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 to treat emotional suffering, specifically depression (Dore et al., 2019). 

History of psychedelics 

The mental health field is seeing the beginnings of what many expect to be psychedelic-assisted psychotherapy (PAP) “boom.” It may seem surprising given psychedelics’ reputation as illicit, mind-altering drugs associated with the counterculture of the 1960s. Still, the history of psychedelics dates back much further than a generation, or even a few. The use of psychedelics has been traced back to as early as 4000 BC, shaping cultures and religions for thousands of years. Scientists and psychiatrists 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 helpful in the understanding and treatment of mental illnesses when done in conjunction with psychotherapy. However, uncontrolled access to these drugs for recreational purposes, coupled with a negative stigma, led governments worldwide to reconsider the legal status of psychedelics. In the 1970s, there were strict restrictions and regulations on psychedelic drugs, and any research on the potential medical applications of psychedelics became more complicated and thus slowed significantly.

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

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

What are the benefits of Ketamine?

As mentioned, The FDA recently approved Ketamine to treat moderate to severe depressive disorder and has been shown to help reduce suicidal ideation for those at an elevated risk for suicidal behavior (Murrough et al., 2015). In addition, Ketamine use off-label to treat anxiety, post-traumatic stress disorder, bipolar disorder, and other mood disorders. 

Using a drug “off-label” means prescribing the drug to treat a condition different from the one FDA initially approved and is a legal and common practice, with 1 in 5 prescriptions written for off-label use (Agency for Healthcare Research and Quality, 2015).

What makes Ketamine different from 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 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 medication and wait several weeks to take effect only to learn it is not the proper medication for them. Some people get lucky and find the appropriate medication on the first try. Others have to try a couple of medicines before they find the right fit.  Sometimes, no traditional prescription seems to relieve their symptoms, no matter how many they try. Excitingly, Ketamine has shown to work for individuals with otherwise treatment-resistance symptoms, offering them a sigh of relief after what has likely been a disheartening journey thus far.

What are the benefits of KAP?

In controlled, low doses, Ketamine results give clients a temporary 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 is not a stand-alone treatment for mental health disorders. Ketamine treatments 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. Dr. John Mendiola, of Mindbody-Therapeutics says “ketamine infusions work best to provide fast relief of symptoms, no side effects and is optimized when people couple the infusions with talk-therapy.  The talk-therapy helps restructure new ways of thinking while capitalizing on the creation of new connections of the brain, referred to as neuroplasticity.”

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