Ketamine was created for use as an anesthetic in 1966 as a safer alternative to previously used anesthetics. Ketamine’s unique properties, which made it extremely successful, included not posing the same risk as other anesthetics as it preserves airway reflexes and respiratory drive.

Hence, Ketamine is an excellent analgesia with an impressive safety profile, making it popular in a variety of patient populations and settings. As such it has been used widely in emergency medicine and combat settings and is heralded for its safety and flexibility.

Ketamine acts by modulating glutamate, one of the brain’s key neurotransmitters, which is an amino acid found in 80 percent of neurons. Glutamate is the most plentiful of all the neurotransmitters and it influences the formation of, and the number of, brain synapses—the vital connections between neurons.

Because of Glutimate’s vast influence on the brain, this process greatly enhances neuroplasticity and potential for healing. Glutamate also acts with another important neurotransmitter, GABA, to maintain a healthy and well-functioning nervous system. An imbalance between GABA and glutamate can cause problems, including anxiety, difficulty sleeping, overstimulation, and other mental conditions.

Evidence suggests ketamine helps rebalance the glutamate system by acting as an NMDA-receptor antagonist and this increase in glutamate is believed to be one key factor in enabling the antidepressant effect.

Ketamine is in a unique league of drugs because it has more than 50 years of clinical use, research, and significant patient safety and efficacy data behind it. Ketamine has been a widely used anesthetic for decades. It is safe to say that the medical community knows a tremendous amount about ketamine, though it continues to be understood better and better as the number of applications expand.

During infusion therapy low doses of ketamine can create side effects such as euphoria, slurred speech, dissociative experience (explained below), increased blood pressure, reduced muscle control, and sometimes nausea.  Unwanted side effects like blood pressure increase and nausea can and will be controlled by other medications used in session when needed. Individuals with uncontrolled blood pressure are not good candidates for Ketamine therapy, but patients regulated by blood pressure medications can still qualify.

During the past 20 years, ketamine has been proven to be effective as an off-label treatment for a variety of mental health disorders, including depression, anxiety, PTSD, and suicidality. It has been shown to be particularly effective for people suffering from treatment-resistant mental health disorders—those patients who have tried many medications and treatments and still do not get well.

Although a form of Ketamine called esketamine is FDA approved for use for treatment resistant depression, it is delivered as a nasal spray. Research shows IV Ketamine to be more effective than nasal application, however, due to bioavailability.

The body’s absorption is 100 percent via the IV route, much greater than when delivered by any of the other methods. A meta-analysis of 1,877 participants showed IV ketamine to be much more effective than esketamine.  It had a longer pronounced effect for the patients in their depression, and also experienced lower drop outs due to adverse events.

Ketamine works by causing physical growth in the prefrontal cortex and other areas of the brain associated with emotion regulation and mental health disorders. It also establishes new connections among neurons while repairing damaged cells. It builds new pathways in the brain that improve function in the areas that control mood, sleep, and emotions.

Ketamine treats depression, suicidality, and PTSD effectively. After many years of use as an anesthetic, human studies for other applications and treatments began in the 1990s.

For the past 20 years, researchers at top scientific institutions and universities have researched the efficacy of Ketamine in the treatment of mental health disorders and shown positive results. Institutions such as Yale, Stanford, Harvard, UCLA, USC, NYU, the National Institute of Mental Health, and the Cleveland Clinic have found that 70 percent of patients treated with Ketamine showed a significant decrease in depressive symptoms; virtually all of these patients failed to respond to traditional forms of treatment including medications.

A randomized, double-blind, placebo-controlled trial of single-dose IV Ketamine infusion (0.5 mg/kg) in 18 individuals with treatment resistant depression found that, within two hours of infusion, Ketamine significantly improved depressive symptoms compared to placebo saline infusion.

The meta-analysis of randomized controlled trials showed the following:

• • One day after the IV Ketamine treatment, patients were seven times more likely to have a positive clinical reaction when compared with the placebo group.
  • Based on the results from the systematic review, “multiple ketamine infusions (0.5 mg/kg, 3 times/week over 2 weeks) not only enhanced its effectiveness compared to a single infusion, but it also delayed clinical relapse.” This is why our care package starts with 6 sessions twice a week for 3 weeks.
  • To sustain the benefits of ketamine, “higher-frequency course of treatments” should be “followed by longer-term, lower-frequency maintenance doses.” This is why a maintenance plan is part of our total care package- 6 sessions 2-4 weeks apart to maintain benefits.
  • These lower maintenance doses could continue as long as necessary.
    This is why we offer continued care until results are consolidated.

Psychotherapy, broadly speaking, is an effort to use communication and the skills of the therapist to help the person suffering from incompletions or dislocations in their development to become more internally whole, so they can move forward with consistency and with less conflict.

One of the things that makes this process so difficult is when the patient cannot participate or is resistant to authentically participating. Ketamine has been shown to be a great asset in removing a patient’s resistance to psychotherapy and allowing them to recall past events and relate to their innermost feelings without the mask of ego defenses.

There are essentially three ways in which ketamine and psychotherapy can be used together for the benefit of the patient. Ketamine-assisted psychotherapy (KAP) is an extensive process whereby ketamine is administered to the patient during psychotherapy. KAP has very specific protocols and the process is predetermined.

Ketamine-enhanced psychotherapy (KEP) is a process by which ketamine is also administered to the patient during psychotherapy; however, it is less rigid than KAP in that the mental health provider can move in different directions more easily and not have to adhere to a specific format of prep, session, and integration afterward.

Finally, you have a process by which the patient receives ketamine first and then, usually within a few days, has a session with their psychotherapist. In this instance, the ketamine has enabled the patient to have moments of realization independently and then discuss them with a mental health professional when not under the influence of the medication.

All three can be beneficial, though most of the clinical research proving ketamine’s effectiveness for mental health conditions has been conducted with IV infusions of ketamine without psychotherapy at the same time which will be the most widely used approach at Abundant Living, although exceptions have and will continue to be made.

There has been evidence showing the later method—receiving a ketamine treatment separate from psychotherapy—as more effective for several reasons. The first is that ketamine is administered intravenously as opposed to routes like intramuscular injections, sublingually, or intranasally.

The bioavailability of ketamine and the body’s absorption is 100 percent via the IV route, much greater than when delivered by any of the other methods. Secondly, to have true, transformative breakthroughs with ketamine, it needs to be given in doses that often do not allow the patient to immediately communicate or have meaningful conversations with a psychotherapist.

Because Ketamine is an anesthetic with dissociative properties it is also understood to come with some mild psychedelic effects.  For most people they have the sensation they are disconnecting from the here and now and are able to enter into a very mindful state inside their brain. Many people report the sensation of moving forward, changes in auditory and visual perception (sessions are with eyes closed), floating sensations, release of thoughts around which the brain is visiting for healing, and release of emotions.

Every session is different, even for the same person. As for myself, I had sessions in the beginning where a lot of trauma was being released emotionally and visually. As I’ve moved on in my journey I’ve also had sessions which were completely spiritually based and revelatory. I’ve had some sessions where I feel I am traveling through my mind with broad visual displays representing my process, and some where I am simply met with the wonder and miracle of my own existence and how mankind is meant to be knit together with love and care for each other.

Ketamine sessions are as unique as the individual because it is the individual’s brain guiding the journey.  The  best way to enter is with a mantra for healing but with no expectations of how it will look or feel; just let go and let the medicine open your mind and go to work.

Call our office for a no cost consultation if you have further questions. Once you are scheduled we will get paperwork from you to pass along to our medical director.  Once approved for ketamine by way of paperwork or medical consultation where necessary, we will get you scheduled for your first 6 sessions as well as get your KAP sessions scheduled with your Ketamine assisting psychotherapist.

You will have one therapy session before your first infusion, one after the 3rd infusion, and one after the 6th infusion. Your therapist will be available along the way for assistance and will help guide you through continued sessions.

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Chronic stress can lead to symptoms of depression. Studies in animals have shown that chronic stress also leads to the loss of communication between brain cells (neurons) in the prefrontal cortex area of the brain. The neurons lose dendritic spines, the small outgrowths on brain cells that receive signals from neighboring neurons. This leads to altered communication between brain cells.

The FDA has approved a form of the drug ketamine to treat depression. Ketamine is a fast-acting antidepressant that relieves depressive symptoms in hours instead of the weeks or longer that previous drugs required.

Research team led by Dr. Conor Liston of Weill Cornell Medicine investigated how ketamine affects the brain after mice experience chronic stress. They used high-resolution imaging to focus on neurons in the prefrontal cortex. The study was funded in part by NIH’s National Institute of Mental Health (NIMH). Results were published in Science on April 12, 2019.

The researchers examined neurons in the prefrontal cortex of mice exposed to long-term stress. They found that mice showing behaviors related to depression had an increased loss of, and decreased formation of, dendritic spines in their prefrontal cortex compared with mice not exposed to stress.

Dendritic spine remodeling. Images taken at baseline, after chronic stress, and after a single dose of ketamine. Red arrows point to eliminated spines; blue arrows to new spines.Conor Liston, Science

Treatment with ketamine rapidly relieved the abnormal behaviors in the stressed mice. The drug also quickly restored the coordinated activity of prefrontal neural circuits that were disrupted by chronic stress. However, the researchers found that ketamine didn’t work by halting the stress-induced spine loss. Instead, the drug led to formation of new functional spines.

“Our results suggest that interventions aimed at enhancing synapse formation and prolonging their survival could be useful for maintaining the antidepressant effects of ketamine in the days and weeks after treatment.”

National Institute of Health, PubMed