Ketamine-Assisted Psychotherapy (KAP); A Word of Caution

Over the past few months, several new clinics have begun offering KAP, or Ketamine-Assisted Psychotherapy, either in-office or at home via remote telemedicine. These clinics are basing their untested protocols not on established protocols for intravenous ketamine therapy which over the past 20 years has proven to be safe and effective in treating depression, PTSD, anxiety and chronic neuropathic pain, but rather on early stage trials currently evaluating MDMA (Ecstasy) and Psilocybin-Assisted Psychotherapy for PTSD. MDMA and psilocybin (the active chemical contained in Magic Mushrooms), while promising, are still not legal to prescribe and are as yet unproven, and both are quite different than ketamine. The premise of KAP is that during an oral or intramuscular ketamine-induced dissociative state, similar to the 4-hour “trip” one experiences with these other hallucinogens, combined with guided therapy and integration, the patient can experience an introspective journey that is both enlightened and somehow reparative.

But this is not how ketamine infusion therapy works. While we recommend ongoing psychotherapy to help incorporate the progress achieved with IV ketamine therapy, ketamine’s profile is far different than either MDMA or psilocybin. Ketamine is not about the “trip” or “journey.” It works by stimulating new dendritic and synaptic growth between the neurons connecting our mood centers. It is an anatomic repair that often does not even begin for eight to ten hours after the infusion has ended, and it is not dependent upon what you experience during the infusion.
In our view, KAP is not appropriate for many patients. Entering into a dissociative state is not necessary for ketamine’s mechanism of action. In fact, some of our new patients with Post-Traumatic Stress Disorder (PTSD) worry that a dissociative experience might trigger disturbing and troublesome flashbacks to times and events they neither want to re-visit nor derive healing benefit from.
While our patients often experience a gentle, “floaty” dissociative experience which most enjoy, other patients prefer to avoid it. With intravenous ketamine, we can adjust both the dose and the speed of infusion, achieving an individualized experience that is right for you. We have found over many years and tens of thousands of infusions that ketamine’s success rates are the same regardless of the infusion experience itself. Controlling the dissociative experience is not possible with oral, nasal or intramuscular ketamine administration which many, less experienced clinics administer. There is no control over where your mind might wander and no way for the physician to intervene, make adjustments or turn it off. Only IV ketamine treatment allows for this flexibility and safety.

Please be thoughtful and careful about your choice of a ketamine provider, their understanding of ketamine’s mechanism of action, their therapeutic intent, and their planned method of ketamine administration. Choose an experience that is most appropriate and safest for you. In our view, based on 9 years of providing relief to over 4,000 patients, ketamine infusion therapy is the gold standard for alleviating symptoms of treatment-resistant depression, PTSD, major mood disorders and chronic neuropathic pain.

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