I’m interested in doing KAP, where do I start?
STP partners with Skylight Psychedelics and Kore Regenerative Medicine to serve clients who want to engage in Ketamine Assisted Psychotherapy. The process for starting with Kore Medicine is slightly different than Skylight Psychedelics. However, the session time with your therapist will remain the same regardless of the prescriber.
A requirement of scheduling your KaP sessions is that you give us the name and phone number of your designated driver who will pick you up after your session. We cannot release clients without this due to a client’s altered level of consciousness. It is NOT ACCEPTABLE for a client to take a taxi or Uber/Lyft home.
Step 1. Reach out to Skylight Psychedelics and schedule a free medical consultation and assessment. This fee may change but for now, it is free. With Skylight, you will be prescribed 6 doses of ketamine.
Step 2: Once cleared for treatment, clients and their therapist receive an email that they have been approved. Along with this comes a form that will need to be signed to confirm that the client is working with you.
Step 3: Schedule your first session with your therapist. KaP protocol recommends that clients take their prescription, six doses, over the course of 2-3 weeks. Your therapist will work with you about a cadence that feels more appropriate if you feel uncomfortable with 6 doses over 2-3 weeks.
Step 4: You will come to Somatic Therapy Partners offices with your sublingual dose of ketamine. At no time will your therapist handle the medication. Prior to taking ketamine, we will measure your blood pressure using a wrist cuff. If your bp is higher than 140/90, we cannot allow you to complete the ketamine session due to heightened risk factors.
Step 5: You will take your ketamine with your therapist present. We allot 2 hours for the first session to include intention setting, the journey and integration. During the session, we strongly encourage that you wear a blindfold and music will be playing either in headphones or via Bluetooth speaker.
Step 6: Once your ketamine session is over, you must have a designated driver come to the office to pick you up and bring you home.
Step 7: Schedule your 30-60 minute integration session within 1 day to 1 week from your KaP session.
Kore Regenerative Medicine (KRM)
Step 1. Reach out to KRM to schedule a new patient visit. The new patient visit costs $375 and includes a number of tests to determine if you are eligible for Ketamine therapy such as a medical history, psychiatric history, and depression and screening questionnaires.
Step 2. If you are cleared for treatment, you will receive doses for 3-4 sessions, depending on your dosage per session.
Step 3. You will come to Somatic Therapy Partner offices with your sublingual dose of ketamine. At no time will your therapist handle the medication. Prior to taking ketamine, we will measure your blood pressure using a wrist cuff. If your bp is higher than 140/90, we cannot allow you to complete the ketamine session due to heightened risk factors. During your initial 3-4 sessions, your clinician will be checking in with Kore to confirm dosing and your response to that dose.
Step 4: You will take your ketamine with your therapist present. We allot 2 hours for the first session to include intention setting, the journey and integration. During the session, we strongly encourage that you wear a blindfold and music will be playing either in headphones or via Bluetooth speaker.
Step 5. After completing your initial 3-4 sessions, and if you and your clinician deem it necessary, you will return to KRM for a check in on progress and a prescription renewal to get through either a) 3 months of therapy, or b) the number of sessions your clinician deems necessary (whichever is less).
Step 6: Once your ketamine session is over, you must have a designated driver come to the office to pick you up and bring you home.
What is ketamine?
Ketamine is a dissociative anesthetic that has been used for a variety of things since the 70’s. It is one of the safest anesthetics in the world.
Which Mental Health Conditions Can Benefit from Ketamine?
Ketamine is used to treat various illnesses. Notably the following:
- Suicidality (Skylight Psychedelics refers all suicidal clients for intravenous or intramuscular ketamine in conjunction with therapy)
- Post Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Substance abuse co-occurring with a primary psychiatric disorder
- Relationship and existential issues such as existential distress
- Bipolar I and II depressive phases (not mania)
- Psychological reactions to physical illness and life-threatening illnesses substance
- Chronic pain (often requires higher doses of ketamine in a medically supervised settings such as a clinics or hospitals)
How Does Ketamine Work for Mental Health Conditions?
The exact mechanism by which ketamine functions as an antidepressant remains largely unknown. So far the medical community has learned that ketamine has an affinity for multiple receptors and it likely affects several different types of receptors in the brain. It has been demonstrated that people who suffer from chronic depression and anxiety experience atrophy of neuronal connections in the frontal part of the brain. Ketamine enhances neuroplasticity, the brain cell’s ability to form new connections with one another via expression of brain-derived neurotrophic factor. Not only has ketamine demonstrated the ability to repair neurons that were atrophied from chronic depression, but it also promotes the growth of new neuronal connections!
It is also referred to as a “psychoplastogen” which refers to small molecule neurotherapeutics that induce swift changes in plasticity following a single administration. These changes are thought to promote lasting changes in behavior patterns.
What are the Contraindications for Ketamine?
There are medical and psychiatric conditions that render people unable to receive ketamine therapy. This includes:
Medical Conditions Contraindications
- Untreated hyperthyroidism
- Untreated hypertension
- Aneurysm or dissection
- Heart disease, including heart failure, heart attacks, or arrythmias
- Severe breathing problems
- Kidney disease
- Advanced liver disease Interstitial cystitis (bladder wall inflammation)
- Glaucoma (unless cleared by an ophthalmologist)
- Active illicit substance abuse
- Pregnant or breastfeeding
Psychiatric Contraindications: As an added safety measure we recommend our clients reach out to their primary care physician to ensure they do not have any contraindications to treatment. Additionally, if a client has a psychiatrist we recommend they contact their psychiatrist to ensure they have no contraindications to treatment.
- Psychotic features
What Substances and Medicines Should be Avoided In Clients Using Ketamine?
- Theophylline or Aminophylline – can lower seizure threshold.
- Benzodiazepines, opioid analgesics, or other CNS depressants (can cause profound sedation, respiratory depression, coma or death, they can also interfere with the mental health benefits of ketamine).
- Lamotrigine (trade name Lamictal).
- Sleeping aids and sedatives such as Ambien, Benadryl, Remeron.
- There are other medicines that may interact with ketamine and therefore your clients medications have been thoroughly reviewed by Skylight Psychedelics physician team prior to their prescription being authorized.
We also recommend clients refrain from using the following substances during treatment as they can interfere with the benefits of ketamine and some can lead to dangerous interactions:
- All illegal substances such as cocaine, etc.
- We do not recommend mixing ketamine with other medicines including using ketamine with psilocybin, MDMA, Kambo, DMT, ayahuasca, mescaline, iboga, etc. Combining medicines has an increased risk of adverse events, notably hypertension, and is not recommended unless the combination is being studied in a clinical trial.
- Further, if a client is on a benzodiazepine we may ask them to taper off under the care of their prescriber prior to a prescription for ketamine being authorized. Rapidly tapering off benzodiazepines is NOT recommended and can result in severe withdrawal and potentially death.
Is Ketamine FDA Approved?
Ketamine does not have FDA approval for any psychiatric illness. Ketamine hydrochloride, trade name Ketalar, is a Schedule III controlled medicine that is FDA approved for general anesthesia in intravenous or intramuscular formulations. Ketamine is a racemic mixture, made up of two molecules that are mirror images of one another, R-ketamine and S-ketamine.
S-ketamine, derived from ketamine, called esketamine, trade name Spravato, was approved in 2019 in nasal spray form, for treatment resistant depression in adults with major depressive disorder with acute suicidal ideation or behavior, in conjunction with an oral antidepressant. Most ketamine being used for mental illness is being used legally by healthcare professionals off-label. Sublingual ketamine used by Skylight Psychedelics is off-label.
How is Ketamine Different Than Other Medicines for Mental Health Conditions?
Ketamine treatments are far less frequent than standard medications for mental health. This in turn results in far fewer side effects. It is recommended that clients begin with 2-3 times weekly administration during their initial six-session program, and then transition to less frequent sessions as needed, if needed.
Clinical trials with IV ketamine have shown that an initial course of 4-6 twice weekly treatments can produce antidepressant effects that last several weeks-months. Ketamine also allows you to connect with the deeper root cause of your struggles, your traumas. Ketamine elevates all types of therapy models and allows people to be more open and able to receive the benefits of various therapeutic approaches.
Is Ketamine Safe?
Ketamine has been used since the 1970s as an anesthetic. More recently, it has proven its ability (at a much lower dose) to act as a therapeutic agent for numerous mental health conditions. It has an extensive safety profile and has very few undesirable side effects which are rarely encountered. The doses used in mental health are so low that many of these side effects are ameliorated.
Does Ketamine Help Everyone?
A small percentage of clients will not respond to ketamine, even at higher doses. Additionally, some clients with rigid personality structures, including those with severe OCD or personality disorders and possibly those with profound PTSD, won’t be able to go into a trance-like state and may find it challenging to maintain the benefits of the treatment experience, if they find any relief with the experience at all. We don’t yet know enough about who won’t benefit and recommend attempting this treatment if no contraindications exist as the medicine is incredibly safe and well-tolerated.
What are the Physical Side Effects of Ketamine?
The most common side effects from ketamine include:
- Blurry vision
- Diminished ability to see/hear/feel
- Dry mouth
- Lip tingling and/or heaviness
- Elevated blood pressure
- Elevated heart rate
- Elevated intraocular or intracranial pressure
- Loss of appetite
- Nystagmus (rapid eye movements)
- Slurred speech
- Synesthesia (overlapping of the senses, for example seeing sounds)
- Dissociation (feeling out of body)
- Tinnitus (ringing in the ears)
- Hypoesthesia (partial or total lack of sensation in a body part)
- Lethargy (fatigue)
- Sedation (somnolence)
- Vertigo (room spinning)
- Feeling drunk
- Rarely a client can experience a feeling of paralysis
Note: There have been no cases of persistent neuropsychiatric sequelae, medical effects, nor increased substance abuse in clinical practice.
Note: The dissociative and/or psychedelic effects of ketamine treatment are a critical piece of the therapeutic process and should not be avoided. We believe this part of the experience can be extremely beneficial to our clients when supported in a trusted healing container.
What Should I Expect to Experience in the Ketamine Session with Sublingual Ketamine?
Many people in a trance-like state from ketamine often describe positive feelings. This has been described as euphoria, empathy, forgiveness, calmness, total relaxation and reduced mind chatter. Each session is completely different from the one prior and also differs significantly from client to client. There is no way to predict what a session will be like for someone. Experiences with Ketamine can often lead to any one of the following and more:
- Feelings of gratefulness, calmness, acceptance
- Feeling of flying
- Feeling of falling
- Seeing God
- Feeling out of body – looking down on oneself
- Feeling of being reborn
- Re-experiencing past events, including traumas
- Ego dissolution/Ego loss – a complete loss of one’s sense of self or self-identity (less likely to occur with sublingual ketamine)
- Falling asleep
What is the Role of Adjunctive Psychotherapy When Using Ketamine for Mental Health Conditions?
Ketamine is routinely given in sterile clinical settings for various mental health indications. Oftentimes there is no therapy provided with this service and clients are left trying to make sense of the experience and to navigate challenging experiences on their own. The lack of therapy short changes people seeking ketamine treatment as they are less likely to be able to integrate the experience into their everyday life.
In 2015, Stephen Hyde published a paper Ketamine for Depression, demonstrating ketamine’s ability to be used successfully via routes other than intravenous and intramuscular, promoting easier use outside of a clinical setting. Incorporating psychotherapy into ketamine treatment sessions was first described by Wolfson and Hartelius in 2016. By the mid-2000s many clinicians were using ketamine in conjunction with therapy. It has become increasingly more apparent that prescribers aren’t required at the bedside, but someone should be there to guide and hold space for clients on ketamine and that’s you.
How are Ketamine Sessions Scheduled?
When used for mental health, ketamine is typically given six times over a 2-3 week period. However, you and your therapist can discuss a cadence that best fits your needs, schedule and preferences.
Precautions After Medicine Sessions
Avoid the following:
- Operating heavy machinery
- Being the sole provider of childcare following medicine sessions
What is Integration?
Integration is when you take the experience from your medicine journey and weave it into your daily life. Integration is a critical part of psychedelic medicine. While the medicine sessions are very important, a time where people get many messages, without the integration many of these messages can get lost or be fleeting. Integration is done with your therapist and a key part of this work.
Does My Insurance Cover Me for Ketamine-Assisted Therapy?
We recommend clients reach out to their individual insurance provider to determine if they can get reimbursed for the cost of the ketamine assisted psychotherapy. We do not take insurance at this time.
KaP session fees are as follows:
- Cara Luckey: 2-hour KAP sessions @ $280/session; each session includes 30 minutes of integration
- 6-session KAP package @ $1500 (total paid upfront)
- Maira Holzmann: 2-hour KAP sessions @ $600/session; each session includes 30 minutes of integration
- 6-sesion KAP package @ $3300 (total paid upfront)