Ketamine Assisted Psychotherapy (KAP)
Information for Your Understanding of the KAP Process
Introduction
Ketamine is now an “off-label” treatment for various chronic “treatment-resistant” mental conditions. Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent and now, often effectively for treatment of depression, alcoholism, substance dependencies, PTSD and other psychiatric diagnoses as well as for existential, psychological and spiritual crises and growth.
How Does It Work? The current, most probable, understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system. This is a very different pathway than that of other psychiatric drugs such as the SSRIs, SNRIS, lamotrigine, anti-psychotics, benzodiazepines, etc.
Ketamine is classified as a dissociative anesthetic, dissociation meaning a sense of disconnection from one’s ordinary reality and usual self. At the dosage level administered to you, you will most likely experience mild anesthetic, anxiolytic, antidepressant and, potentially, psychedelic effects.
While more recent work has demonstrated the possibility of an anti-depressant response to low dosages of ketamine administered in different routes such as intravenous, intra muscular (IM,) intra-nasal and sublingual (in the mouth), this effect tends to be more sustained with repeated use—in other words, a cumulative effect. Hence, frequent sessions occur in the first 2-3 weeks.
No matter the route of administration, ketamine tends to produce dissociative effects in a broad range—almost none occurring in a session to strongly present– depending on dosage and your susceptibility. It is our view that ‘dissociative’ experiences may well be instrumental in providing a more robust effect. In the Trance state, these effects are deliberately reduced in intensity to enable psychotherapy and direct communication. At higher but still sub-anesthetic doses, the dissociative effect predominates for a time, usually about a half hour to an hour.
Both methods tend to produce a positive change in outlook and character and relieve symptoms of depression, PTSD, anxiety, and other difficult states of mind and heart. We employ both sublingual and IM methods — generally beginning with the sublingual–as will be described herein.
Essential to both methods are time-outs from our ordinary state of mind, this period being of varying duration, usually 30 to 90 minutes, though it will seem timeless. Characteristically, there is a relaxation from ordinary concerns and usual mind, while maintaining conscious awareness of the flow of mind under the influence of ketamine. This tends to lead to a disruption of negative feelings and obsessional preoccupations.
It is our view that this relief and the exploration and experience of other possible states of consciousness are uniquely impactful. As therapists, we act as guides to the experience, preparing you for it and facilitating your process. For most people, KAP is singularly beneficial.
Support for Ongoing Treatment
We are very serious about understanding what we and ketamine are accomplishing. We follow up and support your treatment by telephone, email and in-person contact. If you are prescribed lozenges for at-home sessions, we provide support, integrative sessions as necessary and look forward to your reports.
How Long Will It Take Before I Might See Beneficial Effects?
You may experience important positive changes in personality, mood and cognition during treatment, in its immediate aftermath, and in the days and weeks that follow. The ketamine experience itself is designed to enable your own healing wisdom to be accessed and beneficial to you. The psychotherapy support you will receive will aid you in making your experience(s) valuable and understandable to you. We will endeavor to assist you in changing patterns of mind and behavior that are of concern and cause you difficulty.
Why Ketamine Assisted Psychotherapy?
The purpose of the sub-lingual ketamine lozenge sessions is to generate a robust anti-depressant, or other (PTSD, anxiety, etc.) benefit that often occurs over time with repeated administration of the lozenges, often in concert with the IM sessions. For some individuals, only the lozenge experience may be utilized as this is sufficient for effect.
We generally begin treatment with you by assessing responsiveness to the lozenge, this to precede the first IM session, or to continue on a lozenge only basis. This enables us to make a decision about the effectiveness of the lozenge and to adjust the dose. You may well be prescribed lozenges for at-home ketamine sessions, Such sessions will be supported with periodic psychotherapy sessions in which you will meet with us. The sub-lingual lozenge sessions with accompanying psychotherapy may well be your successful strategy with ketamine.
In our ever growing experience, the combination of the sub-lingual method (which is equivalent or stronger in effect–and much less expensive and cumbersome than the IV method) variably coupled with the IM sessions and within a framework of psychotherapy may well prove to be a highly successful therapy for you.
The purpose of the intra-muscular ketamine experience is to create a non-ordinary (“altered”) state of consciousness in order to facilitate profound transpersonal (“transcendental”, “mystical”, “spiritual”, “religious”) peak experiences. These may prove to be auspicious in resolving your existential problems, accelerating your psycho-spiritual growth and leading to a deep personal transformation and optimization of your lifestyle. Such change is best facilitated within a structured supportive psychotherapeutic milieu in connection with therapists who have a view of your issues, hopes, desires, and struggles. As a byproduct of your experience you may well feel improvement in your emotional state and reduction in symptoms that bother you such as depression, anxiety, and post-traumatic manifestations. You may well notice that you are a bit different after a ketamine experience and that difference may well be liberating and allow for new mindfulness and new behavior.
Generally, we ask that new patients undergoing IM treatment make a commitment for three IM sessions as a minimum exposure to this method of employing ketamine. This allows for familiarization with this potent experience and the amplification of its benefits.
Your experience will be unique to you. And if you and we decide to have additional sessions using ketamine, each of your sessions will be different. The number of sessions varies based on personal needs and treatment responses. We cannot pre-program your experience. We do our best to give a prognostic view as we learn with you how KAP affects you. All KAP journeys are adventures that cannot be programmed. They evolve from your own being in relation to this substance. Journeys vary in intensity from the sublingual lozenge trances to the IM experiences. While it is best to form an intention for your journey, you may or may not be able to hold onto that. Indeed, no holding on is best and the journey will flow whether or not you hold on and resist, or follow the path that unfolds and you relax into it. Holding on is the main source of anxiety in this and other related journeys. A ketamine session can be light, dark, or both. There will be concepts, visions, encounters, and you may well deal with your own death, mortality, and immortality. Most journeys are enjoyable and all are filled with awe. Invariably you will discover a new sense of who you are and what is important to you. You will have a time-out from suffering and an opportunity to change your view.
Eligibility for ketamine treatment
Before participating in ketamine treatment, you will be carefully interviewed to determine if you are eligible for ketamine therapy, including a medical history, a physical exam if deemed necessary, review of your medical/psychiatric records, a psychiatric history and administration of brief psychological tests to assess your state of mind.
Pregnant women and nursing mothers are not eligible because of potential effects on the fetus, or nursing child. The effects of ketamine on pregnancy and the fetus are undetermined, and therefore, it is advisable to protect against pregnancy while exposing yourself to ketamine or in the immediate aftermath of its use.
Untreated hypertension is a contra-indication to ketamine use as the substance causes a rise in BP. Similarly, a history of heart disease may make you ineligible to participate.
Information on ketamine’s interaction with other medicines is only partially available and it will be assessed as to your eligibility for KAP. Most psychiatric medications are compatible with KAP.
Ketamine should not be taken if you have untreated hyperthyroidism. There have also been reports of some decrease in immune function in patients receiving surgical doses of ketamine.
Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression.
Bladder dysfunction has occurred in recreational users of ketamine at very high and repeated doses. In clinical practice this has occurred very rarely.
Alternative procedures and possibilities
No other procedure is available in medicine that produces ketamine’s effects. Major Depression (MDD), PTSD and Bipolar Disorders are usually treated with anti-depressant medications, tranquilizers, mood stabilizers and psychotherapy. Electroconvulsive therapy (ECT), and the recently introduced Transcranial Magnetic Stimulation (TMS) are also in use for treatment-resistant-depression. Ketamine has also been used in the treatment of addictions and alcoholism as part of comprehensive and usually residential treatment programs, primarily abroad.
Confidentiality
Your privacy and all therapy records will be kept confidential. They will be maintained with the same precautions as ordinary medical records. To allow others access to your records, you will have to provide a signed release form. The results of this ketamine therapy may be published in clinical literature. Published reports will not include your name or any other information that would identify you.
Voluntary nature of participation
Please be aware that the Food and Drug Administration (FDA) has not yet established the appropriateness of Ketamine Assisted Psychotherapy and its use is considered off-label, the only official ’indication’ for use of ketamine being anesthesia. Your awareness of this situation is key to understanding any liability associated with your use of ketamine. Your signed informed consent indicates you are aware of this situation.
Ketamine is a relatively new psychiatric treatment—the primary studies have been with depression, bipolar disorders and alcoholism. It is moving towards becoming a mainstream treatment.. There is an expanding array of ketamine clinics across the country, primarily administering ketamine intravenously, and usually without a therapy component—in other words, as a drug. That therapeutic effect generally occurs with more than one treatment and is most robust when part of an overall treatment program. It may not permanently relieve depression. If your depressive symptoms respond to Ketamine Assisted Psychotherapy, you may still elect to be treated with medications and ongoing psychotherapy to try to reduce the possibility of relapse. Over time, you may also need additional ketamine treatments or other therapies to maintain your remission.
Your decision to undertake Ketamine Assisted Psychotherapy is completely voluntary. Before you make your decision about participating in KAP, you may ask and will be encouraged to ask–any questions you may have about the process.
Withdrawal from KAP is always your option!!!
Even after agreeing to undertake Ketamine Assisted Psychotherapy, you may decide to withdraw from treatment at any time. Given the intensity of our process together, we ask that you do so after in-depth consultation with us.
We look forward to meeting with you and discussing your interest in and eligibility for KAP