With Psychological Support
What Is Ketamine Assisted Psychotherapy? (KAP)
Ketamine Therapy, or psychedelic assisted psychotherapy in general, helps bring deep-rooted emotions to the surface, giving us a glimpse into the unconscious mind. Emotional suffering comes from triggers such as past trauma and from how we perceive and respond to those triggers. Defense mechanisms are created to push away the unpleasant memories and emotions. These feelings are repressed and stored in our unconscious, where we cannot easily access them. Ketamine Therapy involves ketamine being taken at lower dosages, it produces a state that can break those barriers.
Because ketamine infusion therapy dissociates the mind from the body, you will be able to look at a situation without your body giving you an unpleasant feedback that you are ashamed, scared, or sad. But in your mind, you are fully aware, conscious, and present. This allows you to make changes to how you think and the way you look at the world. The memory of the trauma is still there, but the perception and response to that trauma has shifted. For many patients, this experience can act as a rapid and powerful catalyst for change and insight that might otherwise take months or years to access and work through.
Frequently Asked Questions
Implementing psychotherapy with ketamine infusion therapy allows for physiological changes to the ‘Default Mode Network.’ This is a network of brain structures which function based on the rigid pattern of defenses, perceptions, and patterns that were ingrained since childhood. Classical Psychedelics seem to temporarily relax the ‘default mode network’ by acting on the serotonin (5HT-2A) receptors in the cortex and layer 5 pyramidal neurons. Ketamine infusion therapy works differently by working on the NMDA (N-Methyl-D-Aspartate) receptor and the glutamate system. This unique mechanism of action allows for its additional benefit as a dissociate in addition to its actions on the ‘default mode network’. Ketamine infusion therapy promotes healthier brain function specifically by releasing BDNP (Brain Deprived Neurotropic Factor) in the central nervous system. Current research has shown that ketamine can induce neurogenesis (brain growth) within days, or sometimes hours linked to BDNF release.
The literature indicates about a 70% initial response rate of ketamine. The remission rate (no active illness) for patients with treatment-resistant depression (failed multiple medications) is about 40% to 50%. Treatment is most effective when there are periodic KAP sessions and possibly other medications. However, there is still a percentage of patients who do not respond fully to treatment.
Ketamine Therapy is distinguished from typical psychiatric medications due to its rapid onset which produces relief as soon as a few hours. Ketamine Therapy has a much quicker therapeutic response when compared to the weeks and months often necessary for other psychotropics such as Selective Serotonin (and Norepinephrine) Reuptake Inhibitors (SSRI and SNRI), Serotonin Modulators, Tricyclic Antidepressants (TCA), Monoamine Oxidase Inhibitors (MAOI), Typical and Atypical Antipsychotics, Lithium, mood stabilizers (Valproic Acid, Lamotrigine, Topiramate, etc.) and others. Only electroconvulsive therapy can provide a similar rapid relief of symptoms comparable to Ketamine. Ketamine therapy is an effective medicine for many patients, especially when using the medication to influence positive changes in your life.
After the initial preparatory psychotherapy session(s), we will be monitoring your progress by utilizing brief scales and questionnaires measuring your symptoms and general functioning. It is necessary to obtain your ‘baseline’ scores prior to treatment initiation so we can objectively track your improvement compared to when you first started. Most of these scales and questionnaires will be repeated monthly. Ketamine therapy works best when it is part of an integrated treatment program which includes psychotherapy, lifestyle changes, and sometimes other medications. Over time, you will likely need additional periodic ketamine treatments to maintain remission.
Before your first ketamine assisted psychotherapy session, Dr. Zaman will perform a thorough medical and psychiatric evaluation to assess if you qualify for treatment. Ketamine is NOT first-line treatment for depression, PTSD, anxiety, and many others. Thus, it is considered an OFF-LABEL use for many psychiatric conditions.
You will need to be medically cleared by your PCP specifically regarding your cardiovascular and pulmonary functioning. You will need to complete all the required lab-work which includes, but is not limited to, a Complete Blood Count (CBC), Complete Metabolic Panel (CMP), Urinalysis, Thyroid Panel (TSH), B12, Folate, Urine Drug Screen (UDS), and when applicable, a pregnancy test (beta-hCG). Dr. Zaman will review your medical chart and labwork and if there are no absolute contraindications, then your treatment can begin.
It is crucial to feel comfortable with your psychotherapist prior to starting treatment. Thus, you need to have at least one to two standard psychotherapy session(s) without ketamine, preparing you for the journey. In the preparatory session(s), we will set goals and objectives for the ketamine experience. In addition, we will gather your symptoms and life history, and teach you breathing exercises and mindfulness meditation skills. We will educate you throughout the process so you can have a comfortable and safe experience during each session.
At most ketamine IV (Intravenous) infusion centers, there typically is no psychiatric or psychological support to help you process the emotions that might arise. Many of these infusion centers are operated primarily by Anesthesiologists or Nurse Practitioners, all of whom have not undergone the comprehensive four-year psychiatry training and rigorous board certification process necessary to practice as a Psychiatrist.
At our clinic you will be provided with a comprehensive assessment provided by both a Psychiatrist and a Psychotherapist. The ketamine will be administered by an oral troche (sublingual dissolving medication), which will allow for psychotherapy to be done DURING the ketamine session itself. Research has shown that ketamine has its peak effects within the first 3 days. This means that it is vital to implement psychotherapy during this peak interval, especially during the acute administration phase, so that permanent cognitive restructuring takes place.
Because the sublingual route does not require the ancillary costs of intravenous (IV) ketamine, the price is much cheaper. Soon for an increased cost, we will be offering the intramuscular route which will produce even better results due to its higher bioavailability.
Patients often report feelings of love, peace, compassion, forgiveness, and a touch of euphoria. Usually you will remain alert and will be aware of your body. You will not lose any motor function. You will be able to talk during the session, but your perception and mental state will be altered by the ketamine. Your ego defense is lowered during the session, but your sense of self is intact which will be pivotal to making great strides during the psychotherapy session. We will encourage you to explore your mind while under ketamine and assist you in integrating your experiences afterwards. Patients may undergo a challenging session which is often necessary to overcome past traumatic experiences. Your providers will help you understand these experiences in context of your healing process.
Throughout the ketamine psychedelic assisted psychotherapy session, Dr. Zaman will be monitoring you and will make sure you are comfortable. If requested for Dr. Zaman can step into your KAP session with your psychotherapist and provide you with an anxiolytic (Lorazepam). You will return to a normal state when the medication wears off. The reduced sense of balance, dizziness, and possible nausea when moving your head gradually subside.
At higher dosages, ketamine has the potential to create non-ordinary state of consciousness, creating a profound transpersonal or mystical peak experience. These experiences will expand your sense of self and understanding of your existence and enable you to access your own healing wisdom. Your providers will serve as ‘spiritual guides’ and assist in processing the experience and its impact on your everyday life.
Your experience will be unique to you and each of your sessions will be different. It is best to relax into the path that your ketamine experience unfolds. Many enjoy the journey, while others do not. But you will come through with a greater insight into your yourself and your life. Our program is designed to assist you in integrating these insights into your daily functioning. We assist you in changing patterns of mind, mood, and behavior that cause you difficulty and distress.
Both psychotherapy and psychedelic medicines are effective, and the combination has been shown to be much more powerful than either by itself. This program will be tailored to your personal goals and specific needs. We will provide a structured and supportive psychotherapeutic environment with providers who are aware of your issues, hopes, desires, and struggles.
There are now many studies that demonstrate ketamine infusion therapy can be an effective and rapid treatment for patients. Benefits often occur after only one treatment, though several treatments (especially in the first month) are required for a long-lasting response. Thus, it is necessary to have at least 6 ketamine-assisted psychotherapy (KAP) sessions in the first month. Over time, you will likely need additional periodic ketamine infusion therapy treatments to maintain remission. You can stop ketamine infusion therapy treatment whenever you want, though it is recommended to go through at least 3 ketamine infusion therapy sessions before concluding it is not working.
Ketamine has been approved by the Food and Drug Administration (FDA) for use as an anesthetic agent for many decades, and since 1985 has been on the World Health Organization’s (WHO) List of Essential Medicines. Ketamine is the most widely used anesthetic in the world and has an EXTENSIVE SAFETY record used on MILLIONS of adults, children, and infants at the much higher surgical dosages. It is even safer at the sub-anesthetic dosages administered during your ketamine infusion therapy sessions. Ketamine unlike other medications in its class, does not depress breathing or blood pressure.
To reason if you qualify for this therapy, you should understand enough about its risks and benefits to make an informed decision. In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from Schizophrenia or Bipolar disorder Type 1 (manic-depressive). It may also worsen underlying psychological problems in people with severe personality disorders.
During the experience itself, some people report frightening and unusual experiences. These experiences are often of paramount value in your transition to recovery. Agitation may occur during a ketamine session, so you may be offered an anxiolytic (Lorazepam) to help you relax. You will be asked to lie still because your sense of balance and coordination will be impaired until the effect has worn off. It is possible you may fall asleep. Your visual, tactile, auditory processing, and sense of time may be altered inducing synesthesia (blending of senses).
Other adverse effects may include inaccurate vision, slurred speech, mental confusion, excitability, anxiety, and nausea. Ketamine may also cause an elevation of pulse (tachycardia), double vision (diplopia), rapid eye movements (nystagmus), feeling of pressure in eyes (increased intraocular pressure), and a loss of appetite. If monitoring reveals that your blood pressure is too high, you may be offered an antihypertensive (Clonidine). If monitoring reveals your heart rate is too high, you may be offered a medication (Propranolol).
Since ketamine’s effect on an unborn child are undetermined, woman who are Pregnant or are nursing should not receive treatment. Woman who are not using adequate birth control, will need to take a blood pregnancy test (beta-hCG) and will need to acknowledge the risks to an unborn fetus.
Psychedelic assisted psychotherapy should not be used on patients with untreated High Blood Pressure or Heart Disease. An electrocardiogram (EKG) may be required for those with a history of arrhythmia or cardiovascular issues. The effects on the blood pressure are comparable to the increase that occurs with heavy exercise.
Also, psychedelic assisted psychotherapy should not be used on patients with untreated Hyperthyroidism. In addition, there has been reports of some decrease in immune function in patients receiving surgical doses of ketamine (not seen in the sub-anesthetic doses). High dose, repeated, chronic abuse of ketamine has been shown to cause urinary tract symptoms and even permanent bladder dysfunction (this is very rare in medical use).
Psychedelic assisted psychotherapy using Ketamine, which is a controlled substance and a Schedule III substance under the Controlled Substance Act of 1970. Medical evidence regarding the issue of drug abuse and dependence suggests that ketamine’s abuse potential is equivalent to that of other hallucinogenic substances, which are LOW RISK in terms of abuse liability. However, cravings have been reported by some individuals and there are documented cases of overuse of illicitly obtained and diverted ketamine. In addition, ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly.
Please do not eat or drink for at least the 6 hours before session. If you are nauseated, you may be offered an anti-nausea medication (Zofran). Do not drive or engage in hazardous activities until all effects have stopped. You will be assessed for safety prior to leaving the office premises and a designated driver will be necessary to take you home.
Please consult Dr. Zaman if you are taking any current psychotropics, more specifically benzodiazepines, pregabalin, or gabapentin which may blunt the antidepressant effects of ketamine. Opiates can alter the effects of ketamine and cannot be concurrently taken during treatment. Information on other medication interactions are only partially available but all possible interactions will be assessed throughout.
Psychedelic assisted psychotherapy should ONLY be used under the direct supervision of a licensed physician.
How It Works
You are assessed by a Psychiatrist and evaluated in order to find out whether you would benefit from Ketamine Assisted Psychotherapy.
You have completed Month 1/Package 1 and have responded well to the KAP sessions. You are entering month 2 and will be given three KAP sessions.
You have completed Month 2/Package 2 and have responded well to the KAP sessions. You will be given two KAP sessions this month as we taper off your doses.
You have completed Month 3/Package 3 and are responding well to the KAP sessions. You will be given only one and final KAP session this month, if this is what the Psychiatrist believes is the proper route for treatment, and you are finished with you KAP session therapy.
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Ketamine Psychedelic Assisted Psychotherapy (KAP) Costs
In the first month, you will have a total of 10 treatments and appointments (6 KAP sessions) with your Psychotherapist and Psychiatrist for $3,300. For comparison, intravenous (IV) ketamine infusions (without psychotherapy) for 6 sessions, would cost around $4000 in the first month alone. This is due to the additional ancillary costs of the intravenous (IV) route along with other factors. We will be able to compensate your KAP sessions and psychiatry appointments according to psychotherapy and psychiatry coding, which you can submit to your insurance for out-of-network reimbursement.
Please note you can stop treatment whenever you want, though it is recommended to go through at-least 3 KAP sessions before concluding it is not working.
After the first month of treatment, the number of KAP sessions each month will vary depending on your specific needs and progress. Many patients will be able to taper off ketamine treatment over a few months, while others continue to require multiple KAP sessions each month. And since you will be with your psychotherapist for each KAP session, you will need to have a separate appointment with Dr. Zaman each month, in the beginning of your treatment. This is so he can monitor your progress and prescribe any additional medications and/or other treatments necessary.