1188 Bishop St. Suite #2904, Honolulu, HI 96813, USA
Ketamine Assisted Psychedelic Therapy
Ketamine Assisted Psychedlic Therapy, KAP
Initial consult, preparatory session:
- Evaluate concerns, medical conditions, tx hx
- Elaborate goals, intentions
- Resource development to cultivate resilience
- Target release of shame, guilt, self-defeating beliefs
Pre-Treatment Guidelines:
- Nausea: common side effect, 30% of individuals experience it. You can take Zofran or motion sickness medicine.
- Liquids: drink clear liquids until the hour prior treatment, tx.
- Food: Avoid food 3-4 hr prior treatment, tx.
- Meds: Consult prior tx on meds to discontinue prior tx.
- Avoid: stimulants, alcohol, sedatives, cannabis, violent TV-music-movies 24 hr prior tx
- Recreational substances, alcohol, cannabis, can interfere w/neuroplastic effects of tx.
- Meditation: body-mind practices prepare/quiet the mind for KAP treatment.
Ketamine Experience:
- Intra-muscular injection, IM (sharper peak exp), or IV (40-60 min, slow/stop) starts w/.5 mg ketamine per kilogram. IM takes effect in 1-2 min, IV takes seconds. Euphoric/floating perceptual visual, tactile, auditory hallucinations:insights, new perspective.
- Acute intense effects last 30-40 min: journal, share (dream)
- Provider supports innate healing intelligence by directing attention inward.
- Challenges: resource resilience, What am I here to learn?
Post Treatment:
- Avoid: Operating vehicle or machinery for 12-24 hr.
- 48-72 hr Neuroplastic Window: Reflect on and reinforce new brain pathways, thought patterns, beliefs, behavior.Integrate
- Self-care practices: Time in nature, journaling, artwork, meditation, be w/loved people/pets, mind-body practices. Light nutritious food, hydration, rest/sleep
Integration:
- Debrief, review meaning, form framework to implement insights.
- Kindling effect: potentiate effects w/subsequent tx, titrate w/gradually increasing doses 3-6 sessions w/in 3-6 wk
Ketamine Information
Parke-Davis (Pfizer) patented Ketamine in 1966 as an anesthetic in veterinary and human medicine. Ketamine was administered easily/safely by soldiers and corpsmen in the Vietnam War. It was a battlefield anesthetic, sedative, and analgesic (pain-relieving). It is the most commonly used anesthetic in pediatric surgery. Ketamine was discovered to have rapid acting antidepressant and anti-suicidal effects (2000). In 2019 Spravato, an intranasal ketamine, was FDA approved for treatment resistant depression and suicidal ideation. Ketamine is used in off-label treatment for treatment resistant depression, alcohol and other substance use disorders, PTSD, OCD and more. All psychoactive substances have risk of side effects and may affect individuals differently.
Common side effects:
- Nausea, vomiting, dizziness
- Diplopia: double vision, and slurred speech
- Drowsiness
- Transient increased heart rate and blood pressure
- Confusion
- Euphoria
- Vivid dreams and/or nightmares
- Visual and auditory hallucinations
- Confusion, clumsiness
- Anxiety
- Dysphoria: state of unease, generalized dissatisfaction
- Lowered sensitivity to pain
- Pain at injection site, redness, swelling, rash
Ketamine Long-term effects (w/anesthetic or heavy recreational use)
- Flashbacks
- Poor sense of smell
- Mood/personality changes
- Poor memory and thinking
- Abnormal liver or kidney function
- Bladder problems
- Abdominal pain
- Tolerance and/or dependance
- problems: financial, occupational, social
Rare side effects:
- Allergic: anaphylaxis, breathing difficulties, swelling, hives
- Cardiovascular: arrhythmias, blood pressure elevation, bradycardia, hypotension, L ventricular dysfunction in patients w/heart failure, respiratory arrest, cardiac arrest
- Muscular stiffness and spasms
- Neurologic: confusion, seizures
- Ophthalmologic: increased intraocular pressure
- Psychiatric: amnesia, confusion, depression, disorientation, dysphoria, dissociative state, hallucination, unusual thoughts, fear, irrational behavior, insomnia.
How Ketamine works
Ketamine is an off-label treatment for treatment-resistant depression, alcohol and other substance use disorders, PTSD, OCD, etc.
Depression
Ketamine has a rapid/robust antidepressant effect immediately after use. It can affect remission in 2/3 of patients and reverse suicidal thinking. The antidepressant response lasts 7-days; longer in a comprehensive tx plan.
Addiction
Ketamine can achieve and sustain alcohol abstinence in alcoholics, heroin abstinence n heroin dependence, reduce cravings and decrease self administration of cocaine in clinical trials.
PTSD
Improvements were immediate w/PTSD, lasted 1-2 weeks w/o comprehensive tx.
OCD
Rapid sustained effects in patients suffering OCD.
Ketamine Assisted Psychotherapy
Preparation and integration sessions are utilized to optimize benefits. Ketamine induces neuroplasticity in new awareness, perspective, insight(s).