Ketamine can be a unique, beautiful, psychospiritual medicine. Often evocative of a creative, dreamwork, Jungian-type process of making contact with the unconscious mind.
It is a pattern interrupter, as it trains the mind to slip out of rumination ruts and instead into a space of observation. Often lightening and heart-opening in small doses and evoking deep, dualistic experiences in larger doses. It promotes neuroplasticity, the creation of new neural synapses, therefore post-experience is a great time to activate new behaviour.
Ketamine provides an opportunity to take refuge from the ordinary mind, bringing relief from worries and anxieties, giving rise to a sense of deep connection and universal experience. The person working with ketamine may experience being out-of-body and out of bounded time and space. This ranges from deep, complete scenes to the scattered and the abstract.
First discovered in the 1960s, ketamine is most commonly used as a surgical anaesthetic. It is known to have excellent safety records – unlike other anaesthetics, it does not suppress breathing and blood pressure and is well tolerated by patients. Ketamine can be a highly psychedelic medicine, but not in the classical sense. As a dissociative medicine that quiets sensory input, it is possible to launch into an expansive, transpersonal space, where you may feel detached from your sense of self and your embodied experience. Questions about reality and consciousness can have profound spiritual meaning, especially for those who may be facing the end of their life.
Some consider ketamine to be a gentler introduction into the world of psychedelics, compared to the potent tryptamines like psilocybin, 5-MeO-DMT and ayahuasca.
Ketamine is a tiny molecule that easily passes through the blood-brain barrier. It is a glutamate modulator that acts on the NMDA receptors in the glutamate pathway. This is a different mechanism of action from the classic hallucinogenic psychedelics, which act on the serotonergic system. This makes it a useful medicine for working with people who have disorders such as Bipolar Type 1, which is believed to have a physiological dysfunction of the serotonin system.
Ketamine holds a unique legal status in comparison with other psychedelic medicines. As it holds a valid medical license for anaesthesia in most countries, it is possible and legal for those with prescribing privileges, for example psychiatrists, doctors and nurse prescribers, to prescribe ketamine for psychological therapeutic use in an “off license” or “off label” way.
In this fashion, the individual prescriber is taking a certain level of personal responsibility for any adverse outcomes related to the administration of the medicine. This makes it uniquely positioned as a potentially highly hallucinogenic agent which is legal to prescribe and administer. It offers us the valuable opportunity to study psychedelic, transpersonal, and dissociative experiences without all of the bureaucratic red tape associated with studying other psychedelic and plant medicines.
This means that there are now fully legal and above-board ketamine clinics in the UK and other countries, which are overseen by a medical doctor or psychiatrist and have licensed medical professionals working within the service. In the UK, referral to these clinics has primarily been available for patients suffering from chronic treatment-resistant depression (depression which has not responded to medication or therapy), accessed with a referral from the patient’s GP or psychiatrist.
There is a ketamine treatment service, inclusive of an assessment by a psychiatrist, which is paid for (i.e.not a free NHS service), provided via Oxford Health NHS UK. Northamptonshire Healthcare Foundational NHS Trust offers ketamine therapy for severe major depressive disorder, catatonia, and mania, which may be accessible for free for those living in the Northamptonshire area with a referral from their psychiatrist, but is otherwise a paid for service.
Things are now starting to change in the UK and some ketamine clinics are now accepting self-referrals from those who may be suffering with anxiety disorders, PTSD, chronic pain, eating disorders and addictions to multiple substances, including alcohol.
Some of the UK clinics are:
AWAKNCLINICS
SAVE MINDS UK
COGNACITY
NORTH LONDON PSYCHIATRY PRACTICE
LONDON TMS CENTRE
THE PAIN TEAM
NORTHAMPTONSHIRE HEALTHCARE FOUNDATONAL TRUST NHS
OXFORD MINDS NHS KETAMINE TREATMENT SERVICE
There are luxurious retreats abroad offering comprehensive and holistic ketamine-assisted psychotherapy packages, for those who can afford it. You can search for these online.
There are different ways of administering ketamine, and each route has a different amount of bioavailability (the amount of medicine that effectively reaches the brain). These include; intravenous (infusion via an intravenous cannula), intramuscular (injection into the muscle), nasal (a spray up the nose), oral (via mouth), transbuccal (held in the cheek), sublingual (under the tongue) and transdermal (absorbed through the skin).
It is widely believed that there is not one correct way to use ketamine, different people are best served by different treatment strategies.
The different paradigms for administering ketamine include:
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“Psychotomimetic”: in this treatment strategy the psychedelic side effects are considered an unwanted side effect and the antidepressant effects of ketamine are attributed to its biochemical properties. This is fundamentally a Western or medical model.
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“Psycholytic”: low doses are administered with greater frequency. The goal of the work is not ego-dissolution or self-transcendence; rather, it is for a client to experience a non-ordinary state of consciousness whilst remaining in touch with the present moment and whilst in relationship with their therapist. This approach draws on the more conventional approach of talking therapy, where the client and therapist are both present in the process of work.
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“Psychedelic”: here it may be used to purposefully induce mystical and psychedelic experiences. Participants must be carefully selected and prepared for this kind of experience, as it can get overwhelming and frightening without adequate preparation and support. The participant may temporarily enter into a state of conscious sedation or altered consciousness that is concordant with full anaesthesia and may include temporary partial paralysis. When working in this way, it is considered a psychedelic and shamanic paradigm, in which the mystical visions are valued. The role of the clinician is to ensure the physical and psychological safety of the participant, then to help them construct meaning from their visions and identify the actions that they can take to manifest positive change.
Different ways of thinking about ketamine treatment actually overlap and blend together. For example, when we offer a psychedelic ketamine journey to a patient, we are attentive to the therapeutic relationship, we are interested in the content of the visions and of course the ketamine is affecting the brain on a chemical level, all at the same time.
Ketamine is showing extremely promising results for sufferers of chronic depression. Depression is a debilitating mental illness that brings on feelings of intense sadness and apathy. It is one of the top two reasons for why people seek mental health support in the UK, the number one reason being anxiety. According to mental health statistics, in 2013 depression was the second leading cause of years lived with a disability worldwide.
Ketamine treatment can have excellent results for depression, potentially lifelong. After several months of ketamine treatment many patients no longer identify as being depressed.
Other indications for ketamine treatment may include; pain syndrome, mania, catatonia and mood conditions such as anxiety disorder, PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), addictions and Bipolar Type 1.
Additionally, ketamine may be valuable in end-of-life care.
As with all psychedelic work, therapeutic ketamine use requires psychological care and a robust integration process before, during and after the treatment.
“Even a magic bullet leaves a wound that requires a period of recovery.”Peter Levine
Ketamine treatment offers great promise for those who are suffering with debilitating mental illness, some doctors are describing it as the most promising treatment for depression in decades. The bad news is that it’s currently only widely available for those who can afford it and it can be a very expensive treatment.
I would like to reference the truly inspirational Dr Raquel Bennett, who is a Post-Doctoral Fellow in Clinical Psychology and the founder of the KRIYA Ketamine Research Institute, for some of the information in this blog.
PLEASE NOTE: This blog is intended for information only and does not substitute medical advice. I do not advocate the illegal use of substances.
Written by Jo Dice
Integrative and Psychedelic Integration Psychotherapist
As a psychotherapist, psychedelic integration practitioner, spiritual explorer and registered nurse of twenty years; I offer wisdom from the worlds of knowledge, science, body, soul and spirit for a comprehensive and holistic therapy journey.
If you would like to work with me for Integrative Psychotherapy or Psychedelic Integration Psychotherapy, please drop me a line and we can arrange a free introductory session.