Ketamine assisted therapy: Frequently asked questions

What is ketamine?

Ketamine is a unique medication, originally developed as an anesthetic, but found at low doses to have rapid antidepressant, anti-anxiety, and trauma-lytic properties. Using specific protocols of administration within a therapeutic set and setting, ketamine can bring about profound and almost immediate relief of previously treatment resistant depression. Ketamine works on the glutamate pathway, a different neurotransmitter pathway than all previous antidepressants. It allows the mind to become transiently more open to new ways of seeing things and possibilities. Ketamine has also been shown to enhance neuroplasticity- to actually promote regrowth of neurons in the brain. The dosages used for inner work are considerably lower than anesthetic doses.

What are the risks and contraindications?

Contraindications to ketamine work include the following: uncontrolled high blood pressure, some pre-existing heart conditions, pregnancy, unstable mood disorders or history of psychosis or schizophrenia, obstructive sleep apnea, chronic bladder issues, or active substance abuse.

Ketamine is safe to use in combination with most medications, including antidepressants, because it

is working on a different pathway (glutamate rather than serotonin).

How do I prepare for my first ketamine session?

Ideally you want to come into your experience as “clean” of body and mind as possible. Minimize or avoid altogether: stimulants like caffeine, depressants like alcohol, tobacco and cannabis, and watching TV shows and movies with excessive amounts of violence. Focus on healthy dietary choices like fresh fruits and vegetables, drinking lots of water, meditating, journaling, walking in nature, and doing your best to get 8 hours of quality sleep per night.

What is a session like?

You will be encouraged to recline comfortably in a semi-upright position in a chair or on a couch. You will need eyeshades and a set of headphones connected to a music source. (Ambient music is also ok, but people often find they have a deeper inner journey with headphones.) Your BP will be taken, and if it is OK and when you are ready, you will take your prescribed losenge dose and place it under your tongue to dissolve. You will begin to feel relaxed within about 10 minutes. It will reach peak effect in about 20 minutes. People tend to describe the experience as entering a euphoric, dreamlike state of relaxation, warmth, and release of anxiety. You will gradually emerge to soft but clear consciousness within about 60 -90 minutes.

What is integration, and why is it important?

Integration refers to the process of creating a new personal wholeness in relation to an experience. In the case of ketamine journeying, this involves looking at what came up during the journey, and reflecting on what might it mean. The next step is contemplating how one might manifest or bring these insights into one’s life to live in higher alignment with one’s true nature. In addition to processing insights with your therapist, journalling and painting are especially good tools for this.

How do I get the most benefit from a ketamine series?

The most important aspect of optimizing the benefit of ketamine work is engaging the support of a skillful therapist. If you have a history of childhood or other trauma, ideally your therapist is specifically trained in psychedelic therapy integration work and trauma informed as well. Internal Family Systems (IFS) is a form of therapy that is particularly compatible with psychedelic therapy work. It is non-pathologizing and designed to promote recognition and peace making with parts of oneself that may be in conflict or may have experienced trauma, and connection with one’s inner core self. Rediscovery of the authentic, core self, beneath one's lifetime or even multigenerational accumulation of wounds and self constructed beliefs, is what recovery and healing from trauma is all about.

Is ketamine helpful for end of life transition and support?

The end of life can be an opportunity to process one's life, deepen connections to loved ones, and to find peace. Ketamine can be extremely helpful in connecting with warmth and compassion, letting go of fears, relieving anxiety and in relief of pain as one approaches the end of life.