Since his mom passed away more than a decade ago, Michael Morgan, 37, was stuck in what he calls the grief phase. Years of talk therapy and antidepressants still left him feeling like he needed a reset, so he decided to try something new: at-home ketamine therapy.
Morgan donned headsets that played a voice-guided track supplied by the telehealth company, Mindbloom, and wedged a ketamine tablet between his lips and gums. As the drug kicked in, he reflected. “I want to go to the moment my mom passed away.” Next thing he knew, he was in the hospital holding his mom and sister’s hands. Morgan’s only thought was, “Wow, what a beautiful moment between my sister, my mom, and I.”
He hadn’t been able to witness that memory for very long, let alone in a positive light—it provoked too much sadness. With ketamine therapy, he managed to face his mom’s passing with objectivity, which allowed him to break free of old thought patterns and reframe it. As he puts it, “trauma [is] history, not identity… Something that happened, not who I am.” Morgan’s ability to process painful emotions had transformed.
The US Food and Drug Administration first approved ketamine as a clinical anesthetic for humans in 1970. It wasn’t until 2000 that the first “placebo-controlled, double-blinded” study by Berman et al showed ketamine could work quickly to ameliorate symptoms for patients with depression.
Exactly how ketamine functions remains a bit of a mystery. However, it’s known to work on NMDA receptors, rather than those affected by selective serotonin reuptake inhibitors (SSRIs) commonly prescribed for depression. This “helps stimulate neuroplasticity,” says Dr. Gail Serruya, whose Pennsylvania clinic, Voyage Healing, provides in-office ketamine therapy. “It also decreases our default mode network…that is hyperactive with depression.” In other words, ketamine is thought to tone down negative rumination cycles, like Morgan’s grief phase, and make space for new perspectives.
Historically, psychiatric ketamine treatments took place in clinical settings where practitioners closely watched patients undergoing costly treatments. Thanks to the COVID-19 pandemic, which caused the government to waive in-person exams previously required to prescribe controlled substances, the ketamine telehealth industry has taken off recently. Several companies now offer at-home ketamine administration across most US states.
Users typically start with low doses and ramp up over time depending on their response. Morgan, who has undergone a six-session “program,” says his dosage increased twice. By the third session, he saw visuals. By the fifth or sixth, after deciding he wanted to see his friend who passed away, he says he witnessed “sacred geometry…almost an equation for the whole universe.” Simultaneously, the feeling of how his late friend made him laugh washed over him.
Despite reports of positive experiences, there’s good reason to be wary of companies offering ketamine telehealth. “They’re driven by capitalistic market pressures…so they’re selling ongoing daily ketamine, sometimes large quantities… because if they stop, they don’t make money,” says Serruya. Since researchers haven’t studied the long-term effects of daily ketamine use, she warns that companies should exercise caution.
Then there’s the ever-shifting legal landscape. Mindbloom’s Chief Strategy Officer, Michael Petegorsky, says they offer “limited, incremental dosing.” They work to stay compliant by constantly monitoring changes in state laws. “We spend a lot of money on legal fees,” according to Petegorsky.
Today, practitioners prescribe ketamine for depression, anxiety, and post-traumatic stress disorder, but Petegorsky emphasizes, “there’s research coming out around obsessive-compulsive disorder, anorexia, and bulimia.” Serruya expresses optimism about the future of ketamine therapy, but advises that if the industry becomes too money-driven it could create unsafe conditions for users and face regulatory backlash. “All this incredible healing potential will be shut down,” she stresses.
The Spectrum of Ketamine Telehealth:
Ketamine telehealth company operations vary from very hands-off to more measured and involved. The following outfits represent these respective approaches:
Joyous: For $129/month, users receive a month’s worth of microdose-able ketamine “troches” (waxy squares that melt in the gums) all at once. Deemed questionable by clinical practitioners and other ketamine company operators, it lacks supervision and supplies bulk ket-packs. Also, Joyous can make it near impossible to contact representatives and messages users primarily via auto-text.
Mindbloom: Providing patients with up to six doses at once for $209/session, Mindbloom offers an app replete with musical and/or voice guiding audio recordings for the experience, sometimes followed by sessions with company care providers. Clients’ blood pressure is monitored with helpers on site the first time in case of bad reactions.
