What is KAP (Ketamine Assisted Psychotherapy)
Ketamine is the ONLY legal psychedelic medication currently (excluding cannabis).
Ketamine is classified as an Analgesic and Anesthetic.
Ketamine at lower doses to treat psychiatric conditions such as depression, suicidality and anxiety is considered an off-label use.
Ketamine can be administered via IV, IM, rectal, intranasal, oral and sublingual routes.
Clinical studies have generally detected no long-term impairment of behavior or personality functioning as a result of repeated ketamine use. Ketamine has been shown to be useful as a neuroprotective agent to prevent brain damage from head trauma, strokes, heart attacks, epileptic seizures, low oxygen levels and low blood sugar levels. There has been recent concern about toxicity to the urinary system. Ketamine was approved in 1970 (anesthesia) for children, adults and elderly. Ketamine is included in the World Health Organization model list of essential medications. (The Ketamine Papers, 2016).
About 20 years ago, researchers discovered that a low dose of ketamine (about one-tenth the amount used for anesthesia) worked as a fast-acting antidepressant.
Ketamine works on glutamate, the most common chemical messenger that regulates much of the nervous system and also plays an important role in the brain’s response to experiences. Neuroimaging studies have shown that ketamine increases glutamate release in the prefrontal cortex, a surge that is likely associated with its rapid antidepressant effects as well as its dissociative side effects.
But scientists still don’t know exactly what initiates the glutamate release, or whether it’s even the main driver behind the relief of depression and anxiety.
“We believe that this rapid burst of glutamate activates downstream receptors, which can trigger new synapses to grow,” says Lace M. Riggs, a neuroscience Ph.D. candidate at the University of Maryland School of Medicine who co-authored a recent review of ketamine’s use as an antidepressant. “While we’ve made a lot of progress to understand this process, it probably only scratches the surface of ketamine’s full mechanism of action as an antidepressant.”
https://www.discovermagazine.com/mind/how-ketamine-helps-alleviate-depression
Brain Derived Neurotrophic Factor (BDNF) and Increased Neuroplasticity
Ketamine and three types of commonly prescribed oral antidepressants bind directly to a receptor for the brain derived neurotrophic factor (BDNF), a protein that encourages growth and differentiation of new nerve cells. Ketamine, however, binds to the BDNF receptors within minutes instead of days, which may be why patients experience relief immediately.
As for increasing the brain’s plasticity, this is not in and of itself a good thing, but rather a neutral process. If someone experiences stressful situations during a period of increased neuroplasticity, it could translate into negative emotions.
The first 72 hours post treatment are crucial for successful integration.
https://www.discovermagazine.com/mind/how-ketamine-helps-alleviate-depression
The KAP model includes calming practices for patients during treatment, like wearing an eye mask, focusing on breathing and listening to specific music.
Since ketamine increases neuroplasticity and can temporarily induce an altered state of consciousness, some practitioners believe that it’s critical to administer the medicine in a safe, supportive setting. Research is validating that breakthroughs come more quickly when ketamine is paired with therapy.
“It helps to have a therapist process the experience with you and integrate any insights from ketamine treatment into your daily life, that’s how people can make lasting changes in how they react to depression triggers in the future.”
https://www.discovermagazine.com/mind/how-ketamine-helps-alleviate-depression–
Even though ketamine has been around for 50 years, we don’t know that repeat dosing is safe. One reason the FDA hasn’t approved off-label ketamine as a treatment for depression is because of a lack of long-term, formal data that proves it’s safe. But since ketamine is already widely available, there’s less incentive for pharmaceutical companies to fund testing that provides that data.
Contraindications for Oral Ketamine Treatment administered in the home setting:
•History of ketamine abuse or dependence
•Active psychosis or mania
•Diagnosis of Schizophrenia or Schizoaffective disorder
•Active suicidal ideations or suicide attempt in past year
•Glaucoma
•Increased intracranial pressure
•Pregnant/Nursing
•Medical clearance required for:
•Uncontrolled hypertension
•Congestive Heart Failure
•COPD
•Hyperthyroidism
Patient’s Inner Healing Intelligence: What exactly is this?
A person’s innate capacity to heal themselves and the wounds of their trauma.
It is important to acknowledge that the participant is the source of their own healing. The medicines or breathwork and the therapists are likely to facilitate access to a deep healing process, but it is the individual that takes the knowledge that is brought forth and uses it to make changes in their day to day lives. At Alkamystik Journeys, we are light shiners. We hold the light so that you can find your own path, your own way to the healing you desire. We help you to make sense of the information and formulate a plan for effective, life-long change.
FDA Warning re: Ketamine use for the treatment of psychiatric disorders
On October 10, 2023 the FDA issued a statement titled FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders. To view the entire statement, follow this link: https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine
Their statement in the first paragraph that Ketamine is not FDA approved for the treatment of any psychiatric disorder is not entirely accurate and in fact is very misleading to the public. The FDA approved drug named SPRAVATO (esketamine) is in fact approved to treat Major Depressive Disorder, Treatment Resistant, Major Depressive Disorder, depressive symptoms-acutely suicidal patients. (Epocrates version 23.10.0, 2023)
Esketamine is made from a drug called ketamine, an anesthetic that has also been used for many years to treat depression. Esketamine is derived from part of the ketamine molecule. (https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/esketamine-for-treatment-resistant-depression).
The statement by the FDA goes further: FDA has not determined that ketamine is safe and effective for such uses (a wide variety of psychiatric disorders ). The World Health Organization continues to list ketamine as one of the most essential medications.
(https://iris.who.int/bitstream/handle/10665/371090/WHO-MHP-HPS-EML-2023.02-eng.pdf?sequence=1)
They continue with their statement, expressing: Despite increased interest in the use of compounded ketamine, we are not aware of evidence to suggest that it is safer, is more effective, or works faster than medications that are FDA approved for the treatment of certain psychiatric disorders.
If this is true, then the FDA clearly has not taken the time to read the abundance of research that has been published over the past 10 years, including The Ketamine Papers, a book by Glenn Hartelius and Phil Wolfson that was published in 2016. A google scholar search of the terms Ketamine and Safe returned over 29,500 results between 2020-2023. The issue has been researched extensively. How can the FDA not be aware? An article published in 2022 titled At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial by Hull (et. al) concluded the following:
We found large and persistent clinical effects for four at-home sublingual KAT sessions carried out over four weeks for 62.8 % of depressed patients and 62.9 % of anxious patients, with effect sizes of 1.61 and 1.56, respectively. Less than 1 % of patients deteriorated, and 6 patients dropped out due to adverse events, suggesting that this form of ketamine treatment has an exceedingly desirable safety profile. The combination of strong and rapid effects with very small numbers of adverse events suggest that at-home sublingual ketamine therapy is an important avenue for overcoming long-standing barriers to depression and anxiety treatment, safely and conveniently. Evaluating the durability of these effects will be important for future research. https://doi.org/10.1016/j.jad.2022.07.004
If the FDA was genuinely concerned about the health and safety of the population, the over the counter medication Tylenol would have been pulled from the market years ago. Acetaminophen toxicity is the second most common cause of liver transplantation worldwide and the most common cause of liver transplantation in the US. It is responsible for 56,000 emergency department visits, 2,600 hospitalizations, and 500 deaths per year in the United States. June 9, 2023: https://www.ncbi.nlm.nih.gov/books/NBK441917/#:~:text=Acetaminophen%20toxicity%20is%20the%20second,year%20in%20the%20United%20States.
And then there is the opioid epidemic to consider.
The FDA works with BIG PHARMA. Esketamine or Spravato, manufactured by Janssen Pharmaceuticals, Inc costs $1002.00 for 84mg. Intravenous or Intramuscular ketamine costs about $25.00 for doses between 50-100mg. Oral compounded ketamine tablets cost about $5-10 each depending on the dose. Ketamine is generic and there is no money for BIG PHARMA.
Ketamine, when prescribed under the guidance of a licensed professional with a DEA license who has undergone training to understand the mechanism of action, side effects, contraindication and benefits to patients, is a very safe medication. This statement made by the FDA is misleading and dangerous. Someone who was considering asking their health care provider about this treatment modality, may now be too fearful to seek more information. This could potentially lead to detrimental outcomes for some people who have struggled with mental health complications and for whom the traditional FDA medications have not proven beneficial.