Ketamine is a synthetic pharmaceutical compound classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine and is listed on the World Health Organization’s List of Essential Medicines. It is most commonly used as an anesthetic in surgical settings, including pediatric surgery, due to its excellent safety profile, especially concerning breathing and airway management. It has also been successfully used to manage acute and chronic pain conditions due to its analgesic properties. Off-label, the medication is a legal, safe, and effective drug used to treat various mental health conditions, including depression, anxiety, and complex trauma. It has rapidly-acting antidepressant and mood-enhancing effects, which can begin within 1-2 hours after treatment and last for up to two weeks. The medicine works by blocking the brain’s NMDA receptors and stimulating AMPA receptors, which are thought to help form new synaptic connections and strengthen neural circuits that regulate stress and mood.

Ketamine has also been shown to enhance overall neuroplasticity, leading to longer-lasting symptom improvement. In a safe "set and setting," the medicine can contribute to profound psychological and spiritual insights. The medicine improves our psychological flexibility, allowing us to pause and respond thoughtfully to problems and challenges rather than reacting emotionally or trying to control life circumstances. Also, integrating the experience with KAP enhances mindfulness and anchors people in the present moment, away from negative thoughts and feelings about the past or the future that contribute to anxiety and depression.

Like other psychedelics, the medicine is not a magic bullet or an effective standalone treatment and is best applied as part of a comprehensive therapeutic plan. Discussing your experience in integration therapy sessions within 48-72 hours will help you maximize the gains from this process. While ketamine serves as the catalyst for change, the therapeutic relationship—with mindful reflection, investigation, patience, and integration—becomes the vehicle of transformation. When combined with psychotherapy, it has been shown to relieve treatment-resistant depression and trauma-related symptoms such as anxiety, hopelessness, disordered eating, and poor sleep. The medicine is also not serotonergic, so unlike other classic psychedelics, clients do not have to stop using their psychiatric medications to participate in this treatment.

The medicine can be administered in several forms, including IV infusion, intramuscular injection, nasal spray, and sublingual lozenges. In collaboration with Journey Clinical, our clients are only prescribed the sublingual lozenge form in our practice.

1. Initial consultation with partner psychiatrist:

●  You schedule an initial evaluation with a clinician from our partner psychiatrist via zoom or in person. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are eligible for KAP.

●  If our partner psychiatrist determines that you are eligible for KAP, they will develop a personalized prescription and outcome monitoring plan for you.

●  They will write a prescription for you, and the oral medication will be sent to your home, enough for the first 2-5 KAP sessions.

2. Preparation sessions (1-3 depending on experience):

● Once you receive your lozenges, your therapist will schedule time together for your KAP preparation, dosing and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. If you are a new client, you will need to schedule at least one 90-minute intake session so your therapist can get a complete psychological history with you and you can get to know one another, as well as at least one preparation session prior to the dosing session. The better relationship and rapport you have with one another, the better outcome of the entire experience. The goal of a preparation session(s) is to align on the process and set intentions for your KAP sessions together.

3. KAP Dosing Session:

●  A typical dosing session lasts 2.5 hours and will take place remotely via telehealth. (In-person availability coming in January 2025!)

●  During a dosing session, you will self-administer your lozenge at home. You’ll be in a comfortable, reclining position, wearing an eye mask and listening to calming music, while your therapist is present virtually to guide you throughout the experience. The first dose will help us assess your responsiveness to the medication and evaluate the effectiveness of the lozenges, making any necessary dose adjustments. Some people experience empathogenic effects, such as emotional openness, at this dosage and find engaging in therapeutic exploration beneficial. Others may find speaking difficult and prefer to focus internally, even at this lower dose. We will respect your preferences for engagement. After 15-30 minutes, you may have the opportunity to self-administer a second dose, which you will hold in your mouth for 15 minutes. Each sublingual dose reaches its peak effect in about 20 minutes. Although a KAP dosing session may largely be an internal experience, your therapist will be present virtually the entire time to hold space and provide support as needed. You will also have an in-person chaperone with you to ensure your well-being.

●You are welcome to share as much or as little as you like; there is no pressure to narrate your journey. Your provider will take notes on anything you choose to share, as it may be helpful during the integration of your experience. Once the effects of the medicine have worn off, you’ll have the opportunity to share your insights. Your provider will reconnect with you as you return from the most active phase of your journey and are ready to engage with the outside world. The moments following an altered state can be profoundly poignant and have a unique ability to influence how we connect with others, and your therapist values this opportunity with the importance it deserves. You are invited to share your experience and discuss any insights or perspectives you’ve gained, but some people prefer to quietly reflect on their experience and discuss it in a later integration session. Whatever choice you make will be respected.

4. Integration Sessions:

● After your KAP dosing session, you will meet for at least one integration therapy session with your therapist to review the memories, thoughts & insights that arose during your dosing session, and to prepare for the next dosing session. Many prefer additional integration session as this is really where the magic happens and where the long-term results occur!

5. Follow-up consultations with psychiatrist:

● After your first several KAP sessions, you will schedule as-needed follow ups with our partner psychiatrist to monitor outcomes and prescribe lozenge refills, as appropriate. The frequency of follow ups depends on your unique treatment plan.

The effects of the medication, which most patients find pleasant and relaxing, last for approximately 45 minutes to 1 hour. These effects can make you feel “far from” your body and facilitate shifts in perception that often feel expansive. During this time, your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position. This powerful, fast-acting medication can elicit a state of wonder, manifesting extraordinary visuals and inspiring a deeply felt presence. Your experience will be unique to you, and each session will be different. Such journeys are adventures that cannot be programmed. They evolve from your own being in relation to the medicine, and it’s best to relax into the path that unfolds. Many people enjoy the journey and often come through it with greater insight into themselves and their lives, reporting psychedelic effects such as feelings of oneness, time distortion, and difficulty describing the experience in words.

Though experiences vary greatly, it is generally thought that lower doses provide empathogen-like (heart-opening) responses, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving peak experiences. Dissociation can feel like detachment from your body, environment, and usual sense of self. The experience is characterized by the relaxation of ordinary concerns and mindset, which can lead to a disruption of negative feelings and preoccupations, resulting in significant shifts in overall well-being. At lower doses, you will likely experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience empathogenic effects at this dose range, which can enhance participation in psychotherapy as defenses are relaxed yet communication remains possible. The medicine can help release suppressed emotions such as grief, anger, or sadness. It's common to cry, laugh, or feel a surge of emotions during a session. Many people report heightened emotional awareness, gaining insights into their feelings and patterns of behavior.

Higher doses are more likely to produce psychedelic, dissociative states that are largely internal journeys away from the external world. Body sensations are greatly diminished. Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological (and possibly spiritual) growth, and promoting a positive change in outlook and character, known as a transformative response. Sensory effects of the medicine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, vivid imagery, and changes in visual, tactile, and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar music may not be recognizable, and an ordinary sense of time may morph into time dilation. Some people report psychic experiences, which they perceive as bizarre or frightening, while others describe them as pleasurable, joyful, or fascinating. Even frightening experiences can be valuable to your recovery process. Our team is trained to provide stability for those experiencing extreme states, and you will receive psychotherapeutic help and ongoing guidance to make the best use of these experiences.

Once these effects subside, we’ll spend the remainder of your dosing session giving you space to process and discuss your experience. While it may be hard to articulate what happened, patients often feel that the insights gained are clear. Many individuals feel a stronger sense of connection to themselves and others, fostering feelings of compassion and empathy. Overcoming emotional blocks can also lead to a sense of empowerment and inner strength.

Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the experience.

Treatment has demonstrated numerous benefits, with many studies highlighting its efficacy; however, it is still a relatively new and experimental psychiatric intervention, so there are no guarantees regarding the outcome. Lasting improvement typically requires more than one administration and is most effective as part of a comprehensive treatment program. The medicine may not permanently alleviate your condition. Even if your symptoms respond well, you may choose to continue with other medications and ongoing psychotherapy to minimize the risk of relapse. Over time, you might also need additional booster doses or other therapies to maintain remission.

If you do not respond to the medicine after the first administration, repeated treatments will be offered. However, if there is no response after a series of 8 doses, further treatments will not be provided, as studies indicate it is ineffective to continue treatment for those who do not respond within the first 8 doses. At that point, the treatment team will discuss other available options with you.

Following your experience, you may notice improvements in your emotional state and a reduction in symptoms such as depression, anxiety, and post-traumatic stress. You might feel somewhat different after a dosing session, with that change feeling liberating and enabling new perspectives and behaviors. These shifts can occur during treatment, in its immediate aftermath, and in the days and weeks that follow. Some experiences may be uncomfortable, and we will work with you to understand them in the context of your healing process. Ultimately, our goal is to help you change patterns of thought, mood, and behavior that cause difficulty and distress. This is a unique opportunity for growth and change, so we encourage you to actively engage in both the therapeutic process and medication administration. While the medication provides symptom relief, it is most effective long-term when combined with therapy and your active participation in the integration process.

● Psychiatrist Medical Costs (paid directly to them)

• Initial medical consultation: $375

• First follow-up medical consultation and dosage adjustments (40 min): $250

• Follow-up medical consultations and refills (20 min): $185

● Heal ATL Psychotherapy Costs

• Our therapists hourly rates vary from $135-$200 depending on experience and training.

• Initial Assessment for new clients varies from $200-$350 depending on therapist (not necessary for established clients).

• We do offer package rates for significant savings on multiple KAP sessions, please inquire if interested!

• After your first full course of treatment (8 dosing sessions and 8 integration sessions), you have several treatment options that we can discuss. If you are happy with your progress and your treatment team decides that you would like to continue KAP treatment, we may decide you are an appropriate candidate for self-guided dosing sessions after that point. With this option your therapist would not be present to help support you through the dosing session and would just check in briefly via text before and after the session, and then meet with you for integration sessions following your self dosing. This can be a more affordable option for clients who enjoy the KAP modality and would like to continue treatment long term, but cost may be a barrier.

Most people who find benefit in regular talk therapy often find even deeper benefits in KAP. Today KAP is most often used to treat those with psychiatric diagnoses of:

• Moderate to Severe and Treatment-Resistant Depression

• Ruminative/Passive Suicidal Ideation

• PTSD/Trauma

• Complicated Grief

• Anxiety associated with death

• All Types of Eating Disorders

• Substance Use Disorders

• OCD

• Bipolar Depression

• Adjustment Disorders

• Pain with Depression

Currently being explored and found very beneficial for those with:

• Perinatal Mood and Anxiety Disorders

• Those seeking deeper levels of personal growth or spiritual exploration.

• Those feeling "stuck" or "hitting a wall" in therapy or wanting to try something different.

• Those who feel prevented from "going deeper" due to trauma.

• Couples

If you have:

• Uncontrolled high blood pressure

• Unstabilized medical condition (talk to medical team)

• Severe Cardiac Disease

• Stroke History

• Raised Intracranial Pressure

• Acute Porphyria

• Ketamine allergy

• Epilepsy

• Uncontrolled glaucoma

• Severe breathing issue

• Active ketamine use disorder

• Acute mania or mixed state

• History of Primary Psychotic Disorder

• Preeclampsia/Eclampsia

• Active substance abuse where you would not be able to pause using alcohol/substances for 48 hours before and after dosing.

• Active suicidal ideation or severe decompensation (where a higher level of care would be recommended)

• Not self-sufficient, resourceful, or able to process possible deep emotional exploration.

Please note that if you are found not eligible for KAP by the Journey Clinical medical team for any reason, your medical consultation fee will be fully refunded by them.

1. Ketamine Treatment Guide for Mental Health

2. An Introduction to Ketamine-Assisted Psychotherapy | Psychology Today

3. Ketamine Therapy: A Disruptive Treatment Paradigm | MAPS

4. Ketamine & Depression: How It Works | Yale Medicine Explains

5. Ketamine: Benefits and Risks for Depression, PTSD & Neuroplasticity | Huberman Lab Podcast

6. Paradigms for Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS

7. Trevor Noah on Depression, ADHD & Ketamine Therapy

8. Veronika Gold Podcast - Methods of Ketamine Assisted Psychotherapy

9. Psychedelics are Changing Therapy Forever - with Lauren Taus | Deja Blu Podcast

10. Personal experiences of some who have tried KAP.

11. Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter

At this time, Dr. Shayda Nematollahi and Brittany Hewitt are offering KAP. Additional therapists are in the training process.