Ketamine's Transformative Potential

The United States is experiencing an ever-increasing mental health crisis, which has only been exacerbated by the socially isolating COVID-19 pandemic. In 2023, 45% of adults ages 35 to 44 reported a mental illness, compared to 31% in 2019 (apa.org). People living with mental illnesses, such as chronic anxiety and depression, tend to have less flexible neurons with fewer connections, amongst other structural issues.  Ketamine can provide safe and rapid antidepressant relief, revitalizing the brain’s ability to form new connections and enhancing overall receptiveness to psychotherapy.

Ketamine’s therapeutic effects stem from a variety of mechanisms in the brain:

•  Increased BDNF: Ketamine increases Brain-Derived Neurotrophic Factor (BDNF), which has complex downstream effects. This effect is dose-dependent and time-limited (around one week, with peak at 2-3 days).

• Lowering the Default Mode Network: Ketamine has been shown to reduce the functional activity of the Default Mode Network (DMN), which can give the patient a chance to take a break from habitual thoughts and gain perspective.

• Enhanced Neuroplasticity: Ketamine enhances neuroplasticity by upregulating BDNF. This effect opens a window of opportunity for psychotherapeutic intervention.

• Intrinsic Anti-Depressant Effects: Ketamine has rapidly acting antidepressant and mood-enhancing effects, with a response rate of approximately 50-80% and duration ranging from 2-3 days up to 2 weeks or more. Evidence also supports a unique anti-suicidal effect, independent of antidepressant response.

• Dissociation: Ketamine's dissociative effect may provide patients the opportunity to gain a new perspective on a traumatic or unpleasant situation.

• Responsiveness to therapy: Following a Ketamine dosing session there is a  critical period which allows for higher responsiveness to therapy, caused by the effects. 

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Since the start of the Covid-19 pandemic, the incidence of mental health diagnoses has doubled, and today, nearly half of the US population suffers from some form of depression or anxiety condition. We urgently need effective, novel tools to help ease the burden of those suffering and improve their long-term outcomes.

Of all the psychedelic medicines, the most studied has been ketamine. Over the last several decades, ketamine’s record of clinical safety in ER, outpatient, and psychiatric settings has produced an extensive body of clinical evidence which supports its safety for use in psychotherapeutic settings (source: Dore et al, 2019). Leveraging ketamine as an adjunct to psychotherapy, has been particularly effective for significantly improving clinical outcomes.  While in the short term, ketamine can provide rapid relief in symptoms through increased neuroplasticity, psychotherapy supports the process of meaning-making and the cultivation of anchors through new practices and ways of being that both primes the brain for these new insights and then supports their ongoing integration.

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A 2019 study by Jennifer Dore et al. which examined outcomes from three psychotherapy practices using Ketamine-Assisted Psychotherapy for hundreds of patients over the course of several years concluded that KAP is “an effective method for decreasing depression and anxiety in a private practice setting, especially for…those with severe symptom burden” (Dore et al, 2019). In this study, participants with severe symptom burden (i.e. psychiatric hospitalization, suicidality at intake and within the past year) who underwent KAP treatment demonstrated higher levels of improvement in well-being, anxiety, Beck Depression Inventory, Hamilton Anxiety Scale, PTSD scores and drug and alcohol use scores. Further analysis of the improvement in
anxiety and depression demonstrated that people with PTSD or developmental trauma showed the highest level of improvement in depression and anxiety scores (Dore et al, 2019). Data from the study supports the efficacy of KAP for a host of psychiatric conditions, rapidly and significantly decreasing depression, anxiety and PTSD.
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Many trials have shown that ketamine and other psychedelics produce better clinical results when used in conjunction with psychotherapy: *MDMA is not currently an FDA approved psychedelic, someday soon we hope!

At Atomic Mineworks we practice a collaborative care model in which members (trained KAP facilitators) take on the therapy portion of the experience (including preparation, set and setting, pre session intention setting and integration sessions), while Rena Apon CRNA PMHNP supports patients in all medical aspects. This includes determiningeligibility, developing a custom treatment plan, prescribing the medicine and monitoring outcomes.