Ketamine Therapy in Seattle

Ketamine therapy has the strongest evidence base for treatment-resistant depression, meaning major depression that has not responded to at least two adequate trials of antidepressant medication. It is also used clinically for PTSD, complex trauma, certain anxiety disorders, OCD, and some chronic pain conditions. At Seattle Trauma Counseling, we work primarily with clients whose trauma history is central to their depression or PTSD presentation, and we approach ketamine as one part of a broader therapeutic relationship rather than a standalone procedure.

Many people notice mood improvement within hours to days of a ketamine session, a timeline that is dramatically faster than traditional antidepressants, which typically require four to six weeks to take effect. This rapid-onset effect is one of ketamine's most clinically significant features, particularly for people in acute distress. The initial lift is neurological. Sustaining it typically requires integration work to build on the openings ketamine creates.

These are three different delivery formats of the same compound. IV infusion delivers ketamine directly into the bloodstream in a clinic setting and is the most studied form. Spravato (esketamine) is an FDA-approved nasal spray prescribed for treatment-resistant depression. It is administered in a certified healthcare setting and covered by some insurance plans. Oral or sublingual ketamine is prescribed off-label, taken at home, and typically at lower doses. Each format has different onset timing, intensity, and clinical protocols. The right format depends on your diagnosis, prescriber recommendation, and clinical context.

Most induction protocols involve six sessions over two to three weeks, though this varies by provider, format, and individual response. Some people experience significant relief after two to three sessions. Others require the full induction course before benefit becomes consistent. Maintenance sessions, spaced weeks or months apart, are common for sustaining results. Your prescribing provider will guide the session schedule. Our role at Seattle Trauma Counseling is to support preparation and integration work throughout.

Insurance coverage for ketamine therapy depends on the form and your specific plan. Spravato (esketamine nasal spray) has FDA approval for treatment-resistant depression and is covered by many insurance plans when specific criteria are met. IV ketamine infusions are not FDA-approved for depression (though they are used off-label) and are typically not covered by insurance, with out-of-pocket costs ranging from $400 to $800 per infusion. Psychotherapy and integration sessions, including those at Seattle Trauma Counseling, may be covered through your mental health benefits depending on your plan. We recommend calling your insurance provider directly and asking about coverage for "ketamine-assisted psychotherapy" and your therapist's CPT billing codes.

In most cases, yes. Many people undergo ketamine therapy while maintaining their existing medication regimen. Your prescribing provider will assess any potential interactions, particularly with medications that affect glutamate pathways. Some providers recommend tapering benzodiazepines before treatment, as they may blunt ketamine's effects. Do not adjust any medication without guidance from your prescribing physician or psychiatrist.

Ketamine infusion therapy refers to the medical administration of ketamine, typically IV, by a physician, nurse anesthetist, or ketamine clinic, often without a therapeutic or psychological framework. Ketamine-assisted psychotherapy (KAP) integrates psychotherapy directly into the ketamine experience: a licensed therapist may be present during the session, and preparation and integration sessions bracket each ketamine dosing. Seattle Trauma Counseling operates in the KAP model. Our therapists provide the therapeutic container around your ketamine treatment, coordinating with your prescribing provider, to help you work with and build on the experiences ketamine generates.

Integration refers to the psychological work of making meaning from the ketamine experience and translating any insights, emotions, or shifts it produces into lasting behavioral and relational change. Ketamine creates a temporary window of neuroplasticity (the brain's capacity to form new connections and patterns), but that window does not automatically produce lasting healing on its own. Integration therapy, typically done in the days immediately following a session, is the process of working with a therapist to consolidate what emerged. Research and clinical observation increasingly suggest that integration is what separates a significant therapeutic outcome from a temporary mood lift.

Ketamine is considered safe when administered in a clinical setting with appropriate screening and monitoring. Common side effects include dissociation (a dreamlike or out-of-body perceptual state), nausea, elevated blood pressure during the session, and temporary confusion after. These typically resolve within hours of the session ending. Less common risks include psychological distress during a session, especially for people with trauma histories, which is one reason therapeutic preparation and a trauma-informed clinical relationship are important. Ketamine is not appropriate for people with active psychosis, uncontrolled hypertension, certain cardiac conditions, or a history of ketamine or substance misuse. A thorough intake screening with your prescribing provider will assess your individual candidacy.

Ketamine has abuse potential, particularly at high recreational doses. At therapeutic doses, administered in a clinical context, addiction risk is low but not zero, particularly for individuals with a prior history of substance use disorder. Medical and therapeutic evaluation is essential for this population.

The strongest candidates are people who have not responded adequately to at least two antidepressant medications, or who are living with PTSD, complex trauma, or co-occurring depression and trauma that has been difficult to treat through conventional therapy and medication alone. A formal candidacy assessment is done by a licensed prescriber (psychiatrist, physician, or ketamine-certified nurse practitioner), not a therapist. If you are working with us at Seattle Trauma Counseling, we can help you think through whether to pursue a prescriber referral and what that process looks like.

Preparation typically involves one or more preparation sessions with a therapist before the first dosing appointment. In those sessions, you establish intentions for the experience, identify any fears or concerns, build a foundational therapeutic relationship, and develop a plan for what to do with difficult emotions if they arise during the session. On the day of a session: avoid food and alcohol for several hours beforehand (your prescriber will give specific guidance), arrange for someone to drive you home, and bring a journal if writing or reflecting afterward feels useful. Our preparation work at Seattle Trauma Counseling is designed to help you arrive at each session with a clear frame and a sense of safety.

Therapeutic ketamine is administered in carefully controlled doses by a licensed clinical provider, in a monitored medical setting, with psychological support before and after. Recreational ketamine is typically used at higher doses, without clinical screening, without therapeutic framing, and without integration support. The dose, setting, and relational container are all fundamentally different, and each of those variables has documented influence on psychological outcomes. At Seattle Trauma Counseling, we take the "set and setting" framework seriously: the therapeutic relationship, preparation, and integration work are not add-ons to the ketamine itself. They are part of what makes the treatment clinically meaningful.