Starting ketamine-assisted psychotherapy (KAP) often brings hope for relief from treatment-resistant depression, anxiety, PTSD, and other mental health conditions. Many clients enter treatment expecting a linear path to improvement, but the reality of healing is rarely straightforward. Some individuals find themselves feeling unexpectedly worse during the middle phases of their treatment, leading to confusion, discouragement, and questions about whether the therapy is working.
If you’re experiencing this phenomenon, you’re not alone, and more importantly, it doesn’t necessarily mean your treatment isn’t working. Understanding why this happens can provide reassurance and help you navigate this challenging but often crucial part of your healing journey.
The Nature of Ketamine-Assisted Psychotherapy
Unlike traditional antidepressants that work gradually over weeks or months, ketamine operates differently in the brain. It blocks NMDA receptors and promotes the growth of new neural connections, potentially creating rapid changes in mood and perception. When combined with psychotherapy, this neuroplasticity can accelerate the therapeutic process—but acceleration doesn’t always mean immediate comfort.
KAP creates a unique state of consciousness that can facilitate deep psychological work. This altered state often allows access to thoughts, memories, and emotions that may have been suppressed or avoided. While this access is therapeutically valuable, it can initially feel overwhelming or distressing.
Common Reasons You Might Feel Worse Mid-Treatment
1. Emotional Excavation and Processing
One of ketamine’s most powerful therapeutic effects is its ability to lower psychological defenses and bring suppressed material to the surface. During the middle phases of treatment, you might find yourself confronting:
- Long-buried trauma or painful memories
- Suppressed grief or anger
- Deep-seated fears or anxieties
- Patterns of thinking or behaving that you’ve avoided examining
This process, while ultimately healing, can feel like emotional archaeology—sometimes you have to dig through difficult layers before reaching more stable ground. The temporary increase in emotional intensity often signals that important therapeutic work is happening beneath the surface.
2. The Dismantling of Old Coping Mechanisms
Ketamine can disrupt established neural pathways, including those that support familiar (though perhaps unhealthy) coping strategies. As your brain begins forming new connections, old ways of managing stress, depression, or anxiety may become less effective before new, healthier patterns are fully established.
This transitional period can leave you feeling vulnerable and unsure. You might notice that coping strategies that once provided relief—whether positive or negative—no longer work the same way, creating a temporary sense of being adrift.
3. Integration Challenges
The insights and experiences from ketamine sessions need time to integrate into your daily life. This integration process isn’t automatic and can create internal tension as you try to reconcile new perspectives with old patterns of living. You might experience:
- Confusion about your identity or life direction
- Frustration with the pace of change in your external circumstances
- Difficulty applying insights from sessions to real-world situations
- A sense of being “between worlds” or in transition
4. Neuroplasticity Growing Pains
As your brain forms new neural pathways, there can be a period of instability while these changes solidify. Think of it like renovating a house while you’re living in it—the end result will be better, but the construction phase can be messy and uncomfortable.
During this neuroplastic reorganization, you might experience:
- Fluctuating moods
- Changes in sleep patterns
- Altered perception or thinking patterns
- Temporary cognitive or emotional instability
5. Heightened Awareness of Problems
Ketamine can increase self-awareness and introspection, sometimes leading to a clearer recognition of problems in your life that were previously minimized or ignored. This increased awareness, while ultimately beneficial, can initially feel overwhelming as you become more conscious of:
- Relationship patterns that aren’t serving you
- Career or life situations that need change
- The full extent of your mental health challenges
- Areas of your life that require attention or healing
6. Treatment Frequency and Dosing Adjustments
The middle phase of KAP often involves finding the optimal treatment frequency and dosage for your individual needs. During this adjustment period, you might experience:
- Inconsistent responses between sessions
- Side effects as doses are modified
- Periods where the effects feel less pronounced
- Ups and downs as your treatment team calibrates your protocol
When to Be Concerned vs. When It’s Part of the Process
While some degree of emotional turbulence can be normal during KAP, it’s important to distinguish between productive therapeutic discomfort and concerning symptoms that require immediate attention.
Typically Part of the Process:
- Emotional intensity that feels manageable with support
- Insights that feel challenging but meaningful
- Temporary increases in anxiety or sadness that correlate with session timing
- Feeling “stirred up” but maintaining basic functioning
- Sleep or appetite changes that are mild to moderate
Reasons to Contact Your Treatment Team Immediately:
- Suicidal thoughts or plans
- Severe dissociation that doesn’t resolve between sessions
- Inability to function in daily life
- Psychotic symptoms or severe paranoia
- Self-harm impulses or behaviors
- Substance abuse as a way to cope with treatment effects
Strategies for Navigating the Difficult Middle Phase
1. Normalize the Experience
Remember that feeling worse during the middle of treatment can be a sign that the therapy is working, not failing. Healing often involves temporary discomfort as old patterns dissolve and new ones form.
2. Increase Support Systems
This is not the time to isolate. Lean on your support network, including:
- Your KAP treatment team
- Trusted friends and family members
- Support groups or online communities
- Additional mental health professionals if needed
3. Practice Extra Self-Care
During this vulnerable period, prioritize:
- Consistent sleep schedules
- Gentle physical activity
- Nutritious eating
- Stress-reduction techniques like meditation or deep breathing
- Activities that ground and comfort you
4. Document Your Experience
Keeping a journal can help you track patterns and progress that might not be immediately obvious. Note:
- How you feel before and after sessions
- Any insights or themes that emerge
- Changes in daily functioning
- Coping strategies that help or don’t help
5. Communicate Openly with Your Treatment Team
Your therapist and prescribing clinician need to know about your experience to provide the best care. Be honest about:
- The intensity of your emotions
- Any concerning symptoms
- How you’re coping between sessions
- Questions or fears about the process
6. Adjust Expectations
Healing is rarely linear. Instead of expecting steady improvement, try to view your journey as having natural ebbs and flows. Some days will be harder than others, and that’s normal.
The Light at the End of the Tunnel
While the middle phase of KAP can feel challenging, many clients report that working through this period leads to more profound and lasting changes than they initially expected. The temporary intensification of symptoms often precedes significant breakthroughs in:
- Emotional regulation
- Self-understanding
- Relationship patterns
- Life satisfaction
- Overall mental health
The key is to view this difficult period not as evidence that treatment isn’t working, but as a necessary part of the transformation process. Like a caterpillar in a chrysalis, the dissolution of old patterns can feel chaotic and uncomfortable, but it’s often essential for the emergence of something new and healthier.
Moving Forward with Hope
If you’re currently in the challenging middle phase of ketamine-assisted psychotherapy, remember that your feelings are valid and your experience matters. Feeling worse doesn’t mean you’re failing or that the treatment isn’t right for you—it often means you’re in the thick of real, meaningful change.
Stay connected with your treatment team, be patient with the process, and trust that with time and support, this difficult period can lead to the healing and growth you’re seeking. Your willingness to persevere through this challenging phase is a testament to your strength and commitment to your mental health journey.
The path to healing isn’t always comfortable, but it can lead to a life that feels more authentic, connected, and fulfilling than you might have imagined possible. Hold onto hope, and remember that feeling worse can sometimes be the first step toward feeling truly better.