KETAMINE-ASSISTED
PSYCHOTHERAPY
(Currently wait-listing for KAP)

The most progressive type of treatment available for depression, PTSD, or other issues

                                                                                                                                                                                                 

• Do you struggle with unrelenting depression that has failed to respond to multiple forms of medication or other treatment?                                                                                               

• Have you failed to make or sustain progress for another type of mental health disorder? ​

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• Are you motivated to maximize your psychological and emotional growth in a safe, legal, controlled, and supportive setting?

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What is ketamine? How is it safe?

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Ketamine is an FDA approved substance that's historically been used as an operative anesthetic, but has also been demonstrated as safe across a wide range of applications. Unlike opioid-based anesthetics, it doesn't suppress the respiratory system. Although it can be contraindicated for certain medical conditions such as uncontrolled hypertension, it poses virtually no overdose risk. The Center for HBH offers KAP for ketamine treatment at Wellward Medical, where an MD or a psychiatric nurse practitioner will provide medical evaluation following psychological assessment and approval. Administration will be via IV infusion or intramuscular injection, with vital sign monitoring. 

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How does ketamine work? 

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The exact reason that ketamine reduces depression and other symptoms hasn't been proven,  but the medical model for ketamine focuses on effects to neurotransmitters (especially glutamate) and a neurotransmitter modulator called BDNF, which is linked to neuroplasticity. However, to understand why ketamine can potentially address complex issues like PTSD or provide more than a temporary mood boost, it's important to understand its dissociative, or psychedelic, effect. While the medical approach to ketamine has historically viewed this as a side effect to block or lower, it shares the key impact of the ''classic'' psychedelics such as psilocybin.

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Ketamine and other psychedelics are thought to temporarily disconnect midbrain structures collectively known as the Default Mode Network (DMN)--parts that revert to habitual rumination and reflection when the brain isn't otherwise focused or distracted. As the seat of our repetitive neural networks, or thought patterns, the DMN can also be understood as the seat of our identity, or ego. The DMN's reasoning ability and ego boundaries are obviously necessary and useful.

 

However, the downside of this DMN dominance is disconnection from animal instincts that discharge the physiological tension created by fear and other strong emotional states. Psychedelic researcher David Nutt has stated that in the DMN, ''we've found the neural correlate for repression.'' Cognitively repressed autonomic nervous system reactions (e.g., fight, flight, freeze, or submit) lead to neurotransmitter dysfunction that creates depression, anxiety, other mental health disorders. 

 

A leading neuroscience model for psychedelics, based upon brain imaging studies, proposes that when the DMN is interrupted, what's repressed in the nervous system can surface. This is what I observe in practice as clients progress through a ketamine treatment series--an exavacation through layers of feeling. While this may sound only positive, without adequate psychological preparation, it can actually feel overwhelming, disruptive, or too difficult to interpret. This is why it can be important to prepare for ketamine treatment with a provider skilled in both trauma therapy and the psychedelic process. 

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What does ketamine feel like?

 

Ketamine expert and psychotherapist Phil Wolfson notes how variable the ketamine experience can be, stating ''In general, the greater the dosage, the greater the [effect], but one person's point of [effect] is another person's point of neutrality or another human's profound experience.'' Generally speaking, at lower doses it has a euphoragenic (pleasant and relaxing) effect, but the effect is also extremely variable depending upon a variety of factors.

 

Without preparation and related intention, there is risk of an unpleasant, disappointing, or misleading experience. For example, for those with high anxiety may experience amplification of that anxiety, while highly analytical or rigid personality types may experience a partially or fully blocked experience. This is typically viewed as ''non-response,'' but that can change with the right preparation. The most underrated downside of inadequate preparation is a positive, profound mystical experience that feels important but may not equal psychological growth--a phenomenon sometimes termed ''spiritual bypassing.''  

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How is Ketamine-Assisted Psychotherapy different from regular ketamine treatment?

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At some clinics, ketamine treatments are administered with a degree of sedation, meaning that even if you remain ''awake,'' there is a medication added to lower the dissociative effect. Yet, suppressing this blocks the altered state of consciousness that create a profound sense of connection to something beyond the limited ego state. It also may diminish full benefit to the DMN and nervous system. 

 

Even if ketamine treatments lack a sedative component, the addition of a psychotherapeutic preparation approach has multiple benefits:

 

• It prevents the risk of a blocked response or a spiritual bypassing effect.

• It allows maximum benefit at the fastest pace that is safe for your nervous system.

• The specificity of the intention allows you to easily measure the outcome, so benefits are more enduring. Instead of just experiencing mood improvement, you understand the obscured roots of your issue and become better at managing triggers.

• Booster treatments, which are often needed at some point after standard ketamine treatment, will be less likely, and if necessary, they'll be opportunities for deeper levels of work. 

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The KAP preparation therapy process helps you precisely identify repressed emotions, and develops a strategic intention to begin unraveling them safely with ketamine's psychedelic benefits. To prepare your mind for positive ketamine experiences and safely paced change, I use a combination of Internal Family Systems (a metaphorical framework for the DMN and unresolved emotions in the nervous system), EMDR, and ''active imagination therapy''(guided imagery) rooted in Jungian depth psychology. Integration therapy between ketamine treatments makes new connections that fine tune the process, and supports vulnerability that may arise.

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Can I get ketamine treatment while taking other mental health medications? 

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SSRI and SNRI Medications (e.g. Prozac, Paxil, Lexapro, Effexor, etc.):

 

Unlike the ''classic'' psychedelics such as psilocybin and LSD, which activate a particular serotonin receptor, ketamine acts primarily on NMDA (glutamate) receptors rather than serotonin receptors. It has the distinct of being unlikely to interfere if you already take SSRI or SNRI medication.

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Benzodiazepines (e.g., Xanax, Valium, Klonopin) and other GABA agonists (e.g., Lamictal):

 

Research indicates that the anti-depressant effect of ketamine is blocked or reduced if benzodiazepine medication is also in your system. You may also experience a limited or blocked effect with use of other GABA receptor agonists such as Lamictal. In practice, I've observed that for those who regularly (daily or almost daily) use a benzodiazepine medication (Xanax, Klonopin, Valium, etc.) ketamine is unlikely to alleviate anxiety fully. This may be related to the tolerance withdrawal effect (rebounding anxiety after the dose wears off) associated with regular use. While you can still gain significant insight from the preparation therapy process and make gains by changing dysfunctional thought patterns, you're likely to remain physically anxious. It can be fatal to stop benzodiazepine use abruptly and difficult to taper without debilitating side effects, so do not attempt to do so without medical guidance and your own research. 

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Is ketamine recommended for any mental health disorder?

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Ketamine treatment can be useful for most mental health disorders, but it is not recommended if you have schizophrenia or another primary psychotic disorder. It it also not recommended for unstabilized bipolar disorder. However, note that people with developmental trauma history (C-PTSD) are often misdiagnosed with bipolar disorder due to vacillation from depression to anxiety or anger rather than depression to mania, which is has distinct features. 

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If suicidal ideation or a passive death wish is a newer symptom in your life or one that you would never consider acting upon, ketamine may bring signifcant relief from that in as little as one session. However, for someone who has struggled with a pattern of suicide attempts or threats, ketamine may only create more vulnerability. Because of the psychedelic effect on the brain and nervous system described above, it's important to consider that suicidal ideation, as frightening as it it is, is a coping mechanism supressing more painful feelings. A thorough psychological assessment is important. 

 

If you have been diagnosed with borderline personality disorder, or struggle regularly with borderline symptoms such as repeated suicide attempts, gestures, or threats, self-injurious or reckless behavior, extreme instability of relationships or intense fear of abandonment, this form of ketamine treatment is likely to feel too disruptive, and is not recommended. If you identify with these symptoms, Dialectical Behavioral Therapy is the recommended treatment.

 

If you have an active substance use disorder, it's important to seek formal comprehensive treatment and develop a recovery lifestyle first, as ketamine is not a magic bullet. Although the NMDA receptor antagonism effect can be useful for mood or cravings in recovery, and ketamine-assisted psychotherapy can help you address trauma or emotional wounds masked or created by addiction, there are numerous psychological patterns that can only be reshaped by new behaviors, routines, and positive connections with others.  Ketamine does facilitate ego maturation that chronic substance abuse arrests, but it's unlikely to substitute the lifestyle efforts that build maturity naturally. 

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For obsessive-compulsive disorders, which imply extra rigidity to neural networks in the DMN, ketamine may not alleviate OCD symptoms as quickly as other types. More treatment than average may be necessary to make headway. Ketamine and other psychedelics are likely the best treatment available for the issue, but preparation therapy targeting the underlying root issue may be extra important in this case. For example, a blocked response would be more likely without thorough preparation.

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As noted above, certain physical health conditions are contraindicated, mostly notably pregnancy, certain cardiac problems, and uncontrolled hypertension. Ketamine is also hard on the urogenital tract and may not be worth the risk of exacerbation if you have history of severe and chronic cystitis. or a similar condition.

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Not all providers would agree with my above views about diagnosis and medication, but it's a practice-informed perspective that errs on the side of caution for your benefit. It's better to have more information than less, and then make a decision that feels right to you.

 

Ketamine treatment may seem overwhelming or intimidating, but you'll receive support from start to finish, with assistance from the Wellward Medical Patient Navigator to discuss cost, establishment of a safe relationship in therapy sessions prior to actual ketamine treatment, and a physician's oversight of all the medical aspects. 

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As the therapist in the process, I would be honored to hear your story and facilitate your change.

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