Ketamine-assisted psychotherapy (KAP), is a treatment approach that uses low to mid-range doses of ketamine, a dissociative anesthetic medication in combination with psychotherapy to manage various mental health conditions.

Clients with treatment resistant depression, anxiety, PTSD, OCD, end-of-life distress, chronic pain, drug/alcohol problems, and other conditions may be eligible for psychedelic-assisted therapy with ketamine.

Ketamine is a medication that has been used since 1970 as an anesthetic. The World Health Organization has it on their list of essential medications. It has routinely been used in emergency medicine and minor surgical procedures for pain relief. Ketamine can be easily dosed and injected and is safe with proper medical supervision.

Ketamine works by blocking the activity of the N-methyl-D-aspartate (NMDA) receptor, a receptor in the brain that is involved in the regulation of mood, cognition, and pain perception. Ketamine therapy is thought to have rapid-acting antidepressant effects, with many patients reporting improvements in their symptoms within hours to days after treatment.

First and foremost, ketamine enhances neuroplasticity, the brain's ability to change and adapt in response to stimuli. This process involves structural and functional changes to the brain, such as reorganizing its structure, functions, or connections.

In general, ketamine significantly increases a key brain hormone, Brain-Derived Neurotrophic Factor, which can promote reversal of the loss of connectivity between neurons caused by chronic anxiety and depression by triggering rapid growth of new neurological connections, relieving symptoms of anxiety and depression. Animal studies reveal that ketamine disconnects many synapses within minutes of infusion, and the affected neurons reattach new synapses over the following few hours or days.

Second, ketamine normalizes activity of the default mode network. Studies have found activity in the default mode network to be increased during maladaptive rumination, which might exacerbate depressive symptoms. The default mode network has been implicated in a number of conditions such as OCD, PTDS, depression and other anxiety disorders. In normalizing the activity in the default mode network, ketamine allows for individuals to experience their world in a new way, offering hope and healing.

And lastly, ketamine helps inhibit another mechanism in the brain as well. Unlike other antidepressants, which work on serotonin or norepinephrine pathways, ketamine works via the glutamate pathway. Glutamate is one of the most prominent neurotransmitters in the brain and regulates large regions of the nervous system. Collectively, the available data suggest that excessive physiological and psychological stress can increase the vulnerability of certain neurons in the brain to excitotoxicity, a pathological process that occurs when glutamate overstimulates neurons, damaging or killing them. This may lead to long-term depression and anxiety, and ketamine works by blocking these glutamate receptors.

Ketamine is also a powerful anti-inflammatory medication. Since depression has been linked to chronic inflammation, this may also be part of its antidepressant effect.

All of these mechanisms appear to play a significant role in the rapid antidepressant effects of ketamine.

“[Ketamine] blew the doors off what we thought we knew about depression treatment.”

Dr. James Murrough, Department of Psychiatry, Mount Sinai Hospital, New York

Most sources cite ketamine’s success rate as somewhere between 60-70%, which is pretty hopeful for patients battling treatment resistant depression for years. It must be highlighted that some patients do not respond to ketamine treatment, reflecting the overall average of the treatment’s success.

“Recent data suggest that ketamine…might be the most important breakthrough in antidepressant treatment in decades. First and most important, several studies demonstrate that ketamine reduces depression within six hours, with effects that are equal to or greater than the effects of six weeks of treatment with other antidepressant medications. Second, ketamine’s effects have been noted in people with treatment-resistant depression. This promises a new option for people with some of the most disabling and chronic forms of depression, whether classified as major depressive disorder or bipolar depression. Third, it appears that one of the earliest effects of the drug is a profound reduction in suicidal thoughts.”

TOM INSEL MD

Former Provost of Harvard University and former Director of the National Institute of Mental Health

Research Articles on Ketamine:

Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine withPsychotherapy

Ketamine psychedelic therapy (KPT): a review of the results of ten years of research

Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature

Ketamine-assisted therapy sessions are provided by trained psychedelic-assisted therapists in a controlled and supportive environment such as the client’s home, in a clinical setting or in a therapy office. In our sessions together, you will choose what environment feels the best for you to receive KAP. Ketamine has the ability to induce altered states of consciousness characterized by a sense of ego dissolution, timelessness, and connection to a higher or expanded reality. These experiences can be deeply transformative and may lead to spiritual insights, a sense of unity, and a profound connection to the divine or the universe.

Through its unique mechanisms of action, ketamine can help individuals confront and process past traumas, release emotional blockages, and gain a fresh perspective on their life journey. I will be there to offer guidance and emotional support, facilitating exploration of these experiences through the lens of Internal Family Systems (IFS).

Ketamine-assisted therapy includes a medical evaluation with a trained medical provider experienced in prescribing ketamine for therapeutic use, a preparation session to explore the intention being brought to the session as well as setting up the environment to suit your individual needs, the ketamine session, and an integration session to process and make meaning of the psychological material that arose in the session. Integration is an integral part of the KAP experience as Ketamine has the ability to induce altered states of consciousness characterized by a sense of ego dissolution, timelessness, and connection to a higher or expanded reality. These experiences can be deeply transformative and may lead to spiritual insights, a sense of unity, and a profound connection to the divine, the universe or the collective consciousness. These experiences can instill a deep sense of interconnectedness, compassion, and unity, fostering a greater appreciation for life and a desire to make positive changes in the world. Helping clients integrate these experiences into their daily lives fosters long-term positive changes.