The One Thing You Should Do Before Starting Ketamine Therapy
Before starting ketamine therapy, remember to do one thing: Do your research!
When I was first being trained in ketamine treatment, I quickly discovered several factors involved in this new modality. This reinforced how important it is to deeply understand the nature of this work.
Ketamine has been around since 1962 — an analog of the drug phencyclidine (also known as PCP). It wasn’t until 2019, though, that the Food and Drug Administration approved Esketamine, (ketamine in nasal spray form).
Three years later, Ketamine is now useful for a variety of psychological and behavioral conditions. These include trauma, anxiety, addiction and even existential distress.
And here’s the thing: The administration of ketamine comes in a variety of factors — all with varying results:
- Type and training of health practitioners involved in treatment
- Dosage of the drug
- Different routes of administration
Despite the patent for Esketamine, a nasal spray form of ketamine, a much less expensive form of generic ketamine is available. This generic form can be administered to patients intravenously (IV), intramuscularly (IM), and sublingually (SL) using lozenges.
Each of these different routes of administration (or ways of having ketamine absorbed into the bloodstream) have differential potencies. This is due to different bioavailability (how much crosses the blood-brain barrier) and they each have different duration and intensity of action.
However, before starting ketamine therapy, many people don’t know they often have more choices when it comes to administration routes. Clinicians who work with ketamine must be able to describe these different options, make recommendations, and optimize patient choice when it comes to ketamine treatment.
How To Choose The Right Ketamine Clinic
What about the various practitioners? Health practitioners who offer ketamine may have very little explicit and in-depth training in mental health care. These are professionals like anesthesiologists, primary care physicians, or family nurse practitioners.
However, they may have the requisite education and training to administer all sorts of medications — including ketamine.
Psychiatrists and psychiatric nurse practitioners also prescribe and offer ketamine treatments with or without any psychotherapy before, during, or after ketamine dosing sessions. Some ketamine prescribers also partner with psychologists, social workers, or other licensed psychotherapists. These professionals work with patients in a psychotherapy model before, during, or even after ketamine dosing sessions.
Therefore, patients need to know the following:
- Their prescriber
- The formula of the ketamine administration
- Whether or not some kind of psychotherapy is part of the whole process (as a recommendation or as an option)
- The setting in which any part of ketamine treatment will be delivered
To research ketamine clinics near you, utilize Healing Maps as a resource.
The Importance Of Research Before Starting Ketamine Therapy
From my experience as a ketamine-assisted psychotherapy practitioner, I have heard of various settings in which patients get ketamine treatment.
Below are some options:
- At-home, self-administration of sublingual lozenges. A health practitioner is present via teleconferencing (this was more common during the more intense phases of COVID-19).
- Cash-based clinics where someone is in a recliner with an IV drip. The patient has minimal contact with a clinician or clinic staff member.
- One or more psychotherapy sessions (called preparation), a psychotherapist present throughout the dosing session (up to 3-4 hours), and one or more “integration” or post-dosing psychotherapy sessions.
For all of the above reasons, the one thing everyone should do before starting Ketamine treatment is do the research!
Questions To Consider Asking While Researching Ketamine Therapy
Before starting ketamine therapy, there are questions every potential patient must ask.
Who is the provider? Will insurance cover a ketamine infusion? What form of ketamine is best for me? Where will the treatment take place? What supports are available before, during and after ketamine dosing sessions? How much is ketamine therapy?
These are just some basic questions everyone would benefit from asking before starting ketamine therapy for mental health conditions.
As a psychologist working in this space, I have an obvious bias towards emphasizing the psychological, social, and emotional support within a clearly defined psychotherapeutic model of ketamine therapy.
However, in cases of acute suicidality or crisis, IV administration can provide quick and effective relief. There is no “right or wrong” way to receive ketamine treatment so long as there is trust between the health practitioner and the patient. After all, the human connection is an integral part of one’s healing journey.