Ketamine Assisted Therapy

How does ketamine assisted therapy work?

Ketamine is anesthetic, dissociative, and hallucinogenic. With the right dose, therapeutic framing, and route of administration, a patient can be guided into a hypnotic, trance-like state, during which the patient’s observer mind can see the contents of her own memories without going into a nervous system reaction to it.

Although we’re commonly encouraged to “feel our feelings”, and that’s a good principle as long as we’re stable and strong enough to do that, for some types of mental illness, including post-traumatic stress disorder, we actually need help to feel less of our feelings all at once.

Those of us with trauma need help to be able to witness our own experiences without being pulled into overwhelming feelings about the events, so that we can mentally understand what happened and move on.

It’s very difficult to move on from the emotional and somatic residue of trauma if we can’t place the feelings and terrible sensations in our bodies in the correct context, cognitively. At the same time, it’s very challenging to witness those original events neutrally, without getting pulled into states of shock, devastation, terror, or helplessness all over again.

Ketamine, by numbing and creating a lightly hypnotic state, makes it possible for some people to progress therapeutically in ways that weren’t accessible before.

What conditions does ketamine assisted therapy treat?

Ketamine assisted therapy is used most commonly to treat post traumatic stress disorder (PTSD), treatment-resistant depression, major depressive disorder, suicidality, obsessive compulsive disorder, substance abuse, and anxiety.

What is ketamine?

Ketamine is a medicine that is used in clinical contexts as an anesthetic or to treat physical pain. It also has psychedelic and dissociative properties.

First synthesized in 1957, ketamine was originally developed to be a painkiller and was granted FDA approval for use as a general anesthetic in 1970.  In the 1970s the US military used ketamine on the battlefield in Vietnam as an anesthetic.

In the early 1970s, some researchers interested in the therapeutic applications of psychedelics began using it in mental health contexts. The first study of the use of ketamine to treat depression was published in 2005, and in 2019 the FDA approved ketamine, a derivative of ketamine, for use with serious depression and suicidality.

Ketamine is believed to be helpful with treatment-resistant depression and other difficult mental health conditions, such as addiction and PTSD. Ketamine is also abused as a recreational drug, illegally.

What makes ketamine assisted therapy a promising therapeutic tool?

In low doses, ketamine can induce a patient into a state of relaxation, peace, and euphoria. The patient may experience changes to how they experience time, and observe greater vibrancy in colors. It is also common to hear sound in a more nuanced way and to feel a sense of floating or detachment from the physical body. This is the dissociative effect.

When a therapeutic dose of ketamine is used in combination with psychotherapy, the lightly psychedelic, euphoric, yet detached state makes it possible to bring difficult topics and memories to the surface quickly.

Surfaced topics can then be engaged therapeutically, and the healing work that the psyche needs can take place without the risk of the patient being flooded by intense physiological discomfort, emotional distress, or nervous system shut-down.

In cases of severe trauma, and other kinds of very difficult mental illness, the patient struggles to consciously process the material psychological damage that exists in their memory record, without those memories automatically triggering intense dread, rage, terror, and dissociation. Such states not only block the therapeutic progress but set the patient up for self-destructive and dangerous behavior, such as drug use or self-harm, as a way to cope.

Ketamine is a promising treatment modality because it offers a unique window into the site of the original problems, and allows the patient to discover healing self-forgiveness, resolution, and recognition of their own experiences while in an altered state.

This self-witness and processing of the psychological damage changes how the brain then stores those memories, allowing the patient to move on from needing to reenact and re-feel those same events over and over again. The patient’s agency and ability to make decisions about how they want to think and feel going forward can be restored.

What is the research backing up ketamine assisted therapy’s effectiveness?

According to a study published in March 2019, Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy, “data support the efficacy of KAP for a wide variety of psychiatric diagnoses and human difficulties, significantly diminishing depression, anxiety, and PTSD and increasing well-being.”

A study on emergency use in cases of suicidality found that ketamine “has an important role in the emergency management of severe depression.”

A 2011 review of ten years of research into the efficacy of ketamine use in the treatment of alcoholism states in the abstract that:

“ketamine-assisted psychedelic therapy of alcoholic patients induces … positive transformation of non-verbalized (mostly unconscious) self-concept and emotional attitudes to various aspects of self and other people, positive changes in life values and purposes, important insights into the meaning of life and an increase in the level of spiritual development. Most importantly, these psychological changes were shown to favor a sober lifestyle.”

The authors of Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature, 2022, conclude:

“Ketamine’s demonstrated ability to produce antidepressant and anxiolytic effects likely interacts with the processes involved in psychotherapy, ideally as a conduit for rapid change, increasing treatment engagement and adherence, building the therapeutic alliance, and lowering defensiveness by providing reprieves from distressing symptomology while inducing transpersonal experiences at higher doses.”