Why Ketamine?
We are currently experiencing a renaissance in the treatment of mental health disorders, one that has been attempted but derailed in the past. The use of ketamine to treat addiction, mental disorders and imbalances, along with similarly non-pharmaceutical treatments, such as MDMA and psilocybin, is now more than ever being considered as a valid and superior alternative over potentially damaging pharmaceuticals that come with a multitude of undesirable side-effects.
Traditional use of SSRI’s (Selective Serotonin Reuptake Inhibitors), like Prozac, Lexapro, and Zoloft, which seem to alleviate symptoms but do not result in transformative experiences, has been heavily and increasingly relied upon in the last few decades. Unwanted side-effects (anorgasmia) are not the only concern. All too often, medications are dispensed without the pairing of psychotherapy—what most people recognize as counseling or “talk therapy,” where one speaks to a therapist about their thoughts, feelings, behaviors, and therefore has the opportunity to learn new ways to cope and improve their life. The addition of ketamine to talk therapy further enhances this experience by helping to temporarily diminish or remove our minds’ inherent defense mechanism—the ego. Ketamine allows our conscious (aware mind) to communicate to our unconscious (unaware mind) without a filter. This allows profound insight to take place in a relatively short amount of time–something that would be difficult for many individuals to obtain with talk therapy alone.
A Brief History of Ketamine
In 1964, ketamine was first used on human test subjects with the goal of surgical anesthesia. in 1966, Parke Davis patented ketamine under the brand name Ketalar for use as an anesthetic in humans and animals. As a part of its development, ketamine was successfully used on American soldiers in the Vietnam War. Impressively, the use of ketamine as an agent for analgesia and conscious sedation during battlefield-casualty evacuations helped to decrease mortality rate of wounded soldiers who made it to medical treatment from 4.5% during the Korean War to 2.6% during the Vietnam War.
Critical early research on ketamine was performed by Edward Domino, MD, an American clinical pharmacologist. Domino was the first to discover that ketamine has multiple pharmacologic applications, including anesthetic, analgesic, and anti-depressant effects. Domino was also the first researcher who discovered the hallucinogenic properties of ketamine. These experiences were first labeled as “emergence phenomena,” but Domino’s wife famously coined the term “dissociative anesthetic” as a way to describe these effects without raising too many eyebrows from the establishment that would be approving ketamine for use in humans.
In 1970, the FDA approved the use of ketamine anesthesia with children, adults, and the elderly. Since that time, ketamine has been widely used in hospitals and for office procedures due to its rapid onset, short duration of action, and superior safety. Ketamine has now been used in clinical practice for fifty years. It has been continually used as an anesthetic to evoke general anesthesia, a first line agent to induce procedural conscious sedation, a potent non-opiate analgesic to control both acute and chronic pain, a unique neuroprotective agent to prevent brain damage, a superior anxiolytic to control preoperative and end of life anxiety, a rapid onset antidepressant to treat chronic depression and other treatment-resistant psychiatric conditions, and the only legal hallucinogenic drug available to conduct psychedelic psychotherapy.
Ketamine is included in the 18th edition of the WHO model list of essential medicines, promulgating its availability in a health system.
Ketamine and Psychotherapy
Edward Domino quickly discovered that “emergence phenomena” may occur independently of anesthesia and can be reliably generated by an administration of a subanesthetic dose of ketamine. At a rate of one-sixth to one-tenth of the dose used for general anesthesia, ketamine can create psychedelic experiences with disconnection from surroundings, perceptions of floating and disembodiment, and even dying and going to a different world. He also noted that loss of reality contact appears more pronounced than with other psychedelics.
It is precisely this disconnect that allows the brain to reset and open itself to positive change.
How does it work?
For so long, the main thrust of pharmacologic treatment for depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress has been on increasing the amount of serotonin in your brain. This has been done under the presumption that deficits of the neurotransmitter serotonin in your brain leads to a dysfunction in mental health.
Research has revealed that we have many neurotransmitters. Serotonin makes up approximately 2% of those. Even more interesting is that serotonin comes from our deep (primitive) brain. Glutamate makes up greater than 90% of our neurotransmitters, and is employed by our frontal cortex—the thinking part of our brains. Glutamate is the neurotransmitter most affected by ketamine and it targets the NMDA receptor in the brain.
We have also learned that the term “chemical imbalance” is inaccurate. There is not a deficit of serotonin that results in depression and anxiety.
By targeting glutamate and the NMDA receptor, ketamine therapy results in an immediate reprieve from depression and anxiety that has sustained results with cumulative treatments.
What does it feel like?
The ketamine dissociative experience is, in fact, a non-ordinary state of consciousness (NOSC), during which the individual’s awareness and perception are dramatically changed and radically refocused. This psychedelic experience is often induced by IM injections of Ketamine in doses that are typically used for dissociative sedation and lasts from 45 minutes to one hour. The patient loses contact with external reality and gets involved in a profound psychedelic experience. The ketamine-induced non-ordinary states of consciousness may include any of the following:
- Feelings of leaving one’s body
- Awareness of becoming a non-physical being
- Emotionally intense visions
- Visits to mythological realms of consciousness
- Re-experiencing the birth process
- Vivid dreams and memories
- Experience of ego dissolution, psychological death and rebirth of self, or of reliving one’s life
- Deep feelings of peace and joy
- Sense of transcending normal time and space
- Feelings of interconnectedness with all people and nature, or of “cosmic unity”
- Sense of sacredness
- Profound sense of ineffability of the experience and an intuitive belief that the experience is a source of objective truth about the nature of “absolute reality”
What to expect?
After meeting with your therapist, an initial dose will be discussed and agreed upon. As a patient, you will inform us of your expectations of what you would like to discover and accomplish. The medication will be administered in the most appropriate fashion (sublingual, subcutaneous, or intramuscular). In about five to ten minutes, you will enter into a dream-like, non-ordinary state of consciousness. It is here where you will find therapy. This typically lasts 45 minutes to one hour.
As you leave this state of mind, you will likely feel a bit euphoric and will want to ponder and journal about what you experienced. Your therapist will be by your side throughout the entire experience and help you to integrate what you learned, and then assist you in making real life changes based on your newly gained insight.
The effects wear off in a predictable fashion in two to three hours after the dose has been administered, but we advise using rideshare or having a companion to drive you home, as you will be technically (and legally) impaired to operate a motor vehicle.
Are you a candidate?
If you are already a patient of mine, then just ask. If you are a new patient, we can discuss ketamine as an option for you at our initial consult. Individuals with certain health conditions may not be able to receive this treatment.