My name is Dr. Ray Rivas, and I am the founder and owner of Innerbloom Ketamine Therapy, a ketamine infusion clinic located on the Central Coast of California in San Luis Obispo. At Innerbloom, we specialize in the therapeutic use of ketamine to treat mental health conditions and chronic pain.
To share a bit about my background, I spent over a decade as a general and trauma surgeon, where I frequently used ketamine in emergency and operative situations. However, my personal journey with this medicine began during a particularly challenging period in my life. After experiencing depression following my divorce, I underwent a series of ketamine treatments.
The treatments were nothing short of transformative, offering me a level of healing I had never imagined. The experience was so impactful that I decided to make a major life shift, leaving my career as a surgeon to dedicate myself entirely to ketamine therapy. For the past three years, I have fully committed myself to this field, continuously refining our approach to provide evidence-based care. Each day at Innerbloom, I have the privilege of witnessing the transformative impact this treatment can have on people's lives.
In today’s discussion, I’ll be diving into the world of ketamine therapy: its fascinating history, how it works in the brain, the conditions it treats, specific treatment protocols, and more.
Ketamine is a synthetic drug with a long, fascinating history. It was first synthesized in 1962 by chemist Calvin Stevens and gained FDA approval in 1970 as a general anesthetic. Since then, it has become one of the most widely used medications in emergency settings and operating rooms. In fact, ketamine is listed on the World Health Organization’s list of essential medications, alongside drugs like penicillin and morphine, highlighting its critical importance in healthcare.
What makes ketamine unique is its molecular structure. It exists in two mirror-image forms, known as enantiomers: the R molecule and the S molecule. The intravenous (IV) form of ketamine contains both enantiomers, making it a racemic mixture. In contrast, the patented nasal spray known as Spravato (esketamine) consists solely of the S molecule. This distinction is significant and something we’ll dive into later.
For over two decades, ketamine has been used at sub-anesthetic doses—much lower than those required for anesthesia—to treat a range of mental health conditions such as depression, generalized anxiety disorder, post-traumatic stress disorder (PTSD), and chronic pain. These uses are considered off-label, meaning they fall outside the drug’s original FDA-approved indication for anesthesia. However, off-label prescribing is a common and well-accepted medical practice, with approximately 20% of pharmaceuticals used in this way.
Ketamine’s off-label indications have opened groundbreaking possibilities for treating conditions that are often resistant to traditional therapies such as talk therapy, oral antidepressants like SSRIs, and even electroconvulsive therapy (ECT). Notably, recent studies have shown that ketamine outperforms ECT—long considered the gold standard for treatment-resistant depression—with higher response and remission rates.
According to UpToDate, the world’s most widely consulted medical reference, IV ketamine is now recommended over both ECT and nasal Spravato for treatment-resistant depression. This recommendation is based on ketamine’s superior efficacy, improved safety profile, and fewer adverse events.
Ketamine therapy is most widely recognized for its effectiveness in treating treatment-resistant depression, but its applications go far beyond that. It has shown great promise in addressing:
Many individuals turn to ketamine therapy as an alternative to traditional treatments, seeking rapid relief—often within hours—without the unpleasant side effects commonly associated with oral antidepressants, such as decreased libido, weight gain, and disturbances in sleep and mood.
For depression, ketamine has delivered remarkable results. Studies report up to a 70% response rate within one day of a single infusion, with peak antidepressant effects occurring at 24 hours. While a single infusion typically provides relief, a series of six infusions over two to three weeks can extend that relief for several months.
One of the aspects of ketamine therapy that continues to inspire me is its ability to alleviate negative, intrusive thoughts, including suicidal ideation. In the U.S., a suicide occurs every 11 minutes on average, but ketamine offers hope. A single infusion has been shown to significantly reduce suicidal thoughts within just one hour, offering a lifeline to those in crisis.
While ketamine therapy has shown incredible promise for many people, it is not suitable for everyone. There are specific health conditions and circumstances where ketamine therapy may not be safe or effective.
Here are seven key contraindications for ketamine therapy:
Ketamine is primarily known for its rapid antidepressant effects. Unlike conventional antidepressants, which can take weeks to show results, ketamine often works within hours or days.
Here’s a breakdown of its mechanisms:
Ketamine is administered via four main routes: intravenous (IV), intramuscular (IM), nasal, and oral. Each method has its benefits and limitations, but IV and IM routes are widely regarded as superior in terms of efficacy and safety.
The infusion process is carefully tailored to the patient’s needs. A typical IV session lasts about 40 minutes, with the dose calculated based on the patient’s weight. The concept of "set and setting" is crucial for ketamine therapy. At Innerbloom, we create a warm and welcoming atmosphere with eye masks, blankets, and curated music to help patients feel at ease.
Some patients experience dissociation or a "trip" during their infusion, which can feel unusual but is a natural part of the process. The real healing occurs after the session, as neuroplastic changes take place.
Integration is one of the most valuable components of ketamine therapy. Working with a ketamine-assisted psychotherapist before and after treatment helps patients process their experiences and apply insights to their daily lives.
Ketamine acts as a catalyst for healing, but true transformation requires active participation—making lifestyle changes, embracing therapy, and committing to long-term well-being.
It would be remiss not to discuss the risks and potential dangers associated with ketamine as part of today’s conversation. While ketamine offers tremendous therapeutic benefits, it is essential to approach its use with caution and proper oversight.
One of the key advantages of ketamine is its safety profile compared to many other medications. Unlike benzodiazepines and opioids, ketamine does not compromise breathing and can even stimulate heart rate and blood pressure. However, some patients may experience side effects such as nausea. This is rare but can occur with higher doses or when patients are exposed to visual stimulation during treatments. To mitigate this, patients are often encouraged to wear eye shades during their infusions. If nausea does occur, it can be effectively managed with antiemetic medications such as IV ondansetron.
At high doses and with repeated non-medical use, ketamine abuse can lead to a condition known as interstitial cystitis, or bladder injury. This condition is typically associated with chronic misuse and resolves with the cessation of ketamine use.
It’s important to note that ketamine is not physically addictive. Patients won’t experience withdrawal symptoms like those associated with alcohol or certain pain medications. However, there is a significant potential for psychological dependence, particularly when unsupervised or recreational use is involved.
A growing concern is the ease with which individuals can access ketamine without proper medical oversight. Street ketamine and mail-order oral ketamine services have made it alarmingly accessible, often bypassing rigorous screening and monitoring processes necessary to ensure safe and effective treatment.
We’ve heard cautionary tales of ketamine abuse, such as the late Matthew Perry’s struggle with addiction and the devastating toll it can take, not just on the individual but on their loved ones as well. In my professional opinion, ketamine should only be administered after thorough screening and under the direct supervision of a trained ketamine specialist, following evidence-based practices. Unsupervised daily use carries significant risks and undermines the potential of this powerful therapeutic tool.
Ketamine therapy is a groundbreaking tool for mental health and well-being, offering hope to individuals struggling with treatment-resistant conditions. At Innerbloom, we are dedicated to providing evidence-based care in a safe and supportive environment.
If you have questions or want to learn more about how ketamine therapy could benefit you or a loved one, call us today at 805-321-8471. Together, we can help you take control of your mental health and create a brighter future.
About the Author
Dr. Ray Rivas, a former general and trauma surgeon with over a decade of experience utilizing ketamine, became a ketamine therapy specialist to treat mental health and pain after witnessing its profound impact on his hospital trauma patients and his own mental health. As the founder and medical director of Innerbloom Ketamine Therapy in San Luis Obispo, California, Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
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