Ketamine Assisted Psychotherapy

Ketamine is a popular anesthetic that has been used for several decades for surgeries and in emergency rooms for pain management. Ketamine is a dissociative anesthetic, dissociation meaning a sense of disconnection from one’s ordinary reality and usual self. Ketamine also has mild anxiolytic, anti-depressant and, potentially, psychedelic effects. Altered mental states such as mystical and spiritual often occur with its use. 

Recently ketamine has been found to be a novel and effective treatment of mental health issues and has been utilized in the psychiatric field for the treatment of depression, suicidality, PTSD, OCD and, interestingly enough, substance abuse issues. Why ketamine works when other medications and treatments have failed is thought to be due to its different mechanism of action.  In short, ketamine works on the glutamate receptor systems while most antidepressant medications work on serotonin, norepinephrine or dopamine. Specifically, ketamine binds to the NMDA receptor and is very fast acting.  Many people will improve after their first treatment although most improve after their third to fourth treatment. Its fast-acting nature is particularly helpful in the treatment of suicidality, when time is of the utmost importance. 

How does ketamine work?

When ketamine binds to NMDA receptors it leads to a release of glutamate which is a major excitatory neurotransmitter in our brain.  This increase in glutamate causes a cascade of changes in our brain that helps promote neuronal growth and plasticity, which are important in helping strengthen neurons and improve communications with other neurons. Loss of neuronal plasticity or atrophy is common in depression, chronic stress, trauma, and age.  So, being able to reverse these changes is what has gotten the mental health community excited about its use.

Ketamine and Therapy

Another way that ketamine is thought to help individuals is through the brief opening of the mind. When ketamine is combined with therapy, it helps to reduce defense mechanisms and allows one to temporarily process past or current traumas or painful situations in a different way. It allows one to re-evaluate and process past hurts, ideas and maladaptive thoughts through a different mental state, which can promote true healing.  Ketamine assisted psychotherapy is now being incorporated in practices throughout the country to enhance and expedite therapy for qualified individuals. Therapy can be performed either during or after ketamine sessions depending on how the ketamine is used. 

How is ketamine administered?

At Lopez-Larson and Associates, we combine oral lozenges with psychotherapy to potentiate the powerful antidepressant and anti-anxiety effects of ketamine. When utilized along with psychotherapy, ketamine helps to open the mind, reduce defenses and process past traumas and conflicts. 

In addition to oral lozenges or troches, there are 3 other ways ketamine is given and each delivery method has their own pros and cons and uses. The routes of administration include intravenous (IV) infusions, intramuscular (IM) injections, and intranasal sprays. It is important to review the pros and cons of ketamine treatment and uses with your psychiatric health professional to determine which treatment type would be optimal for you.  

What are the response rates and side effects?

In general, the response rates for ketamine treatments are as high as 70 to 80 percent even for those struggling with treatment resistance.  The side effects are minimal outside of treatment but during treatment some level of dissociations are common. Others side effects including nausea, vomiting, sedation, dizziness and increased blood pressure and heart rate.  The intensity of the dissociative effects and side effects vary depending on the dose and how ketamine is given.

Ketamine is a powerful medication that has a unique mechanism of action making it a potential life-saving and transformative treatment. If you want to learn more about ketamine and ketamine assisted psychotherapy, please reach out and schedule a free consultation.  Help really IS a phone call away!