What is Ketamine?
Ketamine is an off-label treatment for various chronic mental health conditions. This means that the Food and Drug Administration (FDA) has not yet approved ketamine to treat mood conditions. Ketamine is a schedule III medication that has long been safely used as an anesthetic, and now an effective treatment for depression, post-traumatic stress disorder, and other psychiatric diagnoses, as well as for existential, psychological and spiritual crises.
Psychiatric use of ketamine has become relatively widespread in recent years. Ketamine has been studied and promoted by the National Institute of Mental Health (NIMH). Often, it has been used after other treatment approaches have been unsuccessful.
How Does it Work?The current understanding of ketamine’s mode of action is as an NMDA (N-methyl-D-aspartate) antagonist working through the glutamate neurotransmitter system. This is a unique pathway, distinct from other psychiatric medications such as SSRIs, SNRIs, mood stabilizers, etc.
Ketamine is classified as a dissociative anesthetic, dissociation meaning a sense of disconnection from one’s ordinary reality and usual self. Most people experience mild anesthetic, anxiolytic, antidepressant and, potentially, dissociative effects. Recent work has demonstrated the possibility of a mood benefit at low doses of ketamine (administered intravenously or sublingually). It is our view that the dissociative experience may be instrumental in providing a more robust effect. This can include a positive change in one’s outlook and character that we term a transformative response.
A time-out from one’s usual experience of consciousness is one of ketamine’s signature effects. This period can vary from 30 minutes to two hours; one can expect a relaxation from ordinary concerns, while maintaining conscious awareness of the flow of thoughts. This can lead to a disruption of negative feelings and obsessional preoccupations. As therapists we assist in understanding the effects before and after the experience but also as guides during the session.
Routes of Administration
Sublingual ketamine drops can be prescribed by your provider and taken at home. This is just a fraction of a dose that you would receive in the office and is taken every 2-3 days as prescribed by your provider. This is intended for mood enhancement.
Sublingual ketamine lozenge sessions are intended to generate a mood benefit and to determine one’s sensitivity to the medication and to break through mental barriers. This enables us to make a decision to about the effectiveness of the lozenge and to adjust the dose, if necessary. A provider will be with you to ask you questions, guide you, and to help you reintegrate your experience after the session.
Intra-muscular (IM) ketamine sessions will aim to create an altered state of consciousness in order to facilitate profound transpersonal experiences. This will be given as an injection by a medical provider, typically in the shoulder (deltoid) muscle. A provider will be with you to monitor you and help you process your experience.
Intravenous (IV) ketamine sessions are intended to assist those with acute mood symptoms. Therapy is not provided. Most studies demonstrating ketamine’s effectiveness have been administered by the IV route.
It is our belief that medication is helpful to many psychiatric conditions but research has shown that psychotherapy in conjunction with medication is the superior treatment. We encourage lozenge sessions prior to IM. We have also found that when administered properly, IM is less invasive and as effective as IV treatment. We will customize a treatment plan that works for each individual.
Potential Risks of Ketamine Treatment
Pregnant women and nursing mothers are not eligible for treatment because of potential effects on the fetus or nursing child. The effects of ketamine on pregnancy have not been studied and it is therefore advisable to avoid this treatment during pregnancy.
Ketamine is not recommended for individuals with schizophrenia or those currently experiencing a manic episode.
Those with untreated high blood pressure are not eligible for treatment as ketamine causes a temporary rise in blood pressure. Additionally, a history of heart disease or hyperthyroidism may make you ineligible for treatment.
Ketamine has an extensive safety record and has been used at much higher doses for surgical anesthesia without respiratory depression (compromised breathing).
Persons receiving ketamine therapy will be asked to lie still during the session because sense of balance and coordination are affected until the medicine’s effect has worn off. This can last from two to four hours. Other effects may include blurred vision, slurred speech, mental confusion, anxiety, nausea, elevation of pulse, double vision, and loss of appetite.
Potential Abuse or Dependence of Ketamine
Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Ketamine belongs to the same group of chemicals known as arylcyclohexylamines and is classified as a hallucinogen.
Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction. There is no evidence for addiction or dependence if ketamine is taken as medically prescribed. Therefore, ketamine should never be used except under the direct supervision of a licensed physician.
Ketamine Session LengthThe length of ketamine sessions varies from person-to-person and from experience-to-experience. People are most affected by ketamine for 45-90 minutes, depending on the route of administration. We will reserve two hours of time for a treatment and there will be the ability to rest for an additional hour post-session.
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