Ketamine Assisted Therapy Overview

Ketamine, initially developed as an anesthetic in the 1960s, has emerged as a groundbreaking treatment in mental health therapy. Its use in a controlled, therapeutic setting focuses on leveraging its unique properties to address mental health challenges, particularly those resistant to conventional treatments.

Key Characteristics of Ketamine

• Mechanism of Action: Ketamine primarily acts as an NMDA receptor antagonist, modulating glutamate (a key neurotransmitter) and fostering synaptic plasticity. This mechanism promotes rapid improvements in mood and cognition.

• Forms of Administration:

  • Intravenous (IV): Common in medical settings for precise dosing.

  • Intramuscular (IM): Offers rapid absorption and effectiveness.

  • Oral/Sublingual: Often used in outpatient or at-home protocols.

  • Nasal Spray: FDA-approved esketamine (Spravato) for treatment-resistant depression.

Applications in Therapy

1. Treatment-Resistant Depression (TRD):

   • Ketamine provides rapid relief for individuals unresponsive to traditional antidepressants, often within hours to days.

2. Anxiety Disorders:

   • Effective for generalized anxiety, social anxiety, and PTSD.

3. Post-Traumatic Stress Disorder (PTSD):

   • Helps disrupt the neural patterns associated with traumatic memories.

4. Chronic Pain:

   • Addresses comorbid depression and pain conditions by altering neural pathways.

5. Suicidality:

   • Ketamine is recognized for its ability to reduce suicidal ideation quickly.

Therapeutic Framework

1. Preparation Phase:

   • Involves setting intentions, discussing potential outcomes, and creating a safe therapeutic environment.

   • May incorporate mindfulness, breathwork, or somatic practices.

2. Dosing Sessions:

   • Conducted in a controlled setting with medical and/or psychological supervision.

   • The individual experiences a dissociative state that can facilitate insight, emotional release, and neurocognitive shifts.

3. Integration Phase:

   • Focuses on processing the experience through psychotherapy, journaling, or creative expression.

   • Helps translate insights into actionable changes in daily life.

Potential Benefits

• Rapid symptom relief (unlike weeks-long onset with traditional antidepressants).

• Enhanced neuroplasticity, supporting long-term emotional and cognitive flexibility.

• Facilitates deep introspection and reprocessing of emotional wounds.

• Reduces rigid thought patterns often associated with depression and anxiety.

Risks and Considerations

• Side Effects: Nausea, dizziness, dissociation, or increased blood pressure during administration.

• Dependency: While uncommon in a therapeutic context, ketamine has addictive potential when misused.

• Cost and Accessibility: Treatments can be expensive and are not universally covered by insurance.

• Medical Supervision: Essential to monitor physiological and psychological responses.

Integration with Other Modalities

Ketamine therapy often pairs well with complementary approaches like:

• Mindfulness-Based Practices: For grounding during or after sessions.

• Talk Therapy: To integrate insights into daily life. This could take several sessions to fully integrate after each dosing session and beyond.

• Somatic Therapies: To address trauma stored in the body.

• Nutritional and Herbal Support: To stabilize mood and enhance neurochemical balance. Here are further examples of what I utilize to support the mind and body prior, during and after ketamine sessions.

• Herbal Support

  1. Pre-Therapy Herbs:

     • Adaptogens: Balance the stress response and enhance resilience.

       • Examples: Ashwagandha (this herb should be used with caution in individuals with histories of complex truama as in some cases it could exacerbate existing symptoms) , Rhodiola, Holy Basil.

     • Nervines: Prepare the nervous system by promoting calm and focus.

       • Examples: Lemon Balm, Skullcap, Passionflower. Chamomile are some examples. Taking into consideration individual histories, herbs will be suggested for you.

  2. During Therapy:

     • Grounding Herbs:

       • Ginger or Peppermint Tea: To manage nausea or discomfort.

       • Chamomile: Provides gentle relaxation without interfering with the ketamine experience.

  3. Post-Therapy Integration:

     • Neuroprotective Herbs: Support neuroplasticity and cognitive recovery.

       • Examples: Lion’s Mane Mushroom, Ginkgo Biloba.

     • Mood Balancers:

       • St. John’s Wort (if not contraindicated): Enhances serotonin regulation.

       • Saffron: Uplifts mood and enhances emotional balance.

     • Adaptogens for Recovery:

       • Rebuild energy reserves and support stress recovery.

       • Examples: Eleuthero, Schisandra, Reishi mushroom.

  Synergistic Practices

  • Herbal Tea Rituals: Incorporating intentional tea-drinking practices pre- and post-session can aid in grounding and mindfulness.

  • Functional Smoothies: Add adaptogens, greens, and brain-boosting supplements (e.g., MCT oil, spirulina) for post-session recovery.

  Precautions

  • Drug-Herb Interactions: Some herbs (e.g., St. John’s Wort) may interact with medications or ketamine itself. Consultation with a certified herbalist or healthcare provider is essential.

  • Nutritional Timing: Avoid heavy supplementation immediately before therapy to prevent interference with ketamine absorption or effects.

  • Personalization: Tailor nutritional and herbal plans to individual needs, considering mental health history, physical health, and session goals.