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Ketamine Therapy



What is ketamine?


Ketamine is a chemical compound that was developed through medical research in 1962. In 1970, Ketamine was approved by the FDA and introduced as an anesthetic medication. Ketamine was popularized as a safe, effective emergency medication through its use as a field anesthetic for soldiers during the Vietnam War. By the 1990s, researchers expanded their exploration of Ketamine as a treatment for the alleviation of mental health conditions and traumatic distress, specifically in veterans and palliative care patients. In 2019, FDA approval was extended for Ketamine to be recognized as an approved treatment for Depression. Although Ketamine has also been classified as a club drug for abuse related to its psychedelic properties, it has primarily been used as a medication throughout its history.


Ketamine as a treatment for mental health


Research indicates individuals who have received Ketamine treatment for anxiety, chronic PTSD, and depression see significant reduction and resolution of symptoms for 1-2 weeks post-treatment. Some individuals have reported immediate outcomes such as “improved ability to control emotions and behavior…remission of anxiety and hyperarousal, improved mood… normalized sleep without the use of sedatives, and no nightmares” (Liriano et. al., 2019). Ketamine is perhaps best known for the profound experiences that often accompany treatment. Many patients report experiencing a sense of connection to a higher power, witnessing something greater than oneself, and/or feeling a sense of existential awe and wonder. The medical term for this is a “dissociative experience,” but you might be more familiar with the term “tripping.” Dissociative experiences vary from person to person and have generally been described as a form of vivid, dreamlike state.


What are the mental health benefits of Ketamine-induced dissociative experiences?

Individuals with a history of trauma, or those who work in environments where they might experience repeated trauma (such as first responders and veterans) may develop strong cognitive defense mechanisms (compartmentalizing, avoidance, unintentional dissociating) to protect themselves. While these defense mechanisms allow individuals to function in daily life, they often also act as barriers that interfere with one’s ability to connect with others socially and emotionally, to experience positive emotions, or to maintain a sense of meaning and purpose in life. Subsequently, individuals may be high-functioning but develop cynicism, nihilism, fractured relationships, and/or a lack of enjoyment or motivation. For these individuals, life may feel dull, heavy, or meaningless and relationships may feel empty or shallow. It is theorized that Ketamine allows individuals to temporarily and safely put aside defense mechanisms they use to protect themselves, allowing them to connect with deeper emotions, explore complex beliefs, and feel a sense of freedom from burden. When this experience is properly integrated post-treatment, individuals learn that they can maintain their defense mechanisms as needed in daily life, while also being able to access the deeper emotions that promote a sense of meaning and connection, without feeling overwhelmed or out of control.


How does Ketamine support mental health and wellness long-term?


Ketamine treatment in and of itself does not fully resolve symptoms of PTSD, depression, or anxiety in the long-term. It seems that ketamine may serve as a bridge that helps individuals reconnect to healthy outlets and a sense of meaning and purpose in their daily lives. The short-term alleviation of symptoms of PTSD, Depression, and Anxiety appears to give individuals an opportunity to experience positive emotions, reconnect with social support networks, and re-engage in meaningful and enjoyable activities. The dissociative experience(s) individuals have while receiving Ketamine treatment may also alter core beliefs and thought patterns, helping individuals to establish new perspectives and process experiences more effectively without getting stuck in negative thought loops. Ketamine also increases neural plasticity, the brain’s ability to heal and recover from damage or stress. In this way, Ketamine not only helps someone heal from past experiences, but also promotes resilience to future stressors by strengthening neural connections and improving the brain’s capacity to process information.


Unpacking after the trip...


The way someone integrates their experiences during Ketamine treatment and the steps someone takes after Ketamine treatment are integral to support long-term, sustained improvements. Research repeatedly shows that individuals who engaged in Ketamine treatment only, without also focusing on improving resilience factors in other areas of life, saw regression with the return of pre-treatment symptoms approximately 2-4 weeks post-treatment. This is why Ketamine treatment often includes therapeutic “integration” sessions. Advanced Wellness and Pain, a clinic specializing in Ketamine therapy in Arizona, defines integration sessions as “the process of unpacking and analyzing your infusion experiences, and incorporating these insights into your life” (2022). Some individuals also find it helpful to keep journals just prior to, during, and after treatment to help them make sense of any insights gained during treatment, and to reflect on practical ways to apply those insights in daily life.


Treatment

What to expect

Ketamine therapy is provided in a clinical setting and can be administered via oral medication, nasal spray, or IV infusion (the most common form of treatment). Treatment is administered by a medical professional and the patient is monitored throughout the process. Although experiences vary, most individuals report experiencing a relaxed state while maintaining conscious awareness. Some, but not all individuals, may experience disorganized thinking, a sense of disconnection from physical sensations in the body (due to the anesthetic effect), and mild to moderate forms of delirium or “tripping” that are sometimes described as vivid “waking dreams.” Common side effects within the first 24 hours of treatment include “blurred vision, dry mouth, restlessness, fatigue, nausea/vomiting, poor coordination, and headache” (Liriano et. al., 2019). Because Ketamine is a fairly new treatment, there is not necessarily a standardized practice. Some providers may vary in their treatment protocols. It is important to know what to look for when choosing a clinic or treatment program. The following information was adapted from Advanced Wellness and Pain FAQ (2022):


What Should You Look For In A Ketamine Clinic?


1. A physician on the premises should be participating in your care as opposed to “medically directing” the location from afar.

2. The provider should be able to adjust the dose during infusions so that you receive the optimal dose in every session, rather than following a cookie-cutter recipe or protocol. The provider should also be comfortable discussing your dosage with you.

3. You should have adequate preparation before your first infusion so that you’re in the proper mindset to receive care.

4. The setting should be optimized (private room, music, lighting, etc.) so that you feel safe and comfortable. It should not feel anxiety-provoking like a typical hospital environment.

5. You should have adequate integration of your infusion experiences. Integration is the process of unpacking and analyzing your infusion experiences, and incorporating these insights into your life. Without proper integration, you risk missing out on 95% of the benefit of your experience.

6. Your progress should be tracked and objective quantitative feedback given to you as you complete the treatment process.

7. There should be no external distractions, such as televisions in the room, regardless of the content. The purpose of this treatment is to facilitate you looking within your mind and finding a resolution to your state of suffering. To find your inner peace.

8. You shouldn’t feel rushed out the door immediately after your infusion is complete. You should be given time to decompress and do integration work before you leave.


Is Ketamine treatment right for everyone?


Ketamine is NOT recommended for acute stress. If someone has recently experienced a traumatic event, Ketamine may actually prevent processing and integration of the traumatic experience. This could potentially increase anxiety, contribute to difficulty sleeping (insomnia, nightmares), exacerbate posttraumatic stress, or contribute to the development of a delayed trauma response. Ketamine is also NOT recommended for:

  • Individuals with underlying cardiac conditions in which increased blood pressure would pose a risk of complications.

  • Individuals who are pregnant or breastfeeding.

  • Individuals who struggle with substance use and/or may experience challenges maintaining sobriety during treatment. It is recommended individuals who struggle with substance use undergo detox prior to engaging in Ketamine therapy.

  • Individuals with existing diagnoses of Schizophrenia or other conditions that may cause hallucinations and delusions, due to the potential for exacerbating the underlying condition.


 

Where to go from here


If you have questions or you are interested in exploring Ketamine treatment further, the following resources may be helpful:

Videos What Ketamine Treatment for Depression is Really Like: https://youtu.be/13PTtbBdkm0 Ketamine & Depression: How it Works - Yale Medicine Explains: https://youtu.be/nW21-AYY_fs

Peer support Call a member of the Peer Support Team, or schedule a consultation with the Peer Support Counselor Jess from the Mesa Peer website home page: https://mesapeer.com/ Peer Team Email: mfmdpeer@gmail.com Capt. Dan Brady: 480-209-6233 Jess Carter: 480-269-1413

Treatment providers To find out more about treatment from a local clinic specializing in Ketamine therapy, visit Advanced Wellness and Pain: https://advancedwellnessandpain.com/

Books Ketamine (The MIT Press Essential Knowledge Series) By: Bita Moghaddam Ketamine: Dreams and Realities By: Karl Jansen The Ketamine Papers By: Phil Wolfson

Research To do a deep dive into Ketamine research, check out the references from this article:

References Charney, D. (2018, February 14). Ketamine as a rapid treatment for post-traumatic stress disorder (PTSD) - study results. ClinicalTrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/results/NCT00749203?view=results

Du, R., Han, R., Niu, K., Xu, J., Zhao, Z., Lu, G., & Shang, Y. (2022, March 9). The multivariate effect of ketamine on PTSD: Systematic review and meta-analysis. Frontiers. Retrieved from: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.813103/full

Feder, A., Costi, S., Rutter, S. B., Collins, A. B., Govindarajulu, U., Jha, M. K., Horn, S. R., Kautz, M., Corniquel, M., Collins, K. A., Bevilacqua, L., Glasgow, A. M., Brallier, J., Pietrzak, R. H., Murrough, J. W., & Charney, D. S. (2021). A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2020.20050596

Heinzerling, K. Pacific Neuroscience Institute (2021) What is Ketamine Treatment. Retreived from: https://www.pacificneuroscienceinstitute.org/blog/trip/what-is-ketamine-therapy/

Li, L. & Vlisides, P.E. (2016). Ketamine: 50 Years of Modulating the Mind. Frontiers in Human Neuroscience, vol.10. doi:10.3389/fnhum.2016.00612

Liriano, F., Hatten, C., & Schwartz, T. L. (2019). Ketamine as treatment for post-traumatic stress disorder: A Review. Drugs in context. Retrieved July 7, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457782/

Mion, G. (2017) History of Anaesthesia: The ketamine story – past, present and future. European Journal of Anaesthesiology: September 2017 - Volume 34 - Issue 9 - p 571-575. doi:10.1097/EJA.0000000000000638

Rosenbaum, S.B., Gupta, V., Palacios, J.L. (2021). Ketamine. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK470357/



 

© 2023 by Jessica Carter


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