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Key points
- Ketamine-assisted psychotherapy (KAP) may help treatment-resistant depression as well as PTSD, chronic pain, OCD, and anxiety.
- Ketamine has been used as an anesthetic for decades, but its role as a psychoactive substance is well-known.
- The FDA approved ketamine for treating severe clinical depression in 2019.
- Ketamine combined with psychotherapy shows the most robust therapeutic effects.
Coauthored by Katherine Cullen, LMSW, and Mollie Volinsky, LCSW.
By now, you’ve probably heard about the drug Ketamine. Its name has been dropped with increasing frequency across media outlets and clinical circles ever since it received FDA approval as a treatment for severe depression in March 2019.
Synthesized in 1962 as a tamer alternative to the hallucinogen PCP, its psychoactive effects (perceptual distortions and hallucinations; alterations in mood, thoughts, sense of meaning, and bodily boundaries) have been known for decades—especially among the fewer than 1 percent of Americans estimated to use it recreationally. Until quite recently, however, ketamine has been used primarily as an anesthetic in clinical settings.
Researchers studying ketamine's psychoactive effects in the mid-2000s began noticing it could have a profoundly positive impact on clinical depression, leading the National Institutes of Mental Health to affirm the drug's efficacy as an antidepressant. Doctors started recommending ketamine to severely suicidal patients over the next few years, and by 2010 Americans saw the first wave of ketamine clinics pop up around the country.
Subsequent studies have confirmed ketamine's ability to improve treatment-resistant depression, and some suggest it can help treat other conditions, like post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and anxiety disorders. The drug is also being investigated as a potential treatment for Parkinson's.
Similar to how the effects of standard antidepressants (and other prescription drugs) are augmented by psychotherapy, research has also found that ketamine’s effects are greatly amplified by working with a therapist before, during, and after ketamine sessions. Hence, you may have also heard of ketamine-assisted psychotherapy (or KAP).
Even if you’re familiar with some of this information, you likely have some questions about how ketamine and ketamine-assisted psychotherapy work. Below, my colleague Mollie Volinsky, LCSW, KAP provider, and founder of Juniper Therapeutic Services, answers seven of the most common ones.
What Does a Typical KAP Session Look Like?
KAP can look different from provider to provider. Typically, you first meet with a medical prescriber to determine eligibility, dosage, and method of administration. Ketamine can be administered intravenously, intramuscularly, intranasally, or sublingually. Depending on the dosage and method, the medication can last between one to three hours.
Ketamine is classified as a "dissociative anesthetic," meaning one can dissociate or disconnect from one’s ordinary reality and usual self. At the dosage level administered to you, you will most likely experience mild anesthetic, anxiolytic, and anti-depressant effects. A trained psychotherapist will support you while you are experiencing the medication.
Once the medication has worn off, you will engage in an integration phase with your psychotherapist. This may include verbal reflection, journaling, somatic therapy, art therapy, dance therapy, and other methodologies. The integration component is crucial in processing the new insights and information that occurred during the ketamine experience.
What Kind of Person Benefits From KAP?
KAP may benefit many mental health struggles, including depression, PTSD, anxiety, and chronic pain. KAP is especially effective for those who have tried other medications and therapies with little improvement. The most common treatment course is to take an SSRI and participate in talk therapy. While this can be helpful for many, it does not work for all, and often takes lots of time, trial, and error. KAP clients can feel relief from their symptoms just after one session. Many clients feel significant improvement after four to six sessions
Is Ketamine Addictive?
Ketamine is a Schedule III controlled substance. It is seen as a hallucinogen and anesthetic and therefore does not produce a chemical dependence. However, some have reported "cravings" for the sensations and feelings associated with the medication.
How Does KAP Work?
Biologically, the current and most probable understanding of ketamine's mode of action is as an NMDA agonist working through the glutamate neurotransmitter system. This is a different pathway than that of the other psychedelic drugs, such as SSRIs, SNRIs, antipsychotics, benzodiazepines, etc.
Psychologically, ketamine puts one into a non-ordinary state of consciousness, which allows for interference in our default mode network—the neural pathways responsible for our core identities and negative beliefs about ourselves. It's also been found to stimulate the growth of new synapses in our brain, a phenomenon called neuroplasticity, which is responsible for creating new thoughts and insights.
Is There Anyone Who Should Not Try KAP?
Some people would not be good candidates for KAP. Those include pregnant or nursing individuals, people with untreated hypertension and hyperthyroidism, and those who have a history of addiction and/or psychosis, to name a few.
Does Insurance Cover KAP?
Most insurance plans do not cover KAP. Clinicians can provide patients with a superbill to receive some reimbursement from their insurers. Due to the groundbreaking nature of KAP, there is a limited cohort of trained providers. Therefore, it can certainly be a financial investment. Sessions can run from $700-$1,200, depending on a patient's geographical location.
