Ketamine: A Different Tool at Different Doses

Written by Patricia Pop, MD and Will Barone, PsyD | Medically reviewed by Patricia Pop, MD | Published April 2026

Ketamine is a different tool at different dosages.

Of course, you have influences like: individual metabolism, set (mindset, what's on your heart and mind, intention, your comfort and familiarity), setting (is this a psychological approach, do you feel safe and well cared for, what kind of office are you in, all the way out to America in 2026, capitalism, etc).

But… as a clinician, there are various levers you can toggle which will shape the experience: dose, route, & model.

Today, we're talking about dose with Dr. Will Barone.

Will a clinical psychologist in Oakland who's worked in psychedelic sciences for about 15 years, both in clinical research with MDMA and psilocybin and clinically with ketamine for close to a decade. We co-teach a Intro to Ketamine for Clinicians at Alchemy Ketamine Therapy Training and he's been my mentor in this work since I left psychiatry training in 2021 and a lot of how I think about ketamine clinically comes from what he's taught me.

Will:

I was surprised by how different ketamine is at different doses. When I started this work, I thought of dosing as a dial you turn up or down for more or less effect. After several years of clinical practice, I think about it more like choosing between different tools.

A low dose session and a high dose session aren't just different intensities of the same experience. They're doing different things, therapeutically. And that means the dose I choose has a lot to do with what I'm trying to support in a given person at a given time.

They're based on bioavailable milligrams per kilogram of body weight, meaning the amount that's actually reaching the brain after accounting for the route of administration.

I break psychiatric ketamine dosing into roughly three ranges. Keep in mind, these are approximate and they vary person to person. If I aim for a "medium" range dose, that could turn out being a very "high" dose for a particular person in terms of their experience (either on that particular day, or repeatedly, based on individual factors). The numbers will look different for IM versus sublingual versus IV, but the target effect is similar within each range.

Patricia's note: I often talk to people in terms of "low dose" vs. "journey level dose" to highlight this difference. It's generally the same, just medium to high is what I'll call journey range.

Low dose: ~0.25 to 0.5 mg/kg (psycholytic range)

The low dose range is also called psycholytic, or psychorevelatory, which is Phil Wolfson's term.

At this range, the person is fully present, oriented, able to carry a conversation the whole time. They might feel a "softening of the edges." Their body might feel a little different. But they know who they are, where they are, and what's happening. In terms of alteredness, it might be like someone having a half glass of wine versus two or three glasses.

We can choose to have a regular therapy session with back and forth conversation, some clinicians will bring in body awareness practices (like with Brainspotting), and patients can also choose to lie down observing their thoughts and sharing as much as they'd like (so structured a bit like a journey, but with less intensity).

I've been surprised by how much can happen here. For someone with significant trauma history, especially where dissociation is a strong pattern or where anxiety about loss of control is high, this can be the right place to start, sometimes for several sessions. The adage for trauma and anxiety is "start low, go slow," and a lot leans on trust and rapport.

This level turns the volume down on emotional reactivity just enough that material becomes easier to access. I've had sessions at this dose that looked like really deep, extended therapy conversations, where the person said they were able to go somewhere they hadn't been able to reach in years of traditional therapy. The medicine isn't doing the work at this dose, necessarily. It's making the work slightly more possible.

Medium dose: ~0.5 to 0.75 mg/kg (meditative range)

In our clinic, for journey-level dosing we would often aim for 0.5 mg/kg to start as a solid low-mid range target for first-timers.

At this level, people can still generally communicate, but if they lie down with eye shades and music, they'll often drop into something that feels like a deep, vivid, meditative state. People describe floating through memories, having visual phenomena with their eyes closed, encountering images or feelings that seem to come from somewhere they don't normally have access to.

I do a lot of IFS work in this range and it's opened up things I didn't expect. The ability to communicate with different parts, to develop deeper understanding of self, it just moves differently here. The stuck patterns start to loosen more noticeably. But the person is often still grounded enough to describe what's happening, to respond to questions (though we're mostly just encouraging them to follow their own process and experience closely), and to stay in relationship with me throughout the session.

High dose: ~0.75 to 1.5 mg/kg (dissociative/psychedelic range)

Normally, we'd never start people here, but it's something we might build up to, depending on our goals.

Here, one might experience things like out of body travel, moving through dimensions, profound encounters with things that are hard to put into language. People who've done psilocybin or ayahuasca will sometimes say this was the most psychedelic experience they've ever had, because it can feel so otherworldly.

There's a particular utility here for someone who's been deeply mentally stuck, where depression or anxiety has made everything rigid and closed. A friend who's a neuroscientist at NASA studies the mental health of astronauts, and he told me about something that happens when astronauts look back at Earth from space. It's called the Overview Effect: something shifts from being at such a radically different vantage point. I think high dose ketamine can do something similar, sending someone far enough from their ordinary frame of mind that it loosens what's been locked in place.

But more is not always better. Above about 1.5 mg/kg, things often stop being therapeutically useful in my experience. People describe a whiteness, then snapping back to sobriety feeling like they were only in for five minutes. Memory fizzles. They can't hold on to what's happening long enough to work with it. Time distortion is part of ketamine at any dose, but this is different. It's not "time moved strangely." It's "I have no idea what happened in there." And if the goal is psychological exploration, that doesn't serve us.

When people start losing memory or things start moving way too fast to be useful, that's a place to back down from.

I've found that the sweet spot for the vast majority of the work I do falls somewhere in the low to mid range, and I go higher selectively, when there's a clinical reason. The instinct that stronger must mean better doesn't hold up here.

Frequently Asked Questions

What is psycholytic dosing for ketamine?

Psycholytic dosing refers to the lowest range of psychiatric ketamine dosing, roughly 0.25 to 0.5 mg/kg of bioavailable medicine. At this level, the person is fully present, oriented, and able to hold a conversation throughout the session. They may feel a softening of emotional reactivity, which can make therapeutic material more accessible. This range is sometimes also called psychorevelatory (Phil Wolfson's term) and can be particularly useful for people with trauma histories or significant anxiety about loss of control.

What dose of ketamine is used in therapy vs. surgery?

Psychiatric ketamine dosing typically ranges from about 0.25 to 1.5 mg/kg of bioavailable medicine, which is orders of magnitude lower than anesthetic doses. In surgical anesthesia, ketamine is commonly used at 6.5 to 13 mg/kg IM, and in emergency settings around 5 mg/kg. Therapeutic doses are a small fraction of these amounts, about 1/10th, which is part of why ketamine can be safely used in outpatient therapy settings with the right precautions.

Why do some clinicians cap ketamine at 1.5 mg/kg?

Above about 1.5 mg/kg, many clinicians find that sessions become less therapeutically useful. People often report a blank whiteness followed by snapping back to sobriety with little memory of the experience. When the goal is psychological exploration and insight, the inability to hold onto or work with the experience limits its value. In practice, most effective therapeutic work tends to happen in the low to mid dose ranges, with higher doses used selectively for specific clinical reasons.

What is the difference between low dose and journey dose ketamine?

Low dose ketamine (roughly 0.25 to 0.5 mg/kg) keeps the person fully present and conversational, functioning more like an enhanced therapy session (but they’re welcome to lie down, close their eyes, observe and reflect too). Journey level dosing generally refers to the medium and higher ranges (roughly 0.5 to 1.5 mg/kg), where people enter a more altered state. At medium doses, people often experience a deep meditative state with visual phenomena and access to memories or feelings not normally available. At higher doses, the experience becomes even more immersive with potential out-of-body experiences and profound shifts in perspective.

About the authors

Written by Patricia Pop, MD and Will Barone, PsyD

Patricia Pop, MD is a board-certified psychiatrist in Half Moon Bay, California. Her practice focuses on integrative psychotherapy and medication management for adults via telehealth throughout California. She has years of ketamine assisted psychotherapy experience, facilitates psilocybin for clinical trials, created ketamineprep.com, and is passionate about psychedelic education for clinicans and patients alike.

Will Barone, PsyD is a clinical psychologist in Oakland, California with over 15 years in the psychedelic sciences. He has conducted clinical research with MDMA and psilocybin, published qualitative research on participant experiences in psychedelic clinical trials, and has practiced ketamine assisted psychotherapy for close to a decade. He developed his own model of KAP and co-teaches the Alchemy Ketamine Therapy Training.

This post is for educational purposes only and does not constitute medical advice. If you're considering ketamine treatment, talk with a qualified clinician about whether it may be appropriate for your situation.