It is hard not to notice the proliferation of clinics offering ketamine therapy. Up until recently, ketamine was mostly known as a club drug or a horse tranquilizer.
However, ketamine has an interesting history. Developed in the early 1960’s it has well established safety as an anesthetic and analgesic.
Yes, it is used as an animal anesthetic, but it was also widely used during the Vietnam War and its therapeutic potential was noted in the 1970’s but research into various applications was thwarted (along with many psychoactive substances) during Nixon’s war on drugs efforts.
Here we are in 2022 and a very quick google search showed at least ten places in Austin alone offering ketamine infusion therapy.
So, who is it for and what is it for…and while we are at it…what exactly is ketamine?
Before continuing, I must make a key clarification. I am not a medical professional. I do not have a license to practice medicine. The information here is general and NOT a substitute for consultation with a medical doctor. Only you and your doctor can determine if ketamine therapy is appropriate for you.
What is ketamine?
Ketamine is considered a dissociative anesthetic. It has been most widely used as a surgical anesthetic for both animals and humans. It is fast acting and has a short duration, so it is often used for minor surgeries. Ketamine is typically delivered intravenously and according to the World Health Organization (WHO), it is listed as an essential medicine. Although the WHO has worked to have it removed from the schedule of drugs, it remains a schedule three drug.
Ketamine as a club drug
Ketamine has been popular as a club drug due to its dissociative properties. People who use it often feel detached from themselves and from reality. While for many people, this is the point, others find it to be an unpleasant experience. Taken at too high of doses, people fall into the “K-hole,” which is described as feeling numb and/or detached from your body to the extent that people find it difficult to talk or move. This can cause feelings of panic or anxiety and some people experience hallucinations, though this is not always the case.
Although there are risks with recreational ketamine use, the WHO reviewed international reports, consulted an expert panel, and concluded, “ketamine abuse currently does not appear to pose a sufficient public health risk of global scale to warrant scheduling.”
Ketamine as treatment
In 1973, there was a promising study about the effects of ketamine paired with psychotherapy to improve mental health. Research in this area slowed due to the war on drugs, but in the early 2000’s the research gained traction again.
Traditional medications to help with mental health often work on the neurotransmitters, dopamine, serotonin, or norepinephrine. However, ketamine works the NMDA and AMPA receptor. The NMDA receptor is a glutamate and ion-channel protein receptor that gets activated when glutamate and glycine bind to it. Another receptor called the AMPA also gets activated with ketamine and is responsible for the antidepressant effect. At low doses, ketamine also interacts with the opiate receptor.
When used therapeutically, ketamine creates an altered state of consciousness that promotes a sense of calm, openness, and vulnerability, and temporarily “weakens” psychological defenses.
Ketamine infusion therapy is now used for depression and anxiety, as well as problematic substance use, chronic pain and more.
Research has showed ketamine to be effective in managing the use of cocaine, alcohol, and opioids. Effectiveness is greater when ketamine therapy is paired with ongoing therapy. Several studies have shown sustained improvement in cravings and abstinence when compared to control groups.
What is ketamine therapy like?
In short, it feels different for different people. Ketamine is administered most often via IV, but other methods are available which can lead to different experiences. Most places will follow the ketamine assisted psychotherapy (KAP) model which strongly emphasizes the role of therapeutic support as well as set and setting to accentuate and extend the longevity of the ketamine effects.
The importance of set and setting helps to facilitate feelings of trust and safety, both of which are needed to foster a therapeutic value.
You will have a trained clinician who gets to know you before you begin your treatment and is present with you during your treatment. The clinician is also responsible for helping you to integrate your experience. Also present will be a medical professional who monitors you physically during and after the infusion.
Depending on the clinic, you may take part in selecting a music play list and setting an intention for the treatment. At some places there is more emphasis on being guided and conversed with during the experience. Ideally, the process will be individualized for you needs, preferences and circumstances.
Doses are individualized and carefully monitored. Many people will experience some of the dissociative or psychedelic effects, but most people remain lucid and able to communicate during their experience.
Are there people who should not have ketamine therapy?
No treatment is right for everyone and only you and a doctor should determine if it is right for you. However, there are some general contraindications and considerations for ketamine therapy. If any of these apply to you, be sure to discuss them with your doctor if you are considering ketamine therapy.
1. Uncontrolled, high blood pressure
2. Unstable heart disease
3. Uncontrolled thyroid disease
4. Active substance use with certain substances
5. Experiencing mania
6. People who experience hallucinations and/or delusions
Support if you need it
If you are struggling with substance use and would like support, Substance Use Therapy is here for you. Whether you want to examine your use, improve safety and control, or work toward abstinence, support is available. We are also happy to assist you in providing referrals for ketamine assisted psychotherapy or other treatment modalities, such as naltrexone, buprenorphine, etc. Whatever you are facing, you don’t have to face it alone.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.