Ketamine therapy in Tucson: Treatment, Benefits, and expert advice

What is Ketamine and how does it work?

Ketamine is a dissociative anesthetic. It’s a staple medication in both emergency and operating rooms. One of the benefits of it as an anesthetic is that it doesn’t impact breathing like other anesthetic medications. Another unique quality of ketamine is that it can create a psychedelic experience at certain doses. Harnessing this aspect of ketamine is one of the ways that it can be beneficial in mental health. This process is termed ketamine-assisted psychotherapy (KAP).

Psychedelic medicines help people by giving them an experience that is different from their day-to-day lives. Our brains operate under the default mode network (DMN). Some of the functions of the DMN involve how we think about ourselves (our egos), who we are in our environment, including how we interact with others, and is involved in the processing of our moods. Dysfunction in the DMN has been connected to depression, anxiety, post-traumatic stress disorder, and autism. 

These psychedelic medications allow us to break free from the DMN. This can result in a different perspective and new insights that may not have been possible before. Neuroplasticity is the brain’s ability to create new neural pathways, which is stimulated. This is thought to be strongest for about 48-72 hours after receiving ketamine. By utilizing therapy during this period of neuroplasticity, it’s more likely that the new perspectives and insights take hold. 

Ketamine is Unique

Ketamine is unique in its effects on neurotransmitters. While most psychedelics act on serotonin, ketamine primarily affects glutamate. This is one of the ways that ketamine creates neuroplasticity. A major benefit of raising glutamate levels is that it can boost the mood of people rapidly and is not contraindicated with antidepressant use. 

Conditions Commonly Treated by Ketamine Therapy

Depression is the most studied condition for treatment with ketamine. For those with severe depression, it is typically administered twice weekly for a minimum of 3 weeks and then periodically after that. 
Other conditions that have been shown to benefit from ketamine therapy include post-traumatic stress disorder (PTSD), anxiety disorders, eating disorders, substance use disorders, and chronic pain. 

How Often is Ketamine Therapy Needed?

There’s a lot of variability in the frequency of appointments needed. As stated above, those with severe depression benefit from a series of treatments given close together. Someone with less severe symptoms may choose to have treatments spaced further apart. Typically, we recommend weekly treatment for at least three weeks to assess if this is a good fit for someone. Often, people who find benefit from this medicine will do an initial series of treatments and then come in for periodic maintenance.

Who is not a Candidate for Ketamine Therapy?

The current recommendation is that people with a history of psychosis or schizophrenia not use psychedelic medicines. Personality disorders like borderline and narcissistic personality disorders are also considered a contraindication. Those with bipolar disorder can be treated if the mania is managed. Ketamine is contraindicated for use in those who are using opioids, benzodiazepines, or who cannot control their alcohol use. Some medical conditions that are contraindications include uncontrolled hypertension or severe heart, liver, or kidney disease. The first step in proceeding with ketamine therapy is to be assessed by a medical provider for safety.

What is a Ketamine Appointment Like?

In our center, Zola Healing CoLab, the medical provider will check in with the patient for updates and measure vital signs. After that, the patient relaxes in a recliner or a comfortable padded mat on the floor. They have an opportunity to settle in before the ketamine is injected by a small needle in the shoulder. We typically split a dose into two injections, separated by 10-15 minutes. The onset of the effects of the medicine is fairly rapid, within minutes. It lasts for around an hour. A provider, typically a therapist, is present for the duration of the appointment.

An integration session is scheduled for a few days after the medicine appointment. This is an important step as it permits the person to process the material that arose and to anchor it so that it can be beneficial.

What About Abuse?

Ketamine is categorized as a controlled substance by the DEA because of the risk of abuse. Sadly, we’ve all heard the report about the actor Matthew Perry and his death while under the influence of ketamine. It’s important to note that he died because he drowned as a result of being under the effects of an anesthetic level of ketamine, which is many, many times higher than what would be a therapeutic dose in a setting like ours. 

Potential patients are screened for substance abuse histories. This isn’t necessarily a contraindication for treatment, but it may increase the need for monitoring. Our center primarily uses intramuscular injections of ketamine that are administered onsite. For those who receive prescriptions for ketamine to take orally, small quantities are prescribed at a time to correspond with scheduled therapy appointments. The controlled medication database is monitored to screen for doctor shopping. 

A Provider’s Experience with Ketamine Therapy

I’ve been fortunate enough to see the benefits of ketamine therapy firsthand over the past three years after having worked in mental health for two decades. While there are many effective modalities for the treatment of mental health, psychedelics can really augment these. I always emphasize that it’s not necessarily a magic bullet, but it can certainly accelerate the healing process. 

It’s important to have the right “set and setting”. This is the cultivation of a good mindset in the participant and a safe space for them to have the experience.  Integrating the experience with a therapist afterwards is a key component to how effective medicines like ketamine can be.