In this episode of Talking Ketamine, we delve into the science behind how ketamine works for depression, particularly its rapid antidepressant effects via complex brain mechanisms. We explore research on its potential long-term benefits when used in a therapeutic setting, especially for treatment-resistant depression. A crucial distinction is made between therapeutic use and long-term heavy unsupervised use, which carries real risks. These risks include cognitive impairment, particularly affecting spatial memory, potential links to psychiatric symptoms, and even structural brain changes. While temporary issues with working memory after a therapeutic session are being studied, research on significant impairments is mixed. The episode emphasizes that therapeutic ketamine is a promising tool, but it is absolutely vital to separate this from the dangers of heavy non-therapeutic use.