What is ketamine?
Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent and in recent years as a breakthrough treatment of depression, alcoholism, substance dependencies, PTSD and other psychiatric diagnoses, as well as for existential, psychological and spiritual crises and growth.
Ketamine is classified as a dissociative anesthetic and it is currently the only legal psychedelic medicine that physicians can prescribe to give patients access to “expanded states of consciousness” associated with classic psychedelic experiences. During the peak of the therapeutic ketamine experience, clients participate in a realm of consciousness variably described as as “cosmic,” “connected”, “ego dissolved,” and “boundless.”
How does it work?
Ketamine is a powerful 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. Although research clearly shows ketamine produces a powerful, if temporary, anti-depressant effect in patients, scientists are still working to understand the exact mechanism. A 2019 study published in the journal Science found that ketamine was able to “restore electrical activity and then rebuild physical connections between neurons” in the brains of mice. The study also found evidence that ongoing interventions were required in order to sustain the restored synapses. In humans, such interventions could include “additional drugs, brain stimulation therapies, talk therapy, or even exercise.”
How do I know if Ketamine-Assisted Therapy (KAT) is the right course of treatment for me?
KAT is not appropriate for people with specific mental and physical health conditions. KAT may cause a loosening up of one’s perception of reality. In some mental health diagnoses, such as psychosis or schizophrenia, where there is already some disconnect with one’s sense of reality, this treatment can exacerbate these conditions.
Likewise certain physical diagnoses, for example, some heart conditions, may be contraindicated, so further screening is necessary to determine whether or not KAT is a safe course of treatment for you.
Can I try just one dose of ketamine and see if I want to continue?
At Harvest, our focus is client-centered care which uses ketamine as a catalyst for transformation through therapy. Ketamine-Assisted Therapy (KAT) does not provide significant benefits after a single treatment session. The Harvest model considers your unique physical, mental, and emotional needs. We take great care to ensure your safety and find the dosage that best supports your transformation through KAT. Our first ketamine session helps us to determine the most appropriate ketamine dose for you; therefore, we recommend having a minimum of three ketamine-assisted therapy sessions.
How long is a session, and what does it involve?
Each KAT session is 3 hours, including a 15-minute check-in with your medical provider and your KAT provider. Your KAT provider is present throughout the entirety of the session. The ketamine journey itself typically lasts between 30-50 minutes. The remaining time ensures adequate recovery and integration time with your KAT provider.
What is the treatment regimen and how many appointments will I need?
Harvest’s Ketamine-Assisted Therapy (KAT) model involves 1-2 preparation/intake non-ketamine sessions and 3-6 KAT sessions, typically with integration sessions following each KAT session. There is no specific schedule between sessions; everyone’s needs are different. That is why we leave the scheduling of your sessions between you & your KAT provider. Although intensive treatment protocols are available for people who need to travel for treatment, we recommend you wait at least a week between sessions. This may change depending on your response to the medication & input from your provider/therapist.
What is a booster session, and how will I know if I need one?
A booster session is a follow up session after you have completed the initial KAT series of treatment. One way to think about booster sessions are KAT to keep the momentum going in your healing trajectory, to help recenter or to deal with a crisis. Whether you need a booster session or would benefit from it, how to time them and how many you would need, would be up to you and your therapist to determine.
Are intake, preparation and integration sessions included in the cost of KAT treatment?
Intake, preparatory or integration sessions are individually scheduled and not included in the cost of Ketamine-Assisted Therapy sessions.
Does insurance cover Ketamine-Assisted Therapy (KAT)?
Currently, insurance plans do not cover Ketamine-Assisted Therapy. Insurance may cover your intake, preparatory sessions, and integration sessions depending on your plan. Harvest will provide a “super bill” for clients to submit to their insurance company but it is the client’s responsibility to confirm what services are covered.
What if I already have a therapist or mental health provider?
Many mental health providers are becoming increasingly aware of the benefits of psychedelic-assisted therapy yet cannot provide those services for their clients. We encourage you to continue your work with your provider while going through KAT. Your Harvest practitioner will require a specific number of preparation and integration sessions with you. With your permission, your current provider and your Harvest provider will share information to support you through your ketamine journeys. Once you complete your series of ketamine treatments, we recommend you continue with your current provider.
How is Harvest different than other ketamine clinics?
At Harvest, we believe transformative medicine, quality care, and intentional space are core ingredients of healing and growth.
As we surveyed the field of ketamine treatment we found widely varying practices in session length (running as short as 40 minutes), session practices (with some clinics even putting on television during the journey), dosage (with some clinics using doses in which the effects are only mildly noticeable and others using such high dosages that patients are effectively sedated), and support (with many clinics around the country having no mental health professional on-site and minimal to no in-session integration or pre-and post-session preparation and integration).
We found that some ketamine clinics make unfounded and unethical claims regarding ketamine’s efficacy and effect on the brain. We also saw many practice settings that leaned into the medical model of care, feeling much like a doctor’s office. In contrast, at Harvest we aim to create a warm, comfortable environment, with intention given to each part of the process. This includes careful selection of music designed to enhance the therapeutic journey, the use of eyeshades during sessions to deepen the experience, three-hour-long session times to ensure adequate recovery and integration time, post-session refreshments, a KAT provider/therapist who accompanies you in a supportive role throughout all of your ketamine journeys, an onsite medical professional to ensure your physical wellbeing throughout your sessions, and the opportunity for ongoing integrative psychotherapy in concert with your ketamine treatment.
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).
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 for substance abuse treatment?
Although preliminary research indicates that psychedelic therapy is dramatically more effective than any other substance abuse treatment available, we emphasize that psychedelics are not silver bullet cures. Ketamine-Assisted Therapy in particular has 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. For example:
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.