What is the medicine session like?
During the medicine session, the doctor will administer the Ketamine, and then the therapist will be present in the room for the duration of the session. You will be provided a very comfortable chair that reclines, with pillows, blankets and other amenities to ensure optimal comfort.
You will be provided with eyeshades and headphones with a music playlist designed specifically to help support your healing experience.
The therapist will be available for whatever support is needed and bases their responses off of your individual needs. For example, if you have something you want to process, talk about or engage with, the therapist will be there to help. Or, if you prefer to listen to music the whole time, the therapist will support this as well. Beyond the basic measures taken to ensure your safety and that of the therapist, there’s no right or wrong way to do this. The therapist is not there to provide you with direction on how to have the experience, but rather is there to support you in determining what direction makes the most sense for you.
We administer Ketamine in two different ways, and the experiences are a bit different depending on these modes of administration: oral or intramuscular injection (IM).
We start everyone on the oral route of administration, because this helps to orient you to the experience and get a sense of what it is like. This process is also shorter (it’s about 3 hours), while the IM session is about 4 hours. Based on someone’s initial experience with the oral route, we will help determine if they are a good candidate for IM and what kind of dose is most appropriate.
The sublingual/oral use of Ketamine produces a trance-like state that allows you to “dis-associate” from the day-to-day patterns you may feel stuck in, and to gain some distance and ability to observe and interact with your experience in a new and different way. Essentially, you may see your internal experience and the way you interact with the world around you in a new light, thus giving you the opportunity to explore new ways of operating, behaving, and of being in the world.
The oral route often gives one perspective on their own life story and journey, and typically feels very personal- offering lessons that may be applied to one’s day-to-day experiences. This may include insights about one’s own history, relationships, thought/thinking patterns and behaviors.
With the sublingual/oral route, you will be fully aware of your surroundings and able to communicate and interact with the therapist to discuss whatever feelings, experiences and insights you are experiencing.
Intramuscular Injection (IM)
With the IM administration of Ketamine, you are given the opportunity to fully explore your internal world, and take a deep dive into consciousness, free of the body. Although the journey is so difficult to describe, and unique to the individual, most people experiencing the IM journey report having an “out of body experience”, where consciousness is contacted in a more “pure” state. Without the limitations of one’s body, consciousness is expansive, and this experience allows you to contact a deep inner healing intuition.
The IM route is the more “psychedelic” journey-type experience, compared to the oral route of administration, and is often described as transformational to those who experience it. While the oral route is more “personal”, the IM route can produce a “transpersonal” journey- meaning that it goes “beyond” the personal, and into the “bigger picture”- of one’s place in the world, and the connection to deep sources of meaning.
Along with other traditional psychedelics, IM Ketamine can produce “mystical” experiences, which are often felt as spiritual in nature. This does not mean religious or “woowoo”, but a deeply felt sense of connection to the world, Universe and reality itself. For someone who may suffer from a sense of meaninglessness, this sense of connection to a deeply meaningful reality can be tremendously restorative and healing. There are few words that can be found to describe such an experience, because very few of us have a reference point for understanding it.
How does Ketamine work?
It’s complicated. Ketamine primarily works by blocking the NMDA receptors in your brain. This activity, along with mild activity on an opioid receptor, produce the dissociative state and pain relief experienced during procedures. A dissociative state is a disconnection from one’s sense of identity, and is the therapeutic journey we will guide you on.
Ketamine has also been demonstrated to produce rapid (within hours) and sustained (up to 7 days) antidepressant actions in treatment-resistant patients. Like many medications the exact mechanism of action remains to be unknown. However, most hypotheses presume a blocking of NMDA receptors in the mood-relevant regions of the brain, including the medial prefrontal cortex and cortico-limbic areas. In addition, there is growing evidence that additional mechanisms may involve Ketamine metabolites. Metabolites are the product after a compound (like Ketamine) is broken down by the body. This finding is particularly important because one of the metabolites identified is a product of R-Ketamine. Ketamine is composed of two different molecules that are mirror images of each other, S- and R-. Esketamine (S-) has been marketed recently as a new medication to treat depression, but there may be actually more benefit from treatment with Ketamine. For that reason and the significant cost savings, we choose to treat our patients with the option that conveys the most benefit.
What is Ketamine?
You may have heard Ketamine called a “horse tranquilizer”. In reality, Ketamine is the most widely used anesthetic drug in the world. It is an essential drug for both anesthesia and pain relief that is safe to administer to adults and children by a trained provider. Unlike opioids ketamine does not depress your respiratory system which would cause you to stop breathing. It also does not lower blood pressure, which would be equally as dangerous. Because of these characteristics Ketamine has been used on millions of people worldwide, therefore we know a great deal about its safety profile for patients with a variety of different disease states.
How KAP is different from a “Ketamine Clinic”
Today, most clinics that utilize Ketamine rely on a narrow biomedical and pharmacological perspective in the delivery of treatment. The belief is that Ketamine has a strictly biological response, and that the rest of the experience (the subjective, psychedelic part) is just a strange side effect. Based on this assumption, Ketamine infusion clinics don’t provide psychotherapy. Instead, they administer the substance, and leave you for the most part in solitude, with periodic check-ins to make sure you are physically safe.
We believe that there’s more to the story of how Ketamine and other psychedelics work. Because Ketamine is a powerful atypical psychedelic, it produces a wide range of fantastic, sometimes confusing and generally mind-blowing experiences. Ketamine can activate the imagination, magnify thoughts and beliefs, re-examine and interpret memories and deeply explore one’s identity. All of these happenings require support in what’s called “integration”- taking the lessons and deciding how one interprets and applies them to daily life. Because they are so far removed from the day-to-day mode of consciousness we typically maintain, these phenomena require active support in uncovering their meaning and application. We may have great insights or revelations or other hard-to-describe perceptions, and the therapeutic support is vital to enhancing the immediate and lasting impact of the Ketamine experience.
How is KAP Different Than Traditional Therapy
Traditional therapy has many different modalities that focus on the reduction of symptoms of whatever diagnosis a person has and is typically focused on the interaction between two people.
KAP promotes immediate changes in brain functioning, that accompany drastic changes in consciousness and sense of being. Both the pharmacological impact and the subjective experience of a non-ordinary state of consciousness can allow for rapid positive changes in mental state and perception. These effects, combined with the supportive presence and knowledge of a trained psychotherapist, work to maximize the healing potential that Ketamine allows.
Non-Ordinary States of Consciousness
Across the globe, in all cultures that exist today and have existed historically, human beings have accessed non-ordinary states of consciousness for healing, community-connection and to connect with deep sources of meaning.
The importance of music to IIT and personal experiences cannot be overstated. Music as a form of expression is critical to KAP. Music allows nonverbal ways of communication and evokes emotional responses that words often are not able to. The playlist is curated to help clients move through challenging life experiences, memories, or trauma in ways that traditional psychotherapy is not capable of. Music is meant to allow the clients that ability for further introspective thought and insight into issues they are wanting to work on. Music is an immensely important part of the experience and provides a framework for how the experience unfolds.
Music is a vehicle to assist in the experience of medicine-psychotherapies. Oftentimes music is equated to the ship that one rides on, through the oceanic experience provided by the medicine. Medicine-psychotherapies often have a degree of being ineffable; music assists in the narration of that experience that words cannot.
What are the risks?
Outpatient use of Ketamine is very different from inpatient use. The doses are low enough that the patient is still conversant, therefore there is no risk of respiratory depression like with opioids. The most typical effects are nausea, increased blood pressure and heart rate. Vital signs will be checked before your encounter and during if there are signs of physical distress. It is normal for patients that work through their trauma to have moments of distress that do not pose a physical danger to themselves. The therapist will aid in your journey and guide you through those difficult moments. For nausea, you will be offered anti-nausea medication before your session. You can minimize this risk by eating a light meal that day and not eating 4 hours prior to therapy.
What is the difference in dosage used in KAP versus anesthesia?
The doses used in KAP are significantly less than those used for anesthesia, because our goal is not for you to be completely sedated. Our desired effect can be achieved with a dose of approximately 1.5 mg/kg (IM) versus an anesthetic dose of at least 6.5 mg/kg (IM). We also only use sublingual (SL) and intramuscular (IM) routes of administration. These routes decrease the amount of the medicine actually in your system compared to intravenous (IV).
Are there any medical conditions that would prevent me from receiving treatment?
You will receive a complete medical examination before cleared for treatment. Generally, there are few absolute contraindications. These include a history of allergic reaction to ketamine, pregnancy, alcoholism, history of brain bleed, stroke within the last 3 months, significant uncontrolled high blood pressure, heart attack within the last 3 months, untreated thyroid disease, and known or suspected schizophrenia.
Relative contraindications will not necessarily exclude patients from treatment. These conditions will be evaluated in the context of the patient’s overall health to determine suitability. The most common conditions being increased pressure in the eye, decreased lung function (requiring home oxygen), sudden and serious symptoms of heart failure called acute decompensated heart failure, failure of the heart to maintain adequate circulation (ejection fraction < 40%), history of tracheal stenosis, tracheal surgery, or airway instability, and urinary retention.
What does “off-label use” mean?
Once a medication is approved by the US Food and Drug Administration (FDA) for an indication a provider may be able to use it for other indications (off-label) if there is evidence that supports that use. Ketamine has been around for so long that it is now a generic drug. It takes millions of dollars to seek FDA approval for a drug. As a result, pharmaceutical companies do not have any incentive to invest in the study of a generic drug that they cannot recoup the cost. This is why Ketamine’s use to treat conditions such as treatment-resistant depression remains off-label.
Off-label does not mean it is illegal or not advised to use. Several medications that are prescribed for one indication are used for completely different indications. For example, the blood pressure medications Prazosin and Clonidine are used off-label for nightmares and ADHD, respectively. Off-label medications should be prescribed by a provider that understands the weight of evidence, risks, and benefits for its use.
What can Ketamine be used to treat?
Current off-label use of Ketamine has been shown to be effective in many people suffering from many conditions, including major depression, bipolar depression, postpartum depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder, pain syndromes such as neuropathic pain, fibromyalgia and complex regional pain syndrome (CRPS).