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.”
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.
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.”
Contraindications for Oral Ketamine Treatment (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
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
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…
Their statement that “Ketamine is not FDA approved for the treatment of any psychiatric disorder” is misleading. SPRAVATO (esketamine) is FDA approved for:
- Major Depressive Disorder, Treatment Resistant
- Major Depressive Disorder with acute suicidal ideation
Esketamine is derived from part of the ketamine molecule.
The World Health Organization continues to list ketamine as an essential medication.
Research strongly supports ketamine’s safety and effectiveness.
Study: At-home sublingual ketamine telehealth is safe and effective for moderate to severe anxiety and depression.
Tylenol causes far more documented harm annually than ketamine.
Ketamine is inexpensive and generic; esketamine is expensive and patented. This influences FDA and pharmaceutical incentives.
Navigating Difficult Emotions During KAP Sessions
Challenging emotions often arise during ketamine sessions, but these moments can be among the most therapeutically valuable parts of treatment.
The Neurobiological Basis
Ketamine temporarily lowers psychological defenses, quiets the default mode network, reduces fear responses, and enhances neuroplasticity.
Why Your Mind Brings Up What It Does
- Emotional Archaeology: Excavating buried experiences.
- Adaptive Wisdom: Your mind knows what needs healing.
- Therapeutic Timing: Safe environment enables processing.
Common Categories of Difficult Emotions
Grief and Loss
Examples of unprocessed grief, anticipatory grief, ambiguous loss, and childhood losses.
Anger and Rage
Examples of suppressed anger, righteous anger, self-directed anger, and systemic anger.
Fear and Anxiety
Examples of existential fear, fear of change, fear of vulnerability, and childhood fears.
Shame and Self-Criticism
Examples of core shame, behavioral shame, body shame.
Sadness and Despair
Examples of deep sadness, hopelessness, existential sadness.
Recognizing Early Signs of Difficult Emotions
Physical Sensations
- Tightness in chest
- Clenched jaw
- Shallow breath
- Muscle tension
Energy Changes
- Feeling heavy
- Fatigue
- Agitation
- Hot/cold sensations
Visceral Responses
- Nausea
- Heart rate changes
- Dizziness
- Trembling
Mental and Emotional Signals
- Self-critical thoughts
- Memories surfacing
- Feeling overwhelmed
- Desire to escape
Working with Challenging Feelings
The RAIN Approach
Recognize, Allow, Investigate, Nurture.
Curiosity Over Control
- “What is this feeling trying to tell me?”
- “When have I felt this before?”
- “What does this emotion need?”
Body-Based Inquiry
- Where do I feel this?
- Breathing into the sensation
- Color/texture/shape
Breathing Techniques
- 4-7-8 Breathing
- Box Breathing
- Heart-Centered Breathing
Grounding Techniques
- Feel your body in the chair
- Press feet into the floor
- Hold an object
- Focus on temperature or texture
Sensory Grounding
- Listen to sounds
- Notice visual details
- 5-4-3-2-1 technique
Communicating with Your Therapist
Examples of reassurance, grounding, processing, and encouragement statements.
Reframing Difficulty as Healing
Breakthrough vs breakdown, integration opportunities, productive vs destructive difficulty.
Self-Compassion
Compassionate self-talk, self-soothing phrases, treating yourself like a friend.
Working with Specific Emotions
Trauma, grief, anger, shame, self-criticism.
Integration Planning
Immediate post-session processing, ongoing integration, daily life application.
Building Resilience
Emotional tolerance, self-compassion, communication skills, long-term benefits.
When to Seek Additional Support
Normal vs concerning responses.
Ketamine for End of Life
Over the past 20 years there have been several published research articles specifically looking at
the impact of ketamine and palliative, end of life care.
In 2015, Author A. Iglewicz concluded that data suggest that ketamine may be a safe, effective, and
rapid treatment for clinical depression in patients receiving hospice care. The overall findings
support the potential for rapid efficacy and acceptable tolerability of ketamine in treating
depression in this population.
In 2018, Author R. johnson states A meta-analytic study of ketamine use in general palliative care
found that it can be extremely effective in patients with refractory depression, especially those with
chronic pain
In 2022 Author M. Lopuh writes The rapid effect of ketamine on stress, anxiety, and depression may
be of huge importance for the treatment of psychiatric conditions of patients in palliative care.
Anxiety and depression are related to lower quality of life; ketamine may prove particularly useful for
hospice patients who wish to remain home instead of receiving treatment in the hospital.
When used under the supervision of trained prescribers, facilitators and doulas, Ketamine is a safe,
easily administered and affordable medication to assist in relieving the myriad of symptoms that
come with end of life.
While it is not FDA approved for this specific use, ketamine is safe and is listed on the World Health
Organizations list of safest medications to use. It is important your provider performs a thorough
evaluation, reviews your medications, allergies, and specifically your psychiatric history prior to
initiating treatment.
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