Ketamine is a medication that has long been used safely as an anesthetic and analgesic agent. It is classified as a dissociative anesthetic. Ketamine has been used in surgical settings and pain management since its approval by FDA in 1970. It is now increasingly applied clinically as an off-label treatment for various chronic treatment-resistant mental health conditions, such as depression, alcoholism and other substance dependencies, PTSD, OCD, and other psychiatric diagnoses.
Ketamine was discovered by Cal Stevens of Wayne State University and developed by Parke-Davis (a subsidiary of Pfizer) in 1961 marketed as Ketlar and began to be used as unusually safe anesthetic, its use in hospital setting became problematic due to “emergence syndrome”. Salvador Roquet who began using Ketamine as well as other mind altering substances as an adjunct ot psychotherapy in 1967 described this as Ketamine’s fascinating principal effect rather then unwanted side-effect. The emergence phenomenon is in fact a Non-Ordinary State of Consciousness (NOSC).
Ketamine is classified as a dissociative anesthetic, where “dissociation” means a sense of disconnection from one’s ordinary reality and usual sense of self. At the dosage level administered to you at Polaris Insight Center, you will most likely experience mild anesthetic, anxiolytic (calming), antidepressant and potentially psychedelic effects.
Essential to this method is a time-out from one’s usual day-to-day experience.
The experience is characterized by the relaxation of ordinary concerns and usual mindset, all while maintaining conscious awareness. This tends to lead to a disruption of negative feelings and obsessional preoccupations. Many feel that this interruption–and the exploration of other possible states of consciousness can lead to significant shifts in overall well-being.
Ketamine bolcks the N-methyl-D-Aspartate (NMDA) receptor and during a ketamine session, dopamine levels are increased, celluro-plasmic activity and the B-endorphin level is increased, the activity of MAO-A in blood serum and MAO-B in blood platelets significantly decrease. The biochemical data show that the pharmacological actions of ketamine affect the monoaminergic and opioidergic neurotransmitter metabolism.back
KAP is medical treatment with Ketamine Assisted by Psychotherapy. We believe ketamine sessions are most effective when paired with psychotherapy. Our treatment protocol includes sessions that will prepare you for your ketamine sessions, and assist you in integrating your experiences afterwards.
We emphasize the potential for change, and such change is best facilitated within a structured, supportive psychotherapeutic environment with a therapist who is aware of your issues, hopes, desires, and struggles.
A ketamine treatment session has the potential to create a non-ordinary state of consciousness and facilitate a profound transpersonal or mystical process. These sort of peak experiences have been shown to expand one’s sense of self and understanding of existence. Ketamine may also enable you to access your own inner healing intelligence in a manner that is valuable to you. Your therapist serves as a guide, and assists in processing the experience and its impact.
Ketamine assisted psychotherapy varies depending on the particular problems being treated, but we firmly believe in finding the most optimal way to support your growth and healing.
Initial sessions will involve an evaluation of your current problems, concerns, and needs, evaluation of your overall health, as well as evaluation of suitability of this treatment for you. By the end of the evaluation period, we will offer you our clinical impressions and a recommended approach to treatment. It is important that we both consider if we are the best provider of these services to you and if Ketamine Assisted Psychotherapy is the best approach for your situation. If indicated, a referral to a more appropriate provider will be provided. The goals of therapy are arrived at by mutual collaboration . These goals will be reviewed during the course of our work together in order to assess and/or modify the treatment according to your needs. Participation in this treatment may results in a number of benefits but there is no guarantee that this will occur.back
The routes of administration of ketamine are intravenous, intramuscular, intranasal, and oral. At Polaris center we use oral and intramuscular administration.
With oral administration, it generally takes about 20 minutes to begin feeling the effects, which then subside in about 45-60 minutes. With intramuscular administration, it generally takes 3-10 minutes to begin feeling the effects, which then clear in about 45-60 minutes.back
Participation in ketamine therapy can result in a number of benefits, but there is no guarantee that this will occur.
The ketamine experience is designed to enable your own inner healing intelligence to be accessed and become beneficial for you. The psychotherapy support you will receive will aid you in making your experience(s) valuable and meaningful to you.
Ketamine is a new and experimental psychiatric treatment, though there are now many studies demonstrating its efficacy. Improvement generally occurs with more than one administration, and is most robust when part of an overall treatment program. It may not permanently relieve your condition. If your symptoms respond to ketamine, you may still elect to be treated with medications and ongoing psychotherapy to reduce the possibility of relapse. Over time, you may also need additional ketamine booster treatments or other therapies to maintain your remission.
The literature indicates a 70% initial response rate to ketamine, as well as a remission rate (return of symptoms) for patients with treatment-resistant depression of 40-50%. If you respond with mood improvements after 6 treatments, you may go on to receive additional booster treatments periodically to be determined by your treatment team.back
During your pre-dosing intake session, you and your therapist will reflect on your goals for treatment and set intentions for your experience. We also encourage you to hold these intentions lightly, as resistance or attempts to control the experience can produce anxiety and stand in the way of the experience. If desired, you will collaboratively create an invocation, a set of emotionally evocative and relevant statements to be read to you as the ketamine treatment begins, which is meant to induce a growth-oriented mindset for your journey. Your therapist may also offer and teach breathing exercises and other mindfulness or meditative guidance to address any anxiety you might have going into the experience.
We will also discuss the use of music during the treatment session. Music serves to ground and potentially enhance or guide the experience. We provide playlists designed to optimize your benefit from your treatment session.
On the day of your ketamine treatment, please follow the directions given by the treatment team about food and medication intake. Your therapist will be present for support, to guide you through any recommended relaxation exercises, and to read the invocation as you begin if desired.
You will be invited to use an eye mask to facilitate and enhance the experience, and to help you maintain an internal focus. You will spend much of the session “going inside” or focusing on your internal experience. However, your therapist will check in with you periodically throughout your experience and may ask you questions from time to time. You will also have the opportunity to share more once the effect of the medicine subsides.
At the dosage levels we will be using, you will remain consciously aware of where you are and responsive to your surroundings. Your session will last approximately two hours. As the effects of the medicine wear off, you will spend some time discussing your experience with your therapist and then you may be asked to spend some time in the waiting area until your therapist feels it is safe for you to leave. You can plan to spend three hours at the clinic on the day of a treatment although this time may vary.back
The effect of Ketamine changes with the dosage and the dosage is decided based on overall treatment goals and treatment plan. There are some physiological effects that you will experience during Ketamine sessions as changes in perception and sensitivity to light and sound.
Effects of Ketamine have been described in four categories : Empathogenic effect, Out of body experience, Near Death Experience, and Ego – Dissolving experience. In the doses that we use at Polaris Insight Center you will most often experience Empathogenic and/or out of body experience.
Empathogenic effect in lower doses may result in increased awareness of the body, feelings of comfort and relaxation, reduction of ego defenses, increased empathy, compassion, and warmth. This is considered a sub-psychedelic dose and best supports talk therapy as there is more openness and relaxation of defenses.
Out of Body experiences where complete separation form one’s body occurs, there are significantly diminished ego defenses, but the experiencer is well aware of the self, visits to mythological realm of consciousness, possible encounter with non-terrestrial beings, emotionally intense visions, vivid dreams of past and future life and incarnations, re-experiencing the birth process.
Near Death Experience (NDE) where patient can experience a departure from one’s body, complete ego dissolution/loss of identity, experienced physical body and psychological mind death, experience of being a single point of consciousness simply aware of how actions have affected others, with moral judgment of self, reliving its own life, visiting non-physical realities , experience of psychological rebirth of the ego.
Ego – Dissolving experience (EDT) is an ecstatic state of the dissolution of boundaries between the self and external reality, complete dissolution of one’s body and self, transcending normal mass/time/space continuum, connection to collective consciousness, unity with Nature/Universe, Sacredness, cosmic unity with the universe, feelings of becoming God, frequently experiences as an ocean of brilliant white light, deep feelings of love, peace, serenity, joy and bliss, sense of ineffability of the experience.
NDE and EDT sometimes generate some resolution of patients addictive illness, psychological problems, personality disorder, including chronic psychosomatic illness.back
Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any medication, there are also some potential risks and side effects to be informed of and to consider.
Our setting is intended to minimize ketamine’s side effects as much as possible. You will be asked to lie still during the ketamine administration and we will invite you to use an eye mask during your treatment.
Effects of ketamine may include distorted visualization of colors, feeling suspended in space or floating, falling sensations, experiencing out-of-body sensations, vivid dreaming and changes in visual, tactile and and auditory processing. Music that may be familiar may not be recognizable. Synesthesia (a mingling of the senses) may occur. Ordinary sense of time will morph into time dilation.
Other possibilities for adverse effects include dizziness/lightheadedness, sedation, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to hear or to feel objects accurately including one’s own body, diminished awareness of physical functions such as respiration, headache, anxiety, nausea, and vomiting (although rare).
Due to possible blurred and altered vision, as well as impaired balance and coordination, you are advised to lie still and keep your eyes closed (as long as you are comfortable doing so) or use the eye mask provided until the main effects have worn off.
Driving an automobile or engaging in hazardous activities should not be undertaken on the day of the dosing session, and not until all effects have stopped. You will be assessed for safety prior to leaving the office.
Repeated high-dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction in individuals abusing the drug. This has not occurred in our practice. In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying psychological problems in people with severe personality disorders and dissociative disorders.
Some people report the psychic experiences as bizarre or frightening, while many describe them as pleasurable, joyful, or fascinating. We have found that even frightening experiences can be of paramount value to your transition to recovery from the suffering that brought you to your KAP work. You will receive psychotherapeutic help and ongoing guidance from your therapist as to how to make the best use of these experiences.back
Ketamine has a proven safety record as a dissociative anesthetic that has been used with thousands of patients in much higher doses then are used in psychotherapeutic setting. The immediate or rapid relief of depressive symptoms and has a potential for providing an acute interruption of suicidal intent.
Ketamine contributes to cathartic process, stabilizes positive psychological changes, enhances positive psychological changes, personal growth and self-awareness, catalyzes insights into existing problems, increases creative activities, broadens creative activities and spiritual horizons, and harmonizes relationships with the world and other people.
Ketamine has a rapid onset and is a short acting powerful psychedelic with the potential of transformative experiences.back
The amount of sessions is individual depending on overall treatment goals and responsiveness to the treatment. Some patients benefit from only one session, while many benefit from a series of 3-6 sessions, and some come for more ongoing treatment sessions over months or years.
Current research shows that 70% of patients with treatment resistant depression respond positively to 1-3 administrations, and 30-60% report having a remission of their depression for a varying length of time, some patients then receive “booster” sessions. With repeated sessions there is a cumulative effect and in combination with psychotherapy it becomes a treatment.back
Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Medical evidence regarding the issue of drug abuse and dependence suggests that ketamine’s abuse potential is equivalent to that of phencyclidine and other hallucinogenic substances.
Phencyclidine and other hallucinogenic compounds do not meet criteria for chemical dependence, since they do not cause tolerance and withdrawal symptoms. However, cravings have been reported by individuals with the history of heavy use of psychedelic drugs. In addition, ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly.
Therefore, ketamine should never be used except under the direct supervision of a licensed physician. We and our colleagues doing clinical ketamine work have not had patients become dependent on ketamine.
Some individuals struggling with long-term challenging psychological issues find themselves directed to KAP therapy by way of the current media hype. Eye-catching headlines and sound-bite journalism can create unrealistic expectations that are counterproductive to successful KAP outcomes.
Ketamine-assisted psychotherapy (KAP) is sometimes approached with the false notion that ketamine provides a one-off quick-fix mental health shortcut. Some have even incorrectly referred to ketamine as a “happy pill.”
To help protect and promote a productive KAP treatment process, realistic expectations are an important consideration.
We recommend mutually defining realistic expectations and identifying achievable goals for symptom relief with your therapist and/or therapy team:
- understanding and cultivating resilience
- understanding and cultivating meaningful engagement and interconnectedness
- developing heightened compassion for oneself and others
- seeking access to a wider range of feelings (i.e., sadness, joy, grief, wonder, inspiration, anger, etc.) than previously available
- reflecting on one’s identity and history without unhealthy levels of shame, guilt, and self-defeating beliefs
- developing increased appreciation of, and tolerance for, ambiguity and uncertainty
- seeking out, and developing, greater cognitive and emotional flexibility
- not overlooking the value of “small” incremental changes and developments of enhanced emotional and practical life skills
- experiencing enhanced creative problem-solving abilities
- gaining support for initiating new productive patterns of behavior and decreasing or discontinuing dysfunctional patterns
It is helpful to foster realistic expectations for the “sooner and later” timeline of KAP’s effects and benefits. Some changes may come in sudden shifts of perspective during a KAP session that may remain long after the sessions have been completed. Also, it is important to note: some of the most valuable KAP influences and insights may evolve slowly over time with extended integration and reflection.
One should carefully dispel the all-too-appealing but false idea that ketamine has “magic bullet” abilities to quickly replace suffering with happiness; or that it can immediately and permanently recontextualize past traumas, long-term depression and anxiety without extended integration and effort.
KAP is best approached with the understanding that developing “a resilient life worth living” is a process. Although Ketamine is the mechanism for an intervention, it is actually time itself – with mindful reflection, investigation, patience, and integration – that is the vehicle of transformation.