Ketamine Assisted Psychotherapy (KAP)

Ketamine Assisted Psychotherapy (KAP)

What is Ketamine Assisted Psychotherapy (KAP)?

Ketamine Assisted Psychotherapy (KAP) is a novel, emerging therapy that prolongs the antidepressant effect of ketamine by discussing the ketamine psychedelic experience with a trained psychotherapist.

Recent studies have shown that KAP can be a powerful tool to help people with mood disorders like depression, anxiety, and PTSD, as well as chronic pain, dissociative disorders, and addiction. It has also shown effectiveness for people who have not seen results with other treatments.

At Reclaim Joy Medical KAP starts with an introduction session that is three hours long, done in the office with Dr. Suzanna Freerksen. Subsequent sessions are at-home journeys using lozenges, with integration therapy done in the following 2-3 days after taking a dose of ketamine.

What is Ketamine Assisted Psychotherapy (KAP)

Both Counselor Ellen Smith and Dr. Suzanna Freerksen are trained in KAP integration psychotherapy.

If you are interested in starting ketamine assisted therapy, please call our office at 669-242-5151 for more information, or book an appointment with one of our providers to find out more.

What is ketamine?

Ketamine is classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. It was developed in 1963, FDA-approved in 1970, and used frequently by many hospitals and medical offices because of its rapid onset, proven safety, and short duration of action. It is used off-label to treat mood disorders in a way similar to psychedelic compounds. Unlike the psychedelic drugs psilocybin, MDMA, or ayahuasca, ketamine is legal for medical use in the United States with a doctor’s prescription. Ketamine can be administered several different ways, with the most common being sublingual, intramuscular, intravenous, and intranasal. At Reclaim Joy Medical, your first KAP session is in the office with sublingual ketamine, and subsequent ketamine journeys can be undertaken at home.

 

Is ketamine assisted psychotherapy safe?

Yes, ketamine assisted psychotherapy is generally considered a safe and effective treatment option for individuals with certain mental health issues, such as depression and anxiety. Ketamine is known for its low toxicity, minimal side effects, and short-term effects. During the first introduction ketamine session in the office with Dr. Freerksen, she she can help coach you through the possible obstacles, difficulties, and questions that arise.

 

What types of issues can be helped by using ketamine? Is it right for me?

At Reclaim Joy Medical, KAP is a powerful tool to help people with mood disorders like depression, anxiety, and PTSD as well as chronic pain, dissociative disorders, and addiction. KAP can be an effective and safe treatment option for people who have been struggling with these issues for a long time and have not seen results with other treatments. It is important to discuss the overall goals of treatment with a provider to make sure KAP is the best option for you.

 

How soon can I expect to see results?

The response to KAP can vary from person to person, but results can typically be seen within a few weeks. However, it is important to note that KAP is not a one-time treatment, and multiple sessions are recommended to achieve the desired outcomes. Though research has demonstrated an antidepressant response to low doses that are minimally psychoactive or sub- psychedelic, this effect tends to be cumulative, requiring repeated administrations over short periods of time. The present understanding of ketamine’s mode of action is as an NMDA receptor antagonist working through the glutamate neurotransmitter system. Glutamate is a neurotransmitter that is unique from most other psychiatric drugs such as SSRIs, SNRIs, mood stabilizers, antipsychotics, or benzodiazepines. As a result, ketamine has very few drug interactions with other medications.

 

How does Ketamine Assisted Psychotherapy (KAP) work?

KAP works by allowing people to experience a deeper level of understanding of their inner emotional and psychological landscape. This in turn allows a person to access insight, healing, and transformation. During the psychotherapy sessions patients are administered a low dose of ketamine, which allows them to reach a state of dissociation. This state can help create an emotional distance from difficult memories or trauma. The psychotherapist then provides emotional support and guidance as the patient navigates this inner terrain. Both Counselor Ellen Smith and Dr. Suzanna Freerksen have been trained to help you in this way.

Ketamine Assisted Psychotherapy (KAP)

In depression, the long filamentous receptors on neurons that facilitate signal transmission may recede, and the mass of two parts of the brain that govern mood, the amygdala and hippocampus, may shrink. Animal research has shown that ketamine can stimulate neural growth within days (and sometimes hours) of administration of medication. It is believed that ketamine creates a similar neurogenesis in humans, which allows for neuron growth and brain plasticity. This can be helpful in breaking out of rigidity that keeps people stuck in negative patterns that can contribute to mental health conditions. People often Often, in the days after a ketamine journey (whether at home or in the office), people describe an increased mental flexibility and that changing problematic thoughts or behaviors might be less challenging than normal.

A ketamine journey is usually psychedelic in nature, where the routine patterns and rules do not apply. It is possible that this time on a ketamine journey affords a reprieve from negative habitual patterns of thought that are symptomatic of a mood disorder, creating an opportunity for learning new and healthier patterns of thought. Ketamine has also been found to reduce functioning in the Default Mode Network (DMN), which is an interconnected group of brain structures that tends to be most active during rumination, and is thought to be part of what keeps people in patterns that may or may not be healthy. With less time spent in the DMN, people can look at their situation from unique perspectives, and have a chance to develop new, healthier patterns more easily.

There is no current consensus on mode of action, and other mechanisms may be found central to ketamine’s effects. However, what we do see is that ketamine’s pharmacological antidepressant and anxiolytic effects combined with the altered state of consciousness can produce an optimal situation for productive thought and behavior change to take place, especially with a skilled psychotherapist guiding you through.

 

Types of ketamine therapy

Ketamine-Assisted Psychotherapy (KAP) is the most common form of ketamine therapy, and it involves a psychotherapist providing support and guidance as the patient navigates their inner emotional and psychological landscape. However, there are several other types of ketamine therapy available, such as Spravato – a nasal spray form of ketamine – and Ketamine-Assisted Psychedelic Therapy (KAPT). These therapies require the administration of higher doses of ketamine, making them more similar to traditional psychedelic therapy.

Sublingual ketamine lozenges
Sublingual ketamine lozenges

Compounded ketamine sublingual troches (container)

Sublingual ketamine lozenges

Compounded ketamine Rapidly Dissolving Tablets (RDTs) in blister packs

Sublingual ketamine lozenges

Sublingual ketamine lozenges are a type of ketamine therapy where a patient puts a lozenge in their mouth, allowing it to dissolve without swallowing the lozenge or the saliva that accumulates. The person holds the saliva and lozenge in their mouth for 15-30 minutes before either swallowing or spitting it out. This is the method preferred by Dr. Freerksen for her KAP sessions, because it allows for flexible dosing of ketamine in the office in order to accurately prescribe a ketamine dose for home ketamine journeys. Sublingual lozenges allow for easy administration of at-home ketamine journeys.

Intramuscular ketamine

Intramuscular ketamine

Intramuscular ketamine is a type of ketamine therapy where a patient is administered a single dose of ketamine via an intramuscular injection. This method is usually used for patients who are already familiar with the effects of ketamine, and is usually done in a doctor’s office. This type of therapy has the benefits of rapid onset and more precise dosing than sublingual ketamine. Additionally, there is no flavor to an intramuscular injection and there are fewer gastrointestinal side effects with intramuscular versus sublingual administration.

How does Reclaim Joy Medical’s Ketamine Assisted Psychotherapy work?

Your first step towards KAP is booking an evaluation with Dr. Suzanna Freerksen. She will make sure Ketamine Assisted Psychotherapy is medically safe for you, and prepare you for your Ketamine Induction session. If you are medically cleared, she will write you a prescription for ketamine lozenges, to be mailed to your address by a compounding pharmacy such as Pharmaca Integrative Pharmacy, Koshland Pharmacy, or Lauden’s Integrative Pharmacy, usually between $75 and $115, including shipping. After receiving the medicine, you will bring the lozenges to your 3 Hour Ketamine Induction session. KAP Introduction sessions usually start in the late afternoon. You can drive yourself to this session, but need to have a rideshare or friend pick you up as it’s not recommended to drive a car the same day as a ketamine journey.

We recommend that you start your journey with an intention, like “Be kinder to myself” or “Allow myself to take more risks”. The first 15 minutes is spent talking about your intention, taking your blood pressure, and taking nausea medication and/or blood pressure medication if necessary. Dr. Freerksen will give you an eye mask (eyes do not focus well while under the influence of ketamine) and play music (to help create movement and motivation for the journey). You will let the ketamine lozenges dissolve under your tongue and absorb through your mouth tissue over 15-20 minutes. Dr. Freerksen will adjust the dose as necessary. Usually, one is quiet for about 45-60 minutes while experiencing the psychedelic effects of ketamine. Once you come back “into your body, into the room”, Dr. Freerksen will write down anything you care to share or you can record your spoken thoughts on your phone. Dr. Freerksen will help process and integrate your experience, and send you home with instructions regarding dosage and frequency and psychotherapy integration of ketamine home journeys.

Dr. Freerksen will see you monthly to follow your progress, and adjust or refill your ketamine prescription as needed. You can follow up with either Dr. Freerksen or Ellen Smith for post-dosage psychotherapy integration sessions. Psychotherapy integration is an important part of the KAP process, as it helps the antidepressant effects of ketamine last longer, and helps to cement new healthy behaviors into long-lasting healthy habits.

If you are interested in starting ketamine assisted therapy, please call our office at 669-242-5151 for more information, or book an appointment with one of our providers to find out more.

Thank you for choosing Reclaim Joy Medical!

Welcome, Counselor & Therapist Ellen Smith LPC-C!

Welcome, Counselor & Therapist Ellen Smith LPC-C!

Everyone at Reclaim Joy Medical would like to give a warm hello to Ellen!

Ellen Smith Smith LPC-C is an experienced master’s level therapist. She uses a variety of modalities to help individuals and couples seeking counseling. Ellen has advanced specialization in sex therapy and is certified by AASECT.

Ellen Smith, Counselor, MEd, LPCC, CST

Ellen has worked with many diverse populations and in diverse settings. She has training in helping clients integrate the insights gained from ketamine home journeys into their daily lives. She has 30 hours of training in Ketamine Integration therapy from the Ketamine Training Center, taught by Dr. Phil Wolfson.

Neurodiversity can be a complicated and nuanced topic. Ellen has lived experience with neurodiversity and an open acceptance of her client’s experiences. She enjoys helping clients explore what makes them unique and special.

One of Ellen’s favorite modalities is Existential Psychotherapy. What is Existential Psychotherapy, you might ask? It is discovering the meaning and pattern to our existence. One of Ellen’s main inspirations in her practice of Existential Psychotherapy is Irvin Yalom, MD. He is a novelist, physician, and a gifted psychotherapist. Ellen had a session with Dr. Yalom and his words continue to inspire and guide her to uncover a deeper meaning in the day-to-day bustle of life.

Antipsychotic Mood Stabilizers

Antipsychotic Mood Stabilizers

The Good, the Bad, and the Ugly

 

THE GOOD

Originally developed for hearing voices in schizophrenia, but so many other uses!

Great for bipolar mania

Most Antipsychotic Mood Stabilizers (AMS) treat bipolar depression as well

Good addition to antidepressants for moderate to severe unipolar depression

Safe for kidneys and thyroid

Most are generic

Taken once daily

Most help you sleep! (But some give you more energy without the sedation)

Not a lot of medication interactions

Yearly blood tests to check cholesterol and blood sugar

 

THE BAD

Often cause sleepiness (this can be a good thing!)

Can increase blood cholesterol (needs to be checked annually)

Can increase blood sugar and the risk for diabetes (needs to be checked annually)

Mild to moderate weight gain is possible/common

 

THE UGLY

Uncommon: AKATHISIA

  • “Restless legs all over my body”
  • Not fatal, but uncomfortable
  • Can be easily reversed with beta blockers, a blood pressure medication

Very rare: TARDIVE DYSKINESIA

  • Involuntary muscle movements, usually of the face or tongue
  • This is more common at higher doses of AMS
  • 1/3 of the time, it does not go away
  • There are several new medications on the market that are good at treating this if it persists after the medication is stopped
  • Seroquel (quetiapine) has the lowest risk

Mood Stabilizers for Bipolar Disorder

Mood Stabilizers for Bipolar Disorder

If you have highs that last for days to weeks as well as depression, talking to your psychiatrist about the possibility of Bipolar Disorder type I or Bipolar Disorder type II might be a good idea. Bipolar disorder medication is treated inherently differently than unipolar depression, where you only have low moods without the highs. Bipolar disorder requires a mood stabilizers. usually, antidepressants like Prozac can have negative effects effects on mood. First line treatment is a mood stabilizer, and only at that point could your psychiatrist consider adding an antidepressant for anxiety or medication for ADHD.

 

Common Mood Stabilizers

Common Mood Stabilizers - Lithium, Valproate, Seroquel and Abilify

Getting the diagnosis of bipolar disorder can be quite disorienting and fear-inducing. However, there are many successful programmers, attorneys, and even physicians with bipolar disorder. Additionally, there is a connection between bipolar disorder and creativity that is undeniable, even though it has yet to be fully explored. Read The Midnight Disease by neurologist Dr. Alice Flaherty of the Harvard Medical School to learn more.

Treating bipolar disorder is one of the best parts of my job, because while it can be debilitating, with the right medication people feel better and quickly become more successful, effective, and happier. I like being able to help someone find their true self again.

Asperger’s Syndrome Resources

Asperger’s Syndrome Resources

Autism Spectrum Disorder (ASD)

The diagnoses of Autism Spectrum Disorder (ASD) and Asperger’s Syndrome have been coming up frequently lately among people I see, so I thought I would write a blog post with information on the subject.

Autism Spectrum Disorder (ASD) is classified as a Developmental Condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and has gone through several editions and revisions throughout the years. Both ASD and Asperger’s Syndrome were in the fourth edition of the DSM (DSM-IV and DSM IV-TR). In the most recent and fifth edition of the DSM (DSM-5), Asperger’s Syndrome was removed and ASD remained, with numerous specifiers. However, Asperger’s Syndrome continues to be used in clinical settings and by people with Asperger’s themselves. Some of those with Asperger’s Syndrome call themselves “Aspies”. I think to the layperson, Asperger’s Syndrome is thought of as a mild form of Autism Spectrum Disorder. This is true in some respects, as people who identify themselves as having Asperger’s Syndrome are usually verbal (a sizable percentage of people with ASD do not or cannot speak), have intelligence in the average or above average range, and often “don’t look autistic”, meaning that they are assumed to be neurotypical (NT) on superficial acquaintance.

We do not currently know what causes autism, though there have been many hypotheses and studies. It has been soundly DISPROVEN that vaccinations cause ASD. The fact is, vaccinations like the MMR vaccine are given around the age when ASD symptoms begin to become more apparent. There is NO proven relationship between vaccinations and autism, and significant evidence that the original hypothesis was based on unfounded data with faulty analysis.

 

Autism Spectrum Disorder: Definition

ASD Definition

From Merriam-Webster Online Dictionary: Any group of developmental disorders (such as autism and Asperger’s syndrome) marked by impairments in the ability to communicate and interact socially and by the presence of repetitive behaviors or restricted interests — called also pervasive developmental disorder

(“Autism spectrum disorder.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/autism%20spectrum%20disorder. Accessed 17 Oct. 2021.)

 

Asperger’s Syndrome: Definition

From Merriam-Webster Online Dictionary: An autism spectrum disorder that is characterized by impaired social interaction, by repetitive patterns of behavior and restricted interests, by normal language and cognitive development but poor conversational skills and difficulty with nonverbal communication, and often by above average performance in a narrow field against a general background of impaired functioning.

(“Asperger’s syndrome.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/Asperger%27s%20syndrome. Accessed 17 Oct. 2021.)

 

Where do I go from here?

I hope this has been helpful to you if you or someone you love is diagnosed with Autism Spectrum Disorder and/or Asperger’s Syndrome. I have linked some screening self-report measures that have been published in respected academic journals. They may help rule-in or rule-out an ASD diagnosis if you have not been diagnosed yet. The gold standard for ASD diagnosis is the Autism Diagnostic Observation Schedule (ADOS), which I observed being done in medical school and at that time I was told it could only really be accurate when done with young children. More recently, the ADOS-2 has been adapted for children through adults, though it is unknown to this writer how widely it has been validated by researchers and how accessible or cost effective it is to the average adult. Diagnosis of ASD in adults is difficult and in Dr. Freerksen’s practice, it is based on history and clinical judgment. Getting a diagnosis can be very empowering and a relief to someone with ASD.

If you want to know more about ASD or AS, several reputable organizations and well-reviewed books are linked here. In my personal experience, Temple Grandin is the most well-known of the authors represented, and she has several Ted talks as well as books, patents, and memoir published. I also include a category of books about how ASD presents differently in women. The DSM-5 suggests that there is great male preponderance of ASD, though I am seeing a fair amount of undiagnosed ASD/AS in some of the women I know and some authors suggest that the proportion may be more evenly distributed and simply not diagnosed in a large portion of affected women.

 

Health Resource Organizations

CDC page on Autism

Autistic Self Advocacy Network – “Nothing About Us, Without Us.”

Autism Society

Neuroclastic – “The Autism Spectrum According to Autistic People”

 

Scales that Screen for Autism (Peer-reviewed!)

  • Ritvo Autism & Asperger Scale (RAADS)15 questions, scored online at this link.
    • Peer-reviewed and validated
    • Chose whether this happened when you were young, at your current (adult) age, both, or neither
  • Autism Spectrum Quotient (AQ)
    • 50 questions, scored online at this link.
    • Peer-reviewed and validated
    • Binary choice: there are 4 options but really it’s “agree” or “disagree”

General Books on Autism & Asperger’s

Women with Autism/Asperger’s Syndrome

Children with Autism/Asperger’s Syndrome