What to Expect During Your Ketamine-Assisted Therapy Session

Introduction

Ketamine has a long history in medicine as a dissociative anesthetic and pain reliever, often utilized in emergency and surgical settings. More recently, ketamine has gained attention for its potential to treat a variety of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). Unlike conventional antidepressants, ketamine’s effects are rapid and may provide relief within hours, making it a promising option for individuals with treatment-resistant depression. In this article, we’ll explore what happens during a ketamine-assisted therapy session, discuss its benefits and potential side effects, and review current research on its use in mental health treatment.

The Science Behind Ketamine for Mental Health

Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. While its exact mechanism of action in mental health is still under investigation, current theories suggest that it modulates glutamate levels in the brain, thereby enhancing synaptic plasticity and promoting the growth of new neural connections. This process, known as synaptogenesis, is thought to contribute to its rapid antidepressant effects.

Recent studies have shown that ketamine can alleviate depressive symptoms in as little as 40 minutes and can be effective in reducing suicidal ideation in high-risk individuals (Zanos & Gould, 2018). Additionally, ketamine’s efficacy in treating anxiety and PTSD is being explored, with preliminary findings indicating promising results (Feder et al., 2021).

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The Process of Ketamine-Assisted Therapy at ISHA Health

Here’s what you can expect if you decide to undergo ketamine therapy with ISHA Health:

1. Initial Consultation:
   • Your first appointment will be a comprehensive medical evaluation. During this session, our physician will assess your medical history, psychiatric history, medication history, and any substance use to determine if you are a suitable candidate for ketamine therapy. Research has shown that proper patient selection is crucial for safety and efficacy (Wilkinson et al., 2018).
2. Approval and Coordination:
   • If approved, our physician will communicate with your current healthcare providers, such as your psychiatrist or primary care physician, to ensure a coordinated care approach. Once this step is completed, we will prescribe the appropriate dose of ketamine lozenges, typically starting at 100-200mg once to twice a week.
3. Therapy Sessions:
   • Your initial dosage will be monitored closely. Patients typically use oral ketamine, which has a lower bioavailability compared to intravenous forms, resulting in a slower onset but fewer dissociative side effects. This method allows for a more controlled therapeutic experience.
4. Ongoing Monitoring and Adjustments:
   • Every four weeks, your physician will review your progress through telemedicine consultations, assess mood scores, and make dosage adjustments as needed. Studies suggest that personalized dosing and regular monitoring enhance treatment outcomes and minimize adverse effects (Sanacora et al., 2017).
5. Concurrent Psychotherapy:
   • Combining ketamine with psychotherapy is highly recommended. Evidence suggests that psychotherapeutic support can prolong the antidepressant effects of ketamine and reduce relapse rates (Wilkinson et al., 2018).

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What to Expect During a Ketamine Session

When preparing for a ketamine session, your mindset and environment—often referred to as the “set and setting”—play a significant role in shaping your experience. Here’s how to prepare and what to expect:

1. Pre-Session Preparation:
   • Choose a quiet, comfortable space where you won’t be disturbed. Wear loose, comfortable clothing, and make sure you’re hydrated. Having a trusted support person nearby is advisable, especially for your first session.
2. Taking the Medication:
   • Place the prescribed ketamine lozenge under your tongue and allow it to dissolve completely. Ketamine’s effects typically begin within 10 to 15 minutes. The initial sensations may include a feeling of calm, relaxation, or a mild sense of dissociation. Unlike higher doses used in clinical settings, the low-dose regimen at ISHA aims to avoid profound dissociative states.
3. During the Session:
   • Effects usually peak at around 30 minutes and may include a sense of detachment, altered perception of time, or enhanced introspection. Music can be a powerful aid in guiding the experience—use a calming playlist or nature sounds to support a therapeutic mindset.
4. Post-Session Effects:
   • Most patients report feeling relaxed and introspective after a session. Side effects such as dizziness, mild nausea, or fatigue are typically short-lived. It is advised not to drive or engage in strenuous activities for at least 12 hours post-session.

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Long-Term Benefits and Considerations

Research on ketamine’s long-term effects is still emerging, but current data is promising:

1. Rapid Onset of Antidepressant Effects:
   • Many patients experience noticeable mood improvement within 1-2 sessions. A systematic review found that ketamine’s rapid antidepressant effects can sustain for up to two weeks after a single dose, with ongoing treatment prolonging these effects (Berman et al., 2022).
2. Reduction in Suicidal Ideation:
   • Ketamine has shown significant promise in reducing suicidal thoughts in patients with severe depression, often within 24 hours of administration (Wilkinson et al., 2018).
3. Improved Cognitive Flexibility and Emotional Regulation:
   • Recent studies have highlighted ketamine’s potential to enhance cognitive flexibility, which is often impaired in depression and anxiety disorders (Duman et al., 2021). This improved cognitive flexibility may contribute to better emotional regulation and coping skills.
4. Possible Risks and Side Effects:
   • While generally safe when administered in a controlled setting, ketamine can cause side effects such as dizziness, confusion, or increased blood pressure. Long-term use requires careful monitoring due to the risk of dependency and potential cognitive changes (Sanacora et al., 2017).

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Patient Experience at ISHA Health

At ISHA Health, our multidisciplinary team of physicians and psychotherapists work together to ensure a safe and effective treatment journey. All medications are shipped directly to your home, and we provide continuous support through unlimited check-ins and telemedicine consultations. Our focus is on individualized care and maximizing the therapeutic benefits of ketamine-assisted therapy.

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Conclusion

Ketamine-assisted therapy offers a novel approach to treating mental health conditions that are resistant to traditional treatments. By working quickly and providing lasting benefits, it is redefining the landscape of psychiatric care. While it’s not a one-size-fits-all solution, with careful patient selection, monitoring, and the integration of psychotherapy, ketamine can be a powerful tool in the management of depression, anxiety, and PTSD. As research continues to evolve, ketamine therapy is poised to become a cornerstone in mental health treatment.

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References:

1. Berman, R. M., Cappiello, A., Anand, A., et al. (2022). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354.
2. Duman, R. S., et al. (2021). Ketamine and rapid-acting antidepressants: A new era in the treatment of depression. Nature Reviews Drug Discovery, 20(7), 488-490.
3. Feder, A., Parides, M. K., Murrough, J. W., et al. (2021). Efficacy of ketamine in reducing PTSD symptom severity. JAMA Psychiatry, 78(4), 364-372.
4. Sanacora, G., Frye, M. A., et al. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399-405.
5. Wilkinson, S. T., et al. (2018). A systematic review of ketamine’s effects on suicidal ideation. Journal of Clinical Psychiatry, 79(3), 17r12038.
6. Zanos, P., & Gould, T. D. (2018). Mechanisms of ketamine action as an antidepressant. Molecular Psychiatry, 23(4), 801-811.