The Jordan Harbinger Show – Episode 1241: Ketamine | Skeptical Sunday

Release Date: November 16, 2025
Host: Jordan Harbinger
Guest/Co-Host: Nick Bell

Episode Overview

This Skeptical Sunday episode dives deep into the hype, science, and realities behind ketamine therapy. Jordan Harbinger and co-host Nick Bell unpack ketamine’s transformation from “horse tranquilizer and 90s rave drug” to a highly marketed, seemingly revolutionary treatment for depression, PTSD, chronic pain, and more. Drawing on Nick’s personal experience with ketamine therapy, the episode scrutinizes what’s real, what’s wishful thinking, where the risks lie, and what both patients and the public should be skeptical about.

Key Discussion Points & Insights

1. Ketamine’s Reputation and Rapid Rise

[03:31]

• Ketamine has moved from the rave scene and veterinary use to being touted as a breakthrough for severe depression, chronic pain, PTSD, and other treatment-resistant conditions.
• Clinics and ads are everywhere, including therapy-by-mail. Jordan questions, “Anytime there’s a big promise, we here at Skeptical Sunday, we get a little skeptical.”

2. Nick Bell’s Firsthand Ketamine Therapy Experience

[03:39 – 13:31]

• Personal Context: Nick faced complex PTSD from childhood trauma leading to severe insomnia, night terrors, and emotional difficulties.

  • Quote [04:47]: “It was multiple sessions over a period of a year, maybe a year and a half.”

• Therapy Process:

  • Intake was thorough (bloodwork, health screenings, multi-week evaluation), not just “walk in and trip.”
  • Initial week: daily sessions, then follow-up treatments farther apart.
  • Monitored IV administration with a "trip buddy" (medical professional); Nick recounts disassociation so intense he needed someone to hold his feet:
    • Quote [07:08]: “I had my attendant hold my feet once because you don't even know that your body is there.”
  • Ketamine experience described as profoundly un-fun and disorienting, not recreational:
    • Quote [06:54]: “I genuinely…don't understand why anyone uses ketamine recreationally. It's not fun… the best I’ve ever felt on it was, like, vibing.”
    • Quote [08:02] Jordan: “It was not fun. It was…frankly, psychological torture. So again, it’s not something I recommend, frankly, for that reason.”
  • Nick ultimately stopped treatment because his symptoms improved (notably insomnia), not due to cost or lack of access.

• Effectiveness:

  • Nick attributes significant life improvements to ketamine initiating positive changes, but not as a sole solution:
    • Quote [13:31]: “Ketamine has absolutely improved my life… but I don’t see any need to continue treatment.”
  • Other life changes (e.g., quitting pot, better home life) also played key roles.

3. The History and Medicalization of Ketamine

[14:02 – 16:45]

• Ketamine is a synthetic drug, developed in 1962 as a safer alternative to PCP for anesthesia.
  • Used in Vietnam for battlefield surgery due to rapid action and low risk of suppressing respiration.
• Mood-elevating effects noted anecdotally early, but only rigorously studied from the 1990s.
• Still only FDA-approved for anesthesia; all mental health/neurological use is "off label."
  • Quote [16:03] Nick: “That’s what we call off-label use. ...The off-label thing only applies to drug companies. They can't legally advertise their stuff for off-label use.”

4. Ketamine Goes Mainstream—The Boom in Clinics

[21:01 – 23:13]

• Surge after FDA approval of esketamine nasal spray (Spravato) in 2019. Note: esketamine is similar but not identical to ketamine.
• Rapid industry growth: 60 clinics in 2015; 2,000+ by mid-2020s.
  • Quote [21:01] Nick: “Now there’s over 2,000 [clinics]. The total market now is between 7 and 9 billion. Yes, that’s billion with a B.”
• High cost (approx. $500 per session, multiple sessions typical, rarely covered by insurance); for-profit model dominates.

5. Ketamine’s Uniqueness vs. SSRIs—How Does It Work?

[23:13 – 25:59]

• SSRI Antidepressants: Increase serotonin, modify signaling in existing pathways, take weeks to act, often ineffective in “treatment-resistant” cases.
• Ketamine’s Mechanism:
  • Blocks NMDA receptors, leading to a compensatory surge in glutamate.
  • Spurs neuroplasticity (“miracle grow for your brain”), new neural connections, and rapid improvement in symptoms.
  • Quote [24:12] Nick: “Ketamine causes a chain reaction with four steps that works completely different from SSRIs. First, it blocks your NMDA receptor… Your brain surges in glutamate to compensate… That enables learning and memory, thanks to increased neuroplasticity.”
  • Quote [25:25]: “Dr. John Krystal, chair of psychiatry at Yale…likens it to shaking up a snow globe.”

6. Side Effects, Memory, and the Experience

[26:03 – 27:12]

• Dizziness, nausea, hallucinations, and disassociation are common during treatment.
  • Quote [26:35] Nick: “I know stuff happens when I’m bully-dosed. I just don’t remember it.”
  • Favorite treatment playlist: Frank Zappa’s “Apostrophe”; Nick recalls being told he was singing about yellow snow mid-treatment.
• Disassociation is both a side effect and the point:
  • Quote [27:09]: “That’s what we're here for.”

7. Evidence, Effectiveness, and Limitations

[27:12 – 29:07]

• Research shows rapid, sometimes dramatic relief for treatment-resistant depression and suicidality.
• Effects tend to be temporary; repeated dosing or integration with therapy/lifestyle changes needed.
• No long-term or placebo-controlled data (impossible to “blind” the profoundly psychedelic effects).
  • Quote [28:33] Nick: “How do you placebo? That's…just a thing they can’t really study.”
• Not a cure-all. Most promising results from pairing with psychotherapy—early days, not “magic.”

8. Advertising, By-Mail Treatments, and Potential Risks

[29:21 – 31:02]

• Concern about clinics and especially mail-order ketamine:
  • Lack of in-person assessment, monitoring, or medical support.
  • Lower efficacy for lozenges/pills versus IV administration.
  • Looser screening—“anyone with 300 bucks and a pulse qualifies.”
  • Quote [29:57]: “It strikes me as dangerous to be using ketamine without somebody nearby. …Seems like you should have someone there…to make sure…you don't end up getting your brain deep-fried instead of lightly scrambled.”

9. Who Should Not Receive Ketamine Therapy?

[34:41 – 36:09]

• Serious risks for people with schizophrenia, schizoaffective disorder, bipolar disorder, and certain personality disorders:
  • Can increase psychosis or induce mania.
  • May destabilize sense of self in disorders like BPD, possibly heightening self-harm risks.
  • Quote [34:41] Nick: “There are serious questions about the efficacy of ketamine therapy for people with schizophrenia, personality disorders, or bipolar disorder.…it’s going to make them worse.”

10. Addiction, Dependence, and Habit

[36:17 – 38:36]

• True physiological addiction is rare at clinical doses/schedules, but possible at high, frequent, recreational use.
  • Quote [36:33] Nick: “There’s actually very few drugs that are addictive in the way that most people think of it. …People form emotional and psychological dependence on them.”
• Tolerance is real—doses escalate rapidly with repeated use.
• Some psychological craving/jonesing can occur, but not like opiate/benzo addiction.

11. Physical and Psychological Dangers

[38:45 – 41:03]

• Bladder Damage:
  • Chronic high-dose use (not typical clinical use) can cause “ketamine-induced cystitis”—severe, sometimes permanent bladder problems.
  • Quote [39:30]: “Ketamine used chronically at high recreational dosage can cause severe bladder damage. …Apparently not a thing with clinical dosing.”
• Other Risks:
  • Possibility of deepening depression if treatments fail or effects wear off quickly.
  • Anecdotal reports of increased suicidality after short-term relief, but not robustly studied.

12. Overuse, Misuse, and Broader Context

[41:03 – 44:32]

• Some may use ketamine therapy as distraction/escape, not as a real solution—Nick is unconcerned unless self-medication outside clinical settings is occurring.
• Ketamine medicalization parallels marijuana’s trajectory, but Nick perceives key differences:
  • Ketamine is a “hardcore drug,” with much tighter restrictions and higher risks.
  • Unlikely to see ketamine dispensaries or mass recreational use.

13. How to Find a Legitimate Clinic; Red Flags

[43:05 – 44:32]

• Green Flags:
  • Thorough psychiatric evaluation and medical intake.
  • Coordination or communication with your therapist.
  • Providers actively screen out inappropriate candidates.
• Red Flags:
  • Clinics with no mental health staff.
  • Emphasis on “optimization,” spa-like branding, or vague promises to enhance consciousness.
  • Shady “telehealth” or mail-order clinics with no in-person oversight.

Notable Quotes & Moments

• The K-Hole, Described
  Nick Bell (09:39): “I guess it’s like a profound sense of…not depersonalization. It's like almost like an out of body experience. …You have no idea how much time is passing. …You don't even know that knowing things is a thing.”

• On Why Ketamine Isn’t Fun
  Nick Bell (06:54): “I genuinely…I don't understand why anyone uses ketamine recreationally. It's not fun, it's not awful, but the best I've ever felt on it was, like, vibing.”

• How Ketamine Might Work
  Nick Bell (24:12): “Ketamine causes a chain reaction with four steps that works completely different from SSRIs. First, it blocks your NMDA receptor…Your brain surges in glutamate to compensate…enables learning and memory thanks to increased neuroplasticity.”

• What Clinical Ketamine Therapy Feels Like
  Nick Bell (07:08): “I had my attendant hold my feet once because you don't even know that your body is there.”

• On the Boom in Ketamine Clinics
  Nick Bell (21:01): “By 2015, there were 60 clinics coast to coast. By 2018, it was 300. Now there's over 2,000. …The total market now is between 7 and 9 billion.”

• A Balanced Take
  Nick Bell (13:31): “Ketamine has absolutely improved my life, but I don’t see any need to continue treatment. And honestly, that's kind of the best thing I could say about it.”

Timestamps for Key Segments

• Intro to Skeptical Sunday + Ketamine Overview: 01:33
• Nick’s Ketamine Experience: 03:39–13:31
• History & Medicalization: 14:02–16:45
• Ketamine Clinic Boom & Economics: 21:01–23:13
• Mechanism vs. SSRIs & Neuroplasticity: 23:13–25:59
• Side Effects & Subjective Experience: 26:03–27:12
• Evidence & Limitations: 27:12–29:07
• Direct-to-Consumer Concerns & Risks: 29:21–31:02
• Inappropriate Patient Groups: 34:41–36:09
• Addiction, Tolerance, Psychological Risks: 36:17–38:36
• Physical & Bladder Risks: 38:45–41:03
• Legit Clinics & Red Flags: 43:05–44:32
• Closing Reflections: 44:32–end

Final Takeaways

• Ketamine can offer rapid, sometimes life-changing relief for severe, resistant depression, PTSD, and chronic pain—but it is not a panacea, nor is it safe for everyone.
• Its use is safest and most effective in a clinical, medically supervised setting, with proper evaluation and follow-up—not by mail or at dubious clinics.
• The psychological and physical risks, especially for those with certain mental health diagnoses or at high/recreational doses, are real and must be respected.
• Most of all, ketamine is a powerful tool—part of a larger treatment puzzle—not an escape, cure-all, or self-improvement hack.

If Considering Ketamine Therapy:

• First: Talk to a qualified therapist and a real medical doctor—this is not a DIY treatment.

• Seek Clinics That:

  • Conduct full medical/psych evaluations
  • Employ mental health professionals
  • Clearly outline risks, benefits, and screening protocols
  • Do not market as “self-optimization” or wellness

• Red Flags:

  • Easy, no-questions-asked access
  • Lack of medical supervision
  • Dubious claims or promises

Closing Quote

Jordan Harbinger (44:32):
“Remember guys, this is medicine, not a way to trip your face off legally. There’s a huge difference between evidence-based treatment and selling an altered state to people desperate for any kind of solution. Follow the data, not the dopamine rush.”

For more information or mental health resources, visit: JordanHarbinger.com