FAQs for Clients
Skylight is owned by medical doctors! We are a physician owned and operated organization, and our mission is to get affordable ketamine assisted therapy to clients who are likely to benefit. Our founding physicians have extensive training in psychedelics, and each doctor operates their own ketamine practice.
At Skylight, we understand that our clients have established long standing relationships with their therapists, and this is who they should continue to work with while doing ketamine assisted therapy. Unlike our competitors, we do not support the use of ketamine in the home, alone totally unsupervised.
The team at Skylight is also here for you, if you have an issue, question or concern reach out and a live human will get back to you. There are no robots here! We are also the only group that has psychedelic integration yoga and our own virtual reality program all in-house. We will be hosting in-person retreats in the coming months in the foothills of the Rocky Mountains in Colorado!
Ketamine is a dissociative anesthetic that has been used since the 1970’s in many different ways. Due to its excellent safety profile and the fact that it does not suppress breathing, Ketamine was used in war times as an anesthetic to help with trauma on the battlefield. It is used extensively in emergency rooms and it also has a role in veterinary medicine. Ketamine is most often used in hospital settings by anesthesiologists during major and minor surgical procedures as an anesthetic. Recently, lower dose (subanesthetic) ketamine has shown great promise in the treatment of mental illness, most notably depression and suicidality.
Ketamine is one of the safest and most widely used anesthetics in the world according to the World Health Organization. Researchers at Yale have been studying low-dose ketamine since 2000 in controlled clinical settings for patients with severe depression who are unresponsive to other antidepressants. In several studies, more than half show a significant decrease in depression symptoms in 24 hours and approximately 4 out of 5 went on to find significant improvement.
Ketamine is now used extensively for many chronic mental illnesses such as difficult-to-treat depression, suicidality, anxiety, anxious bipolar depression (without mania), post-traumatic stress disorder (PTSD), obsessive compulsive disorder, and chronic pain. Many clinicians, including us at Skylight Psychedelics, classify ketamine as a psychedelic, however it is not a classic hallucinogen like psilocybin, the compound found in psychedelic mushrooms, also with many promising mental health benefits.
The exact mechanism by which ketamine functions as an antidepressant remains largely unknown. So far the medical community has learned that ketamine has an affinity for multiple receptors and it likely affects several different types of receptors in the brain, including N-methyl-D-aspartate (NMDA) receptor, which binds glutamate, the primary excitatory neurotransmitter in the brain as well as Alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor, which is also involved in glutamate neurotransmission.
It has been demonstrated that people who suffer from chronic depression and anxiety experience atrophy of neuronal connections in the frontal part of the brain. Ketamine enhances neuroplasticity, the brain cell’s ability to form new connections with one another via expression of brain-derived neurotrophic factor. Not only has ketamine demonstrated the ability to repair neurons that were atrophied from chronic depression, but it also promotes the growth of new neuronal connections!
Ketamine’s antidepressant effects may be due to activation of the AMPA receptor by the ketamine metabolite. Furthermore, animal studies have suggested that neuronal vascular endothelial growth factor signaling in the prefrontal cortex region of the brain mediates the rapid antidepressant actions of ketamine. It is also referred to as a “psychoplastogen” which refers to small molecule neurotherapeutics that induce swift changes in plasticity following a single administration. These changes are thought to promote lasting changes in behavior patterns. Ketamine also activates at the level of the anterior cingulate cortex and by increasing connectivity between the insula and default mode network.
Note: It remains unclear if the effect ketamine has on the opioid receptors plays a role in its antidepressant effects. Ketamine’s effect on these receptors demonstrates how this medicine also functions as an analgesic (pain medicine) for those with chronic pain
Ketamine is used to treat various illnesses. Notably the following:
- Suicidality (Skylight Psychedelics refers all suicidal clients for intravenous or intramuscular ketamine in conjunction with therapy)
- Post Traumatic Stress Disorder (PTSD)
- Obsessive-compulsive Disorder (OCD)
- Substance abuse co-occurring with a primary psychiatric disorder
- Relationship and existential issues such as existential distress
- Bipolar I and II depressive phases (not mania)
- Psychological reactions to physical illness and life threatening illnesses substance
- Chronic pain (often requires higher doses of ketamine in a medically supervised settings such as a clinics or hospitals)
There are medical and psychiatric conditions that render people unable to receive ketamine therapy. This includes:
Medical Conditions Contraindications
Aneurysm or dissection
Heart disease, including heart failure, heart attacks or arrythmias
Severe breathing problems
Advanced liver disease
Interstitial cystitis (bladder wall inflammation)
Glaucoma (unless cleared by an ophthalmologist)
Active illicit substance abuse
Pregnant or breastfeeding
As an added safety measure we recommend our clients reach out to their primary care physician to ensure they do not have any contraindications to treatment. Additionally, if a client has a psychiatrist we recommend they contact their psychiatrist to ensure they have no contraindications to treatment.
Any client of Skylight Psychedelics who identifies as having suicidal ideation will be referred to a higher level of care, possibly to a setting in which either intravenous (IV) or intramuscular (IM) ketamine in conjunction with supportive psychotherapy will be available. There is data to support the use of ketamine in these ways for suicidal clients.
Theophylline or Aminophylline – can lower seizure threshold.
Benzodiazepines, opioid analgesics, or other CNS depressants (can cause profound sedation, respiratory depression, coma or death, they can also interfere with the mental health benefits of ketamine).
Lamotrigine (trade name Lamictal).
Sleeping aids and sedatives such as Ambien, Benadryl, Remeron.
There are other medicines that may interact with ketamine and therefore your clients medications have been thoroughly reviewed by Skylight Psychedelics physician team prior to their prescription being authorized.
We also recommend clients refrain from using the following substances during treatment as they can interfere with the benefits of ketamine and some can lead to dangerous interactions:
All Illegal substances such as cocaine, etc.
Patients will have an agreement with Skylight Psychedelics that they will not use the above substances during ketamine treatment weeks. We do not recommend mixing ketamine with other medicines including using ketamine with psilocybin, MDMA, Kambo, DMT, ayahuasca, mescaline, iboga, etc.
Combining medicines has an increased risk of adverse events, notably hypertension, and is not recommended unless the combination is being studied in a clinical trial. Further, if a client is on a benzodiazepine we may ask them to taper off under the care of their prescriber prior to a prescription for ketamine being authorized. Rapidly tapering off benzodiazepines is NOT recommended and can result in severe withdrawal and potentially death.
There are many studies supporting the use of ketamine for mental illness. Please refer to any of the studies below for further information.
- Huang YJ et al. New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity. Neural Plast. 2017; 2017:4605971.
- Hamilton et al. Depressive Rumination, the Default-Mode Network, and the Dark Matter of Clinical Neuroscience. Biological Psychiatry. 2015 Aug 15;78(4):224-30.
- Andrade, C. Ketamine for Depression, 1: Clinical Summary of Issues Related to Efficacy, Adverse Effects, and Mechanism of Action. J Clinical Psychiatry 2017 Apr;78(4):e415-e419.
- Gaynes BN et al. What Did STAR*D Teach Us? Results From a Large-Scale, Practical, Clinical Trial for Patients With Depression. Published online 1 Nov 2009. https://doi.org/10.1176/ps.2009.60.11.1439.
- Zarate CA, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression.Arch Gen Psychiatry. 2006 Aug;63(8):856-64.
- Aan Het Rot M et al. Ketamine for depression: where do we go from here? Biol. Psychiatry. 2012 Oct 1;72(7):537-47.
- DiazGranados N et al. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. J. Clin. Psychiatry. 2010 Dec;71(12):1605-11.
- Jennifer Dore et al. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy, Journal of Psychoactive Drugs, 51:2, 189-198, DOI: 10.1080/02791072.2019.1587556.
Ketamine hydrochloride, trade name Ketalar, is a Schedule III controlled medicine that is FDA approved for general anesthesia in intravenous or intramuscular formulations. Ketamine is a racemic mixture, made up of two molecules that are mirror images of one another, R-ketamine and S-ketamine. Ketamine does not have FDA approval for any psychiatric illness.
S-ketamine, derived from ketamine, called esketamine, trade name Spravato, was approved in 2019 in nasal spray form, for treatment resistant depression in adults with major depressive disorder with acute suicidal ideation or behavior, in conjunction with an oral antidepressant. Most ketamine being used for mental illness is being used legally by healthcare professionals off-label. Sublingual ketamine used by Skylight Psychedelics is off-label.
Ketamine treatments are far less frequent than standard medications for mental health. This in turn results in far fewer side effects. Our clients often begin with 2-3 times weekly administration during their initial six-session program, and then transition to less frequent sessions as needed, if needed. Clinical trials with IV ketamine have shown that an initial course of 4-6 twice weekly treatments can produce antidepressant effects that last several weeks-months. Ketamine also allows you to connect with the deeper root cause of your struggles, your traumas. Ketamine elevates all types of therapy models and allows people to be more open and able to receive the benefits of various therapeutic approaches.
Ketamine has been used since the 1970s as an anesthetic. More recently, it has proven its ability (at a much lower dose) to act as a therapeutic agent for numerous mental health conditions. It has an extensive safety profile and has very few undesirable side effects which are rarely encountered. The doses used in mental health are so low that many of these side effects are ameliorated.
A small percentage of clients will not respond to ketamine, even at higher doses. Additionally, some clients with rigid personality structures, including those with severe OCD or personality disorders and possibly those with profound PTSD, won’t be able to go into a trance-like state and may find it challenging to maintain the benefits of the treatment experience, if they find any relief with the experience at all. We don’t yet know enough about who won’t benefit and recommend attempting this treatment if no contraindications exist as the medicine is incredibly safe and well-tolerated.
Skylight Psychedelics uses a specialized sublingual formulation of ketamine that is rapidly dissolving with an onset in less than 3 mins. Our protocol was formulated by a multidisciplinary team of physicians board certified in internal medicine, anesthesia, and psychiatry in conjunction with doctors of pharmacy. Our protocol was developed with client safety and the medicine’s efficacy as top priorities. We provide our clients with client specific dosing based on their weight and body mass index (BMI). Our formulation is associated with less nausea and has a pleasant taste compared to other alternatives.
We chose to work with sublingual ketamine as, not only is it safe but it reliably promotes communication between client and therapist while the client is in a trance-like state. It also allows people to tap into difficult states of mind with decreased fear. Further, it affords clients the ability to integrate healing after the acute phase of medicine starts to wear off. Our team at Skylight Psychedelics believes that the trance-like state is an ideal state of mind for psychotherapy. We find that most often the peak experience on the medicine lasts approximately 25-60 mins and the medicine becomes much less intense after this initial wave.
The most common side effects from ketamine include:
- Blurry vision
- Diminished ability to see/hear/feel
- Dry mouth
- Lip tingling and/or heaviness
- Elevated blood pressure
- Elevated heart rate
- Elevated intraocular or intracranial pressure
- Loss of appetite
- Nystagmus (rapid eye movements)
- Slurred speech
- Synesthesia (overlapping of the senses, for example seeing sounds)
- Dissociation (feeling out of body)
- Tinnitus (ringing in the ears)
- Hypoesthesia (partial or total lack of sensation in a body part)
- Lethargy (fatigue)
- Sedation (somnolence)
- Vertigo (room spinning)
- Feeling drunk
- Rarely a client can experience a feeling of paralysis
Note: There have been no cases of persistent neuropsychiatric sequelae, medical effects, nor increased substance abuse in clinical practice.
Note: Skylight Psychedelics firmly believes that the dissociative and/or psychedelic effects of ketamine treatment are a critical piece of the therapeutic process and should not be avoided. We believe this part of the experience can be extremely beneficial to our clients when supported in a trusted healing container.
Many people in a trance-like state from sublingual ketamine often describe positive feelings. This has been described as euphoria, empathy, forgiveness, calmness, total relaxation and reduced mind chatter. With intravenous and intramuscular dosing clients more often report dissociative effects and can experience the feeling of falling, flying, feeling out of their body, they can relive a past events, they can feel paralyzed, they often cry, laugh, smile, breathe very deeply and quickly, moan, and rarely, some can kick and scream. Each session is completely different from the one prior and also differs significantly from client to client. There is no way to predict what a session will be like for someone.
Experiences with IV or IM Ketamine can often lead to any one of the following and more:
- Feelings of gratefulness, calmness, acceptance
- Feeling of flying
- Feeling of falling
- Seeing God
- Feeling out of body – looking down on oneself
- Feeling of being reborn
- Re-experiencing past events, including traumas
- Ego dissolution/Ego loss – a complete loss of one’s sense of self or self-identity (less likely to occur with sublingual ketamine)
- Falling asleep
- Feeling of paralysis is a rare occurrence, but possible
Ketamine-induced cystitis, a bladder pain syndrome due to chronic ketamine use is associated with ulceration of the bladder lining and chronic inflammation. This condition is typically found in people who abuse street ketamine. Studies have demonstrated that certain concentrations of ketamine were toxic to the cells of the bladder wall, causing damage to the urinary barrier. Further there is data to suggest that some factor in urine (rather than something affecting the whole body) is responsible for the ulceration–most likely ketamine itself or its metabolites. Symptoms include pelvic pain, frequent urination, urgency, hematuria (blood in urine), nocturia (frequent urination during the night) and urinary incontinence. This condition is often reversible once the medicine is stopped. For clients who develop this condition complete ketamine cessation is recommended.
Ketamine tolerance can also develop. Concerns arise over addiction but when used at low doses and with infrequent dosing models, as used in mental health, this is less likely to occur. Neurotoxicity has been identified in ketamine abusers and rodents impacting brain structure and function and reports of liver toxicity have also been found in the literature.
The duration of benefits is variable and depends a lot on why the client sought out ketamine to begin with. Many clients will return for further courses of treatment, especially those with long standing depression, failing multiple medications.
Ketamine is routinely given in sterile clinical settings for various mental health indications. Oftentimes there is no therapy provided with this service and clients are left trying to make sense of the experience and to navigate challenging experiences on their own. The lack of therapy short changes people seeking ketamine treatment as they are less likely to be able to integrate the experience into their everyday life.
In 2015, Stephen Hyde published a paper Ketamine for Depression, demonstrating ketamine’s ability to be used successfully via routes other than intravenous and intramuscular, promoting easier use outside of a clinical setting. Incorporating psychotherapy into ketamine treatment sessions was first described by Wolfson and Hartelius in 2016. By the mid-2000s many clinicians were using ketamine in conjunction with therapy. It has become increasingly more apparent that prescribers aren’t required at the bedside, but someone should be there to guide and hold space for clients on ketamine and that’s you.
1- Interested clients fill out our online questionnaire and our physician team determines eligibility.
2- We contact eligible clients and schedule an appointment to connect. All non-eligible clients will receive an email conveying non-eligibility.
3- We confirm the client has a therapist who is trained in psychedelic-assisted therapy either via our training program or with the Integrative Psychiatry Institute or the California Institute of Integral Studies.
4- The client and therapist will schedule the appointments for treatment and integration.
5- Our partner pharmacy will ship one dose of the medicine to the client.
6- After the initial ketamine session, the client will contact Skylight via email and we will connect and change dosing as needed for the remaining five sessions.
7- The client will log on to our virtual psychedelic yoga integration program and do their first class.
8- The remaining five doses of the medicine will then be shipped to the client.
9- The client and therapist will schedule the remaining five medicine sessions and integration sessions.
10- The client can join us for a weekly check-in Grand Rounds experience where our physicians discuss various topics in psychedelic medicine.
11- The client will complete the remaining psychedelic integration yoga classes online. There are seven total, one to follow each medicine session and an additional two hour workshop with yoga and meditation.
12- If clients are interested in further ketamine treatments they can reach out to us anytime.
When used for mental health, ketamine is typically given six times over a 2-3 week period. Some patients may require booster doses, typically 4 weeks or more from their last session, but this should not be a blanket recommendation for all patients as many may not need additional doses.
After six sessions a patient may reach out to Skylight Psychedelics for further ketamine doses if they had further trauma or other setbacks. Again we do not have patients on a standing autopilot schedule without checking in with them first to ensure they need further treatment. This is a very client specific medicine and the need for booster doses should be determined on a case by case basis by the prescribing physician with input from the patient and their therapist.
Yes, all clients will agree to have a safe ride home the day of treatment.
When taking ketamine prescribed by Skylight you will need to take your blood pressure before and after the session. It is not your therapist’s job to take or interpret your blood pressure. This will be explained in detail once you meet criteria for treatment. You will need to purchase your own blood pressure cuff, found at most pharmacies. We do not recommend the use of wrist blood pressure cuffs as the reading is less accurate.
Yes, we recommend using an eye mask for the duration of time you are on the medicine. This promotes an internal journey. We recommend using the Mindfold mask, which can be found on Amazon.
Integration is when you take the experience from your medicine journey and weave it into your daily life. Integration is a critical part of psychedelic medicine. While the medicine sessions are very important, a time where people get many messages, without the integration many of these messages can get lost or be fleeting. Integration is done with your therapist and a key part of this work.
The founders of Skylight Psychedelics are yogis and understand the power of yoga and its inherent psychedelic nature. We have developed the first of its kind psychedelic integration yoga series with spiritual yoga guru Jackie Smith and are excited to share this with our clients.
More of Jackie Smith’s Yoga Classes can be found here:
If you feel you require additional ketamine doses you can email us @ [email protected] and let us know. We will connect with you and determine if this is appropriate.
Our package includes the following:
- 6 ketamine tablets delivered to your door
- 8 hours of psychedelic integration yoga
- Once weekly online check in Grand Rounds discussions on various topics in psychedelic medicine with our medical team
- Access to our team for you and your therapist when you need us via email and phone
We recommend clients reach out to their individual insurance provider to determine if they can get reimbursed for the cost of the ketamine service provided by Skylight Psychedelics. We do not take insurance at this time.
Once you purchase the package it is non-refundable. We do not accept any medicine returns. If you decide not to use the medicine we ask you bring it to a local pharmacy and dispose of it.
We are licensed in all 50 states.
If you live in CO, FL, AZ, NE, WY, KS or UT the pharmacy will ship your medicines at no added cost via USPS priority which is 1-2 days. Some delays may occur.
If you live outside of the above states shipping rates will apply and the pharmacy will contact you to obtain payment. The shipping rates are as follows:
Next Day: $100
2 Day: $50- $55
3 Day: $15-$20
* Please confirm with the pharmacy when they call what your rate will be as the above pricing is not guaranteed.