Ketamine Assisted Psychotherapy

Ketamine- a new wonder drug in psychiatry!

Ketamine (K) was introduced as a general anesthetic in the 1970’s and is available throughout the world. It was noticed that patients receiving K observed significant improvement in their psychological state. Research and “off-label” use of Ketamine for treatment resistant psychiatric conditions began. Its use remains controversial even though spreading rapidly. It is the only medication in psychiatry that is intended for short- term use and may offer the possibility of safely reducing or getting off psychotropic medications.

How does Ketamine work and how is it being administered?

The fundamental understanding is that Ketamine works as an NMDA (N-Methyl-D-aspartate) receptor antagonist through the glutamate neurotransmitter system. Additionally, opioids and GABA neurotransmitters are involved, making K a very unique psychiatric medication.

Ketamine is classified as a dissociative anesthetic or psychedelic, which can cause temporary disconnect with reality. It is the only legally available psychedelic in the US.

Ketamine can be administered: intravenously (IV) in specialized clinics, sublingually (SL, under the tongue), intramuscularly, intranasal (S-Ketamine), orally and rectally. Even more important are set, setting and understanding which mechanism of K action is being used.

Who can benefit from Ketamine?

Ketamine has only “off label” use in psychiatry, meaning it has never been approved to treat any psychiatric conditions.  The American Psychiatric Association is skeptical of its use.  Some indications for which ketamine is being currently used:

• Treatment Resistant Depression
• Post-Traumatic Stress Disorder
• Suicidal patients
• Anxiety Disorder
• Bipolar Disorder, Depressed
• Bipolar II Disorder
• Obsessive Compulsive Disorder

The treatment resistant psychiatric conditions for which Ketamine can be used but further research is seriously needed:

• Eating Disorders, like bulimia and anorexia
• Substance and alcohol abuse disorders
• Supporting reduction and elimination of psychotropic medications
• Personality Disorders
• Depression with psychotic features
• Schizoaffective Disorder
• Adjustment Disorders and Acute Stress Disorders
• Unresolved Bereavement
• Emotional complications of chronic medical conditions, like Lyme Spectrum Disorder, cancer, Chronic Fatigue and Fibromyalgia
• Alternative to maintenance ECT

Why is there such a proliferation of Ketamine clinics in the last several years?

There is growing discontent among the public: widely advertised promises of psychotropic medications to make people “happy if they just take the right pill” have failed. Few people are able to reach remission using psychotropic medications. If remission does come, it is short lasting. Polypharmacy (use of multiple medications for the same condition) causes side effects and impedes quality of life.

Ketamine clinics and their chains are offering a solution.  In spite of high out of pocket costs, new clinics are being opened, filling up the gap of lost cure promises. Anesthesiologists familiar with alethiological ketamine infusions operate most clinics. Is this a new fad or a real cure???

What makes Ketamine treatment in our office unique and special?

It is difficult to generalize about most Ketamine Clinics.  Based on conversations with clinic owners and reviews of their web sites, some differences can be noted.

Our office specializes in treating those who fail conventional psychiatric treatment options. Ketamine is just the latest addition to our treatment methods. Our office staff consists of Dr. Michael Gurevich, a holistically minded Psychiatrist with 30+ years’ experience and Dr. Tia Trivisonno, a Naturopathic Doctor and licensed Acupuncturist with extensive training in homeopathy.  We offer multiple diagnostic and treatment modalities.

What is Ketamine Assisted Psychotherapy (KAP)?

Ketamine Assisted Psychotherapy (KAP) is a unique, highly effective form of psychotherapy, achieved while a patient is in a Ketamine induced dissociative state of consciousness.  KAP was developed by Dr. Phil Wolfson, MD.  The therapist(s) is always next to the patient assuring safety and security, and assisting in navigating through dissociative experiences and resolutions of symptoms.

What can I expect during a Ketamine Assisted Psychotherapy session?

Ketamine Assisted Psychotherapy (KAP) is a unique experience, but somewhat unpredictable. Its effect depends on the dose, patient’s sensitivity, set and setting, intention and preparation for the session.  It is the expertise of the therapist to optimize the effectiveness of a KAP experience.  Important to remember is that everybody comes back from the journey, no matter how far it takes you.  During therapy a patient may experience sedation, unsteadiness, lightheadedness, sensitivity to light, nausea and vomiting.  Ability to drive will be impaired until the following morning.

Is Ketamine safe for me? What are the common side effects? Can I become addicted?

Ketamine is one of the safest anesthetics and has been widely used in the world for 50 years. Doses used in KAP are significantly lower than those used in anesthesia.

Common side effects during a session: nausea, vomiting, lightheadedness, sensitivity to light, increase in blood pressure and intracranial pressure, sedation and poor coordination.

Ketamine is known as Special K, a party drug.  But given in a controlled dosage and under careful supervision, the addiction potential is very low.  We will control your prescription carefully.

Bladder irritation is a known long-term side effect observed in those using ketamine in high abusive doses over an extended period of time

What are the contraindications to Ketamine treatment?

Ketamine is contraindicated for pregnant and lactating women, and those who have had cerebral aneurism, narrow angle glaucoma or uncontrollable hypertension. Patients with high blood pressure, those with heart problems or other significant medical issues, should consult their medical doctor before therapy is initiated.

How to prepare for a Ketamine session?

In three ways: psychologically, physically and organizationally.

How to take Ketamine at home?

Taking Ketamine at home speeds up recovery and substantially lowers the cost of treatment. You will be given several take-home doses to be taken sublingually (under the tongue), two to three times per week, in the evening when relaxing.  You should prepare yourself emotionally and spiritually for an exploration and healing.  The next day, process the experience by journaling.

How soon will I get well?

Studies show that 50 to 70% of treatment resistant depressed patients can get well.  Some can attain wellness within just a few treatments; for others it may take longer. Many patients notice that they can reduce or in some cases eliminate the medication that they had been taking for years. We will guide you in reducing them properly.

Can I continue to see my therapist or psychiatrist?

Yes, you should.  Ketamine is not a panacea; it is just a new opportunity for you to get well.  Your psychiatrist or psychotherapist, with whom we will communicate on your behalf, will guide you toward resolution of your painful condition.

What is better: Spravato (S-Ketamine) or racemic-Ketamine (usual form)?

Spravato is a patented form of S- Ketamine, which is a left form of Ketamine.  It was approved in an expedited manner by the FDA, in an unconventional, criticized process.  Spravato must be administered in the MD’s office two-three times per week, over a 2-3 hour period.  Only a few insurance companies are covering it. Out of pocket cost can be substantial for the cost of Spravato and the supervision process. There has not been a head to head comparison between Spravato and Ketamine; which one is more effective is unknown. In our office you will have a choice: Spravato or Ketamine.

What are the alternatives for treatment resistant psychiatric conditions?

Unfortunately, most of the approved medications have poor short and long-term effectiveness if previously two or more medications failed.  Medications also always have additional side effects, many of them intolerable.  Electroconvulsive therapy is a well-known option, but with significant side effects and short periods of effectiveness. Therefore ECT is administered as a maintenance treatment, with its own side effects.  Transcranial Magnetic Stimulation (TMS) studies show it has limited success.

Integrative strategies include supplementation, acupuncture, dietary changes, intravenous and neural therapy.   The best alternative is to resolve etiological (illness causing) factors: infections, nutritional deficiencies, and immunological and GI disturbances.