It’s not news that depression (major depressive disorder) is one of the most common mental disorders in the United States. Approximately 21 million U.S. adults had at least one depressive episode throughout their lifetime, with women, young people, and biracial people having higher rates of depression.

Medically, major depression is defined as having at least five of the following symptoms for at least 2 weeks; at least one of the symptoms has to be depressed mood or loss of interest in activities:

· Depressed mood

· Loss of interest in activities

· Weight loss or weight gain

· Sleeping too much or too little

· Moving too much or too little (in a way that’s noticeable to others)

· Fatigue/loss of energy

· Feelings of worthlessness and guilt

· Poor concentration and indecisiveness

· Suicidal thoughts and/or plans

What Is Treatment-Resistant Depression?

There is no official, agreed-upon definition of treatment-resistant depression, but it is generally defined as having tried multiple antidepressants without success. Some definitions also add therapy to the mix.

The US Food and Drug Administration (FDA) uses the most popular definition of treatment-resistant depression: an inadequate response to a minimum of two antidepressants despite adequate length of treatment and patient adherence.

If we use FDA’s definition, about 30% of people diagnosed with depression have treatment-resistant depression.

Up until recently, in order to obtain relief, these people needed to add antipsychotics to their antidepressant or use electroconvulsive therapy, with mixed results.

However, now they have more options: they can try repeated transcranial magnetic stimulation (TMS) or ketamine treatment. Ketamine can be delivered in multiple settings and through multiple ways. Today we are going to look at ketamine-assisted psychotherapy.

What Is Ketamine-Assisted Psychotherapy (KAP)?

Ketamine-assisted therapy or KAP is a modality where the person uses ketamine in a therapist’s office while being supervised by the therapist. The treatment involves a thorough assessment by both the therapist and the medical team as well as preparation and integration sessions led by the therapist.

During medicine sessions, the person takes the ketamine orally (under the tongue) and goes on a “journey” that may have psychedelic qualities.

Note that this approach is drastically different to doing ketamine on your own or in a party setting. The difference lies in intentionality, supervision, and integration of the experience with a trained mental health professional.

How Can Ketamine-Assisted Therapy Help Treatment-Resistant Depression?

A study of ketamine-assisted psychotherapy found that depression symptoms improved for almost 90% of the participants, with 30% reporting having no symptoms after four sessions. 62% of suicidal participants were no longer suicidal after four sessions. The response rates were better than antidepressants, traditional talk therapy, or IV ketamine.

As far as treatment resistant depression goes, one study found that 65% of participants had a 50% reduction in their depression scores within 24 hours of receiving ketamine. Another study looked at people who previously tried electroconvulsive therapy with no success and found that ketamine significantly improved symptoms for them.

Several other studies found that ketamine consistently provides depression symptom relief for a majority of study participants, often after just one dose, and these results are sustained over a period of time, especially when multiple doses are administered.

How Does Ketamine-Assisted Therapy Work?

It’s important to know that KAP is a form of therapy where you may feel more vulnerable than in other settings. So, it is crucial to find a therapist who is a good fit and with whom you feel completely comfortable. After all, the quality of your relationship with your therapist is 7 times more important to your outcomes than the type of approach they use.

As such, the process should begin with you interviewing your prospective therapist! At Courage to Heal Therapy, we schedule free online video consultations for 15 minutes so you can chat with your therapist and determine fit (can be longer if needed).

If it’s a good fit – and if you pass some basic screening questions – you get to meet the medical team at Skylight Psychedelics virtually. They handle all the medical stuff, including prescribing the ketamine and advising you on buying a blood pressure monitor, which you will need for ketamine sessions.

Then, you have an assessment session where you will get to know your therapist, go over the consent forms, and answer questions about your background and reasons you want the treatment. You will set goals that can be reviewed after treatment is completed. After this, the treatment can be separated into preparation, ketamine sessions, and integration.

Preparation

Your treatment will involve at least one preparation session – more if the therapist deems that necessary. Most people need 1-3 preparation sessions. During these sessions, the therapist assesses your ability to “focus inwards” and access calm states of mind and body – then teaches you any skills you need to do that.

Mindfulness is a big part of preparation, and you will have homework to practice mindfulness at home. It is important to take this homework seriously as it will ensure a smooth ketamine experience. You also set your intentions during preparation. Intentions refer to your “set” or mindset and are an integral part of ketamine-assisted therapy.

Ketamine Sessions

Ketamine sessions are usually two hours long and held in late afternoon since you won’t be able to drive or operate machinery afterwards. You must ensure you have a ride to and from the ketamine sessions for this reason. THE AFTER-SESSION RIDE CANNOT BE A RIDESHARE OR TAXI.

During the session, your therapist will make sure you are comfortable, at ease, and in a positive state of mind before self-administering ketamine. You will set an intention specific to the session, choose a mantra to repeat if needed, and prepare yourself in accordance with mindfulness skills you learned during preparation. You will also take your own blood pressure as ketamine cannot be used in cases where hypertension is present.

If you feel ready to proceed, you will take the ketamine by placing it under your tongue and waiting for absorption (10-15 minutes). You will be resting on a couch or a mattress with a weighted blanket and an eye mask for the duration of your journey (usually 45 minutes to an hour). Your therapist will have a playlist for each session that will enhance your experience.

When you come out of your journey, you will remain with the therapist until you have a steady gait and can orient yourself to time and space. Your therapist will once again ensure your comfort and ease as you transition out of your psychedelic experience.

At Courage to Heal, we partner with Skylight Psychedelics and use their protocol of six ketamine sessions with an option to add four maintenance doses.

Integration

Some people choose to have their integration sessions immediately after the medicine sessions, others prefer to wait up to two days afterwards. While it’s possible to go for longer, you don’t want to wait too long to best take advantage of neuroplasticity afforded by ketamine.

During integration sessions, the therapist is there to assist you in making sense of your ketamine experience and the effect it had on your inner world and your view of the outside world. If you are choosing to combine ketamine-assisted therapy with EMDR therapy, this is when EMDR would be done.

Typically, you will need one integration session for each ketamine session although some people may choose more integration (this is especially true for EMDR therapy).

In conclusion…

Ketamine-assisted therapy is an excellent new way to address treatment-resistant depression in just six ketamine sessions (with appropriate assessment, preparation and integration sessions). While results can never be guaranteed, current research tells us that ketamine-assisted therapy is effective against treatment-resistant depression for most people who try it.

How Do I Get Help Now?

If you are ready, schedule a free 15-minute consultation now. You can also contact us or call (720) 340-2327.

Ketamine-Assisted Therapy for Treatment-Resistant Depression