Ketamine is an NMDA receptor antagonist, which affects different receptor sites in the brain than traditional anti-depressant medication. It also allows us to work more fully in the body by bringing greater awareness to interoception, which is a sense that helps people understand and feel what is going on inside the body. It also differs from anti-depressants in that it only elevates positive mood rather than suppressing both negative and positive emotions, which can unfortunately lead to a numbing effect that people complain of on anti-depressants.
We make use of both oral ketamine and IM (intra-muscular) ketamine for the therapy session. Oral ketamine allows for more mental fluidity through partial suppression of the default mode network. People find they are able to discuss trauma without apprehension, giving a voice to trauma that has never been spoken. We can then work on understanding their experience and how the trauma was internalized. Ketamine helps to pull out unconsciously held beliefs and ideas as defense mechanisms are lowered. Oral ketamine allows the person to be more fully aware and stay in complete control of the content of the therapy, making it an ideal agent for trauma work.
After using the oral ketamine, some people are candidates for the IM ketamine, which is more likely to provoke what is termed a “NOSC”, or non-ordinary state of consciousness. In this state of consciousness, intuitive information is easily retrieved without effort. It is often an encapsulation of the psychological experience, and it may include information that cannot always be defined by the rational mind.
We do not currently use IV ketamine in our clinic.
Certain psychiatric conditions, such as psychosis, mania, current substance abuse and acute suicidality could worsen with the use of ketamine. There are also medical problems, including but not limited to hypertension, bladder cystitis, pregnancy, brain tumor or hemorrhage, coronary artery disease or thyrotoxicosis that do not allow for the administration of ketamine.