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The collective lie in ketamine therapy: a call to realign clinical practice with neurobiology

Summary

This article argues that ketamine therapy is commonly misunderstood as a consciousness-expanding psychedelic when it actually works through a completely different biological mechanism. The real therapeutic benefit comes from the brain’s natural reorganization in the days after treatment, not from the altered states people experience during the session itself. The authors call for medical practitioners to stop emphasizing the dissociative experience and instead focus on helping patients build healthy thought patterns during the recovery period when the brain is most ready to form new connections.

Background

Ketamine therapy has become increasingly entangled with psychedelic culture, leading to widespread misinterpretation of its therapeutic mechanism. Many practitioners emphasize the acute dissociative experience rather than ketamine’s established neurobiological function as an NMDA receptor antagonist that promotes neuroplasticity.

Objective

This article challenges the prevailing narrative that positions ketamine as a consciousness-expanding agent or psychotherapy enhancer. The authors argue for evidence-based protocols that align clinical practice with neurophysiology and highlight that lasting therapeutic improvement requires plasticity-driven reorganization in the days following administration, not insights from dissociation.

Results

The analysis demonstrates that meaningful, lasting improvement in mental health outcomes requires plasticity-driven reorganization occurring hours and days after ketamine administration during rest and sleep. The acute dissociative experience is neither necessary nor sufficient for therapeutic success and prioritizing subjective experience over biological timing risks distorting memory and reinforcing maladaptive narratives.

Conclusion

Successful ketamine treatment requires clarity about what ketamine can and cannot do, and when change truly happens. When clinical protocols and psychotherapeutic interventions align with the brain’s actual neurobiological timeline, rather than psychedelic culture traditions, patients receive groundwork for enduring transformation beyond momentary shifts in consciousness.
  • Published in:Frontiers in Psychiatry,
  • Study Type:Opinion/Review Article,
  • Source: PMID: 41058645, DOI: 10.3389/fpsyt.2025.1610335
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