Ketamine-Assisted Psychotherapy (KAP) 101
I am excited to introduce this powerful new tool (in collaboration with Journey Clinical and Austin Ketamine Specialists) into my practice. This partnership enables me to offer comprehensive and individualized care that utilizes the therapeutic benefits of ketamine in a safe, supportive, and accessible way.
Ketamine-Assisted Psychotherapy (KAP) is a holistic modality in which ketamine is used as a complement to psychotherapy to help eligible patients experience more frequent breakthroughs and sustained improvement in symptoms. I take on the psychotherapy portion of the experience, while my partnered medical team supports you on all medical aspects. This includes determining eligibility, developing a custom treatment plan, prescribing the medicine and monitoring outcomes. Below is more information about KAP to help you navigate if it may be a good fit for you.
The Potential Benefits of KAP
While KAP is not a one-size-fits-all solution, it offers potentially profound benefits including:
Rapid alleviation of depressive and anxious symptoms.
Improvement in emotional resilience and insight.
A renewed sense of hope and potential for lasting change.
What is Ketamine?
Ketamine is a legal, safe and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and PTSD. Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1 hr. after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.
Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using sublingual lozenges.
How Does Ketamine Feel?
The effects of ketamine, which most patients find pleasant, last for approximately 45 minutes. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. Once these effects subsided, we’ll spend the remainder of our appointment giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, patients feel like the insights gained are none-the-less clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the Ketamine experience.
How Does Ketamine-Assisted Psychotherapy Work?
The Garden Analogy
Imagine your brain as a garden, where each thought or behavior creates a distinct path through the foliage. Over time, certain pathways become well-trodden and easy to follow—much like habitual thought patterns or behaviors, including those associated with issues like rumination or avoidance.
Within the context of KAP, ketamine creates a window during which the pathways you wish to change become more malleable, granting you greater agency over the garden's landscape. Previously rigid and well-trodden trails can be redirected and new passages—healthier ways of thinking and behaving—can be carved out. For instance, where there once was a path leading toward substance dependency or negative self-talk, a new avenue towards coping strategies and resilience can be established. By creating a window of increased neuroplasticity, ketamine allows for the re-routing of cognitive and emotional patterns . The subsequent psychotherapeutic work ensures these new pathways are reinforced, leading to lasting change and growth beyond the treatment sessions.
Through this process, patients who may struggle with various conditions, including depression, existential dread, anxiety, and addiction, find a unique opportunity for recovery and healing. KAP doesn't just alleviate symptoms; it facilitates a comprehensive reimagining and restructuring of mental landscapes, offering hope and a new perspective on life's challenges.
The Science Behind KAP
In essence, ketamine works by 'resetting' neural circuits that have become dysregulated in various psychological conditions. This reset provides a 'window of opportunity' for deep therapeutic work in KAP, allowing individuals to explore and address their challenges in a supportive environment, leading to lasting change.
The mechanism of action of ketamine in the context of neurological and psychological effects, particularly for Ketamine-Assisted Psychotherapy (KAP), involves several key processes at the cellular and molecular levels.
NMDA Receptor Antagonism: Ketamine is primarily known for its role as an NMDA receptor antagonist. NMDA receptors are critical for synaptic plasticity, which is the brain's ability to strengthen or weaken synapses (connections between neurons) in response to increases or decreases in their activity. By blocking these receptors, ketamine disrupts the normal activity patterns, which can lead to a rapid antidepressant effect. This disruption is thought to help "reset" certain brain circuits associated with mood disorders.
Glutamate Surge: The inhibition of NMDA receptors by ketamine leads to an increase in the release of glutamate, the primary excitatory neurotransmitter in the brain. This glutamate surge occurs in several brain regions, sparking a cascade of events that result in the release of other neurotransmitters and growth factors. The increased glutamate activity then stimulates AMPA receptors, which play a role in synaptic transmission and plasticity, contributing further to the antidepressant effects of ketamine.
Synaptogenesis and Neuroplasticity: One of the most significant effects of ketamine is its ability to increase synaptogenesis, the formation of new synapses, enhancing neuroplasticity—the brain's ability to reorganize itself by forming new neural connections. This is particularly important for individuals with depression and other mood disorders, where reduced synaptogenesis and neuroplasticity have been observed. Ketamine's ability to promote the growth of dendritic spines (small protrusions on neurons where synapses are located) and enhance connectivity within the brain can lead to lasting improvements in mood and cognitive function.
BDNF (Brain-Derived Neurotrophic Factor) Release: Ketamine also increases the levels of BDNF, a protein that supports the survival of existing neurons and encourages the growth of new neurons and synapses. BDNF is vital for long-term memory and plays a crucial role in neuroplasticity. By elevating BDNF levels, ketamine supports the brain's healing and adaptation processes, contributing to its therapeutic effects.
Impact on the Default Mode Network (DMN): Ketamine has been shown to reduce activity in the Default Mode Network (DMN), a network of brain regions that is typically overactive in depression and related to self-referential thoughts and rumination. Modulating the activity of the DMN can lead to a reduction in depressive symptoms and an increased ability for patients to disengage from negative thought patterns.
What is the Cost of Treatment?
Ketamine-Assisted Psychotherapy is an affordable, accessible modality. Although the Journey Clinical medical intake and follow ups are not covered by insurance, they are eligible for out-of-network reimbursement.
My hourly rate is $150/hr (dosing sessions typically take 2- 2.5 hours)
Journey Clinical Medical Costs: Medical Intake: $250 (One time fee, reimbursable through out-of-network)