Ketamine Assisted Psychotherapy

At Linden Medical Centre, our KAP team consists of a psychiatrist, a psychotherapist, and an ACLS trained registered nurse.  An anesthesiologist is also part of the team if the ketamine is being administered IV.

We work collaboratively to provide you a safe and transformative experience.

After we receive a referral from your GP, nurse practitioner or psychiatrist, we will contact you to schedule a consultation with our psychiatrist.  As noted earlier, our treatment team consists of a psychiatrist, a psychotherapist and registered nurse. All three are actively involved in your healing journey.

First meeting: At the first meeting, you will meet with the psychiatrist for a general intake to see if you meet the medical and psychiatric eligibility for KAP treatments. You will review your medical history, including past medical and psychiatric concerns, current and previous medications,  and social history which includes your current and past substance use.

Second meeting: If you meet criteria for KAP, you will meet with the psychotherapist at your second meeting.  Here you will discuss information about your current and past symptoms, previous treatment attempts, life history, and goals for treatment. You will also work collaboratively with the psychotherapist to set goals and intentions for your treatment and experiences. You may also be given breathing exercises and guided meditations if you have any anxiety about your first KAP session. At this time, we will also discuss the use of music during your KAP sessions. People often find music to be helpful during these experiences, as it can enhance and even direct the experience. Based on your music preferences, we curate a specific playlist for you, which is designed to optimize your benefit from the journey. We will also collaboratively create an invocation, which is a set of emotionally evocative and relevant statements that will be read to you as the ketamine is administered. Its purpose is to induce a growth-oriented mindset for your journey.

KAP session: At your KAP session(s), we will start by discussing your current state and remind us all of your intentions/goals for this work. The psychotherapist will lead you through your invocation as the RN begins your ketamine treatment. You will begin with one nasal spray of ketamine, and then rest for 5 minutes before you take your next dose. It will take approximately 20 minutes for you to begin to feel the ketamine effects. After your final ketamine nasal dose, you can lay back on the couch and put on your eye shades and headphones. The psychotherapist will remain in the room with you during the entire session, and will act as a guide. After the ketamine has begun to kick in, you will be encouraged to remove your headphones to begin the therapy portion of the session.  This therapy session can last from 1 to 2 hours, depending on what you need from the session.  The RN will enter the room periodically to check your vitals.  The psychiatrist and RN are available during the session as well should there be any needs requiring their support.

Due to the possibility of blurred vision and altered vision, as well as impaired balance and coordination, you will be asked to remain lying down until the main effects have worn off. You will need someone to drive you to and from your appointment.

Our psychiatrist or RN will check your vital signs before and after the administration of ketamine, and will also monitor these vitals throughout. After your KAP session, you may be required to stay at the clinic in a recovery room for some additional time, where you and your vitals will also be monitored.

If the psychiatrist or RN determine that for any reason your symptoms require emergency services, they will activate emergency response systems (such as calling 9-1-1).

It was widely shown through research that pairing medication with psychotherapy is the most beneficial way to treat mental health disorders, such as depression and PTSD. KAP is no different. It is important to us that you have the most beneficial treatment and opportunity to heal.

Our KAP program emphasizes the potential for change and healing, and such change is best facilitated within a structured, supportive therapeutic environment with a collaborative team who are aware of your issues, hopes, struggles and desires.

The collaborative team serve as guides during your inward journey, and assist you in moving through this journey, as well as processing the experiences and impact on your daily life after your experience. Since ketamine can create conditions of psychological openness, we believe that having an authentic connection and trust with your therapeutic team enables the deepest possible work to occur. Preparatory sessions with the psychotherapist and psychiatrist, before and after your KAP sessions, are meant to build this connection.

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Ketamine is a synthetic pharmaceutical compound, classified as a dissociative anesthetic, that is used in sub-anesthetic doses to treat depression, suicidal thoughts and PTSD. It also used in emergency rooms and surgical suites around the world and has an excellent safety profile.

The current understanding of ketamine’s mode of action, is that it is an NMDA receptor antagonist, which works through the glutamate neurotransmitter system. Other medications used to treat depression, such as SSRIs and SNRIs use a different pathway. With depression, receptors on neurons that facilitate signal transmission may recede, and the overall size of the hippocampus and amygdala may shrink. Animal research shows that ketamine can stimulate neuron growth within days of use (and sometimes, even hours!).

Ketamine can be administered in a number of ways, including intravenous infusion (IV), intramuscular injection (IM), intranasally and sublingually/orally with a lozenge. Routes differ in bioavailability and duration of active effects for each person. We currently use an intranasal route of administration, typically between 50-250mg total for our KAP sessions. Our psychiatrist and RN take into account numerous factors when providing dosing: therapeutic goals, prior exposure to ketamine, body weight, and sensitivity to medication.

Ketamine provides a range of experiences and benefits, based on the varying routes of administration, dosage level and the individual themselves. Generally, ketamine has an effect of relaxing one’s ordinary concerns and usual mindset, while maintaining conscious awareness. It typically leads to a disruption of negative feelings and preoccupations, and can lead to other states of consciousness. It is in these other states of consciousness, or non-ordinary states of consciousness, that people see significant shifts in their over-all well being and healing. These non-ordinary states of consciousness facilitate a profound transpersonal or mystical peak experience. These peak experiences are shown to expand one’s sense of self, understanding of existence, and ability to heal.

At lower doses, you may experience a mild dissociative and mild antidepressant effects, as well as a sensitivity to light and sound, and an altered sense of time. A low dose is useful for lowering psychological defenses, which facilitates deeper psychotherapeutic investigations.

At higher doses, you are more likely to experience psychedelic effects or dissociative states that are internal journeys away from the external world.  You may also experience diminished body sensations. These inward journeys are where we see significant effects, especially in moving through existential concerns, accelerating psychological and possibly spiritual growth, and promoting a positive change in the way you see the world.

Other things you may experience include distorted visualization of colors, feeling of being suspended in space or floating, out-of-body experiences, vivid dreams, changes in processing pathways (auditory, visual and tactile) and synesthetia (a mingling of the senses).

Ketamine has a strong safety profile and is used at much higher doses during surgical procedures and in the emergency room.   However, just as with any medication, there are some potential risks and side effects to be cognizant of, and consider before your session.

The most common side effect is a temporary spike in blood pressure or heart rate. This can be a risk for individuals who have cardiovascular disease or elevated intracranial pressure.

About 60-75% of individuals will experience an out of body experience or visual changes, which includes blurred vision and intense hallucinations. Approximately 50-60% of individuals will feel abnormally sleepy or drowsy, and therefore we recommend that you do not engage in any activities that require alertness, such as driving or working, until the next day. About 40% of individuals experience a change in thinking, which includes altered mental sharpness. Finally approximately 1% of individuals may experience more serious side effects, such as chest pain, shortness of breath, liver damage, bladder inflammation and sudden sever headaches. If any of these side effects occur during your session, your psychotherapist will contact the psychiatrist immediately.  If they occur outside the KAP session, please contact us immediately or attend the emergency room.

There are many benefits to KAP, but it is not the only option for treating depression and PTSD. Psychotherapy without ketamine is available, as is ketamine without psychotherapy. There are also other options outside of our clinic, such as Eye Movement Desensitization and Reprocessing (EMDR) and Somatic Experiencing (SE). If for any reason you do not find support or healing through our program, we are more than happy to make referrals to other providers.