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IV Ketamine: a transformational approach to psychotherapy

 

Perspective is everything. 

Currently, the only psychedelic medicine available for the treatment of emotional suffering is ketamine.  It has been used for treatment resistant depression (TRD) for several years, administered intravenously (IV) without a psychotherapeutic component and where the psychedelic effects are viewed as side effects.  In contrast, when ketamine is used to enhance the therapeutic journey inward, the psychedelic effects are intentional to allow for shifts in consciousness from the ordinary mind-state by expanding states of awareness to viewing life concerns in novel ways to gaining freedom from the worries and anxieties of our daily lives.  

Ketamine originated as an anesthetic drug in the last 1960s and early in its use there were reports of unusual side effects of a dissociative kind, sometimes referred to as the "emergence phenomenon" and widely known as the "dissociative anesthetic."  

Ketamine's potential to treat psychological conditions were first reported in the early 1970s in Argentina as an adjunct for antidepressant psychotherapy.  It was being used across the world from Mexico to Russia to assist in psychotherapy and addiction.  

In 1990, a team at the Yale School of Medicine and West Haven VA Medical Center studied the effects of ketamine in healthy subjects to test novel treatment strategies for schizophrenia by examining the role of glutamate in symptoms associated with the disease.  From there, the Yale/VA team used ketamine to examine how dysregulation of the glutamate system affects depression and found a single dose rapidly alleviated depression in veterans.  In 2006, a National Institute of Health-led study revealed that ketamine provided “robust and rapid antidepressant effects to patients with depression.”  Three years later, the NIH funded a study led by researchers at the Icahn School of Medicine at Mount Sinai and found that within 24 hours of receiving ketamine, patients suffering from TRD showed rapid improvement of suicidal thinking.  This was followed by an NIH study that replicated the Icahn School of Medicine study in 2010.  In 2018, the results of two multi-year Phase 3 clinical trials involving a number of teaching hospitals showed the safety and efficacy of a nasal spray form of ketamine, esketamine.  In 2019, esketamine was FDA approved to be administered under the supervision of a health care provider.

What began as an exploration of the antidepressant potential of ketamine as an alternative to the more traditional medications to treat depression and anxiety had become a reality.  From this, a protocol for the medicalized use of IV Ketamine was formed. The downside to IV Ketamine was that the benefits were short-lived, which led to a more intensive approach of six sessions over a two week period of time with further sessions occurring at various times depending on the practitioner. 

In the mid-2000s, some psychiatrists began administering Ketamine intramuscularly (IM) during psychotherapy sessions.   In 2015, other methods of delivery were being used from sublingually to intranasally and intramuscularly.   

Ketamine Assisted Psychotherapy (KAP) has been around for over five years now where basic clinical strategies have been developed from the accumulation of several hundreds of patients with thousands of sessions.  KAP has been shown to be responsive to, but not limited to, PTSD/Trauma, Depression, Anxiety, Grief & Loss, End-of-Life distress related to dying, and to unresolved issues from childhood.

Side effects of IV Ketamine are generally limited to the timespan directly after the session and usually resolves quickly. They include mild nausea, dizziness, derealization and drowsiness.  To help ease any side effects from occurring, antiemetics are a common add-on to its use. Unlike other routes of administration, the practitioner has the ability to stop treatment if needed with fast recovery.  

KAP’s effectiveness is dose-dependent. It promotes a time-out from the ordinary usual mind and relief from negativity.  An openness to the expansiveness of the mind with access to self in the larger sense can be experienced through KAP. These effects enhance the psychotherapeutic experience.   Each person's "sweet spot," which occurs when you are able to freely journey inward in the absence of emotional constraints of the ordinary mind is different from individual to individual with respect to dosage given the unique make-up of each person.

Author
Yung Park, M.D.

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