Find the answers to the most frequently asked questions about our services.
As an important part of the preparation process, we believe that clients should be well informed and have all their questions answered prior to starting treatment. Ongoing informed consent and collaboration with providers are essential components of effective treatment.
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, anxiety, PTSD, substance misuse and addiction, 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. In 1970 it was approved for human use and was initially marketed as Ketlar and was used as an unusually safe anesthetic. Its use in hospital settings became controversial due to the “emergence syndrome,” a phenomenon involving disorientation and perceptual disturbances when coming out of anesthesia. Some innovative psychiatrists, such as Salvador Roquet, saw the emergence phenomenon as a fascinating principal effect rather than and unwanted side-effect and began using ketamine as an adjunct to psychotherapy. Other psychiatrists, such as Eli Kolp, Evgeny Krupitsky, and Karl Jansen followed, and used high-dose IM ketamine, in combination witt psychotherapy, for the treatment of a variety of mental health conditions. In the 1990’s, Dr. John Krystal at the Yale School of Medicine used ketamine as a treatment tool to understand and treat schizophrenia. The emergence phenomenon is now understood as a potentially desirable effect to facilitate deeper healing through Non-Ordinary States of Consciousness (NOSC).
KAP is hybrid mental health treatment – drug-facilitated psychotherapy – involving medical and psychological components. We believe ketamine administration is most effective when paired with psychotherapy. Experiential sessions are bookended by preparation and integration services that optimize treatment gains.
We create the conditions for therapeutic change and believe 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 elicit non-ordinary states of consciousness and facilitate healing through experiences of profound transpersonal and mystical states. These sorts of peak experiences have been shown to expand one’s sense of self and deepen one’s understanding of existence. KAP may also enable you to access your own inner healing intelligence in a manner that leads to enduring positive life changes. Your therapist serves as a guide and facilitator of transformational space and assists in processing the experience and its impact.
The KAP protocol varies depending on the presenting problems being treated. Initial intake will involve an evaluation of your current problems and needs, evaluation of any health concerns, as well as the suitability of this treatment for you. By the end of the evaluation period, we will offer you our clinical impressions and a recommendations. It is important that we consider if KAP is the best approach for your situation and if we are the best provider of these services for you. If indicated, we will make a referral to a more appropriate provider. 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 result in a number of benefits but there is no guarantee that this will occur.
Routes of administration of ketamine include intravenous, intramuscular, intranasal, and sublingual/bucal At Polaris Insight Center, we use sublingual/bucal and intramuscular intramuscular routes of administration. You will have the option of either using compounded ketamine lozenges (self-administered sublingually/bucally and held under tongue for several minutes) or receiving the medicine via intramuscular injection.
On the day of your ketamine treatment, please follow the directions given by the treatment team about food and medication intake. You can plan to spend approximately three hours at the clinic on the day of treatment, although this time may vary.
At the beginning of the session, you and your therapist will clarify intentions for your experience. We will 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. 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. We will optimize set and setting through the use of invocations, meditative practices, and/or breathing exercises, to support an open, relaxed and growth-oriented mindset, to reduce anxiety and to ease the transition into non-ordinary states of consciousness.
Once the ketamine is administered, you will be encouraged 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 effects of the medicine subsides. Your therapist will take detailed notes on all that you share in order to support recall, insight, and integration.
As the effects of the medicine wear off, you will spend time discussing and integrating your experience with your therapist. In the case that the medicine effects last longer than the alotted time, you will be able to recover in the waiting area until your therapist feels it is safe for you to leave.
Brief self-reporting measures will be sent to you each week to measure your progress in treatment over time.
Participation in ketamine psychotherapy 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 guide your process. The psychotherapy relationship will provide safety, support, dialogue, and containment through the course of treatment.
Potential benefits of KAP may include: Improved mood, reduced anxiety, improved stress-management, enhanced self-esteem and resilience, reduced hypervigilance and fearfulness, resolution of trauma, increased engagement with life and interpersonal relationships, reduced existential distress, increased mindfulness, decreased compulsive and addictive behaviors, increased self-compassion, and a wider-angle lens perspective on one’s history, identity, and future.
Ketamine therapy 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 sustain benefits.
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.
To read more about the efficacy of KAP for treating depression and anxiety in an outpatient setting, see Phil Wolfson’s in-depth clinical study here.
The effects 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 can be described in seven categories: Mindfulness, Empathogenic effect, Out of Body experience, Near Death Experience, Archetypal/Mythological Experience, Ego – Dissolving Experience, and Mystical 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 (OBE) involve complete separation from one’s body; significantly diminished ego defenses but with continued awareness of the self. OBEs may also include mythological/archetypal imagery, visiting non-physical realities, possible encounters with spiritual entities and non-terrestrial beings, vivid dreams of past and future lives and incarnations, and re-experiencing aspects of the birth process.
Near Death Experiences (NDE) involve the experience of complete departure from one’s corporeal and biographical existence, complete ego dissolution/loss of identity, (perceived) death of physical body and identity, reliving/reviewing one’s own life, and merging into the field of collective consciousness.
Ego – Dissolving Experience (EDE) is an ecstatic state that can involve: the dissolution of boundaries between the self and external reality; complete dissolution of one’s body and sense of self; transcendence of time and space and the five senses, connection to collective consciousness; unity with Nature/Universe; sacredness; feelings of becoming one with God; immersion into an ocean of brilliant white light; deep feelings of love, peace, serenity, joy and bliss; and, a sense of ineffability of the experience.
Following NDEs and EDEs, clients can gain perspective on long-standing psychological and existential issues and begin engaging in their lives and relationships in new, more compassionate and fulfilling ways.
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 side-effects and risks to consider. Our setting and medical monitoring are intended to minimize ketamine’s side effects as much as possible.
Effects of ketamine may include nausea, brief, transient increase in blood pressure, changes in perception and visual, tactile, and auditory processing, feeling suspended in space or floating, and falling sensations. Synesthesia (a mingling of the senses) may occur. Perception of time may also be altered. Other possible adverse effects may include dizziness/lightheadedness, sedation, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to feel objects accurately (including one’s own body), diminished awareness of physical functions such as respiration, headache, anxiety, and vomiting (although rare).
Due to possible blurred and altered vision, as well as impaired balance and coordination, you will be advised to remain lying down 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. 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. Neurotoxicity has not been shown to occur in supervised clinical practice; however, in conditions of excessive use over time, mild to moderate cognitive impairments have been noted, specifically regarding memory. While psychological addiction to ketamine has been know to occur in recreational contexts, it is not common in our clinical practice due to lower doses and moderated frequency of administration, psychoeducation about safety, sacredness, and responsible usage, consistent clinical monitoring, and the ongoing trust developed in the therapeutic relationship.
In terms of psychological risks, 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 that the transpersonal experiences are bizarre or frightening, while many describe them as pleasurable, joyful, or fascinating. We have found that even frightening or overwhelming experiences can be of great value to the healing process, and pivotal in the resolution of the suffering that brought people to seek treatment in the first place.
You will receive ongoing guidance from your therapist in making the best and most meaningful use of these experiences.
Ketamine has a rapid onset and is a short acting powerful psychedelic with the potential of transformative experiences.
Regarding the acute effects of ketamine, with sublingual/bucal administration, it generally takes about 10 – 15 minutes to begin feeling the effects, which then subside in about 60 – 90 minutes. With intramuscular administration, it generally takes 3 – 5 minutes to begin feeling the effects, which then subside in about 45 – 60 minutes.
This onset of anti-depressant effects typically occur within 24 hours and has been know to last up up to 2 weeks. Ketamine administration has been shown to effectively interrupt acute suicidal ideation in some patients. Repeated administrations over a short amount of time tend to result in more durable and clinically significant effects.
KAP is a non-linear process and relief from symptoms may wax and wane before stabilization of gains is achieved. Effectiveness of treatment can typically be assessed within a few sessions, although with some clients with more complicated psychological conditions, a longer course of treatment may be needed.
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 benefits from a series of 3-6 sessions, and some come for more ongoing “booster sessions” intermittently over months or years.
Current research on ketamine infusion treatment shows that 70% of patients with treatment resistant depression respond positively to 1-3 administrations, and 30-60% report some remission of their depression symptom for varying length of times. With repeated sessions, there is a cumulative beneficial effect.
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 does have some abuse potential. Ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly. Ketamine has been known to be a drug of abuse in recreational settings. However, in clinical practice, given the limited access, psychoeducation of responsible use, and close monitoring, problems with the abuse and diversion of ketamine are rarely seen.
Because of its potential for abuse or psychological addiction, ketamine should never be used except under the direct supervision of a licensed physician.
Most clients are referred to KAP by their primary therapists, other medical providers, and/or family or friends who have heard about this innovative treatment. Many of those who are referred have undergone courses of psychotherapy and/or trials of anti-depressant medications without success. Self-referral also occurs, especially in response to recent media coverage of the benefits of ketamine- and psychedelic-assisted therapies.
It should be noted that some individuals struggling with long-term challenging psychological issues may find themselves directed to KAP therapy by way of current media hype. Eye-catching headlines and sound-bite journalism can create unrealistic expectations that are counterproductive to successful KAP outcomes. KAP is, therefore, 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” or a “magic bullet.”
To help protect and promote a productive KAP treatment process, managing expectations is an important consideration.
We recommend 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
- gaining access to a wider range of feelings (i.e., sadness, joy, grief, wonder, inspiration, anger, etc.) than previously available
- developing cognitive and emotional flexibility
- gaining perspective on one’s identity and history
- working through and releasing unhealthy levels of shame, guilt, and self-defeating beliefs
- developing an appreciation of, and tolerance for, ambiguity and uncertainty
- increasing self-awareness
- improving interpersonal communication and relationships
- enhancing creative problem-solving abilities
- improving self-care and healthy habit formation
- decreasing or discontinuing addictive and self-destructive behaviors
It is helpful to foster realistic expectations for the short- and long-term timeline of KAP’s beneficial effects. Some changes may come in sudden shifts of perspective during a KAP session that may remain long after the session has 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. We have found that the benefits of KAP are extended when clients engage in a variety of self-care practices during and after the treatment.
Although ketamine is the catalyst for change, it is actually the therapeutic relationship – with mindful reflection, investigation, patience, and integration – that is the vehicle of transformation. KAP is best approached with the understanding that developing “a resilient and meaningful life worth living” is an ongoing process.
Virtual KAP is provided through Zoom in the comfort of your own home. The home setting can be more convenient for supporting the inner process and reducing side effects. You can stay with your process, without interruption, beyond the time of the session. Virtual sessions in a familiar home setting can be experienced as safer for some clients. This treatment modality can facilitate one’s capacity to fully let go into the therapeutic process and thereby allow for access to – and expression of – greater vulnerability.
A typical at-home KAP treatment involves intake (in person or online), a mandatory preparation session (online), and a series of at-home KAP sessions facilitated by a therapist via Zoom. Integration sessions (typically online) will be planned periodically, as needed. During the preparation session, you will be guided through our preparation protocol to understand how to set up your space in a way that is conducive to journeying, including creating a safe and comfortable setting, use of zoom, use of Spotify for music playlists, and review of contingency plans for technical problems.
As human beings, we are wired for relationships. In healthy individuals, personal contact and connection facilitates relaxation, feelings of joy, and openness. However, for many people who suffer with depression, anxiety, and PTSD, personal contact and/or being in clinical settings can increase their discomfort. Thus, a clinical setting can, for some clients, create an obstacle to depth exploration.
Please note: not all patients are good candidates for this treatment. Candidacy will be assessed during intake.