Ketamine-Assisted Psychotherapy (KAP), Part 1: An Introduction

Now, I know what you’re probably thinking: “Ketamine?! Like the psychedelic?”, and the answer is yes! In 2019, the US Food and Drug Administration (FDA) approved esketamine—a derivative of ketamine—for use as a medicine available to mental health providers for the treatment of emotional suffering, specifically depression (Dore et al., 2019).

History of psychedelics

In recent years, the mental health field has seen the beginnings of what many expect to be a psychedelic-assisted psychotherapy (PAP) “boom”, which can seem surprising given psychedelic’s history as illicit, mind-altering drugs that many associate with the counterculture of the 1960s. But the history of psychedelics dates back much further than a generation, or even a few. In fact, the use of psychedelics has been traced back to as early as 4000 BC, shaping cultures and religions for thousands of years. Scientists and psychiatrist first became interested in scientifically investigating the effects of psychedelics in the late 1800s and continued into the mid 1900s. These early studies suggested that, with proper application, psychedelics could be useful in understanding and treating mental illnesses when done in conjunction with psychotherapy. However, uncontrolled access to these drugs for recreational purposes coupled with a negative stigma led governments across the world to reconsider the legal status of psychedelics. In 1970, strict restrictions and regulations were placed on psychedelic drugs, and any research on the potential medical applications of psychedelic became more difficult and thus slowed significantly.

Since then, the FDA has cautiously and sparingly granted approval for studies on the effects of psychedelics in humans to be conducted, and the findings have been optimistic. As modern-day research continues to grow, so too does the evidence that psychedelics, when used properly, have the potential to effectively treat a range of mental illnesses and contribute to the field of mental health in a positive way.

Ketamine itself is not necessarily new to the field of medicine—it has been used as an anesthetic in medical settings since 1970 and has been used off-label in non-anesthetic dosages since the early 2000s to treat chronic pain and some mental health concerns, including depression.

What are the benefits of ketamine?

As mentioned, ketamine has recently been approved by the FDA for the treatment of moderate to severe depressive disorder and has shown to help reduce suicidal ideation for those who are at an elevated risk for suicidal behavior (Murrough et al., 2015). Ketamine is also used off-label for the treatment of anxiety, post-traumatic stress disorder, bipolar disorder, and other mood disorders.

To use a drug “off-label” means to prescribe the drug to treat a condition different than the condition the FDA originally approved it for. Off-label prescribing is a legal and common practice, with 1 in 5 prescriptions being written for off-label use (Agency for Healthcare Research and Quality, 2015).

What makes ketamine different than other, more traditional treatments?

Traditional medications generally take several weeks to take effect, meaning there is a significant amount of time between someone beginning medication and getting any relief from their symptoms. For many, this wait can be frustrating and annoying; for individuals at high-risk of self-harm, this wait can increase the chances of them acting on such urges. A huge benefit of using ketamine as a treatment is that it works quickly, offering individuals relief from their symptoms within hours and sometimes almost immediately.

Finding the “right” traditional medication—i.e., one that works and does not have side effects that too negatively impact one’s life—can also be a process of trial and error. It is not uncommon for people to begin a medication and wait several weeks for it to take effect only to learn it is not the right medication for them. Some people get lucky and find the right medication on the first try, many people have to try a couple medications before they find the right fit; but for others, no traditional medication seems to relieve their symptoms, no matter how many they try. Excitingly, ketamine has shown to work for individual with otherwise treatment-resistance symptoms, offering them a sign of relief after what has likely been a discouraging journey thus far.

What are the benefits of KAP?

In controlled, low doses, ketamine has been shown to help clients temporarily step away from their psychological defense mechanisms, creating the opportunity for more profound self-reflection and psychological processing. In this manner, the use of ketamine can support and enhance the therapeutic process. However, ketamine cannot be used as a stand-alone treatment for mental health disorders. Ketamine treatments do offer fast relief from emotional suffering, but the effects do not persist—nor are they nearly as constructive—unless coupled with other forms of psychotherapeutic treatment.

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