At a party last week, I was asked by a new friend what was exciting in my work lately - and my eyes lit up while I told her about Ketamine Assisted Psychotherapy (KAP). Though I am inspired by many aspects of what I offer - for instance: parts work with the inner critic, wounded child, and wise Self or shadow play where we dive into the imaginal realm and explore what’s there through the body/soma, since KAP has been the most recent addition to my practice, and where she had the most questions, that’s where I began.
My friend was intrigued as she’d heard a bit about it from friends and sensational stories in the news, yet she was also confused - it’s often known as a party drug and can have some pretty negative effects when it’s abused. She had lots of questions and we went in depth for a while….
I’ll share my responses here as I’m guessing there may be quite a few others who also are curious.
First of all, she wondered (and you might, as well) - what is Ketamine?
Ketamine is a legal, safe, and effective medicine used to treat a variety of mental health conditions, including depression, anxiety, and PTSD.
Ketamine has rapidly-acting antidepressant, anti-anxiety, and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment and last for up to 2 weeks.
It is often used in emergency medicine for its quick acting pain relieving effects, its safety, and because the effects wear off quickly.
It is a sedative (anesthetic at higher doses) and yet it also acts as a psychedelic (visuals, hallucinogenic) and also empathogen (increasing emotional connection/empathy).
Ketamine was first synthesized in 1962 and approved for use as an anesthetic in 1970 by the FDA. It was then approved as Esketamine (Spravato - a nasal spray) in 2019 as a treatment for depression. It is currently used off-label for many mental health issues.
Who is it for and how does it work?
KAP is used to help those struggling from a variety of mental health conditions, and chronic pain but namely for those with depression, anxiety, and PTSD.
It is speculated that ketamine causes many synapses that have been “misconnected” to first disconnect and then, fairly rapidly (in the following hours to days), causes them to re-grow and re-attach as they were before stress or trauma impacted them.
Ketamine works on the glutamate system by blocking the glutamine receptors (“the most common chemical messenger in the brain that when overactive, have been linked to depression). This helps to give you that sense of calm and distance from reactivity and encourages synaptic changes in learning and memory, as well as acting as an anti-inflammatory.
Ketamine stimulates the AMPA receptors (critical for brain functioning) which work to enhance the regulation of mood and stress and inhibits NMDA receptors, allowing for increased neuroplasticity.
It creates new dendritic growth - enabling the enhanced neuroplasticity (ability to grow new neural pathways - to adapt to external stimuli and evolve in structure and function).
How does it feel?
Though everyone is unique and each experience can be different (even with the same client) - this treatment often feels relaxing and brings a sense of dissociation from the body within a few minutes of taking it. Most people enjoy the sensations that arise and some people even see visuals (hallucinations). It is an internal process and can engender an expansiveness in perception, though verbal and motor abilities are temporarily reduced.
What is the recommended length of treatment?
Generally 6-8 sessions are recommended
What about its safety and potential for addiction?
Ketamine is safe when used under supervision, with a specific focus.
It can be dangerous for people with heart problems or high blood pressure as it elevates both heart rate and blood pressure.
It may be addictive (psychologically), especially for those who have a history of other addictions (though sometimes it is also used to treat addictions).
What about physical and/or emotional side effects?
Side effects may vary - each person has unique chemistry and as such, the effects will range. Not only that, but each experience may feel different. This is especially true as clients delve more deeply into their issues.
Most people experience a sense of calm and distance from their regular emotional reactivity. Many people feel lighter and happier. Some in treatment feel sadness, frustration or emptiness, or heightened sensitivity.
Some individuals have more energy, with uplifted mood and clarity. Others may experience decreased energy, mental fogginess, confusion, headache, nausea or dizziness (generally these “negative” symptoms resolve fairly rapidly). In rare cases, people may experience psychotic symptoms or mood disorders.
Rare side effects include nausea, vomiting, or agitation. Fortunately, the “swish and spit” method (we use the rapidly dissolving tablets that are not swallowed) vastly decreases the chance of these more challenging symptoms.
At higher doses of ketamine, there can be temporary loss of motor coordination.
Are there any long term effects or consequences?
Using ketamine as directed by medical providers with adjunct therapy seems to mitigate the long term effects.
When abused or used recreationally over the long term, both structural and functional brain changes appear such as decreased white and gray matter (resulting in decreased executive functioning and even memory impairment, along with decreased connectivity in thalamocortical and corticocortical areas).
With chronic, regular usage (at least three times/week) it may cause ulcerative cystitis (inflaming and shrinking the bladder) as well as impacting the kidneys (potentially causing renal failure).
Regardless of after effects (note that most of the negative ones do not occur with therapeutic usage, or occur only temporarily), it is crucial to honor the experience of the medicine, to be gentle with oneself and to utilize what emerges from the experience.
Why am I so excited about using ketamine to treat my clients?
When used within the therapeutic container, ketamine can act as a catalyst for the therapy work - it can help create internal space more rapidly and allow for a vastly different experience in relation to the way you interact with others and yourself. It can quiet that internal critical voice, and when it does arise, it can allow you some distance so that you can more easily respond to it rather than reacting from or being caught up in it. Ketamine can allow one to have an increased feeling of ease and sense of agency in how you comport yourself.
Ketamine helps you create new dendritic growth, facilitating new neural connections (neuroplasticity) which enhance the ability to create new patterns of thinking and behaving.
It has mood-enhancing and antidepressant effects which take effect within a few hours of the session and last for a few weeks (and longer, if those new thoughts and behaviors are continually reinforced).
I tell all of my clients: the importance of this work is not so much what occurs in the dosing session, it’s more about what happens after the session. How do you use the newly enhanced sense of spaciousness? How do you take advantage of the increased neuroplasticity? How do you integrate and implement what you’re learning?
Clinicians who implement ketamine assisted therapy for healing promote this therapeutic approach and offer not only to serve as guides, but also for accountability as the client integrates what they learn (taking advantage of the disruption of the default mode network and cementing in the new thoughts and behaviors). The benefits are vast including likely relief of challenging symptoms and dysfunctional behaviors.
If this speaks to you (or you have any other questions), please reach out to me - - drloi@drloi.com
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