Some of the words I love most to hear from patients (real patients, real words):
“I have more energy than I did in high school.” — 27-year-old woman, after her second infusion
“I got out in my yard and did stuff.” — 46-year-old man, after his first infusion
“Two days I didn’t cry over what happened a year ago.” — milestone observation, after infusion #5
Patients often ask me the same question: what does it actually feel like when ketamine therapy starts to work? The answer surprises most of them — because what changes first is almost never what you think will change.
What Changes First Is an Absence
You expect to wake up with energy. You expect to feel happy. You expect the big things. The big things do come — they’re just not what changes first.
What changes first is smaller. The crying for no reason stops. The Sunday dread stops. The 3 AM rumination stops. You sit through a meeting without scanning for the exit. You drive home, the radio is on, and you notice the song. Someone asks how you are and you pause for a second before saying “fine” — and realize you don’t actually have an answer ready. That pause is the change.
Many of the small wins my patients describe in the first three weeks are absences — things they used to feel that simply aren’t happening anymore. The brain stops doing the loud thing it had been doing every day. That gap is what capacity feels like: room to think, room to notice, room to sit through a Tuesday without bracing for it.
This Is What Brain Repair Looks Like at Week Two
Not joy. Not motivation. Just the absence of the thing that had been running underneath everything. The joy and the motivation come later — around week three or four, sometimes week six or eight. By then your nervous system has had enough quiet weeks to remember what oscillation feels like. But the first thing is the absence. The dread that used to live there is just not living there anymore. That is brain repair.
One Thing to Try This Week
Pick one small thing that has been bothering you every day for the last six months — the Sunday-night dread, the 3 AM replay loop, the flinch when your phone buzzes. Write it on a piece of paper and put it in a drawer. Pull it out four weeks from now and ask one question: is this still happening every day? If the answer is no, something you’re doing is working — keep doing it. If the answer is yes, it may be worth looking into treatment that targets brain health directly.
You can learn more or book a consultation at AlphaOmega Wellness, or watch the related video on why we keep treating the wrong layer of the brain.
— Dr. Dee Bonney, MD
Board-Certified ER Physician & Founder of AlphaOmega Wellness
Frequently Asked Questions
What is the first sign that ketamine therapy is working?
Often it’s an absence rather than a presence — the dread, the crying for no reason, or the 3 AM rumination quietly stops. Many patients notice these gaps in the first three weeks, before joy or motivation return.
When do joy and motivation come back?
For many patients they return later in the course of treatment — commonly around week three or four, sometimes week six or eight — after the nervous system has had several quieter weeks.
How should I measure progress early in treatment?
Instead of asking “do I feel happy yet,” notice whether one daily burden has gotten quieter — the dread, the rumination, the heaviness. Tracking absences is often a better early metric than tracking positive feelings.