Ketamine

Psychiatric use of ketamine has become relatively widespread in recent years, has been studied and promoted by researchers at the National Institute of Mental Health, and has had front-page publicity as an effective antidepressant with a novel pharmacological mechanism of action. Ketamine can be administered by intravenous, intramuscular (IM), sublingual, oral, and intranasal routes. Often, it is used after other treatment approaches have been unsuccessful.

Ketamine is now an "off-label" treatment for various chronic "treatment-resistant" mental health conditions. Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent and in recent years is being used as an effective treatment of depression, alcoholism and other substance dependencies, PTSD and other psychiatric diagnoses.

Ketamine is classified as a dissociative anesthetic, dissociation meaning a sense of disconnection from one's ordinary reality and usual self. At the dosage level administered to you, you will most likely experience mild anesthetic, anxiolytic, antidepressant and, potentially, psychedelic effects. While more recent work has demonstrated the possibility of an antidepressant response to low doses of ketamine administered intravenously, intra-nasally and sublingually (orally) that produce minimal psychedelic effects (with this effect tending to be more sustained over a series of weekly treatments-in other words, a cumulative effect) it is our view that more psychedelic "dissociative" experiences may be instrumental in providing a more robust effect.

This may include a positive change in outlook and character that we term a "transformative" response. We tend to employ both methods together as will be described herein. Essential to both methods is a "time-out" of one's typical experience of thinking and self-perception, with the duration of this period varying usually between 30 minutes to 2 hours. Duration of drug effects tends to be dependent on the dose and route of administration delivered. Relaxation from ordinary concerns and one's usual state of mind, while maintaining some level of conscious awareness, is characteristic during the drug effects of ketamine. This often leads to a disruption of negative feelings and obsessional preoccupations. It is our view that this relief and the exploration and experience of non-ordinary states of consciousness are singularly impactful. As ketamine-assisted psychotherapists, we act as stewards to the experience and assist clients in processing their experience and its impacts both before and after each ketamine session.

How Does It Work?

The current understanding of ketamine's mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system. This is a very different pathway than that of other psychiatric drugs such as SSRI's, SNRI's, lamotrigine, antipsychotics, benzodiazepines, etc. The mu-opioid receptor may also play a role in the acute antidepressant effects of ketamine. Research has indicated the efficacy of ketamine in increasing neuroplasticity through the modulation of brain derived neurotrophic factor (BDNF), which assists in adaptive learning and behavioral changes, especially accessible in a window of 36-72 hours immediately following ketamine treatments.