Ketamine-Assisted Psychotherapy.

Discovered by Cal Stevens of Wayne State University, Ketamine is a psychoactive drug that was first synthesized in 1962 and has been used in the United States as an anesthetic and analgesic agent in medical settings since 1970. It is on the World Health Organization’s List of Essential Medicines. It is classified as a dissociative anesthetic. Salvador Roquet, who began using it as an adjunct for psychotherapy in the 60's, described the dissociative effects as ketamine's principal effect rather than an unwanted side-effect. Ketamine is now increasingly applied clinically as an off-label treatment for various chronic treatment-resistant mental health conditions and physical pain. Ketamine has proven rapid antidepressant effects. While the antidepressant effects tend to be temporary after a single ketamine treatment, multiple treatments have proven to have a cumulative effect, successfully alleviating symptoms in approximately 30 - 60% of individuals with treatment-resistant depression.

Ketamine-assisted psychotherapy (KAP) is used to enhance and deepen psychotherapy, to loosen the grip of habituated patterns and coping mechanisms, and to amplify and prolong the curative effects of ketamine. Change is best facilitated within a structured, supportive psychotherapeutic environment with trained and skilled clinicians who are focused on assisting you with your issues, hopes, desires and struggles. KAP provides an opportunity for the temporary softening of psychological defenses, allowing for deeper self-reflection and psychotherapeutic processing. The process is characterized by the relaxation of ordinary concerns and usual mindset, all while maintaining conscious awareness. This can lead to a disruption of negative feelings and obsessional preoccupations. Many patients find that this interruption can produce significant shifts in overall well-being. KAP can lead to greater clarity and insight into inner dynamics and parts, a new capacity for handling life's challenges, increased ability to surrender into interconnectedness, as well as facilitating a sense of meaning. Tethered Healing approaches KAP from a graded, slow, process that honors getting the nervous system's consent to explore non-ordinary states versus risking re-traumatization with high doses right at the start.

The effect of Ketamine changes with the dosage and the dosage is decided based on overall treatment goals and treatment plan. There are some physiological effects that you will experience during Ketamine sessions as changes in perception and sensitivity to light and sound. Effects of Ketamine have been described in four categories : Empathogenic effect, Out of body experience, Near Death Experience, and Ego – Dissolving experience. In the doses that Tethered Healing uses, you will most often experience Empathogenic and/or Out of Body experience. During empathogenic effect in lower doses, you may experience increased awareness of the body, feelings of comfort and relaxation, reduction of ego defenses, increased empathy, compassion, and warmth. This is considered a sub-psychedelic dose and best supports talk therapy as there is more openness and relaxation of defenses. During Out of Body experiences where complete separation form one’s body occurs, there are significantly diminished ego defenses, but the experiencer is well aware of the self, visits to mythological realm of consciousness, possible encounter with non-terrestrial beings, emotionally intense visions, vivid dreams of past and future life and incarnations, re-experiencing the birth process. During Near Death Experience (NDE) where patient can experience a departure from one’s body, complete ego dissolution/loss of identity, experienced physical body and psychological mind death, experience of being a single point of consciousness simply aware of how actions have affected others, with moral judgment of self, reliving its own life, visiting non-physical realities, experience of psychological rebirth of the ego.

Ketamine is used off-label to address a variety of mental health disorders, including depression, chronic pain, post traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and addiction. Ketamine can have anxiolytic effects, but has less efficacy than it does for depression. Of note, OCD and addiction are beyond the scope of Tethered Healing's practice and if these are your primary treatment targets, Tethered Healing would provide referrals. Under the model Tethered Healing uses, ketamine is contradindicated for those with schizophrenia, bipolar disorder, severe personality disorders and dissociative disorders. Some medical and psychiatric conditions need to be treated before you can safely work with ketamine. These conditions include hallucinations, untreated mania, cardiovascular disease, uncontrolled hyperthyroidism, increased intracranial pressure, cystitis, or evidence of liver disease.

Ketamine can be delivered through various routes, but Tethered Healing offers only oral administration via rapid dissolving sublingual lozenges. With oral administration, it generally takes about 20 minutes to begin feeling the effects, which then subside in about 45-60 minutes. The overall medicine experience lasts 1.5-2 hours, depending on the dose and person. The lozenges are shipped to you from a compounding pharmacy.

Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any medication, there are also some potential risks and side effects to be informed of and to consider. The effects of ketamine can include distorted visualization of colors, feeling suspended in space or floating, falling sensations, experiencing out-of-body sensations, vivid dreaming and changes in visual, tactile and and auditory processing. Other possibilities for adverse effects include dizziness/lightheadedness, sedation, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to hear or to feel objects accurately including one’s own body, diminished awareness of physical functions such as respiration, headache, anxiety, nausea, and vomiting (although rare, and anti-nausea meds can be prescribed in advance). Synesthesia (a mingling of the senses) may occur. Ordinary sense of time will morph into time dilation. To ensure your safety during virtual lozenge sessions, you will be asked to lie down during the dosing session and you will be invited to use an eye mask during your treatment. Due to possible blurred and altered vision, as well as impaired balance and coordination, you are advised to lie still and keep your eyes closed (as long as you are comfortable doing so) or use the eye mask provided until the main effects have worn off. Driving an automobile or engaging in hazardous activities must not be undertaken on the day of the dosing session, and not until all effects have stopped.

Repeated high-dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction in individuals abusing the drug. In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying psychological problems in people with severe personality disorders and dissociative disorders. Some people report the psychic experiences as bizarre or frightening, while many describe them as pleasurable, joyful, or fascinating. That said, even frightening experiences can be of paramount value to your transition to recovery from the suffering that brought you to your KAP work. You will receive psychotherapeutic help and ongoing guidance from Tethered Healing as to how to make the best use of these experiences.

Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Medical evidence regarding the issue of drug abuse and dependence suggests that ketamine’s abuse potential is equivalent to that of phencyclidine and other hallucinogenic substances. Phencyclidine and other hallucinogenic compounds do not meet criteria for chemical dependence, since they do not cause tolerance and withdrawal symptoms. However, cravings have been reported by individuals with the history of heavy use of psychedelic drugs. In addition, ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly. Ketamine should never be used except under the direct supervision of a licensed physician.

During the first intake, we will develop a treatment plan is customized to your unique needs. The amount of sessions will depend on your overall treatment goals and responsiveness to the treatment. Some benefit from only 1-3 sessions, while many benefit from a series of 3-6 sessions, and others may come for more ongoing treatment sessions over months or years. Current research shows that 70% of patients with treatment resistant depression respond positively to 1-3 administrations, and 30-60% report having a remission of their depression for a varying length of time, some patients then receive “booster” sessions. Tethered Healing recommends a commitment to at least 3 ketamine sessions, as this medicine tends to have a cumulative effect and is most beneficial after multiple treatments. Please note, Tethered Healing requires a minimum of 8 weekly prep sessions before a ketamine session. After each dosing session, patients will have a minimum of 2 integration sessions: one within 24 hours of the dosing session and the next the following week. The number of integration sessions between dosing sessions can be increased, if indicated.