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What is Ketamine?


Ketamine is a DEA Schedule III medication that has been in use since the 1960’s as an anesthetic agent. It is classified as a dissociative anesthetic. In addition to its use as an anesthetic, ketamine has found to be useful as an off-label treatment for specific psychiatric disorders including major depressive disorder, treatment resistant depression, depressive episodes associated with bipolar disorder, suicidal ideation, mood disorders, obsessive compulsive disorder and post-traumatic stress disorder.

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 for up to four months at a time.   

Ketamine is considered very safe and has been used for decades with medically fragile patients, soldiers in the battlefield and in children.

Ketamine can be delivered through a variety of methods: intravenously, intramuscular injection, oral dissolving lozenge, and intranasal. 

 

How Does Ketamine Work?


The current understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system. It increases expression of Brain-Derived Neurotrophic Factor (BDNF). This results in enhanced neuroplasticity, or the ability of brain cells to form new connections with one another. 

 

At the dosage level administered to you, you will most likely experience analgesic, anxiolytic, antidepressant, and psychedelic effects. Ketamine also may bring about “transpersonal,” or “out-of-body” experiences that may also serve to facilitate a shift in your perspective and emotional state.

 

Who might be a good candidate for ketamine treatment?


At Alaska Compass we use ketamine for a variety of mental health conditions including depression, post traumatic stress, suicidal thinking and some forms of anxiety.  There are many ways to use ketamine.  Ketamine at Alaska Compass is incorporated into a psychotherapy program that aims to help patients who want to make shifts in patterns of thinking and behavior that can keep us in the cycle of depression. 

Ketamine is not right for everyone.  Some medical and psychiatric conditions need to be treated before you can safely work with ketamine. These conditions include hallucinations, dissociative disorders, chaotic substance use, untreated mania, cardiovascular disease, uncontrolled hyperthyroidism, increased intracranial pressure, cystitis (urinary bladder inflammation), or evidence of liver disease.
 

 

Ketamine is not FDA approved for mental health treatment


Ketamine is a federally controlled substance, scheduled with the DEA.  Ketamine is FDA-approved for anesthesia, but it is not currently FDA-approved for any psychiatric or psychological indication; however, it can be used legally as an “off-label” treatment when certain criteria are met.  In 2019, one enantiomer of ketamine (called “esketamine”) received FDA approval for treatment of refractory depression.

Because ketamine is not FDA approved, it is typically not covered by most insurance plans.  Cost can be a factor in deciding if ketamine is the right approach for you. 
 

 

What are common side effects of ketamine?


During the medication experience people may experience dissociation, floating out of one’s body, nausea and vomiting, increased blood pressure, increased heart rate, headache and anxiety.  Unpleasant sensations and re-experiencing of traumatic experiences can occur.  While not sought after, these difficult experiences can be useful in the path to healing when placed in the context of a comprehensive psychotherapy program. 

Less common side effects of ketamine include worsening hallucinations in persons with underlying psychotic disorder, dysphoric mood, mania in persons with underlying bipolar disorder, and liver damage.  People who take ketamine continuously can develop substance dependence.  In heavy daily users, greater than a gram a day, people can go on to develop bladder damage and cognitive impairment.  These doses are 20 to 30 times greater, and used in greater frequency, than those used for treatment at Alaska Compass. 
 

 

What is Psychedelic Assisted Psychotherapy?


Mental and emotional suffering may come from external triggers (such as past trauma and present life conditions) and also, importantly, from how we perceive and respond to those triggers. Our perceptions and responses are determined by deep beliefs and behavioral patterns, influenced by genetics, and shaped through early and later experiences – both positive and negative. We are only sometimes aware of these processes that shape how we perceive and respond to our life challenges.

 

All psychotherapy attempts to improve how we perceive and respond to past and present life challenges. When memories emotions and experiences arise which we feel powerless to respond to effectively, or are otherwise unbearable, they arouse anxiety and our defenses kick in so we can cope. Therapy helps us bear these emotions, feel safe with another person, and soften maladaptive defenses so that we can act more effectively. Such change takes time because anxiety can be overwhelming and protective defenses are entrenched and habitual.

 

We develop a rigid pattern of defenses and a perception of ourselves that is based on these rigid patterns. Neuroimaging reveals a system of interrelated brain structures – called the ‘default mode network’ – that operates when we are actively monitoring and making decisions based on these limited patterns, and our limited sense of self.

Psychedelics seem to temporarily relax this default mode network through acting on the serotonin 5HT-2A receptors in the cortex and layer 5 pyramidal neurons. This releases the constraints on the raw here-and-now data coming in from our senses. As the psychedelic experience recedes this information is re-integrated in surprising ways that challenge our rigid patterns. We can rewrite our sense of ourselves and the world in profound and lasting ways.

We can make the most of this opportunity with careful preparation: setting a clear intention, ensuring an experience of curiosity and openness to new learning and integrating the insights into new knowledge.  The intense connected experience provided by the combination of medicine and therapist can provide a corrective emotional experience, changing a previously frightening or avoided emotional memory into one infused with compassion and hope. Deliberate psychotherapy can result in deep and lasting change, sometimes far more rapidly than with psychotherapy or use of psychedelics alone.

 

What is Ketamine Assisted Psychotherapy?


Ketamine works slightly differently but has many of the same results as classical psychedelics such as psilocybin or LSD. Ketamine targets NMDA glutamate receptors, which are crucial to memory and synaptic plasticity. One set of actions may deactivate the anti-reward center, and restore the connections between the default mode network and the lower brain structures active in processing feelings. People once again feel a capacity for pleasure, and are able to experience emotions and associated memories without the constraining habits from a lifetime of trauma and other painful experiences. Compared with traditional psychedelics, ketamine causes less visual hallucinations and patterns common in traditional psychedelics because ketamine is less active in the visual cortex; but there can be deep emotional experiences that open us to connection, memory and meaning.

 

The NMDA action of ketamine may bring a special capacity for relearning and rewiring. Memories, once open and activated, become malleable. Ketamine prolongs this reconsolidation window so that new memories can solidify. With careful evocation of painful memories or cravings for drug and alcohol use, followed by ketamine administration, new and flexible knowledge and habits can be established.

 

Ketamine-Assisted Psychotherapy is a practice that allows participants to gain access to the “felt-sense” of emotional content and difficult unconscious material in a rapid and powerful way, allowing the participant to open up a doorway to allow that content to be accessed, worked with, and processed with the assistance of a highly-trained therapist. Ketamine is a powerful catalyst to allow inner access to difficult and often “stuck” material and emotions, and the psychotherapy allows the participant to actively examine, work with, and effectively process that material for long-lasting change, often far more quickly than traditional talk-oriented psychotherapies. It may have additional roles in the treatment of addictions, where stuck memories can be softened and replaced.

 

Want to know more?   Call for an assessment today.  907-744-3218

Find Out More

 

Kriya Institute

https://www.kriyainstitute.com/videos/


American Society of Ketamine Physicians, Psychotherapists & Practitioners
https://askp.org/

Sage Institute
https://sageinst.org/kat

Ketamine for major depression: New tool, new questions
https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-new-questions-2019052216673