Ketamine is a synthetic pharmaceutical compound, classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. As an anesthetic, it is most commonly used in surgical settings, including pediatric surgery, due to its excellent safety profile, particularly around breathing/airway management. It has also been utilized successfully in managing acute and chronic pain conditions due to its analgesic properties. Off-label, ketamine is a legal, safe and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and complex trauma. The medicine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood.

Ketamine has also been shown to enhance overall neuroplasticity, leading to longer-lasting symptom improvement. In a safe "set and setting," the medicine can contribute to profound psychological and spiritual insights. The medicine improves our psychological flexibility, allowing us to pause and respond thoughtfully to problems and challenges rather than reacting emotionally or trying to control life circumstances.Also, integrating the experience with KAP enhances mindfulness and anchors people in the present moment, away from negative thoughts and feelings about the past or the future that contribute to anxiety and depression.

As with all other psychedelics, the medicine itself is not a magic bullet and is not an effective standalone treatment, and is best applied as part of a comprehensive therapeutic plan. Discussing your experience in integration therapy sessions within 48-72 hours will help you maximize the gains made in this process. Although the medicine is the catalyst for change, it is the therapeutic relationship – with mindful reflection, investigation, patience, and integration – that is the vehicle of transformation. When coupled with psychotherapy, it has shown to be helpful for the relief of treatment-resistant depression and trauma-related symptoms such as anxiety, hopelessness, disordered eating, and poor sleep. The medicine is also not sertonergic, so unlike other classic psychedelics, clients do not have to stop using their psychiatric medications in order to participate in this modality.

The medicine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using sublingual lozenges. In my work with my partner psychiatrist, my clients are only prescribed the sublingual lozenge form.

KAP can provide quick relief of depressive, anxious, and compulsive states. When the medicine is administered in a subanesthetic dose, it quickly lifts depression by causing a surge of a chemical called glutamate in the brain. It also triggers the growth of new nerve connections, improving nerve pathways and creating a more adaptable brain to process more effectively.

KAP is also a great tool for processing emotions that we have pushed deep down or internalized. The medicine allows us the space to take a step back, breathe, and process in a safe and supportive container with a therapist. Sometimes we just need some time to relax our nervous systems so we feel safe enough to process trauma and emotions that have been repressed.

Working with a KAP therapist allows you extra support and safe space to process in and allows for higher rates of transformation long-term.

1. Initial consultation with partner psychiatrist:

●  You schedule an initial evaluation with partner psychiatrist via zoom or in person. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are eligible for KAP.

●  If our partner psychiatrist determines that you are eligible for KAP, they will develop a personalized prescription and outcome monitoring plan for you.

●  They will write a prescription for you, and the oral medication will be sent to your home, enough for the first 2-5 KAP sessions.

2. Preparation sessions (1-3 depending on experience):

● Once you receive your lozenges, we will schedule time together for our KAP preparation, dosing and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. If you are a new client, you will need to schedule at least one 90-minute intake session so I can get a complete psychological history with you and we can get to know one another, as well as at least one preparation session prior to the dosing session. The better relationship and rapport we have with one another, the better outcome of the entire experience. The goal of a preparation session(s) is to align on the process and set intentions for our KAP sessions together.

3. KAP Dosing Session:

●  A typical dosing session lasts for 2.5 hours and will take place remotely via telehealth. (In-person availability coming this fall!)

●  During a dosing session, you will self-administer your lozenge in your home. You will be in a comfortable, reclining position wearing an eye mask and listening to calming music while I will be present virtually and guide you throughout the experience. The first dose will help us assess how responsive you are to the medicine and allow us to evaluate the effectiveness of the lozenges, adjusting the dose if necessary. Some people experience empathogenic effects, such as emotional openness, at this dosage and find that engaging in therapeutic exploration can be quite beneficial. Others may find speaking difficult and prefer to focus internally, even at this lower dose. I will respect your preferences for engagement. After 15-30 minutes, you may have the opportunity to self-administer a second dose, which you will be asked to keep in your mouth for 15 minutes. Each sublingual dose reaches its peak effect in about 20 minutes. Although a KAP dosing session may be largely an internal experience, I will be present virtually with you the entire time to hold space and provide support as needed. You will also have an in-person chaperone present with you to ensure your well being.

● You are welcome to share as much or as little as you like, but there is no pressure to narrate your journey. I will take notes on anything you choose to share, as it may be helpful during the integration of your experience. You’ll have the chance to share once the effects of the medicine have subsided. I will reconnect with you as you return from the most active phase of your journey and are ready to engage with the outside world. The moments following an altered state can be profoundly poignant and have a unique ability to influence how we connect with others. I value this opportunity with the importance it deserves. You are invited to share your experience and discuss any insights or perspectives you’ve gained. However, some people prefer to reflect on their experience quietly and discuss it in a later integration session. Whatever choice you make will be respected.

4. Integration Sessions:

● After our KAP dosing session, we will meet for at least one integration therapy session to review the memories, thoughts & insights that arose during your dosing session, and to prepare for the next dosing session. Many prefer additional integration session as this is really where the magic happens and where the long-term results occur!

5. Follow-up consultations with psychiatrist:

● After your first several KAP sessions, you will schedule as-needed follow ups with our partner psychiatrist to monitor outcomes and prescribe lozenge refills, as appropriate. The frequency of follow ups depends on your unique treatment plan. 6-8 sessions are recommended as an initial course of treatment to provide ongoing efficacy & lasting improvement.

The effects of the medicine, which most patients find pleasant and relaxing, last for approximately 45 minutes-1 hour. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. This powerful, quick-acting, and quick to wear off psychedelic can elicit a state of wonder by manifesting extraordinary visuals and inspiring deeply felt presence. Your experience will be unique to you, and each of your sessions will be different. All such journeys are adventures that cannot be programmed. They evolve from your own being in relation to this medicine, and it is best to relax into the path that unfolds. Many enjoy the journey and often come through it with greater insight into themselves and their lives. Many people report “psychedelic” effects (feelings of oneness, time distortion, inability to describe the experience in words). 

Though experiences vary greatly, it is generally thought that lower doses provide empathogen-like (heart-opening) responses, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving peak experiences. Dissociation can feel like detachment from your body, the environment and your usual sense of self.  The experience is characterized by the relaxation of ordinary concerns and usual mindset. This tends to lead to a disruption of negative feelings and preoccupations which can lead to significant shifts in overall well-being. At lower doses, you will likely experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience empathogenic effects in this dose range. This state may also enhance participation in psychotherapy, as defenses are relaxed, yet communication with others is still possible. The medicine can help release suppressed emotions such as grief, anger, or sadness. It's common to cry, laugh, or feel a surge of emotions during a session. Many people report heightened emotional awareness, gaining insights into their feelings and patterns of behavior.

Higher doses are more likely to produce psychedelic, dissociative states that are largely internal journeys away from the external world. Body sensations are greatly diminished. Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological (and possibly spiritual) growth, and promoting a positive change in outlook and character, this is known as a transformative response. Sensory effects of the medicine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, vivid imagery, and changes in visual, tactile and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar music may not be recognizable. An ordinary sense of time may morph into time dilation. Some people report psychic experiences, which they perceive as bizarre or frightening, while others describe them as pleasurable, joyful, or fascinating. We have found that even frightening experiences can be of great value to your recovery process.

Once these effects subside, we’ll spend the remainder of your dosing session giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, patients feel like the insights gained are none-the-less clear. Many individuals feel a stronger sense of connection to themselves and others, fostering feelings of compassion and empathy. Overcoming emotional blocks can also lead to a sense of empowerment and inner strength.

Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the experience.

Treatment has shown several benefits, with many studies highlighting its efficacy; however, it is still a relatively new and experimental psychiatric intervention, so there are no guarantees regarding your outcome. Durable improvement typically requires more than one administration and is most effective when part of a comprehensive treatment program. KAP may not permanently relieve your condition. Even if your symptoms respond well to the medicine, you may still choose to continue with other medications and ongoing psychotherapy to minimize the risk of relapse. Over time, you might also need additional booster doses or other therapies to maintain remission.

If you do not respond to the medicine after the first administration, repeated treatments will be offered. However, if you do not respond after a series of 8 doses, additional treatments will not be provided, as studies indicate it is ineffective to continue treatment for those who do not respond within the first 8 doses. At that point, the treatment team will discuss other available options with you.

As a result of your experience, you may notice improvements in your emotional state and a reduction in symptoms such as depression, anxiety, and post-traumatic stress. You might feel somewhat different after a session, with that change feeling liberating, enabling new perspectives and behaviors. These shifts can occur during treatment, in its immediate aftermath, and/or in the days and weeks that follow. Some experiences may be uncomfortable, and I will work with you to understand them in the context of your healing process. Ultimately, my goal is to help you change patterns of thought, mood, and behavior that cause difficulty and distress. This is a unique opportunity for growth and change, so I encourage you to actively engage in both the therapeutic process and the medication administration. While the medication provides symptom relief, it is most effective long-term when combined with therapy and your active participation in the integration process.

What is the Cost of Treatment?

● Psychiatrist Medical Costs (paid directly to them)

• Initial medical consultation: $375

• First follow-up medical consultation and dosage adjustments (40 min): $250

• Follow-up medical consultations and refills (20 min): $185

● Psychotherapy Costs

• My hourly rate is $200.

• Initial Assessment for new clients is $350 (not necessary for established clients).

• I do offer package rates for savings on multiple KAP sessions, please inquire if interested.

• After your first full course of treatment (6-8 dosing sessions and 6-8 integration sessions), you have several treatment options that we can discuss. If you are happy with your progress and your treatment team decides that you would like to continue ketamine treatment, we may decide you are an appropriate candidate for self-guided dosing sessions after that point. With this option I would not be present to help support you through the dosing session and would just check in briefly via text before and after the session, and then meet with you for integration sessions following your self dosing. This can be a more affordable option for clients who enjoy the KAP modality and would like to continue treatment long term, but cost may be a barrier.

Most people who find benefit in regular talk therapy often find even deeper benefits in KAP. Today KAP is most often used to treat those with psychiatric diagnoses of:

• Moderate to Severe and Treatment-Resistant Depression

• Ruminative/Passive Suicidal Ideation

• PTSD/Trauma

• Complicated Grief

• Anxiety associated with death

• All Types of Eating Disorders

• Substance Use Disorders

• OCD

• Bipolar Depression

• Adjustment Disorders

• Pain with Depression

Currently being explored and found very beneficial for those with:

• Perinatal Mood and Anxiety Disorders

• Those seeking deeper levels of personal growth or spiritual exploration.

• Those feeling "stuck" or "hitting a wall" in therapy or wanting to try something different.

• Those who feel prevented from "going deeper" due to trauma.

If you have:

• Uncontrolled high blood pressure

• Unstabilized medical condition (talk to medical team)

• Severe Cardiac Disease

• Stroke History

• Raised Intracranial Pressure

• Acute Porphyria

• Ketamine allergy

• Epilepsy

• Uncontrolled glaucoma

• Severe breathing issue

• Active ketamine use disorder

• Acute mania or mixed state

• History of Primary Psychotic Disorder

• Preeclampsia/Eclampsia

• Active substance abuse where you would not be able to pause using alcohol/substances for 48 hours before and after dosing.

• Active suicidal ideation or severe decompensation (where a higher level of care would be recommended)

• Not self-sufficient, resourceful, or able to process possible deep emotional exploration.

Please note that if you are found not eligible for KAP by the Journey Clinical medical team for any reason, your medical consultation fee will be fully refunded by them.

Have more questions? Concerns about safety? I highly suggest you check out these resources as they address more details about the mechanisms of the medicine, treatment paradigms, past research, and the process and history of KAP!

1. Ketamine Treatment Guide for Mental Health

2. An Introduction to Ketamine-Assisted Psychotherapy | Psychology Today

3. Ketamine Therapy: A Disruptive Treatment Paradigm | MAPS

4. Ketamine & Depression: How It Works | Yale Medicine Explains

5. Ketamine: Benefits and Risks for Depression, PTSD & Neuroplasticity | Huberman Lab Podcast

6. Paradigms for Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS

7. Trevor Noah on Depression, ADHD & Ketamine Therapy

8. At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial.

9. Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression | Goop

10. Veronika Gold Podcast - Methods of Ketamine Assisted Psychotherapy

11. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy – research study by Jennifer Dore et al, 2018

12. Psychedelics are Changing Therapy Forever - with Lauren Taus | Deja Blu Podcast

13. Ketamine-assisted psychotherapy for trauma-exposed patients in an outpatient setting: A clinical chart review study

14. Personal experiences of some who have tried KAP.

15. Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter

16. Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature by Drozdz, S. J. et al. (2022)

17. Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research by Krupitsky, E. M., & Grinenko, A. Y. (1997).