For decades, ketamine has been viewed primarily through two lenses: a safe anesthetic or a rapid-acting antidepressant "reset button." But a new paper by Sophie Holland argues we may be missing half the picture. This episode challenges the binary view of ketamine by exploring two distinct therapeutic pathways defined essentially by dose: the Psychedelic and the Psycholytic.The Psychedelic Path (High Dose): We examine the "reset button" model—intense, dissociative experiences driven by a massive glutamatergic burst. The goal here is ego dissolution, allowing patients with severe, treatment-resistant depression or PTSD to emotionally decouple from trauma and achieve rapid symptom reduction.The Psycholytic Path (Low Dose): We contrast this with the "relational tool" model. Here, the goal isn't to leave the body, but to loosen the ego just enough to lower psychological defenses. This trance-like state allows patients to stay connected to their therapist, accessing repressed memories and processing emotions in real-time with less fear.The discussion also tackles the debate over ketamine’s classification—is it truly a psychedelic? While chemically distinct from "classic" psychedelics like psilocybin, its ability to induce neuroplasticity (acting as a psychoplastogen) and non-ordinary states of consciousness places it firmly in the psychedelic therapeutic spectrum.Finally, we look at the physical realities. With chronic high-dose use linked to ulcerative cystitis, does the low-dose psycholytic approach offer a safer, more sustainable model for long-term relational work?. We also touch on the frontier of "betterment of the well," exploring how low-dose protocols might enhance creativity, teamwork, and problem-solving in healthy individuals.Reference:Holland, S. (2025). Ketamine reimagined: Distinguishing psychedelic and psycholytic modalities for next-generation therapies. Silva Wellness. DOI: 10.22541/au.176538434.48451693/v1

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