Ketamine is a legal, safe, and effective medication used to address various mental health conditions, such as depression, anxiety, addiction, chronic pain, and PTSD.

It has rapid antidepressant and mood-enhancing effects that can start within 1-2 hours after treatment and may last for up to 2-3 weeks.

Ketamine functions by blocking the brain's NMDA receptors and stimulating AMPA receptors, which are believed to aid in the formation of new synaptic connections and enhance neural circuits that regulate stress and mood. Additionally, ketamine has been shown to improve overall neuroplasticity, leading to lasting symptom relief.

It can be administered in several ways, including IV infusion, intramuscular injection, nasal spray, and sublingual lozenges. In my collaboration with Journey Clinical, we exclusively use the sublingual lozenge form.

The effects of ketamine typically last around 20-45 minutes. During this time, you may feel a sense of detachment from your body and experience shifts in perception that can feel expansive. Your motor and verbal skills will be diminished, so you will be lying down comfortably throughout the experience. Once these effects wear off, we will use the remainder of our appointment to give you space to process and discuss your experience or processing will occur in an integration session within 24-72 hours (ideally) or within 5 days of your dosing session.

Research has indicated that the mood benefits and neurological growth can persist for up to 2-3 weeks following the ketamine experience.

1. Initial Medical Consultation with Journey Clinical

   • You will schedule an (virtual) initial medical consultation with a clinician from the Journey Clinical medical team. During this meeting, they will review your medical, physical and psychiatric history, provide information about the treatment, and assess your eligibility for KAP.

   • If you are deemed eligible for KAP, the medical team will create a personalized ketamine prescription and outcome monitoring plan tailored to you. If you are deemed not eligible, Journey Clinical will give you a full refund for the initial consultation.

   • Journey Clinical’s medical staff will write a prescription for ketamine, and a small supply of oral ketamine will be sent to your home, sufficient for your first two KAP sessions. Prior to our KAP sessions, the medical team will instruct you on how to take your vitals and self-administer the ketamine lozenges.

2. Preparation Sessions

   • Once you receive your ketamine lozenges, we will schedule time for our KAP preparation, dosing, and integration sessions. Preparation sessions will be arranged like regular therapy sessions before the KAP dosing session. The aim of these preparation sessions is to align on the process and set intentions for our KAP work together.

3. KAP Dosing Session

   • A typical ketamine dosing session lasts between 1-2 hours (psycholytic dose) or 2-3 hours (psychedelic dose) and will occur remotely via telehealth unless discussed otherwise.

   • During the dosing session, you will self-administer your ketamine lozenge at home (unless discussed otherwise). You will be in a comfortable, reclining position, wearing an eye mask and listening to soothing music. While the KAP dosing session may primarily be an internal experience, I will be present with you throughout to provide support and hold space as needed.

4. Integration Sessions

   • Following our KAP dosing session, we will have several integration therapy sessions to discuss the memories, thoughts, and insights that emerged during your dosing experience, as well as to prepare for the next dosing session.

5. Follow-Up Consultations with Journey Clinical

   • After your first KAP session, Journey Clinical’s medical team will schedule regular follow-ups to monitor your progress and prescribe refills of the ketamine lozenges as necessary. The frequency of these follow-ups will depend on your individual treatment plan, with a minimum of one follow-up per quarter.

• Increased BDNF: Ketamine increases the levels of the neurotransmitter Brain-Derived Neurotrophic Factor (BDNF), which has complex downstream effects. This effect is dose-dependent and time-limited (around one week, with peak at 2-3 days).

• Lowering the Default Mode Network: Ketamine has been shown to reduce the functional activity of the Default Mode Network (DMN), which can give clients a chance to take a break from habitual thoughts and gain perspective.

• Intrinsic anti-depressant effects: Ketamine has rapidly-acting antidepressant and mood-enhancing effects, with a response rate of approximately 50-80% and duration ranging from 2-3 days up to 2 weeks or more. Evidence also supports a unique anti-suicidal effect, independent of antidepressant response.

• Dissociation: It is believed that ketamine's dissociative effect may provide clients the opportunity to gain a new perspective on a traumatic or unpleasant situation.

• Enhanced neuroplasticity: Ketamine enhances neuroplasticity by upregulating BDNF. This effect opens a window of opportunity for therapeutic intervention, which is what we will capitalize on during integration sessions

  
  

While it can be helpful to discuss the neurochemical effects of ketamine, there are other ways of thinking about the benefits of ketamine as well. For example:

• Changing the Camera Angle: Imagine your mind is a movie, and you usually see it from a fixed camera angle. Ketamine acts like a drone that changes the camera angle, offering new perspectives and angles you haven’t seen before. This shift can help you understand and interpret your thoughts and emotions in ways you never could from the ground.

• Stepping Back from the Canvas: Think of your thoughts and emotions as a complex painting you’re working on up close. Ketamine allows you to step back from the canvas, giving you the space to see the whole picture. This distance helps you to appreciate the broader context and make more informed decisions about how to proceed.

• Creating a Bubble Around You: Imagine you are in the middle of a storm of thoughts and emotions, being battered around by the wind and rain. Ketamine creates a protective bubble around you, giving you a moment of calm within the chaos. Inside this bubble, you can observe the storm without being directly affected by it, providing a sense of clarity and peace.

• Clearing the Fog: Think of your mind as a landscape covered in dense fog, where it’s difficult to see clearly or navigate through your thoughts and feelings. Ketamine can act like a sudden gust of wind that temporarily clears the fog, giving you a clearer view of your mental landscape. This clarity can help you and your therapist identify and address underlying issues more effectively.

• Unlocking a Stuck Door: Imagine your mind is like a house with many rooms, and some of these rooms contain painful memories or emotions. Traditional therapy might help you work on these rooms slowly, unlocking them with different keys over time. Ketamine, in this analogy, acts like a master key that quickly unlocks these stuck doors, allowing you and your therapist to enter, explore, and clean up these rooms more efficiently.

• Jump-Starting a Car Battery: Consider your mental health as a car battery that has run down, leaving you feeling stuck and unable to move forward. Ketamine works like a jump-start for your brain, providing the necessary boost to get your mind running again. This boost can help initiate the healing process and make traditional therapy more effective.