First FDA approved in 1970, ketamine is among the safest and most widely used medications in the world. In recent decades, researchers have studied it for its promising potential as a treatment for depression and other mental health conditions.
Prior to the Controlled Substances Act of 1985, psychedelic medicines were researched and used for successful, safe treatment of a variety of mental health conditions. However, the popularity of these compounds for recreational use led to their categorization by the DEA as Schedule I drugs, preventing 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 regarding the usefulness of psychedelic medicine 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 considered one of the safest anesthetics available 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 conditions can ketamine therapy treat?
Ketamine therapy has been shown to be effective in treating a variety of mental health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and bipolar disorder. It has also been used as an alternative treatment for chronic pain and substance use disorders. While it is not a cure for these conditions, ketamine therapy can be a powerful tool to help alleviate symptoms and provide relief, especially for individuals who have not found success with other treatments.
Can ketamine treat depression?
When used in an appropriate clinical setting, ketamine therapy can be a uniquely promising treatment option for depression. Unlike conventional antidepressants, the response to ketamine is nearly immediate. 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. Prior to receiving ketamine therapy, you will consult with an integrative psychiatrist 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?
What is a psychedelic state? How is it useful?
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 (under the tongue). For our protocol, we will be using only the sublingual or intramuscular route.
A psychedelic state is a unique experience that can alter our perceptions and the way we interpret those perceptions. While some people may find the experience enjoyable, others may not. It is best to approach the experience as a useful challenge, especially if you are unfamiliar with psychedelics. The altered state of consciousness can lead to a sense of both universality and insignificance, providing access to new ways of seeing the world around you.
Psychedelics can also alter basic perceptions of sight and sound in ways that can be confusing, beautiful, or alarming. Ketamine does produce a psychedelic state, and this is one aspect of its therapeutic efficacy. 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.
When used correctly, the use of psychedelic medicines can dramatically increase the effectiveness of therapy. Our approach is to combine guided nature connection with each therapy session, including Ketamine-Assisted Psychotherapy Sessions. By allowing nature to be the context for non-ordinary states of consciousness, we aim to improve the duration of the therapeutic effects of psychedelic medicine. This helps our clients intentionally connect to the healing space created by psychedelics in day-to-day life by focusing on natural surroundings.
What are the potential side effects of ketamine?
Ketamine can cause a temporary elevation in blood pressure and heart rate. Your blood pressure, heart rate, and oxygen saturation will be monitored during treatment. Ketamine can cause nausea and vomiting in some patients, and your physician may 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 associated with short-term use. It is possible to develop a dependency on ketamine with prolonged or recreational use, but dependency is unlikely when used for short periods of time under the guidance of a physician.
What is a typical Ketamine-Assisted Psychotherapy (KAP) session 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. Despite being intimidating, this experience of existing without controlling is valuable. In general, if you enter the psychedelic state when you feel safe and supported, you will have a positive experience.
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 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.