ON POINT: KETAMINE ASSISTED PSYCHOTHERAPY

Helios Psychiatry's Dispatches from the Frontline of Psychotherapy and Medication Management

by Dr. Jennifer Dore

Thanks in large part to the groundbreaking work of psychiatrists like Philip K. Wolfson, MD Ketamine Assisted Psychotherapy is gaining increased understanding and acceptance in the medical community.  Here at Helios Psychiatry we are especially excited about the potential Ketamine holds particularly for patients with intractable depression, anxiety, including those suffering from suicidal ideation.

As we continue to gather and organize our findings we thought it would be useful to provide a brief guide to help prospective patients better understand what Ketamine-assisted psychotherapy is and how it can be used to positively affect psychological change in even the most difficult cases.

So what is Ketamine anyway?

Ketamine is a Schedule III controlled substance classified as an anaesthetic and NMDA receptor antagonist. Commonly used as anaesthetic in children, Ketamine can induce a trance-like state and is used primarily for pain relief and sedation.  Side effects of the medication include but are not limited to increase and decreased blood pressure, and, rarely, spasms of the larynx.  It is regarded in the medical community as a safe anaesthetic used commonly in procedures involving children.  It is also include on the World Health Organizations list of Essential Medications.

Why is it being used for depression?

An article in Time in May 2016 points to two recent studies showing the efficacy of Ketamine in treating depression. Most interestingly, the Journal of Clinical Psychiatry found that “among 14 people with depression and suicidal thoughts, a few infusions of ketamine helped them to lessen their suicidal ideations considerably after three weeks.”  There are a number of theories as to what’s going on here, but a study from the journal Nature found that a metabolite that is a byproduct of Ketamine remains in the system for days after the drug is taken triggers antidepressant effects that last for days.

How does a qualified provider administer Ketamine?

Ketamine can be taken sublingually (a lozenge under the tongue) or it may be injected intra-muscularly or intravenously.  Each route of administration allows for varying levels of absorption and may also impact the longer term efficacy of the treatment.  Patients of Helios work with Dr. Dore and her team to determine which approach is right for them.

Will I hallucinate? Is it a scary experience?

While each individual’s experience may vary, most patients report a pleasant onset as the drug begins to take action, followed by feelings of “letting go” and/or “going into oneself”.  The setting where the drug is administered matters considerably.  The effects of the drug last anywhere from twenty minutes to an hour. Patients have described a spectrum of feelings from euphoria to temporary agitation to profound inner peace.  Each Ketamine session administered at Helios is carefully supervised by a trained medical professional.  

How will I feel afterwards?

At Helios we encourage our patients to relax for at least an hour after the effects of the drug have worn off.  Some patients have reported temporary dizziness. Patients are encouraged to arrange transport after taking Ketamine as operating a motor-vehicle may be dangerous.  Hours later and the days to follow many patients report feeling good, less anchored to worries, and less depressed, although again every patient is different.

Is there anything else I should know about the Ketamine experience and how to make it most effective?

Ketamine does not combine well with alcohol or any other substance.  Patients are strongly urged to abstain from alcohol or marijuana use a minimum of 48 hours before Ketamine use.  Other factors may also contribute to the overall experience, not the least of which the degree to which the patient is open and ready to accept the experience.  Helios offers optional Yoga or meditation before Ketamine sessions.

Ketamine-assisted psychotherapy is an exciting but also a scantily explored terrain in the treatment of depression and anxiety.  Patients are encouraged to speak with Dr. Dore and her team about the risks and benefits of the treatment.