you read that a decades-old anesthetic – ketamine – can bring relief in hours rather than weeks, you naturally wonder whether the cure might come with a catch. Is ketamine addictive when used for depression?

I know that question well. My own journey into ketamine-assisted psychotherapy (KAP) started with a healthy dose of skepticism. As a family physician, addiction-medicine provider, and mental-health researcher, I have watched substances save lives in the hospital walls and ruin lives on the streets. I believe no one should start a new treatment without knowing both the good and the bad. So let’s lay it all out together. I’ll walk you through what the science tells us about ketamine, the steps we take to minimize addiction risk, and how Field Trip Health is committed to helping you complete treatment feeling empowered – not reliant.

What Ketamine Is – and Why It Captivated Psychiatrists

When ketamine was first approved in 1970, its claim to fame was rapid anesthesia without suppressing breathing. Surgeons loved it. Combat medics relied on it. Then, almost by accident, mental-health researchers noticed that surgical patients who happened to suffer from depression often woke up feeling unexpectedly optimistic. Over the next two decades, controlled studies confirmed that small, carefully timed doses could lift even stubborn depressive symptoms.

Ketamine does not work like traditional antidepressants. Instead of tweaking serotonin, it blocks NMDA receptors that regulate glutamate – your brain’s main excitatory messenger. That single blockade sets off a chain reaction that boosts brain-derived neurotrophic factor (BDNF). Think of BDNF as fertilizer for neural connections: it encourages dendrites to sprout, synapses to strengthen, and new pathways to form. In depression, those pathways can become rigid and pessimistic; ketamine loosens the cement so healthier patterns can take root, especially when you add focused psychotherapy during the so-called window of neuroplasticity.

Researchers keep documenting this rapid effect. After only three intravenous ketamine infusions across eleven days, 52 percent of participants with severe depression reached full remission, while another 15 percent showed meaningful improvement, as highlighted by the Bio-K series of trials. Even more striking, half the patients who entered treatment with persistent suicidal thoughts reported a dramatic drop in those impulses after a single dose.

Those numbers can give you hope, but they also raise eyebrows: anything powerful enough to change mood so quickly must be used wisely. So let’s define what addiction really means before we decide whether ketamine fits the bill.

Understanding the Differences: Addiction, Dependence, Misuse

Addiction, or substance-use disorder, is more than just liking a drug. It involves compulsive use despite harm, cravings that override choice, and withdrawal symptoms when the substance stops.

Physical dependence is the body’s adaptation to repeated exposure. It may or may not lead to compulsive behavior.

Misuse refers to taking a drug in a way that doctors never intended – higher doses, riskier settings, or purely recreational motives.

You will notice that these definitions revolve less around the ketamine molecule itself and more around context: frequency, motivation, and supervision. That distinction becomes crucial when we compare medical ketamine with street ketamine.

Medical Ketamine and Street Ketamine: Worlds Apart

In your mind’s eye, you might picture ketamine sprinkled on crowded dance floors. Recreational users often snort unknown quantities of powder, sometimes mixing it with alcohol or stimulants, chasing dissociative euphoria night after night. Not surprisingly, tolerance can rise quickly in that setting, and some users slide toward compulsive patterns.

Now, let’s move to a different setting in one of our Field Trip Health clinics. You walk into a spa-inspired lounge with warm lighting, aromatherapy, and zero-gravity recliners. A nurse measures your blood pressure, oxygen saturation, and heart rate. Your therapist is with you to help you prepare for the experience, set an intention, and provide guidance and support throughout the session. Your dose is precise – usually 0.5 to 1 mg per kilogram by intramuscular injection or a sublingual lozenge – far below the levels sought by partygoers. We space ketamine-assisted psychotherapy sessions several days apart, typically six over three or four weeks, and then we pause to evaluate. You spend the next sixty to ninety minutes under continuous monitoring, guided by curated music and meditative prompts. When the medicine wears off, your psychotherapist helps unpack the imagery, emotions, and insights that surfaced. Someone you trust or a taxi will take you home, since driving isn’t allowed for the rest of the day.

Those environmental and procedural differences matter. Addiction rates correlate strongly with unstructured, high-frequency exposure – not with medically supervised, time-limited care.

What the Data Really Shows About Ketamine Addiction Risk

You may be surprised to learn that only about 2% of Canadians have tried ketamine non-medically, whereas 65% consume alcohol and 11.8% reported having used opioid pain relievers – a figure that counts both prescribed use and non-medical, recreational use. Even within nightlife circles, sustained ketamine addiction remains relatively rare compared with cocaine or methamphetamine.

Clinical trials support that observation. Across hundreds of studies – whether at Yale, Johns Hopkins, or here in Canada – patients receive small, intermittent doses under supervision. These studies have not cited psychological features or behaviours associated with addiction. Lower-dose protocols administered every few weeks show no measurable increase in dependence. A scoping review of the literature reported that clinical studies indicate that single or repeated ketamine administrations in professionally controlled settings did not result in misuse, dependence, diversion and/or gateway activity in patients with treatment resistant depression. 

Animal studies do warn that high, frequent doses can establish tolerance. That is why responsible ketamine clinics cap the total number of sessions, insist on integration therapy, and always reevaluate before any maintenance treatment. The goal is to create durable change that outlasts the medication, not to keep you coming back for another chemical honeymoon. 

Our clinical experience with thousands of patients across Canada in controlled clinical settings with ketamine validates that patients do not express any craving or seeking of the medicine. As another layer of caution and judicious respect for the medicine, this is why at Field Trip Health we do not give patients the medicine to take home for themselves. It must be given by a health care provider, whether at one of our clinics or via our At-Home program. 

How We Keep You Safe at Field Trip Health

Here is how Field Trip Health clinics ensure your safety:

1. Rigorous Screening.

Before you ever receive a first dose, you complete a comprehensive intake that covers medical history, psychiatric diagnoses, current medications, and substance-use patterns. If you live with uncontrolled high blood pressure, active psychosis, or are pregnant, we explore alternative options. Each client also undergoes a psychiatric evaluation to confirm diagnosis and gauge suitability.

2. Controlled Ketamine Dosing and Spacing.

Our standard treatment series includes six to nine sessions, typically spaced twice per week to allow time for integration. After the initial series, we can schedule up to three maintenance sessions if needed – but only after reconnecting you with your prescribing clinician to reassess your progress and determine whether further treatment is appropriate. We never schedule ongoing ketamine sessions without clinical oversight. These built-in pauses help prevent tolerance and reinforce that ketamine is a therapeutic catalyst – not something to rely on long term.

3. Integration-Focused Psychotherapy.

In my experience, ketamine on its own is enhanced when paired with psychotherapy. We pair every dosing experience with preparation meetings beforehand and integration meetings afterward.

During integration, you and your therapist turn psychedelic insights into daily practices: communication strategies with your partner, new boundaries at work, breathing techniques when anxiety spikes.

At the end of your sessions, you walk away with helpful tools you can use in daily life, even after the ketamine has worn off.

4. Environmental Design That Lowers Anxiety.

Our clinics look more like boutique wellness centers than hospitals. That aesthetic is intentional. Soothing decor, noise-cancelling headphones, and blackout eye masks help your nervous system settle. When your body feels safe, you can explore difficult memories without panic  – helping you build resilience and reduce the emotional weight that might otherwise carry into daily life.

5. Ongoing After-Care.

Within a week of completing ketamine-assisted psychotherapy (KAP), you attend a follow-up appointment to reassess mood, sleep, and any side effects. Some clients find additional benefit from non-pharmacologic support such as mindfulness coaching, nutrition counseling, or breathwork, which may be recommended alongside your care plan.

A First Responder’s Story – More Hope, No Craving

Here is what Mark, a veteran first responder, shared with us: “I have seen a lot of violence, death, and trauma in my life, and I didn’t want to relive those feelings again.” He arrived feeling vulnerable and uncertain, yet also desperate for change. After six supervised KAP sessions, he emerged with what he called “a renewed lease on life.” Mark felt calm leaving the clinic, not restless for more ketamine. “The treatments gave me strong actionable items to move forward,” he said. “I felt like the team at Field Trip let me feel once again – hope, empathy, cautious optimism.”

Now, Mark tells other first responders that if standard treatments haven’t worked, KAP is worth exploring. His journey mirrors the low dependency rates we see in our broader patient population.

Tackling the Most Frequent Ketamine Concerns

You may still have lingering questions, and that’s healthy. Let’s address the most common ones.

If relief comes so quickly, won’t I crave more ketamine?

Quick relief alone does not create addiction. Compulsion thrives on unstructured access and unresolved psychological pain. Because we have strict inclusion criteria, tightly monitor KAP sessions, insist on therapy, and design exit plans from day one, the craving cycle very rarely takes root.

Will I experience ketamine withdrawal?

Ketamine does not produce the classic physical withdrawal you might associate with alcohol or opioids. While some patients may notice mild sedation the day of treatment, it is not a withdrawal effect. Adjunct treatments may be paired with ketamine like repetitive Transcranial Magnetic Stimulation (rTMS). 

What if I already have a history of drug addiction?

Your past does not automatically exclude you, but we proceed with extra care. We may require more frequent check-ins, or recommend alternative therapies first. There is a robust and growing literature on using ketamine and ketamine-assisted psychotherapy to treat various forms of addiction specifically. Many individuals in recovery excel because they already practice self-reflection and accountability skills that can be an asset in combination with ketamine-assisted psychotherapy. Those skills can also help enhance the behavioural, psychological and lifestyle habits important in mental health as well. 

Why Taking a Multidisciplinary Approach Is Essential for Ketamine Therapy

Field Trip Health is not a one-trick pony. Yes, ketamine is currently the only legal psychedelic medicine available outside of special-access exemptions in Canada, but we complement it with other evidence-based techniques. For instance, repetitive Transcranial Magnetic Stimulation (rTMS) delivers magnetic pulses to mood-related brain circuits without drugs, and Dual Sympathetic Reset (DSR) targets the autonomic nervous system to calm trauma-related hyper-arousal. By offering multiple tools, we minimize reliance on any single intervention.

In fact, I genuinely believe the future of mental health care lies in integrating pharmacology, neuromodulation, and transformative psychotherapy – delivered in environments that honour the whole person.

That is why we are also launching Canada’s first large-scale trial of group-based MDMA and psilocybin therapy for wellness. While ketamine is the focus today, our commitment to innovation ensures that you will always have a path forward, even if your needs evolve.

Practical Details About Ketamine-Assisted Psychotherapy (KAP)

Here are some practical details about Ketamine-Assisted Psychotherapy (KAP) you might be curious about:

Eligibility at a Glance

If you are an adult struggling with major depressive disorder, bipolar depression, PTSD, or anxiety that has resisted at least two conventional treatments, you likely qualify – provided your medical status is stable and you are not pregnant, psychotic, or dealing with uncontrolled hypertension. A quick phone screening starts the process.

Logistics and Lifestyle Considerations

You cannot drive after each session, so plan a ride. Expect to spend two to three hours door-to-door. Most employers accommodate time off once they understand the medical necessity and the reasonably short duration of the protocol.

Financing and Insurance

Some private insurers reimburse a portion of the psychotherapy component. We supply letters of medical necessity, and financing plans are available. Considering the economic cost of untreated depression – missed work, strained relationships, medical bills – many clients think of this expense as putting money toward feeling better in the long run.

The Bigger Picture: Ketamine as Catalyst, Not Cure-All

I once treated a patient who described depression as “Wearing fogged goggles. Everything looks gray.” Four sessions into KAP, they said, “The goggles are off, but I still need to learn how to navigate all this light.” Ketamine removed the fog. Integration therapy taught her to use the compass.

That story captures my core message for you: ketamine does not replace the hard work of healing – it jump-starts it. By temporarily expanding neural flexibility, it gives you the chance to rewrite mental scripts that may have run your life for decades. But the pen is still in your hand.

Key Takeaways

First, context seems to play a very important role. Addiction risk stems more from setting and intention than from ketamine’s pharmacology alone.

Second, structured psychotherapy turns a biochemical window into a life-changing doorway.

Third, multidisciplinary clinics like Field Trip Health exist precisely to safeguard that process through medical oversight, comfortable design, and integrated wellness tools.

Finally, remember that ketamine should be delivered with respect and structure. While its effects and benefits may unfold quickly, they solidify through weeks of reflection, conversation, and courageous lifestyle change.

Conclusion

I founded Field Trip Health because I believed – and still believe – that people deserve more than symptom management. They deserve transformational treatment grounded in science and compassion.

If any doubts or concerns remain but you are interested in the treatment, reach out. My team and I are happy to discuss your unique situation, share additional research, or connect you with stories of alumni who share openly about their journeys. Together, we can decide whether ketamine-assisted psychotherapy is your next best step toward relief, resilience, and renewed purpose.

Frequently Asked Questions

About the Author

Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.

Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in  Toronto,  Montreal,  Vancouver,  Ottawa, Hamilton, Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.