Ketamine Assisted Psychotherapy

Ketamine-assisted psychotherapy (KAP) is a holistic modality in which ketamine, a medication that is FDA Approved, safe, and effective medicine, is used to treat a variety of mental health conditions, including Major Depressive Disorders, Post-traumatic Stress Disorder (PTSD), Bipolar Depression, Obsessive-Compulsive Disorder (OCD), Severe Anxiety, Suicidal Ideation, and Treatment-Resistant Depression.

Ketamine is used in conjunction with psychotherapy as a tool for clients to effectively process and create a foundation for long-lasting change and sustained symptom improvement.

Ketamine has a long history of use and research. Ketamine was initially used as an anesthetic and was first synthesized in 1962, a derivative of PCP. In the 1970s, researchers also noted that one of the main side effects of ketamine was disassociation and hallucinations like floating in outer space. This was considered undesirable for clinical practice at the time. From 1978 onward, ketamine became a Class III substance under the US Controlled Substances Act 1999. 

More recently, the FDA approval of esketamine (SPRAVATO®) to treat mental health resulted in increased research on ketamine and its benefits.  Universities such as Harvard, Yale, and Johns Hopkins have completed research and found that ketamine can treat many mental health conditions.

“We cannot solve our problems with the same thinking we used when we created them.”— Albert Einstein

Who May Benefit From KAP?

Data supporting ketamine efficacy in the following treatment:

Medical exclusions for outpatient ketamine Administration include the following:

  •  Vascular abnormalities ( aneurysm, uncontrolled hypertension)
  • Pregnancy
  • Breastfeeding
  • Renal insufficiency
  • Active benzodiazepine use
  • Active alcohol dependence
  • TBI – requires medical clearance
  • Glaucoma requires medical clearance

 Psychiatric exclusions for ketamine-assisted psychotherapy include the following:

  •  Untreated/suspected bipolar disorder without treatment of a mood stabilizer
  • Thought disorders (schizophrenia) 
  • Adults who have not responded to previous behavioral health treatments (treatment resistance).
  • Adults with symptoms related to traumatic stress (e.g. history of assault, first responders, healthcare providers & veterans).
  • We are an open, safe, LGBTQIA+, and non-binary-friendly practice.

How Ketamine and Esketamine Work?

The two forms of ketamine interact differently with receptors in the brain. The delivery of ketamine and the type given affect drug effectiveness and side effects. Behavioral Health Resiliency PLLC does NOT offer IV infusion. However, delivery methods are available for intramuscular injection, nasal spray, and sublingual lozenges.

  • The Ketamine Intermuscular (IM) Injections have a faster onset. The length of this treatment can last the same as the IV, depending on the patient’s recovery. The medication can be administered all at once or split between 1 to 2 doses, within 10 – 15 minutes apart between the injections. Bio Availability Approx. 93%
  • Ketamine is administered orally. The pharmacy determines the bioavailability percentage, typically 50% – 70%.
  • Following nasal spray administration, the mean absolute bioavailability of ESK is 48%. The time to reach maximum ESK plasma concentration is 20 to 40 minutes after the last nasal spray of a treatment session.

Ketamine and SPRAVATO® work for depression through a different mechanism than other antidepressant drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine, and dopamine. These chemicals are messengers that relay communication between brain cells.

The theory is that having more significant quantities of these neurotransmitters allows better communication between brain cells, positively affecting mood. Ketamine and SPRAVATO® block NMDA receptors in the brain, thereby increasing levels of glutamate, the most abundant chemical messenger in the brain. Blocking NMDA receptors also activates AMPA receptors to release other molecules that help brain cells communicate with each other along new pathways.

Depression is the leading cause of disability. Treatment-resistant depression (TRD) is a subset of Major Depressive Disorder that does not respond to traditional and first-line therapeutic options. Studies indicate that 29% to 46% of patients with major depressive disorder show partial or no response to treatments.

Ketamine works by blocking the brain’s NMDA receptors and stimulating AMPA receptors. Research shows these receptors help form synaptic connections and boost neural circuits regulating stress and mood. Ketamine has been shown in studies to have procognitive effects. Further studies have shown clinical and statistically significant decreases in depression scores.

Procognitive effects include enhancing the neural circuits that help us to cognitive processes, executive function, and cognitive-emotional processing. Ketamine has also been shown to improve overall neuroplasticity, which is why Ketamine is a tool to use with psychotherapy, much like other psychopharmacological interventions.

Consequences of Untreated Depression

Depression can impact every aspect of your life: physical health and your psychosocial well-being.

Depression is fully manageable and treatable, and recovery is possible.

These are some of the most common effects of depression on your body:

A meta-analysis found that depression is linked to a significantly greater chance of myocardial infarction and coronary heart disease.

The risk of under-treated or treatment-resistant depression is too significant to accept good enough treatment. It is time you live your full authentic life.

Which Treatment is Right for You?

Ketamine has a proven history, and there is much more research in support of ketamine treatments. Ketamine is not FDA-approved to treat depression, but it can be used “off-label,” meaning it is used for a purpose other than initially developed or approved. Up to a third of all psychiatric medications in the US are used “off-label.” As research continues, it is increasingly evident that ketamine benefits patients with depression, PTSD, anxiety, and chronic pain.