Prior to the controlled substances act of 1985, psychedelic medicines were researched and used for the treatment of a variety of psychiatric conditions with success and safety. The popularity of these compounds for recreational use and the harms associated with recreational use led to them being categorized as DEA Schedule I drugs, which prevented further medical use or research. Since then, research has continued outside the United States, organizations such as MAPS have supported legislative change and new research, and there has been a shift in public opinion with regards to the usefulness of psychedelic medicines when administered in a clinical setting for appropriate reasons.
Ketamine is a psychoactive compound that was never removed from our medical formulary due to the fact that, at high doses, it is a well-tolerated anesthetic. It is perhaps the safest anesthetic known and does not interfere with breathing. It is widely used in emergency rooms as a sedation agent for painful procedures, primarily in children, where there are few drugs that are equally as safe. Its effects vary considerably depending on the dose. At higher doses, it is a sedative amnestic drug. At much lower doses it creates a short but powerful psychedelic experience that has been shown to be effective in facilitating personal growth and in treating depression, PTSD, addictive behaviors, and other "treatment-resistant" mental health issues. Using ketamine in this context is considered an “off-label” use of the drug and is not an FDA-approved use of the drug. Our physicians and therapists believe that ketamine is safe and effective based on experience and available evidence and that the risks are less than or comparable to other available treatments for depression.
What is Ketamine's role in the treatment of depression?
Ketamine’s role in treating depression is unusual in that the response is nearly immediate and many patients demonstrate improvement on depression inventories within 24 hours. Effects vary in duration, however, and can fade after several weeks or sometimes even days. The response can be improved with repeated ketamine sessions and, in our protocols, we incorporate guided nature connection to prevent relapse in patients who have been successfully treated for depression. You will consult with an integrative psychiatrist prior to receiving ketamine therapy to assess other aspects of your current treatment regimen and lifestyle that might be addressed to optimize healing. We strongly believe that pharmaceuticals and psychedelic medicines are powerful and useful tools that are best used for short amounts of time to reach specific goals and work best when used in natural settings as part of a comprehensive integrative treatment plan.
How does Ketamine work?
Similar to most pharmaceuticals, ketamine’s exact mechanism of action is not completely understood. It is an NMDA antagonist that works through the glutamate transmitter system. It can be administered intravenously, intramuscularly, nasally, or sublingually. For our protocol, we will be using only the sublingual or intramuscular route. Ketamine does not affect breathing, even in high doses. It can cause a temporary elevation in blood pressure and heart rate. Your blood pressure, heart rate, and oxygen saturation will be monitored during treatment. In the past, it was thought that ketamine produced increased intraocular and intracranial pressure, but research has shown this to be unlikely to be true. Ketamine can cause nausea and vomiting in some patients and your physician will possibly suggest a dose of anti-nausea medicine before the first treatment. With chronic and frequent use, ketamine can damage the bladder but this has not been seen with short-term use. With prolonged or recreational use, it is possible to develop a dependency on ketamine, but dependency is unlikely when used for short periods of time and under the guidance of a physician.
What is a psychedelic state and how is it useful?
Ketamine does produce a psychedelic state and this is one aspect of its therapeutic efficacy. Some people enjoy the psychedelic experience and some do not. If you are unfamiliar with psychedelics, it is best to anticipate the experience as a unique and useful challenge. Psychedelic experiences are, by nature, hard to categorize because they alter our perceptions and the way we interpret those perceptions. They can lead to a sense of universality and insignificance simultaneously and allow access to new ways of seeing the world around you. Most people are very much in the habit of being themselves. It can be both liberating and frightening to perceive the world without the habit of self. Psychedelics can also alter basic perceptions of sight and sound in ways that can be confusing, beautiful, or alarming. Your initial ketamine session will use a slightly lower dose as an introduction to the experience and all initial sessions will be attended by a physician and therapist.
The use of psychedelic medicines can dramatically increase the effectiveness of therapy when used correctly. Our approach is to combine guided nature connection with each therapy session and with the Ketamine Assisted Psychotherapy Sessions as well. The purpose of this is to improve the duration of the therapeutic effects of psychedelic medicines by allowing nature to be the context for non ordinary states of consciousness. This helps our clients intentionally connect to the healing space created by psychedelics in day to day life by focusing on natural surroundings.
What does a typical Ketamine Assisted Psychotherapy (KAP) session look like?
Shortly after receiving a dose of ketamine, you will begin to feel its effects and we encourage you to “lean in” to the experience. It is normal to feel a loss of control over the situation and your thoughts and feelings. This experience of existing without controlling is valuable, despite being intimidating, the first time it occurs. In general, if you enter the psychedelic state when you feel safe and supported, you will have a positive experience. It is important to be honest with yourself and your therapist if you do not feel safe in the treatment space or if you do not feel comfortable with anyone that is present. Your therapist will ask you to set an intention for the experience, but the degree of focus on this intention will be entirely up to you. Using an eye mask or closing your eyes can allow you to focus more on the internal experience and the evocative power of music can extend the range of your internal journey. Your therapist may ask you questions as a way of documenting your experience so that you can reflect on it later. When possible, sessions will be conducted outdoors or in our outdoor office.
You can expect the full ketamine experience to last for 1-2 hours. As you return to your default mode of thinking, you may experience some confusion. It can be as surprising to re-enter the default self as it can to leave it behind. Your therapist and medical provider will monitor you until it is agreed that you may safely leave, typically 2-3 hours after ketamine administration. You will need to arrange transportation home and should refrain from driving, operating machinery, or engaging in physically stressful activities for the duration of the day. Your thoughts and perceptions may remain slightly altered for several hours and you may be unaware of these alterations. You should arrange child care as needed and avoid tasks that require intense concentration or focus or situations where you are responsible for the safety of others. The medicine will be more effective if you are allowed to let yourself relax and recover without distraction for the duration of the day.