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Ketamine

An Introduction to Ketamine-Assisted Psychotherapy

Laying out the basics of an alternative approach to mental health care.

Key points

  • Ketamine-assisted psychotherapy (KAP) utilizes ketamine to help patients struggling to find relief from mental health symptoms.
  • Research has explored the potential of psychedelics in psychotherapy for several decades.
  • Ketamine's dissociative and pain-managing processes help individuals safely explore painful emotions and memories.

Talk therapy has been an excellent–sometimes life-saving–process for many struggling with mental health.

But for others, no matter how long they spend on the therapist’s couch, they struggle to find relief for their symptoms. In those cases, nontraditional therapy tools might be more effective—tools like ketamine.

 Ketamine has a number of properties that make it useful in the medical field.
Mohamed Nohassi/Unsplash
Source: Ketamine has a number of properties that make it useful in the medical field.

Ketamine is a drug that is best known for both its pain relief and its psychedelic properties.

Ketamine can decrease sensitivity to pain, and depending on dosage, route of administration, etc., it can create hypnotic, dream-like, or even fully dissociative trance states for a person.

Thanks to these effects, ketamine has had many uses in the medical field over multiple decades. It is often used as a part of general anesthesia to control pain during and after surgery. Ketamine has also developed something of a negative reputation as of late due to increased instances of misuse and addiction on the street.

However, ketamine is beginning to gain traction in quite a different context: psychotherapy.

Ketamine-assisted psychotherapy (KAP) is a mental health treatment method that involves using ketamine’s trance-inducing and pain-relieving properties to help individuals work through various mental and emotional challenges.

As a certified KAP provider in California, I field inquiries from patients interested in this treatment on my website. I hope to address some of the most common questions in this post.

 Jared Rice/Unsplash
Ketamine has many uses in the medical field.
Source: Jared Rice/Unsplash

For a few decades, researchers have looked into the uses of psychedelic substances like psilocybin (commonly associated with magic mushrooms) and MDMA (commonly associated with ecstasy) as an alternative and/or supplement to traditional talk therapy.

All this research has proved promising, but ketamine has pulled a bit ahead of the pack in many ways.

The first reports of using ketamine in psychiatric treatment came in 1973.

Since then, research and personal anecdotes have painted a successful picture of ketamine in treating anything from depression to addiction to post-traumatic stress disorder (PTSD).

In 2019, ketamine became the first psychedelic drug to be approved by the FDA for use in treatment-resistant depression.

Today, KAP is most often used in treating major depressive disorder (MDD) and PTSD but has made appearances working with issues like substance use disorders and obsessive-compulsive disorder (OCD), among others.

What is it about ketamine that makes it such a promising therapeutic tool?

Treating mental illness is not often as simple as weekly talk therapy or daily medication. Sometimes, it can be difficult, maybe even seemingly impossible, for a person to manage their symptoms.

 Gift Habeshaw/Unsplash
Finding relief for mental health symptoms can be challenging.
Source: Gift Habeshaw/Unsplash

Let’s face it—our minds can be scary sometimes. Unpleasant thoughts, painful memories, stubborn beliefs about ourselves and the world? These are not always easy things to sit with, let alone long enough to deal with.

Because our brains are wired to try to protect us, the root of these issues can often be shoved down out of our reach, leaving us to deal with the aftermath.

So, someone living with MDD might be battling a constant wave of hopeless thoughts and negative beliefs about their self-worth, while someone with PTSD is trying to manage debilitating fear and uncontrollable flashbacks.

This is where KAP comes in. During a typical KAP session—prefaced by thorough evaluation and discussions with the provider—a patient will usually lie down in a quiet room and take the prescribed dose of ketamine. Providers might put on soft music or have patients wear an eye mask to keep the environment as relaxed as possible.

 Ann Danilina/Unsplash
KAP aims to be a safe space to explore difficult emotions and memories.
Source: Ann Danilina/Unsplash

In many cases, the medication will be in the form of a lozenge that dissolves under the tongue and takes about 10 minutes to kick in. Other methods include a nasal spray or a series of injections, depending on the patient, the therapist, and the treatment setting.

Shortly after, patients will start to feel the dissociative effects. For the next 45 minutes or so, with the therapist monitoring, patients explore whatever arises.

According to both providers and patients, these trance-like states that ketamine can produce relax the walls that often come up when trying to address painful emotions. With these walls down, patients can access these things in a controlled environment without fighting against the mind’s natural defenses.

After the experience, the patient and provider sit together and discuss what came up. Patients can continue to work through their challenges in the weeks following, ketamine included or not.

Notably, patients tend to report few side effects from KAP, aside from those typically expected from psychedelic substances—dizziness, nausea, vomiting, and increased heart rate being the most common.

Jesse Gardner via Unsplash
KAP can provide an opportunity for those who have struggled with other treatments
Source: Jesse Gardner via Unsplash

As with any practice that involves bringing up painful feelings and experiences, things can feel a lot worse before they start to feel better. Anyone looking into KAP should keep this in mind and discuss a potential plan with their therapist if necessary.

Many have found that the experience of KAP led to therapeutic breakthroughs at an exponentially faster rate than traditional talk therapy. They’ve uncovered repressed memories, faced previously unbearable emotions, and even found the purpose they have been searching for.

Research is, of course, still ongoing for KAP and other psychedelic psychotherapies. While this doesn’t mean KAP will be a guaranteed fix, it opens a much-needed door for people struggling to progress with more traditional forms of therapy.

Disclaimer: As a KAP therapist, I lead patients through treatment, but I do not prescribe the ketamine involved in treatment.

If you pursue KAP, please discuss these next steps with your provider.

To find a therapist near you, visit the Psychology Today Therapy Directory.

References

Romeo, Karila, L., Martelli, C., & Benyamina, A. (2020). Efficacy of psychedelic treatments on depressive symptoms: A meta-analysis. Journal of Psychopharmacology, 34(10), 1079–1085.

Khorramzadeh, E., & Lofty, A. O. (1973). The use of ketamine in psychiatry. Psychosomatics: Journal of Consultation and Liaison Psychiatry.

Dore, J., Turnipseed, B., Dwyer, S., Turnipseed, A., Andries, J., Ascani, G., ... & Wolfson, P. (2019). Ketamine assisted psychotherapy (KAP): patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of psychoactive drugs, 51(2), 189-198.

Liu, Y., Lin, D., Wu, B., & Zhou, W. (2016). Ketamine abuse potential and use disorder. Brain research bulletin, 126, 68-73.

Drozdz, S. J., Goel, A., McGarr, M. W., Katz, J., Ritvo, P., Mattina, G. F., ... & Ladha, K. S. (2022). Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature. Journal of Pain Research, 15, 1691.

Gao, M., Rejaei, D., & Liu, H. (2016). Ketamine use in current clinical practice. Acta Pharmacologica Sinica, 37(7), 865-872.

Romeo, B., Karila, L., Martelli, C., & Benyamina, A. (2020). Efficacy of psychedelic treatments on depressive symptoms: A meta-analysis. Journal of Psychopharmacology, 34(10), 1079-1085.

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