KETAMINE-ASSISTED PSYCHOTHERAPY
What is Ketamine-Assisted Psychotherapy (KAP)?
KAP is a model of psychotherapy that utilizes a legal medicine, ketamine, as a tool in psychotherapy. Cultivating Connections offers this structured model of therapy for adults only in partnership with a board certified physician, who typically administers the medicine at their clinic intravenously or intramuscular injection. These treatments are bookended pre- and post- with a psychotherapy session. KAP is typically a short term intensive treatment (between 6-12 medicine sessions are most common), after which a client can continue to engage in talk therapy with or without occasional “booster” ketamine treatments, or if clinically indicated, discontinue mental health treatment.
A Little About Ketamine:
Ketamine is an anesthetic drug that was synthesized in 1962 for use in veterinary and military field hospital settings. At lower doses, ketamine induces a psychedelic state where people experience amplified or altered visual imagery, sensations, moods, perceptions, and consciousness. Initially it was primarily used for anesthesia in the United States but doctors and scientists in other countries quickly recognized its potential for psychiatric treatment.
In the 1980s, ketamine became increasingly diverted from medical and veterinary settings and gained notoriety as a recreational club drug. As a result, the US government restricted research on ketamine’s therapeutic potential outside of anesthetic contexts until the late 1990s/early 2000s. The loosening of restrictions twenty years ago have resulted in a wealth of research on the mental health applications of ketamine. Consistently, the drug has demonstrated profound efficacy in clinical trials for treating depression, anxiety, trauma, and more.
What Ketamine has to offer psychotherapy:
Ketamine, when used as an adjunct to psychotherapy, can assist clients by with three mechanisms of action:
At the Neuro-Chemical Level - Ketamine is thought to work by blocking the overproduction of a neurotransmitter in the brain called NMDA glutamate, which may be associated with mood disorders. For the 40-50% of people who take antidepressants and see little improvement in symptoms, this treatment may offer greater efficacy. The scientific community is still actively researching how neurotransmitters impact mood disorders.
At the Neural-Pathway Level - Neural pathways are connections in the brain that send signals from one region of the brain to another. These pathways are how our brains recognize stimuli in the world around us and decide how to respond to it using our nervous systems. For example, if you’re out on a hike and you see a bear, your brain recognizes that the bear could be dangerous and sends signals to the body to protect itself by fight, flight, or freeze. These pathways allow the brain to do its most basic job - keep us safe and alive. But sometimes these pathways keep us stuck in a pattern of reaction that may no longer be helpful. These pathways are more flexible (neuroplastic) earlier in life, as they harden in adulthood. There is some evidence, in both imaging and behavior studies, that ketamine may open up a window of neuroplasticity for people to implement changes in their perceptions and behaviors.
At the Psychedelic Level - Psychedelic experiences put us into an altered state of consciousness, which might allow an opportunity for someone to see their world and experiences differently. A common discussed experience of a ketamine session is that one feels separated from their body or mind, which allows them to observe their internal experiences. This kind of psychedelic experience might be a powerful way to gain insight into your own mind and heart, and also how you engage with the world around you.
Who might benefit from Ketamine-Assisted Psychotherapy?
KAP, as demonstrated in research, can offer significant symptom relief and therapeutic progress for Major Depressive Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, and more recently, Alcohol Use Disorder. In conjunction with mood stabilizers, ketamine has been efficacious in treating depressive episodes in Bi-Polar II spectrum clients as well.
Diagnoses aside, how might an individual decide whether to pursue KAP? In Rachel’s experience as a provider of KAP, she has seen two groups of clients benefit the most from it: 1) people who have tried multiple avenues of treatment but seen little progress or symptom reduction (eg: prescribed psychotropic medication and talk therapy), 2) and people who have already made progress with standard treatments but find themselves at a stuck point or plateau.
There are some contraindications to KAP however. Use of ketamine and other psychedelics in a recreational setting has been associated with emergence or recurrence of psychotic symptoms in people with a history of psychosis or direct family history of it. Psychosis is a constellation of sensory-based symptoms that can occur in patients with Schizophrenia, Schizoaffective Disorder, Bi-Polar Spectrum, Paranoid Personality Disorder, Schizotypal Personality Disorder, Delusional Disorder, and Postpartum Psychosis. Untreated hypertension and cardiovascular disease is also contraindicated, as ketamine can temporarily raise blood pressure. At this time, not enough research on ketamine or psychedelic-assisted therapy exists to demonstrate the efficacy of treatment for personality or substance use disorders, so generally it is not indicated for private practice settings.
How can I find out more or sign up?
Just like any other type of psychotherapy, your therapist must get to know you, your history, and current challenges to help you evaluate whether ketamine-assisted psychotherapy might be a safe and potentially beneficial treatment for you. You will also need to provide medical records from your current psychiatric provider or your current physician who is most familiar with your mental health history.
When evaluation is complete and both you and your therapist agree to do KAP work together, you will be referred to the local physician Rachel has partnered with. Prescriber partners are board certified anesthesiologists trained and experienced in the use of sub-anesthetic ketamine. IV infusion or intramuscular injection sessions will be scheduled with the physician’s office, whereas the psychotherapy sessions are scheduled with me.
What about cost?
Ketamine infusion or injection sessions are not yet well covered by insurance companies, whether a physician is in network with your plan or not. For the psychotherapy component, this practice can bill intake, preparation, and integration sessions to your insurance plan, if we are in network with your plan. If your therapist is offering you therapy during your ketamine administration session, this session is a private pay expense due to length (120 minutes, instead of 45 to 50 for talk therapy). Therapy during ketamine administration sessions, or if your plan is not in network with this practice, are offered at a sliding scale rate based on self-reported income.
Prescriber Partnerships
Currently this practice works with a physician in the Capital District:
Agapi Ermides, D.O., P.C. / Entheon - Troy, NY - Website
Schedule a consultation today to learn more!