What to do after Ketamine Assisted Psychotherapy (KAP) consultation

So you’ve decided to move forward with Psychedelic Assisted Psychotherapy…but what happens next to get this process started?

KAP is used an adjunct to psychotherapy to enhance the benefits of ketamine

This means I use Ketamine as a tool versus the primary aspect of treatment, so that we can tap into the benefits (like the neuroplasticity window) to create lasting changes in your negative patterns.

Ketamine is a legal, safe, and effective treatment for relational issues as well as anxiety and post-traumatic stress. It has a rapid antidepressant and mood enhancing effect, which can last up to 2 weeks

Ketamine works as a dissociative anesthetic under the umbrella of psychedelics

Ketamine is widely used in hospital settings across the world and as a procedural anesthetic. This provides pain relief, sedation, and even amnesia. At higher levels, it becomes a psychedelic.

It was first synthesized in the 1960s and was FDA approved for that kind of anesthesia since the early 1970s. In the 80s and 90s, doctors started noticing Ketamine’s inherent antidepressant effect and research was off and running!

By 2019, a version of Ketamine called S Ketamine was approved by the FDA for treatment resistant depression.

This docu series on the human brain exploring the science behind memory, dreams, anxiety, mindfulness, and more.

Watch Season 1, Episode 5 on Netflix to learn what happens to the brain on psychedelics.

Types of Ketamine treatments

  • Delivered directly into the bloodstream through an intravenous drip.

    IV clinics don't typically specialize in mental health (usually have pain specialist or anesthesia as the operator) so the experience of those can be different as there isn't usually psychotherapy involved.

    Advantages:

    • Rapid Onset: Effects are typically felt within minutes.

    • High Bioavailability: Nearly 100%, ensuring the full dose reaches the bloodstream.

    • Controlled Dosing: Allows for precise control over dosage and can be adjusted quickly if necessary.

    Disadvantages:

    • Invasiveness: Requires insertion of an IV line, which can be uncomfortable and may cause anxiety in some patients.

    • Clinical Setting: Typically needs to be administered in a medical facility, requiring professional supervision.

    • Cost: Generally more expensive due to the need for medical personnel and equipment.

  • Injected directly into a muscle, usually in the upper arm or thigh.

    Advantages:

    • Rapid Onset: Effects begin within 5-10 minutes, slightly slower than IV but still fast.

    • Ease of Administration: Does not require IV access, making it less invasive.

    • Portability: Can be administered in more settings compared to IV.

    Disadvantages:

    • Moderate Bioavailability: Lower than IV, around 90-95%, as some of the drug is metabolized before reaching the bloodstream.

    • Pain at Injection Site: Can be uncomfortable and may cause soreness.

    • Still not a affordable as nasal or oral routes of administration

  • Administered through a nasal spray.

    Advantages:

    • Ease of Use: Non-invasive and can be self-administered in some cases.

    • Rapid Onset: Effects can be felt within 15-20 minutes.

    • Convenience: Does not require needles or clinical supervision, though initial doses are often given under medical supervision.

    • Some insurances cover this route of treatment

    Disadvantages:

    • Variable Absorption: Bioavailability is lower and can vary between 25-50%, leading to less predictable dosing.

    • Nasal Irritation: Can cause discomfort or irritation in the nasal passages.

    • Less Controlled Dosing: Harder to control the exact dosage compared to IV or IM routes.

  • Taken by mouth, usually in the form of a liquid, rapid dissolving tablet (RDT), or lozenge.

    Advantages:

    • Ease of Administration: Non-invasive and can be taken at home, making it highly convenient.

    Disadvantages:

    • Slower Onset: Effects can take 10-25 minutes to begin, slower compared to other methods.

    • Low Bioavailability: Significantly lower than other routes (around 20%), meaning a higher dose is needed to achieve the same effects.

    • First-pass Metabolism: Metabolized in the liver, reducing the amount of active drug reaching the bloodstream.

I collaborate care with a medical team who prescribe oral tablets but I also partner with facilities/offer preparation and integration sessions for other routes of administration.

The difference in Ketamine versus other traditional psychedelics

Relatively Quick Onset + Short Journey

Onset takes about 10 minutes for oral Ketamine vs 20-45 minutes with other psychedelics.

The lasting effects of the Ketamine experience is around 45-75 minutes compared to 5-6 hours with MDMA

*This makes it easier to come in for a shorter time period to dose rather than spending a whole day in treatment if time is limited in your schedule*

Dissociation Effect on Body

Your mind is all of a sudden not really attached to your body. You're kind of in a floating or dreamlike state that is very specific to Ketamine.

Other psychedelics act on different neurotransmitters and receptors in the brain creating heightened oxytocin levels or the “love hormone.”

Why choose Ketamine treatment

  • It's safe

  • It's legal

  • Side effects are short lasting, but after effects are long lasting

  • Good primer for introduction to other psychedelics

Ketamine is NOT a magic pill to achieving your goals

Rather, KAP helps you develop a new relationship to your mind/parts/symptoms that are plaguing you.

How to begin Ketamine Assisted Psychotherapy treatment

MEDICAL JOURNEY

    1. I will refer you to the medical provider as discussed in our consultation via email

    2. You will schedule an appointment with the medical team to assess your KAP eligibility / psychiatric medical clearance for treatment

    WHAT IF I’M NOT ELIGIBLE? You will receive a refund from Journey clinical for your medical evaluation if you are not cleared for treatment

    1. Complete forms about consent to treatment, your medical, and psychiatric history

    2. Attend your appointment and review eligibility, discuss any concerns, receive KAP education, review what medications to continue as scheduled and which ones to hold off on (if applicable) with medical provider

    3. If eligible for KAP, your medical provider will give you a personalized treatment plan

      1. Your treatment plan includes your vitals (taken with blood pressure cuff), your medication dosage, and frequency of dosing session.

      2. Your treatment plan is then emailed to you with instructions on taking medication

    • You will receive your sublingual ketamine mailed to your home

    • These arrive as rapidly dissolving tablets (enough for 2 dosing sessions after initial medical evaluation)

THERAPEUTIC PREPARATION

    1. Complete personalized KAP Workbook BEFORE this appointment

    2. Choose your personalized KAP experience & payment structure

      Choose your desired treatment:

      1. Individual, Couples, or Group retreat style

        1. You may also add on an ART intensive for an additional session fee or in lieu of an extended integration session

      2. In-Person, Remote, or Self-Guided

    1. Review Informed Consent

    2. Review completed KAP workbook

    3. Discuss any concerns, fears, or anxiety about KAP

    4. Review Chaperone Procedures

    5. Schedule preparation, dosing session, and integration session

    1. This will be a talk therapy session guided by your completed KAP workbook to set intentions, establish goals, set expectations, create a mindful set and setting, and safety protocols

    2. Scheduled 1-2 weeks before your first KAP dosing session

    3. Setting intentions and goals

DOSING JOURNEY & INTEGRATION

    1. Scheduled in a 3-Hour block between the hours of 9am and 7pm

    2. Self administer vitals and prescribed dosing of oral ketamine tablet

    3. You’ll be in a comfortable, reclining position wearing an eye mask and listening to specifically curated music to help guide your journey.

    4. Although a KAP dosing session may be largely an internal experience, I’ll be present with you the entire time to hold space and provide support as needed.

    • 45 minutes - Welcome, housekeeping, check-in, administer vitals

    • 15 minutes - Getting comfortable

    • 75 minutes - Ketamine Journey

    • 45 minutes - Initial discussion of experience, final vital check, closing, & next steps

  • During this time together, we’ll review the memories, thoughts, and insights that arose during your dosing session, and prepare for the next dosing session.

  • You’ll schedule a 30 minute follow up consultation with medical team for prescription refill, adjustments to your treatment plan as needed, and outcome monitoring.

*REMOTE AND SELF-GUIDED KAP CLIENTS*

  • In the context of ketamine-assisted-psychotherapy, the chaperone provides support and assistance when the therapist is not physically present in the room. This individual is an adult (18+ years old) and a reliable and trusted person in the patient’s life, such as a partner, close friend, family member, or roommate, with whom the patient shares a positive and uncomplicated relationship.

    During the session, chaperones may be asked for assistance by either the therapist or the patient as needed.

    • Chaperone choice is discussed with therapist in the preparation session

    • Chaperone is made the client’s emergency contact and release of information is signed for therapist to communicate with them.

    • Therapist will contact chaperone via phone number on file for a 15 minute phone call

      • Therapist will inform chaperone of their role and answer any questions they may have.

    • Blood pressure cuff: This is to self-administer vitals and report therapist to ensure appropriate range for dosing

    • Confirmation from client/chaperone that they discussed specific consent to touch

    • Confirmed client/chaperone discussed permission to walk client to the bathroom