There is a particular kind of person I keep meeting.
They have done the therapy. Not badly, and not briefly. Years of it, with someone good.
They can tell you exactly what happened to them and exactly why it affected them. They have the language. They have the insight.
And they are still stuck.
If that is you, I want you to hear something Kelly Francini said to me this week, because it reframed the whole problem for me.
Antidepressants are only effective for about 30% of the adult population.
Sit with that.
Nearly everyone you know is on something, or has been offered something, and for roughly seven out of ten people, it is not the thing that works.
Kelly has spent twenty years watching what happens next.
People cycle through three or four medications looking for the one that fits.
Some of them gain seventy pounds.
Some of them lose their sex drive and watch it damage their marriage.
Some go flat, and the flatness costs them a promotion.
All while doing the work.
All while getting more aware, not less.
Her word for it was disheartening.
That is a very generous word.
The Part I Did Not Expect
I assumed this conversation would be about a drug.
It was not.
It was about a mechanism.
Here is the picture that stayed with me.
Your brain is a road map.
When you are depressed or anxious or carrying trauma, the neural pathways start to atrophy, and the map simplifies.
Eventually, you are left with the main highways only.
Same handful of routes, over and over, and every one of them ends somewhere you have already been.
What ketamine appears to do is put the back roads back on the map.
Not fix you.
Not decide for you.
Just restore the options.
So you can look at the same intersection and choose a different turn, and then practice that turn until it is a road again.
That is why Kelly does not offer it as a treatment on its own.
The medicine opens the map. The therapy is what walks the new route.
What Actually Happens
I asked her to be specific, because I think vagueness is where fear lives.
There are three routes in:
* An IV in a clinic, which is the largest dose and the deepest dissociation.
* Spravato, a nasal spray, which a lot of insurance plans cover, including Medicare and Medicaid in her experience.
* A lozenge you hold in your mouth for ten to fifteen minutes, which is the lowest dose and the one most people start with.
The protocol is about six sessions over two to three weeks.
Not one and done.
You set an intention beforehand, though Kelly is quick to say that what comes up is often not what you set.
Music without words.
An eye mask, so you turn inward instead of outward.
Someone in the room who is not impaired, always.
Afterwards, you journal, and then you process it in a real therapy session, ideally within twenty-four hours.
That last part is the part people skip, and it is the part that does the work.
And the thing Kelly loves most about it is the thing I did not anticipate:
You do not have to already know what is wrong.
Most of us think we know.
We have a story about the moment it all went sideways.
Kelly says that in her experience, it is almost never that one moment.
It is a hundred small ones that led up to the moment you remember.
Your subconscious knows where they are buried.
The ketamine brings them up so you can finally deal with them.
If you have ever sat in therapy and thought, I do not even know what to bring in today, that sentence might be worth a second read.
The Part We Had To Talk About
We could not have this conversation without addressing the headlines.
Ketamine has been in the news for a death, not for a recovery.
And the honest answer is that the failure in those cases was not the molecule.
It was access without screening.
Kelly’s line was blunt:
Do not go somewhere that does not take a full health history.
There are real medical conditions that rule you out, and any clinic willing to skip that step is telling you something important about itself.
She also pointed out something I did not know.
Ketamine has been used in anesthesia for a very long time. It is not new, and it is not exotic.
At the prescribed dose, in a controlled environment, with someone sober in the room, its safety record is not the thing that should worry you.
What should worry you is a place that says yes without asking any questions.
Why I Wanted This Episode
You know I am not here to sell you a protocol.
I am here to give you permission to ask a question:
I was taught X. Is X actually true?
Is ketamine bad?
Is MDMA bad?
Is LSD bad?
Or were a lot of us raised on an egg in a frying pan and a very effective slogan, and never invited to look again?
Kelly’s answer was the most useful thing she said all hour:
It is both.
There are very few things in this world that are only good or only bad.
It is how you apply it, who you trust, and whether you are willing to stay curious long enough to find out.
Maybe this is not for you.
Maybe it is for someone in your life you have quietly been judging.
Either way, curiosity is the cure for most of what breaks down between people.
So here is another option.
And here is why it might be worth a look.
About Kelly Francini, LCSW
Kelly Francini, LCSW is the clinical director of Sanctuary Wellness in Madison, New Jersey, and is licensed in New Jersey, New York, and Connecticut.
She is a certified clinical trauma professional and was named one of the top 50 therapists nationwide in 2024 by YouWill.
You can find her at sanctuarywellnessco.com, where the ketamine page links out to the Yale research she mentions.
This conversation is for educational purposes and is not medical advice. Ketamine treatment should only be considered with qualified medical and mental health professionals who can assess whether it is appropriate and safe for you.
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