Ketamine is a synthetic pharmaceutical compound, classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. It was developed in 1963, FDA approved in 1970, and adopted by many hospitals and medical offices because of its rapid onset, proven safety, and short duration of action. As an anesthetic, ketamine is most commonly used in surgical settings, including pediatric surgery, due to its excellent safety profile, particularly around breathing/airway management. It has also been utilized successfully in managing acute and chronic pain conditions due to its analgesic properties. When a new drug is approved for medical use, the manufacturer produces a “label” to explain its use as approved by the FDA. Once a medication is approved by the FDA, physicians may use it “off-label,” meaning for purposes other than what is listed on the label, as long as the use is based on sound medical evidence. In the last two decades, ketamine has been increasingly used off-label to treat various chronic and treatment-resistant mental health conditions, such as depression, alcoholism, substance dependencies, post-traumatic stress disorder, anxiety disorders, and other psychiatric diagnoses.

Ketamine is classified as a dissociative anesthetic, where “dissociation” means a sense of detachment from one’s body, environment, ordinary reality, and usual sense of self. The present understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system, as well as an opioid receptor agonist. In depression, the spindly receptors on neurons that facilitate signal transmission may recede, and the amygdala and hippocampus (both of which help govern mood) may shrink. Animal research has shown that ketamine can stimulate neural growth within days (and sometimes hours). One hypothesis is that there is similar action in humans. Another hypothesis is that ketamine affords a reprieve from habitual patterns of thought that underlie mood and behavior, thereby creating an opportunity for learning new and healthier patterns of thought. There is no current consensus on mode of action, and other mechanisms may be found central to ketamine’s effects.

The ketamine experience is characterized by the relaxation of ordinary concerns and usual mindset. This tends to lead to a disruption of negative feelings and preoccupations. Some ketamine providers feel that this interruption, and the exploration of other possible states of consciousness, can lead to significant shifts in overall well-being. At lower doses, you will likely experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience empathogenic (similar to MDMA) effects in this dose range. This state may also enhance participation in psychotherapy, as defenses are relaxed, yet communication with others is still possible. Higher doses are more likely to produce psychedelic, dissociative states that are largely internal journeys away from the external world. Body sensations are greatly diminished. Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological and (and possibly spiritual) growth, and promoting a positive change in outlook and character that we refer to as a transformative response. Sensory effects of ketamine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, vivid imagery, and changes in visual, tactile and and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar music may not be recognizable. An ordinary sense of time may morph into time dilation. Some people report psychic experiences, which they perceive as bizarre or frightening, while others describe them as pleasurable, joyful, or fascinating. We have found that even frightening experiences can be of great value to your recovery process. Our team is trained in providing stability for those experiencing extreme states, and you will receive psychotherapeutic help and ongoing guidance as to how to make the best use of these experiences. The effects of ketamine typically start 5 to 10 minutes after ketamine dosing. The peak effects typically last 20 to 30 minutes, and then slowly diminish for the next hour. Some alterations in sensory perception, speech, and motor ability may continue for approximately 5 hours.

Ketamine can be administered in a variety of ways, including as an intravenous infusion (IV), intramuscular injection (IM), a subcutaneous injection (SC), intranasally, or sublingually/orally as a dissolving troche or tablet. Routes vary in the onset, bioavailability and duration of active effects for each person. Though research has demonstrated an antidepressant response to low doses that are minimally psychoactive or sub-psychedelic, this effect tends to be cumulative, requiring repeated administrations over short periods of time. Some practitioners view the psychedelic and dissociative experiences that occur at higher doses to provide a more robust and longer-lasting outcome. Though experiences vary greatly, it is generally thought that lower doses provide empathogen-like (heart-opening) responses, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving peak experiences. In our practice, ketamine is administered by sublingual (oral) dissolving tablets, a strategy which may allow for psychotherapy during the treatment, and an easier experience for those who are hesitant about injections. We use a range of dosing strategies to create a personalized approach for each client, adjusting the dose, frequency, and time in between sessions based on each individual’s needs.

Ketamine has the potential to create a non-ordinary state of consciousness, facilitating a profound transpersonal or mystical peak experience. These sorts of peak experiences have been shown to expand one’s sense of self and understanding of existence, and may enable you to access your own healing wisdom. Your therapist serves as a guide, and assists in processing the experience and its impact on your everyday life. Ketamine’s altered state can create conditions of relational and psychological openness​, and thus we believe that trust in your therapist enables the deepest possible work to occur. Psychotherapy sessions are meant to build a sense of connection and trust between you and your therapist. Many have found it beneficial to set an intention for the experience. Intentions should be personal and focused, which could include alterations in habits (such as the use of alcohol or cannabis, exercising, etc.), shifts in self-defeating patterns of thought or social interactions, or exploration of spiritual/existential realms. Your therapist will work with you to formulate your goals, and will also encourage you to hold those lightly, ​as resistance or attempts to control the experience can produce anxiety. Your experience will be unique to you, and each of your sessions will be different. All such journeys are adventures that cannot be programmed. They evolve from your own being in relation to this medicine, and it is best to relax into the path that unfolds. Many enjoy the journey, while others do not. Everyone comes through it, and often with greater insight into themselves and their lives.

As a byproduct of your experience, you may feel improvement in your emotional state and reduction in symptoms such as depression, anxiety, and post-traumatic manifestations. You may notice that you are a bit different after a ketamine experience, and that difference may feel liberating, allowing for new perspectives and behavior. These shifts may happen during treatment, in the aftermath, and/or in the days and weeks that follow. Some experiences may be temporarily disturbing to you, and we will work to help you understand these in context of your healing process. Ultimately, we are working to assist you in changing patterns of mind, mood, and behavior that cause you difficulty and distress. This is a unique opportunity for growth and change, and so we encourage you to actively engage in the therapeutic process as well as the medication administration. While medication on its own provides symptom relief, it is most effective in the longterm when combined with therapy and your active participation in the process of integration.

Ketamine is distinguished from other psychotropic medications by its rapid onset, often producing relief in as soon as a few hours. The literature indicates a 70% initial response rate to ketamine, as well as a remission rate (return of symptoms) for people with treatment-resistant depression of 40-50%. Durable improvement generally occurs with more than one administration, and is most robust when part of an overall treatment program. It may not permanently relieve your condition. If your symptoms respond to ketamine, you may still elect to be treated with other medications and ongoing psychotherapy to reduce the possibility of relapse. Over time, you may also need additional ketamine booster administrations or other therapies to maintain your remission. If you do not respond to ketamine after the first administration, repeated treatment will be offered. If you do not respond after a series of 8 dosings, additional ketamine will not be offered. Studies have shown it is not effective to keep treating with ketamine in those who do not respond to the first 8 doses. The treatment team will discuss with you other available options at that time. Although a course of ketamine treatment typically provides only a few months of benefit, repeated treatments have been shown to have a cumulative effect, prolonging mood improvements, and current research is focused on how to sustain these benefits with an optimal dosing schedule and integration of psychotherapy.