Definitive Guide on Ketamine Assisted Psychotherapy for Better Mental Health

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Ketamine has been used as an off-label drug for pain, treatment-resistant depression or TRD, anxiety, suicidal ideation, post-traumatic stress disorder, and substance addiction.

It has been found to provide fast relief from depression and suicidal ideation. It’s safe and effective at low doses. The Injection and Infusion Clinic of ABQ has been administering ketamine IV infusions since 2017. If you have questions about ketamine IV, you may call us at 505-445-4300.If you’re already receiving ketamine IV infusion, you may want to look into a more meaningful experience. Ketamine-assisted psychotherapy is a relatively new therapeutic approach that combines ketamine infusion with psychotherapy sessions. It’s performed by a mental healthcare clinician.

In this blog, you’ll learn about what, why, and how ketamine-assisted psychotherapy works:

What is Ketamine Assisted Psychotherapy?

Ketamine with psychotherapy was first reported in the 1970s. It’s defined as psychedelic with psychotherapy or “psychedelic-assisted psychotherapy.” Those specific to ketamine is called “ketamine-assisted psychotherapy.” 

Ketamine has been suggested as a means of facilitating psychotherapy with proper assessment and considerations. Mental healthcare professionals may use it as an effective and safe substance in interventions by setting the mind-frame and therapeutic environment

Ketamine and psychotherapy form a synergistic effect. You may experience a dreamlike state during the ketamine infusion. At this time, a mental healthcare clinician conducts psychotherapy. Your psychological barrier is lowered which allows for personal reflection and psychotherapeutic intervention. You may feel the dissociative and psychedelic effects at moderately higher doses. This state offers more profound insights and a deeper sense of spiritual connection.

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Positive effects of Ketamine Assisted Psychotherapy 

There are a few yet compelling studies on the effects of KAP used for various mental health conditions.

  • Alcoholism. A study reveals that KAP was significantly more effective in the treatment of alcoholism than standard psychotherapy. It also resulted in positive life changes beyond sobriety.
  • The same results were validated in another study. The researchers indicated that KAP resulted in psychological changes in favor of sobriety and a positive view about self and others. It brought significant insights into the meaning of life and increased spiritual development. 
  • Anxiety. Terminally-ill people underwent ketamine-enhanced psychotherapy in five stages to treat their death anxiety. It provided a change in attitude about death and overcame their existential anxieties about dying. The researchers concluded that ketamine-enhanced psychotherapy as a promising practice in resolving anticipated grief, such as death anxiety.
  • Depression. Findings of a study suggest KAP as an effective means of reducing anxiety and depression in people suffering from severe symptoms and among older adults, too.

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5 Questions to ask yourself if you are eligible for ketamine-assisted psychotherapy

You will be interviewed to determine your eligibility before you can proceed with the Ketamine Assisted Psychotherapy. You will be evaluated based on your medical profile and psychiatric history. This includes medications, supplements, and over-the-counter drugs you are taking. 

You are eligible for KAP if you answer “no” to the following questions:

  1. Do I have untreated hypertension?

Rationale: Ketamine may increase blood pressure and pulse rate. People with heart disease may likewise be ineligible for KAP. These include arrhythmias, coronary heart disease, and congestive heart failure.

  1. Do I have hyperthyroidism?

Rationale: In a study, ketamine increased blood pressure and pulse rate after administration of thyroid replacement therapy. People with hyperthyroidism have an increased heart rate and taking ketamine may worsen it.

  1. Am I suffering from substance abuse?

Rationale: Ketamine may be used as a therapy for substance abuse. Ketamine though may be infused only after proper detoxification from the drugs you are addicted to. Mixing drugs may have unpredictable effects that may also be life-threatening.

  1. Am I pregnant?

Rationale: Does this mean that ketamine can cause potential adverse effects on the fetus? A recent study suggested possible neurotoxicity to the brains of developing fetuses. More studies have yet to determine the cause of ketamine to unborn children in the womb. It’s best not to expose pregnant women to ketamine, which may potentially harm the baby. 

  1. Am I breastfeeding?

Rationale: More data have yet to surface regarding the effects of ketamine on breastmilk. It’s also best to refrain from KAP while breastfeeding to ensure the safety of your baby.

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3 Routes of ketamine administration

Ketamine can be administered sub-lingual (SL), intramuscular injection (IM), and intravenous infusion (IV). These are thoroughly discussed in a Ketamine-Assisted Psychotherapy Informed Consent form:

1. SL ketamine lozenges: SL ketamine lozenges are dissolvable tablets to be taken under the tongue. It has a lower dose compared to IM and IV. This aims to uplift you from your depression or other mood disorders. It allows you to experience psychological healing. Full benefits may be achieved through repeated administration of lozenges. 

2. IM: IM ketamine is given either in the hip or shoulder. It has a rapid onset that creates a dissociative experience. This aims for an altered state of consciousness for a deep transpersonal experience. 

A mental healthcare clinician or therapist guides you through the process of KAP. At this state of consciousness, you may be able to resolve existing worries and speed up your spiritual growth. This will lead to your deep personal transformation and an improvement in your general lifestyle. 

This is also why you have to be honest and trusting of your mental healthcare clinician or therapist. Because all the information you will give out will help in overcoming your issues and struggles during KAP.

3. IV: You will receive ketamine through an intravenous line for about 40 minutes to an hour. This depends on your dose and preference on the rate infusion. This provides the best means for a profound KAP experience compared with SL and IM. 

A study shows that a low dose of 0.5mg per kg of ketamine IV has a response rate of 50-70% among people with treatment-resistant depression. Relapse may occur in the third weekup to 18 days. This may require you to get additional sessions. KAP though may enhance these response rates.

3 Roles in ketamine assisted psychotherapy

The Ketamine Research Institute or KRIYA released Guidelines for Therapeutic Ketamine Clinicians. The three roles of a therapeutic ketamine treatment are the following:

  1. Medical practitioner: The medical practitioner or healthcare provider assesses the client’s physical status before the therapy. Monitoring the client’s status is a major responsibility. This includes ensuring safety protocols are in place and addressing potential adverse reactions during the therapy.
  2. Mental healthcare clinician: During preparation, the clinician conducts the client’s initial interview/assessment and plans for the integrative treatment. The clinician also provides psychological support and manages psychological emergencies throughout the therapy.
  3. Client: The client should be honest in giving all the needed information during the interview/assessment. This enables the clinician to come up with a good plan for the integrative therapy. Honesty and open communication are also important. This will let the clinician and medical practitioner know about the client’s condition during the therapy. Most of all, the client is expected to participate in the integrative treatment plan.

3 Phases in ketamine assisted psychotherapy

There are three phases of KAP according to McInnes and Yu’s presentation on Ketamine-Assisted Psychotherapy: A Practical Guide for Medical Providers. They presented the stages of preparation, administration, and integration during the 2020 Psych Congress Virtual Experience. These stages originated from a recent study on ketamine psychedelic psychotherapy.

The authors noted that psychotherapeutic interventions are provided during the administration and integration stages. A mental healthcare clinician also monitors the person undergoing KAP throughout the whole session.

Preparation: You will undergo a liver function test and urine test for pregnancy, and drug use. Your vital signs will be checked. This includes your exact height and weight as these are needed in calculating your ketamine dose. You will then sign a consent form. You will be oriented about ketamine and what to expect during KAP.

Administration: You may sit or lie down in a comfortable position as ketamine will be administered either SL, IM, or IV.  The Injection and Infusion Clinic of ABQ provides the IV route. In the case of the authors, they chose the SL route as an example. Instrumental music may be provided as you go through KAP. You may or may not experience side effects at this phase.  Some potential side effects may include anxiety, headache, irritability, dissociation, and increased blood pressure or heart rate.

Integration: The integration phase happens after the ketamine infusion session. Therapeutic techniques offered are cognitive behavior therapy, dialectical behavioral therapy, emotion modulation therapy, guided imagery, mindfulness, and mindful compassion. The most vital aspect of KAP is a personal narration of your profound and healing experience. 

McInnes and Yu discussed evidence-based cases on KAP. One, a 65-year old man with TRD reported interpersonal and physical improvements, as well as a renewed sense of purpose in life. Another, a 39-year old female with TRD reported a feeling of a sense of unity and that “everything will be okay.” 

Your thoughts about Ketamine-Assisted Psychotherapy matters

KAP is gradually gaining traction as a new intervention coupled with ketamine IV infusion. Although, KAP may not be for everyone due to its medical restrictions. Share your thoughts about KAP with us, so we know how better to serve you. You may visit us in Albuquerque, Santa Fe, Rio Rancho, Tijeras, Edgewood. Or, we’d appreciate it if you’d leave a comment and we’ll get back to you as soon as we can.