How to Talk to Your Therapist About Ketamine

You've done the research. You've read about how ketamine works for depression, anxiety, or PTSD. You think it might be worth trying. Now comes the part that many patients tell me feels harder than it should: bringing it up with your current therapist or prescriber.

I understand the hesitation. You might worry about being judged, dismissed, or told you're "doctor shopping." You might not know how to explain what you've learned without sounding like you got your medical degree on Reddit. And if your provider isn't familiar with ketamine therapy, the conversation can feel uphill.

Here's how to navigate it.

Why this conversation matters

Before the how, the why. You might be wondering whether you even need to tell your therapist or psychiatrist if you plan to pursue ketamine through a separate provider. The answer is yes, for three reasons.

Coordinated care produces better outcomes. Your therapist understands your psychological history, your patterns, your triggers. When they know you're doing ketamine therapy, they can adjust their approach to help you integrate what emerges.

Medication safety. If you have a psychiatrist prescribing other medications, they need to know about ketamine to watch for interactions and to adjust your existing regimen if needed.

Your therapeutic relationship deserves honesty. Hiding a major treatment decision from your provider creates a disconnect in a relationship that needs trust. Being open about what you're considering, even when the conversation feels uncomfortable, is an act of self-advocacy, not defiance.

Preparing for the conversation

A little prep helps.

Know your "why." Your reasoning carries more weight when it's grounded in your own experience, not just general information. Think about what you've tried and how it went ("I've been on three different SSRIs over the past two years; the best I got was marginal improvement with significant side effects"), what's not working in your current treatment ("I'm doing the work in therapy, but the depression is heavy enough that I can't access the tools we discuss in session"), and why ketamine specifically ("I've read that it works through a different mechanism than SSRIs, and the serotonin-based approach hasn't been effective for me").

Have a few facts ready. You don't need to deliver a medical lecture, but it helps to know: ketamine has been used in medicine for over 50 years, primarily as an anesthetic. It works through the glutamate/NMDA system, not serotonin. The FDA approved esketamine (Spravato) for treatment-resistant depression in 2019. Racemic ketamine (the at-home form) has extensive clinical evidence for depression. At-home sublingual ketamine is legal, prescribed by licensed physicians, with ongoing clinical monitoring.

Pick the right moment. Don't spring this on your therapist in the last five minutes of a session. If possible, let them know in advance: "I'd like to use some of our time next session to talk about a treatment option I've been looking into." That gives them time to prepare a real answer.

How to frame it

Leading with your experience instead of the treatment tends to work better.

Instead of: "I want to try ketamine therapy."

Try: "I've been thinking about where I am with treatment. I've been on [medication name] for [duration], and while it's given me some stability, I'm still struggling significantly with [specific symptoms]. I've been researching other options and want to talk about ketamine therapy."

This frames the conversation as collaborative rather than a request for a specific prescription.

Acknowledge their expertise. "You have a much better understanding of my clinical picture than I do. I wanted to bring this to you so we can discuss whether it makes sense for my situation." This positions you as a partner in your care, not someone bypassing their judgment.

Address the elephant. If you sense hesitation about the word "ketamine," get in front of it: "I know ketamine has a complicated reputation because of recreational misuse. What I'm looking at is supervised low-dose therapy prescribed by a physician specifically for treatment-resistant depression. It's a very different context."

Be honest about where you got the information. "I've been reading clinical literature and looking at providers who specialize in this. I'm not asking you to prescribe it; I'm asking for your perspective on whether it could be a reasonable next step given my treatment history."

If your therapist is supportive

Some will be immediately receptive. If so:

Ask them to be part of your care team. Let them know you'd like to continue therapy alongside ketamine treatment, and ask if they'd be open to coordinating with your ketamine prescriber.

Discuss integration. Ketamine often opens emotional windows that can be productive in therapy. Ask your therapist if they're familiar with integration work, or if they'd be willing to learn about it.

Set up a communication plan. With your consent, your therapist and your ketamine physician can share relevant clinical notes. We welcome this collaboration.

If your therapist is skeptical

Not all providers are up to date on ketamine research, and some carry outdated assumptions. Here's how to handle common objections.

"There isn't enough research." The research on ketamine for depression actually goes back over 20 years, starting with the landmark NIH study in 2000. There have been numerous randomized controlled trials since then, and the FDA approval of esketamine in 2019 was based on substantial clinical evidence. Offer to share specific studies if they'd like.

"It's just a recreational drug." Ketamine has been on the WHO's List of Essential Medicines for decades because of its anesthetic safety profile. At therapeutic doses for depression (much lower than anesthetic doses), it works through specific neurological mechanisms that have little to do with recreational use patterns.

"You should try another antidepressant first." A reasonable counter: "I appreciate you wanting to be thorough. I've already tried [list medications and durations]. At what point would you consider a different mechanism of action worth exploring? The clinical literature defines treatment-resistant depression as failing two or more adequate antidepressant trials, and I've met that threshold."

"I don't know enough about it to feel comfortable." A respectable answer deserves a respectful response: "I appreciate that honesty. Would you be open to reviewing some research? I can also provide information about the provider I'm considering; they'd be happy to discuss their protocols with you."

If your provider is firmly opposed

Sometimes, despite your best effort, a therapist or psychiatrist simply isn't open. A few things to keep in mind.

Respect their position, but advocate for yourself: "I appreciate your perspective and understand your concerns. I'd still like to explore this option with a provider who specializes in ketamine therapy, and I hope we can continue working together regardless."

You don't need your therapist's permission. Coordination is ideal but not required. You have every right to seek additional medical opinions and pursue treatments you believe are in your best interest. Ketamine therapy through a specialized practice is a separate medical relationship, the same way seeing a cardiologist is separate from your therapist relationship.

Consider whether the response is a red flag. A provider who dismisses a well-researched, evidence-based treatment without engaging with the evidence may not be the right fit for your ongoing care. A good therapeutic relationship includes room for respectful disagreement and collaborative decision-making.

What to tell them about the provider you're considering

If the conversation turns to which provider you're looking at, here's the substance worth sharing:

Physician-led evaluation and prescribing (not mid-level providers working independently). Comprehensive video consultation before any prescription is written. Ongoing monitoring and follow-up, not a one-time prescription. Licensed, DEA-registered compounding pharmacies. Willingness to coordinate with existing providers when patients consent. Serving patients in Florida and New Jersey currently. Clear safety protocols.

A note about self-advocacy

Having to advocate for your own treatment shouldn't be this hard. In an ideal world, every mental health provider would be current on the evidence for ketamine therapy and would proactively discuss it with patients who haven't responded to conventional treatments.

We aren't in that world yet. But the landscape is shifting; more providers are becoming informed, more patients are asking the right questions, and treatments that seemed fringe five years ago are increasingly recognized as mainstream options.

You aren't being difficult by bringing this up. You're being an informed, engaged participant in your own healthcare. That's what good medicine actually looks like.

The conversation you don't need to have first

While talking to your therapist is valuable, it isn't a prerequisite. Whether you've already had the conversation or are still working up to it, you have options either way.

Frequently Asked Questions

How should I bring up ketamine therapy with my current therapist or psychiatrist?

Direct works best. Open with: "I've been researching ketamine therapy for treatment-resistant depression [or anxiety, PTSD, etc.] and I'd like your perspective." This frames it as informed exploration rather than a fragile request for permission. Have specifics ready: what you've read, what specifically about your situation makes you think it might fit, what you'd want to evaluate. Most providers respond well to patients who are informed and direct; vagueness invites dismissal.

What if my therapist or psychiatrist is opposed to ketamine therapy?

Distinguish two kinds of opposition. Informed concern (your provider knows ketamine and has specific reasons it doesn't fit your situation, e.g., active substance use, cardiovascular issues, severe anxiety about dissociation) is worth taking seriously and asking them to elaborate. Unfamiliarity (your provider doesn't know much about ketamine and is defaulting to caution) is worth offering recent literature for and continuing the conversation. If neither produces a productive response, you're entitled to seek a second opinion or pursue ketamine through a separate prescriber who specializes in it; your therapist isn't your gatekeeper.

Do I need my therapist's or psychiatrist's permission to start ketamine therapy?

No. Ketamine therapy is a medical decision made between you and the prescribing physician; your existing therapist or psychiatrist isn't required to approve or coordinate it, though their input is welcome. The Tovani Health intake conducts its own clinical evaluation independently. That said, continuing care with your existing therapist during ketamine treatment improves outcomes substantially; the integration work between sessions is much easier with talk therapy in parallel. If your therapist is willing to support without prescribing, that's typically the best arrangement.

Should I tell my primary care physician I'm doing ketamine therapy?

Yes, strongly recommended. Your PCP should know about every prescription medication you're taking and every active treatment, both for medication-interaction safety and for coordinated care. Most PCPs are neutral-to-supportive about ketamine therapy when it's being managed by a qualified prescriber. We can send a treatment summary to your PCP with your permission. The exception would be a PCP whose disapproval might affect employment or other situations; in that case the conversation deserves more thought, but at minimum the relevant medical record entry should exist somewhere accessible to anyone treating you in an emergency.

Curious whether ketamine therapy is right for you?

Tovani Health is a physician-led at-home ketamine therapy practice serving Florida and New Jersey. Our eligibility screening is free and confidential. Our physicians conduct their own comprehensive evaluation and will recommend coordination with your existing providers where appropriate. If your therapist is supportive, we welcome the collaboration. If they aren't, you can still pursue care here independently.

Check your eligibility →

Questions before you submit, or want to talk through how to handle the conversation with your provider? Call 561-468-6981.

Benjamin Soffer, DO — Tovani Health

---

Related reading: what to expect in a consultation, after failed antidepressants, treatment-resistant depression, safety protocols.