What is ketamine?
Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent and now, often effectively for treatment of depression, alcoholism, substance dependencies, PTSD and other psychiatric diagnoses as well as for existential, psychological and spiritual crises and growth. Use of ketamine for mental health treatment is considered an “off-label” prescription and is not covered by health insurance.
How does it work?
The current understanding of ketamine’s role of action is as an NMDA antagonist working through the glutamate neurotransmitter system. This is a very different pathway then that of other psychiatric drugs such as the SSRIs, SNRIS, lamotrigine, anti-psychotics, benzodiazepines, etc.
Ketamine is classified as a dissociative anesthetic, dissociation meaning a sense of disconnection from one’s ordinary reality and usual self. At the therapuetic dosage level, you will likely experience mild anesthetic, anxiolytic, antidepressant, and potentially psychedelic effects. While more recent work has demonstrated the possibility of an antidepressant response to low doses of ketamine administered intravenously, intra-nasally and sublingually (orally) that produce minimal psychedelic effects, this effect tends to be better sustained with repeated use, offering a cumulative effect. Psychedelic, ‘dissociative’ experiences may well be instrumental in providing a more robust effect and this may well include the positive change in outlook and character considered as a ‘transformative’ response.
Can I get addicted to ketamine?
In a meta-study by Cambridge University: Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review, researchers reviewed 83 ketamine studies. In particular, they looked for evidence of ketamine dependence/abuse and found:
“Given that ketamine may also be used recreationally, it is notable that even in addiction treatment, no studies in our review report a transition to illicit use engendered by introduction to ketamine in a therapeutic context. “
This is powerful evidence, and it aligns with the experience of practitioners in our provider network. Harvest is part of a Ketamine therapy network that has conducted more than 500 in-office Ketamine therapy sessions and has filed more than 100 take-home prescriptions and refills in the past three years, and to date, not a single patient’s ketamine use has escalated in the direction of addictive or dependent use.
Rather, in nearly all cases, clients begin with more frequent use (i.e. 1 in-person session every 2-3 weeks, 1 home session every 1-2 weeks) and gradually move to infrequent (i.e. 1x per month to 1x every other month) or as needed (i.e. a few sessions over a 6 month period).
Harvest is also affiliated with the Ketamine Training Center, which operates three large ketamine therapy clinics in the United States, and has cumulatively conducted thousands of Ketamine sessions. The only concerning addiction/dependence case they have reported was one in which they had prescribed the Johnson and Johnson ketamine nasal spray for home use. Due to the convenience of use and ease of varying dosage, the ketamine nasal spray has more potential for abuse (although in this case, it did not result in physical dependence).
In terms of precautions, Harvest’s model emphasizes regular points of contact and conversation among the client, the medical provider, and the mental health provider to ensure that ketamine is a good fit and is continuing to be a therapeutically productive tool.
Is ketamine effective with nicotine addiction?
Although there is substantial evidence that psilocybin-assisted psychedelic therapy is effective in curbing nicotine addiction, the research is limited when it comes to ketamine. A study that showed ketamine was effective in curbing nicotine addiction indicates that ketamine may be effective in reducing nicotine cravings for rats, but it hasn’t been an area of research in humans yet.
Ketamine and other psychedelics are not silver bullet cures. However, they’ve been shown to be highly effective when combined with psychotherapy, cognitive behavior therapy, mindfulness, or other specific strategies for behavior change.
Harvest clients wanting to improve their self-control or cease problematic substance use behaviors have had success when they’ve committed to long-term practice. Ketamine’s effect can be described as helping people decouple their needs from the problematic substance or behavior, meaning it helps them to notice when they are going into auto-response, whether it be reaching for a drink or grabbing a cigarette. In going through Ketamine therapy, people often report an increased capacity to pause, notice themselves, and respond rather than react.
What kind of results do people experience?
Our experience is that ketamine helps interrupt the automatic, default patterns that all of us get stuck traveling, to the detriment of ourselves and others. We find people are coming to us with so many different issues, but the common thread is that the ketamine experience helps people realize that they are agents in their own lives with endless opportunities to respond to their circumstances rather than to be carried away by them.
1. A client wanted to decrease drinking so that he was able to go to bars socially with his buddies, but gain more self-control over the amount he drank. After three ketamine sessions, he found he was able to go out to the bar and when he looked at the menu, he was able to really ask himself what he wanted and realized that he preferred a non-alcoholic drink.
2. A client who wanted to change her pattern of zoning out on her phone at the end of a day described after ketamine treatment the experience of being aware of her phone, realizing that nothing on the phone was all that interesting, and instead decided to go for a run.
3. A client was beginning to go down a familiar road of marital conflict with her husband, but after he got the first few sentences out, rather than fight, she paused and said “I don’t like it when you talk to me like that.” Rather than fight as they usually would have, they had an intense conversation about how her husband speaks to her and how she wants him to speak with more respect towards her, even if they disagree.
Can ketamine cure me?
Ketamine itself is not a cure and it does not change your behavior. Instead, if you’re willing to learn and embrace the new pathways that the experience with ketamine opens up, it can be highly effective in helping you change problematic habits.
Does insurance cover therapy?
Use of ketamine for mental health treatment is considered an “off-label” prescription and is not covered by health insurance.