Ketamine is the only psychedelic that is currently legal to prescribe in Massachusetts. There are many misconceptions about this marvelous medicine which is frequently devalued as having lesser therapeutic potential than other psychedelics like MDMA or psilocybin. This is not the case.
In low doses, it has been safely used to alleviate suffering in a wide variety of conditions including depression, post-traumatic stress syndrome, obsessive-compulsive disorder, addiction, eating disorders, pain syndromes, ruminative suicidality, anxiety related to the end of life, and very fruitfully for personal exploration and spiritual growth. It can potentially contribute to the healing of the psychospiritual component of chronic complex medical conditions such as chronic fatigue, fibromyalgia, Ehlers-Danlos Syndrome, as well as discontinuation syndromes related to psychiatric medication withdrawal. All of these conditions frequently involve activation of the limbic and autonomic nervous systems and are thus accompanied by prominent psychiatric symptoms. Ketamine soothes the limbic system and acts like a nervous system tonic.
Ketamine is classified as a dissociative anesthetic that was approved for use in 1970. It was given to soldiers for battlefield anesthesia in Vietnam, and was known as the “buddy drug,” and is used as a safe and effective short-acting sedative in emergency rooms., particularly with children. It is so safe and valuable that it is listed on the WHO’s list of essential medicines, drugs that are considered absolutely indispensable for any health care system. It works via the glutamate pathway in the brain, and thus in contrast to MDMA and psilocybin, does not require tapering off of SSRIs before administration.
Contraindications to the use of ketamine include uncontrolled blood pressure, cerebral aneurysm, bladder or kidney disease, active mania, severe dissociative diagnosis, recent traumatic brain injury, unstable heart disease, active psychosis, current substance misuse, pregnancy or breastfeeding, and obstructive sleep apnea.
The only FDA-approved, insurance-covered form of ketamine for use in treatment-resistant depression is a nasal spray, eskatamine, whose brand name is Spravato. There is little evidence that the patented nasal spray offers any additional benefit compared to generic ketamine. Ironically, insurance companies sometimes will cover treatments with Spravato, which is quite costly, but not generic ketamine. Recently intravenous off-label ketamine clinics have been springing up across the country. Ketamine infusions are typically offered without any accompanying psychotherapy and though can be transiently beneficial, do not have an enduring effect and thus require maintenance visits. In a psychotherapy office setting, ketamine is most usefully administered via a lozenge, though intramuscular injection is also possible.
There is so much that is still unknown about ketamine-assisted psychotherapy, and unfortunately, because ketamine has been around so long and cannot be patented, there is no financial incentive to do the clinical trials that would be necessary to answer many important questions. A typical ketamine session is 3 hours long, and a course of treatment is usually administered once a week for 4-6 weeks. This schedule and duration of treatment seem to provide the most benefit. At this point, ketamine-assisted psychotherapy is not covered by insurance companies, and thus the cost can prevent access for many patients.
Ketamine stimulates neuroplasticity and acts like a sort of Miracle-Gro for the brain, particularly in the 7-10 days following a session. In a recent excellent training in ketamine-enhanced Internal Family Systems (IFS) offered by Sapience, a ketamine-assisted psychotherapy clinic in western Massachusetts, one of the gifted instructors, Jennifer Baldwin, recommended that subsequent to a ketamine session, one should invite in those experiences that one wants more of in life. She suggested that one engages in activities that support the integration of the psychedelic experience such as meditation, spending time in nature, creative pursuits, movement, journaling, physically decluttering your space and just daydreaming.
She likened ketamine to WD-40 for the brain. Those parts of the self and patterns of behavior that are rusted and stuck together can be loosened so that there is more freedom of movement and the possibility of change. She speculated that some of the adverse responses that some patients in IV ketamine clinics have experienced after multiple high-dose IV infusions administered in rapid succession, have to do with too much loosening of the personality structure without the time and attention devoted to the integration of the profound changes catalyzed by the ketamine treatment; “too much, too soon, too fast” She speculated that the parts of the self that were developed for protection become overwhelmed and a person can feel distressed and dysregulated.
Ketamine can help reclaim what IFS refers to as the “Core Self”, who we truly are when all of our sub-personalities, or parts, are integrated. When a person is healed, they have increased access to their Core Self. The Core Self is characterized by the 8 C’s: confidence, calmness, creativity, clarity, curiosity, courage, compassion, and connectedness, as well as the 5 P’s: presence, patience, perspective, persistence, and playfulness. During these times of accelerated change when people feel so vulnerable, helpless, and fearful, connection with the Core Self fosters resilience, empowerment, and joy. KAP therapy offers the possibility to more fully embody and truly express who one really is.
Here is a YouTube video of a fascinating conversation with Dr. Richard Schwarz, the originator of IFS, and Phil Wolfson, MD, a pioneer in KAP about the integration of the two modalities: