Sasha and Ann Shulgin famously believed that dissociatives (e.g., ketamine, xenon, phencyclidine) have no safe role in psychedelic therapy:

  "We are strongly prejudiced against psychedelic drugs which cause such mind-body separation, as we are against any drug which causes separation from feelings and emotions. However, we acknowledge that the ketamine state can be highly instructive for researchers trying to understand the functions of the human mind."

Dissociatives are too addictive, too pleasurable, and reliably produce long-lasting delusional states (e.g., as observed in John C. Lilly and Marcia Moore).

For example, see D. M. Turner's "The Essential Psychedelic Guide". Before he died in his bathtub (after injecting ketamine), he wrote the following (https://www.ketamine.co.uk/dmturner/index.html):

  "A major concern regarding safe use of Ketamine is its very high potential for psychological addiction. A fairly large percentage of those who try Ketamine will consume it non-stop until their supply is exhausted. I've seen this in friends I've known for many years who are regular psychedelic users and have never before had problems controlling their drug consumption. And I've seen the lives of several people who developed an addiction to Ketamine take downward turns."

  "After about two years of once-per-week Ketamine use I even found that I had developed an addiction. Although it was less severe than what I've described above, it took considerable effort to break the cycle of repeatedly using it, even though I was aware of detrimental effects that it was causing. Since that time I've used Ketamine only occasionally, but find that I must continually exercise a high degree of will power to prevent myself from falling into a pattern of regular use. Amongst those I know who use Ketamine, I've seen very few who can use it in a balanced manner if they have access to it."

On the other hand, there are very useful and beneficial tryptamines (e.g., psilocybin) and phenethylamines (e.g., mescaline). These drugs produce informative, useful, introspective, challenging mental states and are NOT prone to abuse. These are the valuable psychedelics.

Ketamine's antidepressant effect doesn't require any dissociation or psychedelic effects to work.

Many of the legitimate clinics keep the doses low enough to produce only mild dizziness at most.

Unfortunately many of the alternative-medicine style providers have gone to the other end of the spectrum, embracing excessive doses and promoting the psychedelic component as part of the therapeutic process.

Experienced drug users (loosely using that term, don’t want to call them drug addicts :p) will tell you not to even attempt a psychedelic if you are not in the right headspace. You’ll have a bad trip. Is that still not the case? Isn’t depression about as bad a headspace you can be in to try this stuff?

From what I have read, following the topic for many years, the key is to have a (human) guide to help you if they see you heading in the wrong direction. Psychedelics can be thought of as emotional amplifiers; feed them bad thoughts for too long and you get a runaway spiral to permanently scarring your emotional well being. The same, however is true for good thoughts, leading to euforia, transcendental thoughts, etc., which I guess is why many folks come back to do them again (once they have rebuilt whatever reserves are needed). What any one person may experience on the same dose of the same chemical may vary wildly though, I imagine due to the levels of other chemicals already in the body, and the current emotional state.

This is why being in a safe and comfortable environment with a friend that you trust is very important!

Bad trips are intense emotional states, but can be powerful learning experiences too. A safe, loving environment can let someone work through the thoughts/emotions/memories that may underlie their depression. It makes it easier to see the negative patterns and find a different path.

Bad trips are mainly Really Bad when you're in both a bad mindset _and_ a bad setting, whether that's due to bad vibes, bad friends, being out in public, etc.

Set and setting are 100% drivers of the experience you'll have with psychedelics. You have to be in a good state of mind, and you have to be in a safe, stable environment. Psychedelics will amplify and loop experiences of your trip, so if you're in a negative headspace, that will feed back into itself. Confronting the inner darkness is a thing, and experienced users will have gone through at least one "bad trip" which they'll view as horrible at the time, but valuable because of the insight into the workings of tsensory.

There's been some recent trends among psychedelic communities in saying there's no such thing as a bad trip, only difficult ones. I tend to agree, but only in the context of responsible use.

Being depressed doesn't mean you can't prepare and manufacture a headspace and experience with psychedelics. It does mean you need an experienced guide who will be by your side through the experience. It must be someone who you trust and feel comfortable with, and who you've told the truth about your state of mind and intentions. Never try tripping alone in a negative headspace.

Much like skydiving with squirrel suits, you need a teacher and experience before you should attempt anything risky or complex. An experienced guide can also "show" interesting and beautiful and profound places in your mind and sensorium.

It's very important to draw on the experience of others, to have a sitter, and to educate yourself about psychedelics in general and the substances you are going to use in particular.

Mushrooms are a wonderful starting point, and Terence McKenna a great resource to learn about the experience of using them. They're nominally the safest and most forgiving psychedelic to start with with a huge array of people to learn from.

Ultimately psychedelics are tools that can give you access to internal perspectives. They operate on the fundamental workings of intelligence and consciousness, mirroring and modifying your neural signals into strange loops and unexpected activations, which can break your mind free from all sorts of negative patterns.

Above all else, learn as much as you can about safe use and harm reduction. A little effort and responsibility goes a long way towards guaranteeing the success of what can be the most profound and moving experiences you can have as a human.

Why not let the free market work its magic? If ketamine doesn’t work, the word will get out and these places will go out of business. People will self medicate with whatever is available to them. If you lock up ketamine, people will reach for alcohol.

Look, I think that ketamine has some great potential... but the medical (especially pharmaceutical) industry has shown time and time again that regulation is absolutely necessary.

From what I've gleaned, low-dose ketamine is quite effective at reducing treatment-resistant suicidal ideation, which can be a literal life-saver and has very low risk. The alternatives include doing nothing and hoping for the best, and antipsychotics.

High-dose ketamine (k-hole) is a significantly riskier proposition: people can grow dependent on it, and it does significant long-term damage to the body (and in the short term, apparently, walking out of the clinic tripping balls and getting injured). As an emergency emergency remedy (treatment-resistant depression), paired with talk therapy, the high-dose treatments may be promising.

A real risk is blowback: if the industry is too cavalier, then there will be actually good reason to clamp down on it. If the industry can get their shit together and be careful, then there's no need for strict regulation. If the industry blows its chance with public sentiment now, we won't have a chance to see the positive effects for another few generations.

> Why not let the free market work its magic?

the literal snake oil market? no thanks.

Tell that to China’s 100 years of shame.