Ketamine Assisted Psychotherapy

Ketamine is an FDA approved “dissociative anesthetic” agent originally developed in 1962. It has been used primarily as general anesthesia in surgery for children, adults, and animals. Ketamine has an extremely safe track record in medical use.

Over the past few decades, ketamine has been researched and used clinically “off label” as an effective treatment for depression, PTSD, anxiety, and addiction. In California, the use of ketamine off label for mental health needs is legal.

Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.

Ketamine stimulates BDNF production. BDNF stands for brain derived neurotrophic factor. Some people think of BDNF as “fertilizer” for the brain. BDNF boosts results in “…neurogenesis, the growth of new brain cells, and synaptogenesis, the formation of new connections between brain cells.” Ketamine helps facilitate neuroplastic window in which people can use to shift internal patterns and behaviors or relational dynamics that may have previously felt more stuck.

When someone experiences chronic stress or mental health issues like depression or anxiety, it can lead to damaged neurons in the brain. ketamine is beneficial because it helps “fertilize” new cells and pathways in the brain.

This is why integration is so essential shortly after a KAP session because we are trying to build new habits and insights when the neuroplastic window is the most potent (usually 24-48 hours after taking ketamine). Shifts that one makes during the neuroplastic window will help to establish new, more adaptive patterns and these will be more likely to stick over time.

Generally, Ketamine enhances bonding, learning, excitement, BDNF levels and interpersonal openness.

It also decreases DMN (Default Mode Network) activity. DMN is a system of connected brain areas that show increased activity when a person is not focused on what is happening around them. This includes daydreaming which can lead to creativity. But it also includes rumination, and people who experience depression and loneliness have a lot of DMN activity. Individuals will ruminate about their regrets, failures, shame, and anger.

Decreasing the DMN allows people to experience the present moment, in the way that one can experience this via meditation or being out in nature.

The effects of ketamine, which most clients find pleasant, last for approximately 45-60 minutes. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature.

Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience.

Once these effects subside, we’ll spend the remainder of our appointment giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, clients may still experience some clear insights that they may continue to process after session.

Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the Ketamine experience.

This will be addressed between you and the prescriber more specifically.

But generally speaking, ketamine and KAP is not recommended for individuals actively experiencing psychosis or mania/hypomania, as it can potentially exacerbate these symptoms.

Other general contraindications can include: schizophrenia and other thought disorders, active substance use disorder, if you are taking benzodiazepines regularly, pregnancy, sleep apnea, high blood pressure or cardiac and pulmonary issues.

For issues such as high blood pressure, you may need to get medical clearance and/or management of these conditions prior to safely engaging in KAP. Unlike other psychedelics, most psychiatric medications will not need to be tapered off prior to engaging in KAP, although your prescriber will have specific recommendations for the day of or the week leading up KAP regarding what medications to take and what substances to stop prior to your KAP sessions.

Generally, side effects of ketamine can include: Nausea ( usually if you have a history of nausea or motion sickness—if this is the case please let your prescriber know as they can prescribe you anti-nausea medication to prevent this), Headache or migraine trigger, Blood pressure (10 to 20 point bump typical). Dizziness, Fatigue, Euphoria, and Transformational events. Ketamine has a short half life, these side effects would likely occur very shortly after taking the medicine.

Please talk with your prescriber for more detailed information regarding side effects.

This is dependent on the individual and their goals/reasons for using KAP.

Generally. I will schedule 2-3 1-hr preparation sessions in which we go over informed consent, presenting concerns or issues, current symptoms, go over what KAP sessions could look or feel like, any questions or concerns regarding KAP, reviewing your goals and intentions regarding use of KAP, and generally preparing your mindset (set) and environment (setting) for the experience.

The actual KAP sessions in which you self administer ketamine are typically 2-3 hours in length each.

Following your KAP medicine session, we will also have a 1-hr integration session, which will be scheduled 24-48 hours after your KAP medicine session.

KAP treatment can take from 2 to several months depending on spacing of these sessions, your presenting symptoms and goals.

Your prescriber will usually prescribe 2-3 KAP sessions worth of medicine at the initial consult. From there, you, your prescribe and I can consult regarding whether further medicine sessions would be beneficial.

The KAP medicine sessions are typically 2-3 hours long.

You will come to my office with your prescription (which you will receive from a compounding pharmacy recommended by your prescriber). On the day of, you are asked to fast for 4-6 hours prior to your session and you will be asked to have a chaperone drop you off and pick you up for your sessions (you cannot drive after your KAP session).

We will check in, go over your intentions for your session, explore grounding or meditation as needed, and co-create your safe container for the session. This can include a range of things, it can be helpful to bring items that are meaningful to you, read poetry or pull oracle cards that can represent certain messages you feel connected to. These are all optional but can help create some guidance and meaning to your experience.

Once you are ready, you will self-administer your ketamine dose. This may either be sublingual (lozenge form) or with a nasal spray. If using sublingual, you will will hold and swish the ketamine in your mouth for approximately 20 minutes as it dissolves and then spit the medicine out.

I will be at your side the whole time to offer support and grounding to you. Music will be playing during your session via headphones that I will have available to you as well as via a blue tooth speaker, so if you feel you need to take off the headphones music will still be playing in the room. We can go over music options ahead of time as well.

Most people begin to feel the effects of the medicine within 15 minutes, and can experience a period of time of up to 60 minutes going inward. I will provide you with eye shades to support your internal process.

While you are inward, I will be with you the entire time at your side. If you need anything, you are typically able to signal or talk despite feeling further away. I will offer non-directive support, and generally ensure the space and experience are safe for you to explore.

After the medicine wears off, people may wish to process what came up for them and we are able to do so during the remainder of the KAP session. You may also feel like experiencing quiet reflection, journaling, or drawing/creating. I invite you to embrace whatever feels best for you at the time.

I will assess you to make sure you are safe to return home, assist you in contacting your chaperone and we will have a follow-up integration session 24-48 hours after your KAP session.

At this time, insurance will not cover KAP sessions. If I am in network with your plan, it is possible to cover the preparation and integration sessions as those are considered general psychotherapy services, however the KAP medicine sessions will be out of pocket and extended sessions (beyond 53 minute sessions) are generally not covered by insurances.

If I am out of network, I can provider you with a superbill for the preparation and integration sessions, but the KAP sessions will be considered “Unlisted Psychiatric Service or Procedure” and therefore the medicine sessions will likely not be covered or recognized by your insurance carrier.

The prescribers I connect with are out-of-pocket as well, but they can provide a Superbill for you to try and get full or partial reimbursement by your plan if you have out-of-network benefits.

Below are some general costs to consider for KAP treatment.

For the prescriber the fees will include:

-$225 - 1-hr medical intake with MD/psychiatrist/NP - typically prescribed 2-3 doses

-$150 - follow-up consultation with MD/NP if you are interesting in pursuing additional KAP sessions after those first 2-3 doses

- compounding pharmacy prescription for ketamine for # of sessions can range but generic ketamine is typically affordable

My fees for KAP:

• $175/preparation and integration session.

  • The one hour preparation and integration session that occur before and after the KAP medicine sessions are $175 out of pocket or if I am INN, these may be covered depending on your plan, whether you have a copay or deductible, etc.

• $300-450/ KAP session

  • The estimated cost of those KAP sessions could be between $300 - 450 per KAP session, depending on how long the session goes (2-3 hours)

I understand that funds can be challenging, I am open to spacing out sessions if needed and I do not expect you to do a certain amount of KAP sessions, it is really dependent on your goals, what you get out of the sessions, and of course budgeting for these costs.

I have also partnered with a non-profit that is working to reduce barriers to psychedelic treatment by raising funds to support individuals who cannot afford it.

If you feel you would benefit from KAP, but cannot afford some of the out-of-pocket costs of KAP, please let me know and I can reach out to the organization to see if there are funds available to assist at the time.