You'll Probably Be Back: What MDD and TRD Patients Should Really Expect from Psychedelic Therapy and How Care Providers Should Be Talking About It

There's a particular kind of hope that arrives with a first ketamine infusion, or a first psilocybin session. For many people living with Major Depressive Disorder (MDD) or Treatment-Resistant Depression (TRD), it's the first time in years, sometimes ever, that the weight has lifted.

But there's a conversation that doesn't always follow that moment — one that clinicians might not be having, that medical staff don't always know how to approach, and that marketing materials rarely want to touch. It's the conversation about what happens next. When asked directly, clinical staff will be transparent, for the most part. They’ll explain that the therapeutic journey is lifelong, and that psychedelic-assisted therapy is not a magic bullet, nor a promised cure.

What we don’t talk about enough, even amongst ourselves as scientists and clinicians, is the longer arc. Just as someone with TRD might take an oral antidepressant every day for the rest of their life, that same person might return yearly for a couple of booster ketamine sessions, a full 8-week protocol, or one or two additional psilocybin sessions. Year after year. After year, after year. And they will very likely remain in therapy throughout. That isn't failure. If anything, it's a more profound and meaningful process than a daily pill that manages symptoms without ever asking anything of the person taking it — that numbs and flattens, without ever encouraging them to hold up the mirror, dig deeper, get to know themselves better, or show up more fully to their own life.

And let's be honest about something else: different chapters of life have a way of bringing people back to the work they thought they'd already done. Every significant challenge — grief, transition, rupture, growth — is an invitation to look in the mirror again. For those with a history of MDD or TRD, that reality is even more pronounced. The mirror doesn't go away. But with the right tools and the right support, people get better at facing it.

So what does that actually look like? What happens in the months and years following a profound psilocybin therapy journey, or an 8-week ketamine protocol? What should we be saying to new patient callers? Or to the patient who does beautifully for eight months and then feels the darkness return?

This is the return visit nobody talks about.

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