Ketamine works through the glutamate pathway, triggering BDNF, a kind of fertilizer for the brain that helps form new neural connections. That neuroplastic shift loosens rigid thought patterns, and the integration work afterward helps the change last.
Patients often want to know why a few infusions can move something that years of effort couldn't. The honest answer is that we're working with a different mechanism, and timing it carefully.
What the medicine opens
Most antidepressants work slowly on serotonin. Ketamine works on glutamate, the brain's main excitatory signal, and it prompts a brief rise in BDNF, brain-derived neurotrophic factor. Think of BDNF as fertilizer for new connections. For a window of hours to days after a session, the brain is more able to form and reshape those connections than it usually is. That window is the opportunity, not the cure.
Why integration matters
A more plastic brain learns whatever it is given. If you spend the days after a session in the same grooves, the old isolation, the old scan, the plasticity reinforces those just as readily. So we ask patients to use the window. Gentle movement, real sleep, time with people who steady you, a little reflection on what felt different. The infusion loosens the pattern. What you do next decides what sets in its place.
We don't promise a fixed number of sessions or a guaranteed result. Some people respond quickly, some need a longer series, and some are better served by another treatment. What we can say is that the biology gives you an opening. The work is meeting it, in the quiet days afterward, with small things done on purpose.