What is ketamine?
Ketamine was originally developed as an anesthetic and has been widely used for more than 50 years, especially in emergency medicine (including with children) and pain treatment. Ketamine’s safety as a medication has been extensively studied; its safety and side effects are well known. Ketamine became more widely used in psychiatry about 15 years ago when its rapid and effective antidepressant effects were discovered. The administration of low-dose ketamine as an intravenous infusion is currently a strong evidence based and widespread practice worldwide, especially in the treatment of forms of depression that do not respond well to conventional drugs.
What is ketamine-assisted psychotherapy?
This is a form of psychedelic-assisted therapy that uses ketamine as a medication. Ketamine causes a short-term altered state of consciousness lasting 45-60 minutes, the intensity of which depends on the dose of the medication. Ketamine has the ability to rapidly stimulate the formation of new nerve cells and the connections between them (neurogenesis and synaptogenesis, respectively) and thereby dramatically increase the adaptability of the brain (neuroplasticity). Based on these changes, the brain becomes psychologically more flexible and capable of learning, and using it thoughtfully, it becomes possible to “overwrite” old and non-functioning thought, behavioral and emotional patterns. The changes described above are not limited to the acute effect of ketamine, but they also persist for some time after the subjective effect of the drug has disappeared.
What changes occur in the state of consciousness under the influence of ketamine?
People often perceive the effects of ketamine as a dream-like journey, during which they visit the deeper and unconscious parts of their own psyche. Ketamine also reduces psychological “defense mechanisms”, which makes various repressed memories easier to access and process.
How is ketamine infusion therapy different from ketamine-assisted psychotherapy?
In the case of standard ketamine treatment, the medication is administered in small doses and frequently, and the treatment lacks a psychotherapeutic component, including preparation for navigating in an altered state of consciousness. The result is often a relief of symptoms, but it usually tends to be short-lived. Ketamine-assisted psychotherapy, on the other hand, is closely intertwined with the psychotherapeutic approach. The patient is thoroughly prepared for the experience and considerably larger doses of the drug are used if necessary. In the case of these two methodologies, the attitude towards the altered state of consciousness and accompanying psychedelic effects is fundamentally different. In the first case they are considered “side effects” of the medication and an attempt is made to reduce them as much as possible. In the case of the second approach they are seen as a necessary and unavoidable part of the therapy, which creates the potential for deeper and longer-lasting changes arising in the human psyche. Also, in the case of ketamine-supported psychotherapy, great emphasis is placed on the period after ketamine sessions, when the brain’s ability to learn remains significantly higher than usual.
How is the therapy conducted?
Three main parts can be distinguished in the therapy process: preparatory meetings, ketamine sessions and integration meetings.
- The purpose of preparatory meetings is to establish a therapeutic relationship, identify the client’s problems and background, theoretical and practical preparation for therapy sessions, and formulation of therapy goals. With a client coming to ketamine therapy for the first time, we usually hold preparatory meetings for three hours (if necessary, more) before the first session.
- When conducting ketamine sessions, we proceed from the basic principles of psychedelic therapy, taking into account the specific characteristics of ketamine. Sessions take place at Minu Kliinik in a specially adapted and prepared room, and the therapist is with you throughout the session. Ketamine is administered as an intramuscular injection. During the therapy session, the therapist will usually ask you to stay in a lying down position and direct your attention to your inner experience. To reduce stimuli from the external environment and encourage introspection, we use blackout mask and listen to specially prepared playlist through headphones. During the session from time to time, the therapist will monitor your blood pressure and heart rate. The entire session, including recovery, usually takes up to three hours.
- The purpose of the integration meetings is to recall and make sense of the ketamine sessions content in cooperation with the therapist. Based on this we will prepare an individual plan with you for the most effective and long-term use of the achieved treatment effect.
During preparatory, integration and ketamine sessions, we use theory and practical elements from different approaches, such as mindfulness, psychoanalytic therapy, transpersonal psychology, cognitive-behavioral therapy and Acceptance and Commitment Therapy (ACT).
Who is ketamine-assisted psychotherapy suitable for?
Ketamine-assisted psychotherapy is particularly suitable for the treatment of mood and anxiety disorders, obsessive-compulsive disorder and trauma spectrum disorders. In special cases, we also treat alcohol addiction and eating disorders. In particular, people who have already tried conventional psychiatric medication and psychotherapy in the past, but feel that they have not received sufficient support from these approaches and are still stuck in their patterns, could turn to therapy.
This therapy method is not suitable for use with people with a previous or current diagnosis of a psychotic disorder (e.g. schizophrenia) or permanent impairment of cognitive function (e.g. dementia). In the case of drug abuse, addiction disorders or personality disorders, the appropriateness of this treatment method should first be discussed with the therapist.
What are the risks of the therapy?
The most common physical side effects of ketamine are drowsiness, sleepiness, disturbances of coordination and balance, nausea, blurred/double vision, difficulty speaking, and mild/moderate increase in blood pressure and heart rate. Such side effects almost always pass no later than four hours after administration of the drug. After the immediate effect of ketamine wears off, headache and weakness may occur. Ketamine can also cause intense changes in the state of consciousness, emotional state, and body perception, which can be confusing and frightening at times. To reduce the possibility of negative psychological reactions, thorough preparation and post-session integration are necessary before ketamine sessions.
Can ketamine be addictive?
With controlled medical use, the risk of ketamine addiction is minimal. It is important to understand that self-initiated use of ketamine to induce euphoria is very different from medical use. Conversely, several scientific studies and clinical practice have shown that ketamine-assisted therapy can be effective in certain cases, such as in the treatment of alcohol, heroin and cocaine addiction.
