Ketamine for Mental Health: What's out there?

So you've been doing some research on Ketamine, and you've found everything from infusions to at-home therapy. What is the difference between each of the many options popping up? Let's take a look at each so you can decide what's right for you.

In the spectrum from therapeutic to therapy, the main difference to consider is the relationship between you and a therapist and the agreement that you make with them. Some modes of treatment will involve a therapist, some won't, and some will be in-between.

Ketamine for Pain Management

The original application of ketamine was as an anesthetic. Used in surgery as a pre and post operative medicine, ketamine has delayed and reduced the use of opioids as a pain management tool. I have personal experience with this particular application. My dad is a chronic pain patient, and a couple of years ago he was referred for a round of infusions to help him decrease his dependence on opioid medications. It's been an effective treatment for him and continues to be a promising area of research. This article outlines how ketamine is used in a hospital setting, including what medical professionals should look for when recommending this treatment.

Ketamine Infusions for Depression

This breakthrough use of ketamine is the most mainstream as of this post. In 2000 the first blind randomized trial on the use of ketamine to treat depression was conducted. While the mechanisms of action are still largely unknown, there are several theories on why ketamine works so well. All theories are based on how ketamine inhibits or excites different neurons in the brain. For example, a study in 2018 revealed that ketamine acts on the opioid receptors, and that when those receptors are blocked, study participants didn't receive any benefit at all. In fact, researchers ended the trial early because the effect was so obvious.

At an infusion clinic, clients usually agree to a 6-session protocol within a 2-week period. I regularly refer clients to infusion clinics when I notice that their depression and suicidal thoughts are unmanageable. Infusions give an amazing boost that makes traditional psychotherapy more effective. When you feel better, it's easier to learn and problem solve.

During an infusion, clients either have an IV or get an intramuscular injection. An IV continuous drip feels a bit more like a rolling hill, and an IM injection is more like a steep slope with a peak and a steeper drop off. During my infusions I didn't notice a huge difference between the two modes of administration. What I did notice, and my other clients report as well, is that it was difficult to speak/communicate, and that there weren't many psychedelic effects due to the higher dose. I listened to Vivaldi's Four Seasons and was transported to the dappled sunlight of the English countryside.

In an infusion, typically there is no therapist to guide you. Due to the higher dose and direct delivery method, there really isn't a reason to have a therapist there. It may be very helpful to have a therapist to speak with after receiving infusions. They can help you evaluate how helpful the treatments are, how you are improving, and how to make the most out of your upward momentum.

Ketamine At-Home with Supervision

Several companies have popped up in the last few years who provide mail-order, telehealth supervised, ketamine sessions. MindBloom, My Ketamine Home, Trip Sitter, and Better U are the most established. These platforms prescribe and mail ketamine to your home, help you set intentions for during your experience, and help you process after a session. Ketamine is usually administered sublingually, at a lower dose, which means more psychedelic effect. This can be a cost-effective way of getting psychedelic-level doses of ketamine, however it shouldn't be confused with psychedelic-assisted psychotherapy. This method of ketamine treatment is a helpful stop-gap between infusions and true therapy, and would be useful for people who have good support systems and milder mental health concerns.

Ketamine-Assisted Psychotherapy (KAP)

This way of using ketamine changes everything. Not only are you getting the benefit of the medicine, but you also get the psychedelic effect with a therapist in the room with you, who knows you, helping you focus on your body, mind and intentions for the session. Ketamine is administered under the tongue, which means you get 35%-45% of the total dose in the troche. If you are prescribed 100mg, your body will get 35-45mg. This is considered a low, psychedelic dose. It takes about 15 min to dissolve under the tongue.

My clients have experiences ranging from just feeling like emotions and trauma are easier to talk about - all the way to having visions of their ancestors, soul, and connection to all living things. What I can say from my years of experience in this field is that what needs to come up in a session will naturally come up, and that once we get out of our own way, humans have an incredible ability to heal themselves. My job as a therapist is to help you prepare, help you focus, and help you integrate your experiences into the rest of your life. KAP treatment can last as long as you need it - from weekly sessions, to intensive weekends, to a booster experience every 6 months - you and your therapist will find what works best for you. I've seen resolution of trauma, elimination of depression symptoms, and even more empathy for self and others come about as a result of psychedelic therapy. Every person is different though, and that makes it difficult to predict how your treatment will go. When considering flexibility, customization, and an approach based on you and what you need, KAP is my go-to.

Psychedelics for mental health is a promising field, able to access the wisdom of hundreds of generations of healers, and the support of scientists and researchers. Wide-spread acceptance of psychedelics is new in the 21st century, some say we are in a period of renaissance. In your search for mental health and soul healing, wisdom is usually in the middle. KAP may be a great fit, and it may not. We suggest finding someone you feel like you can trust, and then working with them to create a holistic path of healing that will work for you.

Feel free to contact us with questions - your healing and happiness matter!