I offer a therapeutic modality called Ketamine-Assisted Psychotherapy (KAP) in
partnership with an organization called Journey Clinical in California.
Ketamine-Assisted Psychotherapy (KAP) is a holistic modality in which ketamine is
used as a complement to psychotherapy to help eligible patients experience more
frequent breakthroughs and sustained improvement in symptoms. I take on the
psychotherapy portion of the experience while Journey Clinical’s medical team
supports you on all medical aspects. This includes determining eligibility, developing a
custom treatment plan, prescribing the medicine, and monitoring outcomes. Below is
more information about KAP to help you navigate and decide whether it may be a good fit for you.
Study 1: Wilkinson, S. T., et al. (2018).
This study explored the effects of ketamine on depression. They found that ketamine showed a rapid antidepressant effect within hours or days, as opposed to the weeks required for traditional antidepressants. This rapid response is pivotal for patients with severe depression.
Study 2: Feder, A., et al. (2014).
In a randomized controlled trial, patients with PTSD showed a significant reduction in symptoms after ketamine treatment compared to a placebo. This study augmented the burgeoning evidence that ketamine could be an effective intervention for trauma-related disorders like PTSD.
Study 3: Grunebaum, M. F., et al. (2018).
A double-blind, randomized, placebo-controlled trial found that ketamine significantly reduced suicidal ideation in patients with major depressive disorder (MDD). Since suicidal ideation is closely related to both depression and anxiety, this finding is crucial in understanding ketamine's broad impact.
Study 4: Dore, J., et al. (2019).
This qualitative study included a cohort undergoing KAP for major depressive disorder and generalized anxiety disorder. Patients reported substantial improvement in mood and anxiety levels, with many highlighting the psychotherapy component as essential for sustaining these benefits.
Study 5: Rodrigues, G., et al. (2021).
This meta-analysis of multiple studies on ketamine's impact on depression and anxiety disorders confirmed the substance's effectiveness. Notably, the analysis called for further research to delineate the psychotherapy component's role in these outcomes.
Biological Mechanisms:
NMDA Receptor Antagonism:Ketamine is an NMDA receptor antagonist, promoting synaptic plasticity and rapidly enhancing connectivity in brain areas critically involved in mood regulation.
BDNF Increase:Ketamine triggers an increase in brain-derived neurotrophic factor (BDNF), fostering neurogenesis and synaptic connections, aiding in the alleviation of depressive and traumatic symptoms.
Psychotherapy Component:
Integration and Contextual Understanding:Psychotherapy helps individuals process and integrate the dissociative experiences or insights gained during ketamine sessions. This contextual understanding fosters sustained therapeutic growth.
Emotional Release and Reprocessing:Psychotherapy can guide patients through emotional release, enabling the reconsolidation of traumatic memories in a safer, more controlled environment.
Neuroplasticity and Cognitive Flexibility:
Enhanced Neuroplasticity Post-Ketamine: Studies like Dore et al. (2019) and Rodrigues et al. (2021) emphasize ketamine's role in augmenting neuroplasticity, which psychotherapy leverages to inculcate healthier cognitive and emotional patterns.
Set and Setting:
Treatment Environment:The therapeutic environment, emphasizing safety and support, helps maximize ketamine's positive psychological effects.
Therapeutic Alliance:A strong, empathetic therapeutic relationship can make a significant difference in how patients assimilate and apply their ketamine-experience insights into their daily lives.
Please reach us at jhuang@presentmomentwellness.org if you cannot find an answer to your question.
Ketamine is a legal, safe and effective medicine used to treat a variety of mental
health conditions, including depression, anxiety and PTSD. Ketamine has
rapidly-acting antidepressant and mood-enhancing effects, which can begin to
take effect within 1-2 hrs. after treatment and last for up to 2 weeks. It works by
blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors,
which are thought to help form new synaptic connections and boost neural
circuits that regulate stress and mood. Ketamine has also been shown to
enhance overall neuroplasticity for lasting symptom improvement. Ketamine can be administered in a variety of ways, including IV infusion,
intramuscular injection, via nasal spray and using sublingual lozenges. In my
work with Journey Clinical we only use the sublingual lozenge form.
The effects of ketamine, which most patients find pleasant, last for approximately
45 minutes. These effects can make you feel “far from” your body, and facilitate
shifts in perception that can often feel expansive in nature. Your motor and verbal
abilities will be reduced, so you’ll be lying down in a comfortable position during
the experience. Once these effects subsided, we’ll spend the remainder of our
appointment giving you space to process and discuss your experience. While it
may feel hard to articulate what happened during the experience, patients feel
like the insights gained are none-the-less clear. Studies have shown that the
benefits to mood and neurological growth can last up to two weeks after the
Ketamine experience.
Initial consultation with Journey Clinical
1. You schedule an initial evaluation with a clinician from the Journey Clinical
medical team via zoom. They will go over your medical and psychiatric
history with you, provide education on the treatment and determine if you
are eligible for KAP.
2. If Journey Clinical’s medical team determines that you are eligible for KAP,
they will develop a personalized Ketamine prescription and outcome
monitoring plan for you.
3. Journey Clinical’s medical staff will write a ketamine prescription for you, and a small amount of oral ketamine will be sent to your home, enough for
the first 2 KAP sessions. You will be taught to take your vitals and self-administer the ketamine lozenges by Journey Clinical’s medical team in advance of our KAP sessions.
Once you receive your ketamine lozenges, we will schedule time together
for our KAP preparation, dosing and integration sessions. Preparation
session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on
the process and set intentions for our KAP sessions together.
A typical ketamine dosing session lasts between 2-3 hours and can take
place either in-person at my office, in your home or remotely via telehealth.
During a dosing session, you will self-administer your ketamine lozenge
either in my office or in your home. You will be in a comfortable, reclining
position wearing an eye mask and listening to calming music. Although a
KAP dosing session may be largely an internal experience, I will be
present with you the entire time to hold space and provide support as
needed.
I might incorporate Internal Family Systems (IFS), Eye Moment Disensazation and Reprocessing (EMDR), Brainspotting, or Acceptance and Commitment Therapy (ACT) after you complete your internal journey to support your processing based on your goals and experience.
Integration Sessions:
After our KAP dosing session, we will meet for multiple integration therapy
sessions to review the memories, thoughts & insights that arose during
your dosing session, and to prepare for the next dosing session.
Follow-up consultations with Journey Clinical:
After our first KAP session, Journey Clinical’s medical team schedules
regular follow ups with you to monitor outcomes and prescribe ketamine
lozenge refills, as appropriate. The frequency of follow ups depends on
your unique treatment plan, at a minimum of once per quarter.
Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any medication, there are also some potential side effects and risks to consider. Our setting and medical monitoring are intended to minimize ketamine’s side effects as much as possible.
● Effects of ketamine may include nausea, brief, transient increase in blood pressure, changes in perception and visual, tactile, and auditory processing, feeling suspended in space or floating, and falling sensations. Synesthesia (a mingling of the senses) may occur. Perception of time may also be altered.
● Other possible adverse effects may include dizziness/lightheadedness, sedation, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to feel objects accurately (including one’s own body), diminished awareness of physical functions such as respiration, headache, anxiety, and vomiting (although rare).
● Due to the risk of nausea and vomiting, patients will be advised to refrain from eating for at least 4 hours before a session.
● Due to possible blurred and altered vision, as well as impaired balance and coordination, you will be advised to remain lying down and keep your eyes closed (as long as you are comfortable doing so) or use the eye mask provided until the main effects have worn off.
Janice partners with the medical team at Journal Clinical to jointly provide KAP to our clients. The medical portion of KAP appointments is billed separately through Journey Clinical.
- $900 /session (in-home in San Francisco Bay Area; travel fee will be added for
other areas in California)
- $750 /session (in-office in San Francisco)
- $700 /session (virtual in California)
- $600 /session (in-home in San Francisco Bay Area; travel fee will be added for
other areas in California)
- $498 /session (in-office in San Francisco)
- $448 /session (virtual in California)
* Insurance might cover 53-minute preparation and integration sessions, but dosing sessions are fully out of pocket.
* Sliding scale slots are available.
* KAP groups help save money and are offered periodically. If interested, please email Janice directly to be added to the list: JHuang@PresentMomentWellness.org