Author – Patrick Wester PMHNP at Principium
When we discuss physical health, we often hear recommendations that involve a combination of different therapies for optimal results. For example, people with diabetes or hypertension are often prescribed medications along with counseling about diet and lifestyle changes. The same is true with our mental health. Sometimes people may try several different medications or spend hours speaking with their therapist but feel stagnant or stuck in their journey to optimizing their mental health. While both techniques have been shown to be effective in treating mental health conditions, we often see the best results with a combination of medication and psychotherapy. Usually, we think of this as a dedicated time to meet with a therapist in addition to a time to meet with a psychiatrist to discuss the effectiveness of medications. However, there is an exciting modality that incorporates psychotherapy sessions while being administered ketamine, known as ketamine-assisted psychotherapy, or KAP.
The origins of KAP lie in the increasingly popular and researched field of psychedelics. Psychedelics can be derived from plants such as psilocybin and ayahuasca or chemical compounds such as LSD, MDMA and ketamine. These substances can induce non-ordinary or altered states that can induce changes in mood, cognition, and perception. In the 1950s, LSD was one of these substances that was first used in treating alcohol use disorder, which later led to its uses for other mental health conditions. Despite initial promising results, the 1960s saw a halt in LSD and other psychedelic research for psychiatric uses due to new FDA restrictions in the light of the War on Drugs. However, beginning in the 1990s, there was a resurgence of interest in the psychedelic research field. In 2006, there was the first study examining the potential of psychedelics for psychiatric purposes, with a study emerging on the use of psilocybin and depression. Around this same time, ketamine was being explored for its psychiatric uses, as it was noted to have antidepressant effects. Ketamine has been studied more than any of the psychedelics noted previously and is an FDA-approved medication that has commonly been used off-label to treat mental health conditions including depression. Additionally, an intra-nasal version of ketamine (Spravato) is FDA-approved for the treatment of major depressive disorder.
What is ketamine?
As you can read more about here, ketamine is an anesthetic that has been used for off-label uses in treating depression. It has also been demonstrated to be a successful tool in treating bipolar depression, PTSD, OCD, and pain. Ketamine works on glutamate receptors in the brain and has been shown to enhance neuroplasticity, which is the ability of neural networks in the brain to change through growth and reorganization. This results in a “re-wiring” of the brain to help alleviate mental health symptoms. Ketamine has been shown to alleviate symptoms of mental health conditions quickly and robustly, including suicidal ideation. Ketamine has been shown to improve symptoms at a rate that is superior to traditional psychopharmacological medications like antidepressants, which can take 4-6 weeks to take full effect. For people who require fast relief in symptoms, or are not experiencing adequate response from their medications, ketamine can be an excellent adjunct therapy.
What is psychotherapy?
Psychotherapy is sometimes referred to as talk therapy and involves exploring your thoughts and feelings with a therapist to work through difficult or distressing aspects that are impacting your mental health. It is an umbrella term that includes several different modalities that you may be familiar with such as cognitive behavioral therapy, dialectical behavioral therapy, psychodynamic therapy, humanistic therapy, and mindfulness-based therapy to name a few. These types of therapy can be very effective in achieving goals to promote mental health by identifying and changing negative thought patterns and behaviors, encouraging personal growth, enhancing self-esteem, reducing stress and anxiety, and working through past traumas. Often there are specific goals that you and your therapist are working towards together over the course of your therapy.
What is ketamine-assisted psychotherapy?
Ketamine can induce a brief, transient psychoactive state. This state has the potential to enhance the experience of traditional psychotherapy, allowing you to explore a mind space in which you experience:
- an increase in psychological flexibility
- changing your perspectives
- improved access to previously unresolved traumatic memories
- the ability to reframe events critically
- fear reduction
- reduce defensiveness
- enhance rapport with your therapist
- stimulate of personal insights
The objective of KAP is to enter this state and navigate these feelings, memories, insights, and perspectives in a controlled and safe space with the assistance of a trained therapist. Being in this vulnerable and altered state and navigating this experience may sound scary, which is why you are never alone. A specially trained therapist is with you for your entire session, working through your emotions, feelings, and memories in the same way they would during a traditional psychotherapy session. At Principium Psychiatry, ketamine is administered through an IV which allows for safe, careful, and controlled dosing of the medication. Like other psychotherapy sessions, a trained clinician is there to keep you safe, guide you through your experience and provide psychological insights to topics that arise during your session. While ketamine has been shown to rapidly reduce symptoms of depression and other mental health conditions, there is some evidence that adding psychotherapy through a KAP model may be effective in enhancing and prolonging the positive effects of ketamine. In addition to improvement in your health, some studies have demonstrated that KAP is associated with other positive outcomes such as increased engagement and adherence to treatment and increased therapeutic alliance with your clinician. KAP is not a replacement for other treatments, but rather an adjunct therapy, meaning that patients engaging in KAP often continue taking their medications and are encouraged to continue traditional psychotherapy. Ongoing psychotherapy outside KAP sessions allows you to continue and integrate the positive strides you have achieved during KAP. Research has demonstrated that this model is strongly associated with prevention of relapse of symptoms.
Is KAP right for me?
KAP can be beneficial for several different people. KAP may be an appropriate treatment plan for you if are still struggling with depression, anxiety, OCD, PTSD, or bipolar depression despite being treated with medications or psychotherapy. Additionally, KAP can be helpful if you have benefitted from ketamine infusions in the past but are looking to have a more enhanced experience or pronounced response to traditional ketamine infusion sessions. If you are interested in delving deeper into some of the insights and experiences you have noted during your previous ketamine sessions or are curious to explore these in a guided, therapeutic space.
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Boulin, S.J. & Henningfield, J.E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7-19. https://doi.org/10.1016/j.neuropharm.2018.02.018.
Dore, J., et al (2019). Ketamine assisted psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of Psychoactive Drugs, 51(2), 189-198. https://doi.org/10.1080/02791072.2019.1587556.
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