When Depression is in your bed

From Cautiously Curious to Confident: What I Learned Before Starting Ketamine Therapy

• Trish Sanders, LCSW • Episode 44

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Healing doesn’t always arrive as a lightning bolt. Sometimes it looks like a short, supported window where defenses soften and your nervous system finally has space to reorganize. That’s the potential of ketamine-assisted psychotherapy: not a shortcut, but a different door into change.

We take you from ketamine’s legal role as an anesthetic to its misunderstood 90s reputation, then into the research era where clinicians began seeing fast-acting benefits for people labeled “treatment-resistant.” We talk plainly about why that label can feel shaming, how trauma and chronic stress reshape the brain and body, and why words alone can’t always reach the places that hurt. Along the way, we draw clear lines between ketamine and classic psychedelics like psilocybin and LSD, and touch on MDMA’s empathogenic profile—each alters consciousness, but the experiences and mechanisms differ in meaningful ways.

The heart of our conversation is integration. Infusions without therapy can produce a lift, but integration is where insights stick. We share how guided preparation, a safe dosing container, and post-session processing turn inner imagery and softened defenses into practical shifts—sleep, boundaries, relationships, and daily habits that support mood. We also outline safety basics: licensed prescribers, trained therapists and healers, ethical settings, and trusting your own readiness rather than pushing through fear. This isn’t a sales pitch for psychedelics; it’s an invitation to learn, ask questions, and consider whether KAP belongs in your healing toolkit.

If this conversation sparks curiosity, follow the show, leave a review, and share it with someone who might need a new path forward. Your feedback shapes future episodes—join us and keep the dialogue going.

If you and your partner are ready to co-create the roadmap to the relationship of your dreams, join us for the next in-person "Getting the Love You Want" Weekend Couples Retreat!

For support in how to have deeper connections and better communication in the relationships that matter most in your life, follow the host, Trish Sanders on Instagram , Bluesky or LinkedIn.

SPEAKER_00:

Hello, and welcome to the When Depression is in Your Bed podcast. Today, we're continuing our conversation about ketamine assisted psychotherapy, or CAP, and zooming out to look at the bigger picture, how ketamine fits into the world of psychedelic assisted therapies, why it's often grouped with psychedelics, even though it isn't one, and why CAP has become such a powerful and popular option for treating depression. I'm your host, Trish Sanders, and I am delighted that you are here. Let's get started. I just want to begin today, similarly to how I started the last episode that I did on ketamine, just saying that even though I am a licensed clinical social worker and I will be talking about ketamine-assisted psychotherapy today, otherwise known as CAP, as well as touching on some of the other psychedelic-assisted therapies. I am only giving my personal or professional perspective. And everything I share is intended for educational use only. I am not giving medical advice, making treatment recommendations, or suggesting that anyone should try CAP or psychedelic assisted therapies, and I can't guarantee the effects or the impact that any of this would have. However, if you are thinking about CAP or any other kind of psychedelic therapy, I do encourage you to check with a licensed healthcare provider who can guide you safely with your own personal experience, your needs, and what you're looking to achieve through the therapy. I want to start off with a little history about ketamine, but not in a way that you could just Google. Although a lot of what I am sharing, you can really just search up on the internet yourself if you're interested. But really what I have learned about the history as I have gone through my own decision of pursuing ketamine-assisted psychotherapy as a treatment for myself and looking at my own perspective on ketamine as a teenager in the 90s, how that affected my view of ketamine. And as I was looking into why it had gained such popularity, what really stood out to me. So I'm really sharing a limited history and there's a lot more information, but this is really my own process of what I learned and felt helpful in me making a decision to move forward with CAP for myself. So to start, ketamine has never been illegal for medical use as an anesthetic. And it was discovered sometime in the 1960s and then approved in 1970 by the FDA as a dissociative anesthetic. It is considered to be a controlled substance in the eyes of the law. It's a Schedule III controlled substance, which essentially means it is more closely regulated because of its potential misuse, but it is considered to be a moderate to low risk when it comes to physical addiction, which is different within when you compare it to opioids or things like that. And I think this is important because I grew up in the 90s when ketamine, back then was known as special K, really soared into the recreational drug scene. And it did not occur to me when I was a teenager that it was even a legal substance. And I mentioned this in the last episode I did. I had heard that it was a horse tranquilizer, which it does have veterinary use as an anesthetic, so it can be used on horses. But I didn't even realize when I was a teenager that it was also able really to be used as an anesthetic for humans, and it was legal to do so. And as I mentioned, in the 90s it really became very popular as a street drug. It was commonly used in raves, big dance parties. Uh, that was not really my scene, by the way. I was a mosh pit girl back then. Still am, as a matter of fact, but it was popular then because it could intensify audiovisual experiences for somebody. And it was also short acting. So it wasn't something that you did and you were experiencing the effect for hours and hours. It could be like a short little burst. So I won't go too much into that, but just to know that for me, that was really my introduction to ketamine when I was young, thinking that it was like this recreational drug. And I didn't know for a very long time that it actually had this really common medical use with humans. Then in the 2000s, there started to be research about ketamine and depression. And this is when things really started to shift. I was not aware of this at the time. This is what I came to learn as I started to research the history and how what I had known as this club drug special K when I was growing up was actually becoming so incredibly popular in treating depressions. So I started to realize that the history of ketamine was so much more than I had realized at first. And so at that time when that research was being done, ketamine was permitted to have off-label use for treating depression. It wasn't considered an antidepressant, but they started really being able to show the impact on what is often labeled treatment-resistant depression. I have mentioned this, I think, before. I think that has a strong negative connotation, a lot of stigma around that. If you think of yourself as having something that is treatment resistant, that is so pathologized and feels really hopeless. I guess you can say, like, oh, well, ketamine gives hope to people that maybe otherwise be hopeless because they've been on antidepressants for a long time or use other treatments and nothing has worked. But I think that, and I won't go off on this too long. I talk about this a lot in my other episodes. I think how we view depression really could benefit from a serious overhaul that this is not that treatment-resistant depression that often makes the person who's depressed feel like there's something wrong with them, but actually there is an impact on our nervous system, which ketamine actually does, in fact, work with, which I'll talk more about in the next episode. But moving on with the history for now, around 2015 or so, give or take a few years, they started to really pair ketamine infusions or ketamine use for depression with therapy. And this is something that I really can't emphasize enough because even today, you can get ketamine infusions, which is given through IV at a ketamine clinic, and you can go and you can get your dose of ketamine, however, frequently I'm not sure of all the different protocols out there, but you can essentially go into a clinic, get your dose of ketamine, and then leave with no therapy attached to that. There is research to show that there can be some benefit from that. However, I would strongly caution against using that model, at least using that model alone without therapy, support, and integration, which I've touched on before the idea of integration, and I'll talk more about integration probably today, but definitely also in the next episode. But the importance of pairing ketamine and continued support really makes the difference for it to really stick and for the changes that you can experience and for the growth to happen and for new patterns to emerge. So I think that this change that we started pairing ketamine treatment with therapy was really significant. And then in 2019, there was a nose spray that was FDA approved, which was intended for use with that quote unquote treatment resistant depression. And that really helped reduce the stigma that there was around ketamine because there was this like FDA approval. And then it kind of just blew up after that. And CAP clinics started to emerge, and many more therapists started getting trained in being able to provide ketamine-assisted therapy. And now, fast forward these several years and it's becoming more and more considered mainstream. I think there's a lot of misinformation out there, as well as the idea that you could have ketamine treatment without therapy. So ketamine-assisted psychotherapy is different than ketamine treatment because of that reason. And I think that that's an incredibly important thing to realize if you are pursuing CAP treatment. And I will just briefly say this and something that I've already said in my last episode about ketamine, and I'll continue to talk about and emphasize is that for me, my own definition of what I would say is the difference between recreational use and therapeutic use of some of the medicines that are grouped under psychedelics, which I'll talk more about in a moment. It really is the support that you get during the treatment, having a trained, professional, healing person with you while you're with the medicine, and then also having integration follow-up after the medicine because that really makes all the difference between something which recreational could be fun, could be enjoyable. You could even have a transformational experience. And as I said before, ketamine treatments through research have shown that you can have just an infusion and experience improvement in your depression. However, I don't always think that that's the most ethical practice. And I think that when you add integration and follow-up, it really transforms the experience and really supports the progress that you can make using caps. So I cannot stress the importance of integration and just to review integration really essentially means being able to have sessions with a therapist after a cap session where you take the medicine so that whatever comes up in the session when you took the medicine, you're able to begin to integrate that into your life. So it's not just these insights or experiences that you had when you were on the medicine, and then they disappear and no changes actually get translated into your day-to-day life. And integration really is, I think, the key to all of what we're talking about, whether we're talking about CAP, or all the medicines that are encompassed under the umbrella of psychedelics, which I will talk a little bit more about right now. So there are several medicines that are grouped together when we talk about psychedelic assisted therapies. And some of them are true psychedelics, like LSD or psilocybin, which is the active ingredient in what you would call magic mushrooms, ayahuasca and things like that. But then ketamine, which is actually not a true psychedelic, is grouped with these medicines, as well as MDMA, or how I knew it when I was growing up, the street drug ecstasy. And the reason they're all grouped together, even though they're not actually the same thing and they can work very differently, and even the experiences can be pretty different, they do have some commonalities, and that's why they're all under the same umbrella. So they do alter consciousness and they do cause someone to be in a non-ordinary state, and they also reduce the rigid defenses that we hold. So basically, our mind spends a lot of time in a very unconscious way most of the time, trying to protect us from the pain of our life, the trauma that we've experienced, the stress that we've experienced. And that's a pretty important job because if we were flooded constantly with all of these negative and difficult and challenging emotions, we really wouldn't be able to function. And I think that if we think about mental health, this is a huge part of the problem. It's not that people are defective in any way, or even that they're broken, it's that their systems are so overwhelmed by the impact of perhaps many years of trauma and stress that they don't have the flexibility of their nervous system and that their neurological capacity is actually changed through those experiences. And so we tend to pathologize those people and blame them and think that there's something wrong with them. We call them mentally ill a lot of the time. But I would say most of the time, in my opinion, people are actually having very understandable reactions and responses to the impact of trauma and stress. So I will pause there for a moment, but I feel very passionately about this, and this is why I don't use terms like mental illness and I'm cautious with my use of diagnosing as well for this reason, because I think it puts a lot of blame on people who need support and healing in a very different way than we often offer it. And I do think that for many people, psychedelics can often come in, provide support in a way that the mental health industry, as it stands, often does not provide, even though the people who work in the mental health industry, I think so many of us helpers in the profession, we want to help so passionately, so deeply, but I don't think the system is set up well for us to do what we really want to do. But again, also more on that another time. I feel very strongly about that. That's also part of the reason why I'm doing this episode on ketamine today and also expanding a bit to include some of the psychedelics, because I do think that there is potential, maybe not for everyone. And there's certainly precautions that you'd want to take, including where you get medicine from, and as I mentioned, the people that you're sitting with when you are taking medicine, the trained healing professionals that you're with, and of course the integration that happens after you have medicine. So there's a lot of things to consider. And I'm not trying to present this as magic, which I'll talk about also a bit, but I think that it's really an amazing option for so many people. And today I'm talking mostly about ketamine, but I think that this can expand to other psychedelics as well. But if we really understand what they are, what they do, and their history, then we possibly can open up the door for more people to have truly healing experiences. That's really one of my big life goals is to support whoever I can really in healing and feeling better, because I think that that's how the world heals and feels better by supporting the individuals in it. So back to psychedelics, MDMA, ketamine, and the psychedelics and plant medicines that I mentioned before, they all alter consciousness. And when you sit with those medicines in your system, you do go into a non-ordinary state. And that allows your defenses to kind of melt and be softened as well as they increase your openness and they really can support deep therapeutic work in a very different way than regular therapy can support it. And I won't go into a lot of details, but just to say that for me, I have been in therapy on and off since I was 11 years old. So we're talking about over 30 years of being in therapy. And I've had some amazing therapists. I'm a therapist myself. I believe in therapy. This is not knocking therapy at all. However, I've only had nine ketamine-assisted psychotherapy sessions over about a year. And in that time, I have had such a significant amount of transformation that therapy could not have done and did not do in 30 years. And one of the reasons for that is because talk therapy, which is the primary modality that I have used and often offer in my practice, cannot reach your nervous system, cannot reach the parts of your brain where trauma has impacted. Talking and words just can't get there. It's biologically not available through that avenue. And when you shift to using psychedelics, you actually can access that. And true healing can occur in a totally different way. I also just mentioned when we talk about the psychedelics as a group, they're often discussed together for policy and research as well as in efforts to legalize them. As I mentioned, ketamine has actually not been illegal as an anesthetic for medical use and is legal for use in mental health. However, psilocybin, otherwise known as magic mushrooms, MDMA, LSD, other psychedelic medicines are not yet legalized. Some of them are legal in some places, but not everywhere. But there's a ton of really amazing research that I'm not going to share today, but I do really encourage you, if any of this sparks your interest, to go and look up the research. There's really great books, there's really great resources out there that can explain probably far better than I can how these medicines work with our brains, with our nervous system, and how healing is possible. I often think of the stereotypes of hippies, kind of like the peace and love era, and how psychedelics were a part of our history and part of that time. And I think that there is a lot of relationship there. And I would say that that idea of peace and love sometimes is minimized, like, oh, that's some hippie thing, and they were on drugs, and it can be really stigmatized and criticized and judged and downplayed. But in my opinion, when we can create a space where people can find peace and love within themselves and with each other, I think that's how we change the world. And I'm not trying to say that everyone must do psychedelics and that's how we'll change the world, although I do think that we could probably get some movement in that way. But any of the psychedelics, ketamine included, are not for everybody. And I do think that's true. And I, as I mentioned, I think that you have to really proceed with caution because they are serious medicines that really have impact on us. But for the people who are called to this, who are curious about these kinds of medicines, I think that it's really worth exploring. And that's really why I'm talking about this stuff today. So I want to just move on to talk a little bit now about how ketamine is under the psychedelic umbrella, but also how it stands apart and is different from true psychedelics, because I think that it's important to have a clear understanding of what ketamine is or could be for you if you're interested and what it would not be for you. So often when people think about psychedelics and what the experience is, oftentimes it's very intense. There's like the idea of this quote unquote trippy experience where there's a lot of external visuals, distorted reality, perhaps rainbow technicolor images, things don't look as they really are, that kind of thing. And that is not the experience of sitting with ketamine as a therapeutic medicine. When you take ketamine, you could have what's considered dissociative visuals because it is a dissociative anesthetic. And I mentioned in my own experience that I did have colorful visuals when my eyes were closed with an eye mask on. So, like behind my eyes, behind my eyelids, in my mind's eye, there were colors and shapes and images. But when I took my mask off, my room just looked like my room. I had like a floaty feeling. Ketamine is an anesthetic, and it could feel sort of like dreamy or like you're kind of walking through water kind of thing. But that external psychedelic visual experience is not something that is a part of the ketamine experience. And I mention this because it might seem scary to think about seeing rainbows and colors and things that aren't there or distorted versions of things that are there. And ketamine is a very different experience to what would be considered a true psychedelic. And I will also just briefly mention here, and I'm not going to talk about MDMA extensively at all, but MDMA is also not a true psychedelic. It's actually what's considered an intactogen or an empathogen, which is something that it's considered to help you touch your experience or open your heart. And again, you would not expect to have that quote unquote trippy kind of rainbow technical or visual experience with MDMA either. But all of these medicines can be so transformational in their healing if it is determined that number one, you're interested in pursuing these kinds of medicine. I think that that's a good starting point because if you have fear around it, that's probably a good indicator that you're not really at the place to move forward with trying any of these things out. It might not mean that you're never going to be ready, but this isn't something that you should feel like you should do or have to do, or it's your last resort. So even though you have reservations about it, you should just go for it. I think that these are medicines that are very intuitive in a lot of ways. And you have to be really attuned to yourself and your own intuition. What are the messages that you're receiving about moving forward with these types of medicines? And if you feel like, hmm, I am curious, I might have concerns, I might have questions, then absolutely try to connect with somebody. And ketamine is very widely accessible and available these days. You can connect with a psychiatrist or a nurse practitioner that can prescribe you ketamine, and then you can have a therapist. And again, I do strongly, strongly recommend having a therapist, even if you're talking with a medical doctor or whoever your prescriber is, and you can go to a clinic and have an infusion and it's not required to follow up with therapy or have integration. I think that it's incredibly, incredibly important because of the transformation that can occur. And I will talk more in detail about that next time as well when I continue talking through the lens of my own experience. But really, why I experienced what I experienced from a neurological perspective or from a biological perspective, the impact of the medicine on my system and on my brain and how that allowed the healing experience that I had to happen. So I really do invite you to be open for a few reasons. One, because I think that there's so much misinformation out there. And even myself, there was so much I did not know about ketamine and the psychedelics that I have learned over the last several years. And I do plan on becoming trained as a ketamine assisted psychotherapist. And I'm really very interested in the psychedelics because the research is so incredible. And then that's really the second reason is that there's this other healing option that seems to be available to us that if you don't have accurate information, you may totally overlook or disregard or feel fear around or even look down upon. I think that that's something that can also really happen. So you might have a totally closed heart to something that could potentially be helpful for you. But again, as I mentioned in the last ketamine episode, this is not a ketamine commercial or a commercial for psychedelics in any way. It really is an invitation that if you are feeling stuck in your life, if you're feeling stuck in depression, and this sounds like something that could be interesting for you, that could be a possibility, that could be a door that you might want to open, then I think it's really important to listen to that inner wisdom. And I encourage you to connect with a provider that can really speak to you and support you through what could be the next leg of your healing journey. And I look forward to having you join me next time when I talk more about my own healing journey with ketamine assisted psychotherapy. As our time comes to a close, I ask you to keep listening for just a few more moments because I want to thank you for showing up today. And I want to leave you with an invitation as you hit stop and move back out into the world on your own unique wellness journey. In order to move from where you are today to the place where you want to be, the path may seem long or unclear or unknown. And I want you to know that if that seems scary or daunting or downright terrifying or anything else, that is totally okay. Know that you do not have to create the whole way all at once. We don't travel a whole journey in one stride. And that is why my invitation to you today is to take a step, just one. Any type, any size, in any direction. It can be an external step that can be observed or measured, or it could be a step you visualize taking in your mind. It can be a step towards action or towards rest or connection or self-care or whatever step makes sense to you. I invite you to take a step today because getting to a place that feels better, more joyful, more connected than the place where you are today is possible for everyone, including you, and even when depression is in your bed. If today's episode resonated with you, please subscribe so you can be notified when each weekly episode gets released. I encourage you to leave a review and reach out to me on social media at Trish.sanders.lcsw. Your feedback will help guide future episodes, and I love hearing from you. Also, please share this podcast with anyone who you think may be interested or who may get something from what I have shared. Until the next time we connect, take care of yourself and take a step.