Ketamine is a glutamate (NMDA receptor) modulator, and is the only legal psychedelic medicine available to mental health providers for the treatment of easing emotional suffering. Studies have shown psychedelic assisted psychotherapy utilizes the acute psychological effects to enhance the normal mechanisms of psychotherapy. Ketamine is a dissociative drug, allowing the patient to achieve a state of dissociation of the mind from the body, look at experiences differently, thus allow changes to how one thinks and thus sees the world while in that state. As the Ketamine wears off, the memory of the trauma is still there, but the physical and emotional charge around it is lifted.
Ketamine infusions are described as inducing a hypnotic or dream-like state. In this state the mind is more malleable, allowing the breakdown of psychological defenses, in turn accelerating processing of emotional material that would otherwise take months to work through. In other words, ketamine-facilitated therapy allows us to gain access to the unconscious, allowing for deeper, more meaningful and transpersonal experiences than talk therapy or hypnotic therapy, alone. Creating the bridge between intellectual awareness and emotional memory, in a therapeutic environment, can be the key in allowing the processing of trauma.
Ketamine was introduced into clinical practice in the 1960’s and FDA approved in 1970 for sedation and analgesia. Due to its safety as an analgesia it has been used extensively in combat field medicine and pediatrics. Beginning in 2000, research studies began to show IV subanesthetic doses of ketamine consistently decreased symptoms of treatment resistant depression symptoms including suicidal ideation, as well as anxiety and PTSD, in a rapid, effective, and sustained manner.
Ketamine is typically IV, infused over 40 minutes. Pts report mild visual hallucinations, interesting thoughts and ideas, change in perspective, light and sound sensitivity and dissociation. Biologically, ketamine has lasting effects, enhancing neuronal activity by acting as a NDMA receptor antagonist to increase glutamate and brain derived neurotrophic factor, creating neuroplastic changes in the brain facilitating growth of new neuropathways. Results are typically seen with repeated doses of 6 infusions over the course of 2-3 weeks. After this initial phase of treatment, many pts use ketamine for continued maintenance of symptom remission once a month, and/or 1-2 treatments as needed when symptoms begin to return.
Ketamine can also be used as a one-time infusion to treat acute suicidal ideation and core symptoms PTSD, including intrusive thoughts, dissociative reactions, nightmares, increased autonomic arousal and associated depression.
Ketamine is not FDA approved for the treatment of depression, thus it is not covered by insurance. Ketamine is not indicated in patients who are pregnant, nursing, those with cardiac conditions, active drug use, active psychosis or current bipolar mania.