Understanding Ketamine Assisted Psychotherapy

Ketamine Assisted Psychotherapy (KAP) is a term we hear quite often, but what exactly does it mean? What is Ketamine? At its core, Ketamine is a dissociative anesthetic with psychedelic features that has recently surged in popularity as studies show there are vast benefits for one's mental health. Ketamine has been used since the 1960s as a form of anesthetic for humans and animals and most commonly will cause a euphoric state and alleviate pain. Additionally, dissociation and forgetfulness are important effects to consider. As studies continue to emerge, we can see the benefits of ketamine therapy in treating mental health conditions such as PTSD, self injurious behaviors, and substance abuse. Ketamine assisted psychotherapy can also alleviate symptoms of depression, but it is best to ask a medical provider to see if it is a good option. 

What is Ketamine Therapy?

Ketamine therapy involves ingesting low doses of ketamine under the supervision of a trained medical professional. It can be administered intravenously (IV), intramuscularly (IM), or through the FDA-approved nasal spray Spravato (esketamine). Ketamine assisted psychotherapy can also be prescribed sublingually, meaning that the drug is administered via a lozenge that the patient places under the tongue. Similarly to Transcranial Magnetic Stimulation (TMS), this is a treatment where those whose symptoms are medication resistant can benefit greatly. Most antidepressants, for example, target dopamine production, but ketamine therapy works with the brain’s glutamate system and NMDA receptors which enhances neuroplasticity (the brain's ability to bounce back) in the brain and with enhanced neuroplasticity, people often experience improvements in their symptoms.

What are the Benefits of Ketamine Therapy?

Ketamine therapy has a rapid onset compared to other medications for depression. After treatment, many patients feel improvement from symptoms within hours or days, which is a lot less time compared to the weeks it often takes other forms of treatment to become fully effective. These effects will also go away within 7-14 days depending on the person without further treatment meaning we should keep track of symptoms even after treatment is complete. Ketamine assisted psychotherapy can even be life saving for individuals experiencing suicidal thoughts as the medication aids in providing insight. 

Sounds Tempting! What are the Risks? Side Effects?

Like all medications, it is important to consider the side effects of ketamine therapy. Common side effects include dizziness, nausea, dissociation, and mild hallucinations (they typically end shortly after the session). Because ketamine can induce a state of euphoria, there is the potential for misuse. Ketamine should also be administered in a controlled clinical environment by a qualified professional. 

Am A Good Candidate?

Ketamine therapy is appropriate for people 18 years and older. Good candidates would have tried some form of treatment in the past (Ketamine therapy is not appropriate as a first-time treatment) in order to be considered. It is often used for individuals with treatment resistant depression, acute suicidal thoughts, PTSD, anxiety, and substance abuse. Good candidates should not have hypotension or heart disease, history of psychosis, kidney or liver disease. Ketamine is also not recommended for women who are pregnant or breastfeeding.

How Does The Process Work?

Ketamine can be administered at home or at a clinical office. In a clinic, medical professionals can monitor vitals and have staff who can interject in case of an emergency. For KAP, standard practices will have patients undergo infusions for 6-8 weeks over 6-16 weeks (duration is dependent on the patient's needs). Sessions last between 50 minutes to one hour, whether the appointment is in person or via telehealth.  A comprehensive exam from a licensed physician is essential in determining whether or not someone may be a good candidate for ketamine therapy, regardless of where they choose to do it. A clinician will observe the patient for at least 30 minutes in both clinics and telehealth settings. 

How does KAP differ in telehealth settings?

KAP will look different depending on where we are doing the work. A telehealth KAP appointment requires the patient to be able to self-administer the medication, alongside a trained medical professional who will appear on a video call for usually 1-3 hours. As the medication begins to take effect, the trained professional will hold space, and guide the client throughout the journey. Telehealth patients may be inclined to utilize a blindfold or other sensory deprivation tools to fully delve into the experience. The clinician will explore insights, memories, emotions and more alongside the client throughout the appointment. The client and clinician will then continue the work during integration sessions, in which the client works to unpack their experience and illicit change.

As research into ketamine therapy continues, there is a sense of renewed hope within the healthcare field. With ketamine-assisted psychotherapy, we continue to see the possibilities for healing and resilience with its use. Understanding the background of ketamine therapy is critical for determining whether it is a good fit for us. If you are interested in ketamine-assisted psychotherapy, fill out one of our consultation request forms.