Ketamine As An Alternative For Treatment Resistant Depression

Written by Jayma C. Sitton, LCSW

 

Ketamine has been a hot topic in the world of mental health in recent years. Approved by the FDA as an anesthetic, it is currently undergoing many studies for its effectiveness for refractory (treatment resistant) depression, pain with depression, bipolar depression, refractory OCD and ruminative suicidal ideation. As a result of its current success with many of these patients, doctors have been prescribing ketamine for these areas of treatment “off label,” meaning at the discretion of the administering physician. The ability of physicians to prescribe for clients who fit the criteria listed has caused an expansion of options, including IV infusion, intramuscular, sublingual and nasal.

A nasal spray called Spravato, produced by a molecule taken from Ketamine (esketamine), was approved by the FDA in 2019, and has proven to have an anti-depressant effect when taken with oral anti-depressant medications. This is currently the only method of Ketamine that is approved by Medicare, but does not allow for variability in dosage as other methods of administration do. 

At higher doses, “Ketamine can produce feelings of unreality; visual and sensory distortions; a distorted feeling about one’s body; temporary unusual thoughts and beliefs; and a euphoria or a buzz,” says John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine in Connecticut, where he is a leader in studying ketamine’s antidepressant effects.

While there are risks of casual use, and the potential for addiction when taken regularly, researchers have taken notice of it’s profound impact on treatment-resistant depression. “Some people with long-term depression lose some important connections in their brains (called synapses) that let nerve cells communicate…But research shows that within 24 hours of the first dose of medically supervised ketamine, those lost connections start to regrow. The more synapses they grow, the better the antidepressant effects of ketamine are for them.” 

“Ketamine may work in other ways in the brain, too. Some nerve cells (neurons) in the brain involved in mood use a chemical (neurotransmitter) called glutamate to communicate with each other. The nerve cells need glutamate receptors — think of them like catcher’s mitts for glutamate — in order to join in this communication. In the brains of some people with depression, those nerve cells don’t get so excited by glutamate anymore. It’s as if the glutamate receptors — the catcher’s mitts — are deactivated or weakened. But after people with this particular problem receive ketamine, those nerve cell connections get restocked with new glutamate receptors. It’s as if ketamine helps make new catcher’s mitts for the glutamate, so that the nerve cells can respond to it again.”

“As for the drug’s action on glutamate receptors: Regrowing and reactivating synapses helps the brain’s ability to change, which may help it shift out of depression. That may also explain why antidepressants or psychotherapy that didn’t help before ketamine may help afterward.” 

The tendency to get stuck in repetitive behaviors-buying into consistent negative thoughts that hold us back from our true potential, engaging in behaviors that are harmful to ourselves or negatively impact our relationships-are typically connected to the so-called Default Mode Network (DMN) in the brain. Studies show that ketamine reduces the functional activity of the DMN, acting almost as a reset button or clean slate following ketamine use. “Accordingly, by turning the volume down on the internal mental chatter, you can start creating new stories, empowering thoughts, phrases, and or beliefs that you have about yourself or about the world. Much of the suffering we experience in life comes not from the actual events or people around us, but rather from the stories and beliefs we have about them. The new meaning you create can be incredibly restorative and healing.” 

This is where the importance of being able to control the dosage of the medication comes in. Ketamine-assisted-psychotherapy (KAP) is growing in importance as researchers and clients recognize that progressive step-ups in dosage allow for deeper insights once the Default Mode Network turns off, thereby eroding ego defenses and giving clients guidance about how to move past maladaptive behaviors. The power of Ketamine-assisted-psychotherapy is the integration of images, metaphors, and insights into daily life, taken from the use of the medicine. While there is much touting of the benefits of ketamine as a stand-alone medicine, ketamine is best used as a tool that helps create the opportunity for real change in our lives. Setting intentions for what one hopes to achieve with this new “reset” is crucial, as is the work of understanding what the medicine shows us while under its influence. As with all experiences while in an altered state of consciousness, paying attention to and interpreting imagery, symbolism and archetypes will provide insight  into how to manifest the intentions we have set. 

For assistance in finding a ketamine-assisted psychotherapist in the Philadelphia area, please contact us. 

Resources:

  1. https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain
  2. https://www.resetketamine.com/blog/how-ketamine-affects-default-mode-network

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Jennifer O’Donnell

Jennifer O’Donnell

M.A., Counseling Psychology, Certified Psychedelic Facilitator through Soundmind in Phila.

Jennifer is an experienced mindfulness-based psychotherapist. She holds
a Master’s degree from Delaware Valley University in Counseling
Psychology, and a Bachelor of Arts degree in Political Science from
Temple University. Jennifer is a certified sexual assault counselor, an
experienced certified yoga therapist, and a certified yoga and Pilates
instructor. Jennifer has completed post graduate training with
Soundmind Institute in Philadelphia as a certified Psychedelic
Facilitator. She offers an array of therapeutic techniques which include:
Trauma Focused – Cognitive Behavioral Therapy (TF-CBT), Dialectical
Behavior Therapy (DBT), Mindfulness Based Stress Reduction
strategies and trauma informed yoga therapy. Jennifer’s therapeutic
approach encompasses the integration of therapy, yoga, breath work and
mindfulness and includes a blend of therapeutic modalities such as
somatic experiencing, attachment theory, psychodynamic, and Hakomi.

“ I see counseling as a safe and therapeutic relationship. My approach
is a blend of both clinical and alternative therapies designed to meet the
needs of each individual. The goal is for you to gain insight and clarity
into your thoughts and feelings in a supportive and encouraging
relationship as we uncover new paths to your personal healing and
transformation. I believe we all carry inner wisdom, and when we start
quieting our minds and listening to our bodies the wisdom can then be
heard.”
Jennifer has experience in treating trauma, PTSD, anxiety, depression, bipolar
disorder, obsessive compulsive disorder, women’s issues, family
conflict, sexual and gender identity issues, grief, behavioral issues and
life transitions. Jennifer has a deep understanding of how trauma shows
up in the body, and continues her personal practices to deepen her own
understanding of self, consciousness, and collective healing.

Sophia Polin

Sophia Polin

MASTER OF SCIENCE MS: MENTAL HEALTH COUNSELING

I am an integrative therapist whose practice combines relational theory with elements of Cognitive Behavioral Therapy. In my standard practice I work with adults and adolescents with histories of trauma, who are facing major life transitions, struggling with anxiety and depression, who are dealing with relationship discord, or who want to explore their full potential. I have substantial experience working with Post-Traumatic Stress Disorder as well as Obsessive Compulsive Disorder. I practice Exposure and Response Prevention (E/RP) for OCD, and take expert care in helping my clients face and overcome what they fear most.

In session, I emphasize attuning to the mind-body connection, habituating to feelings of vulnerability, and integrating disparate “parts” of the psyche in order to guide clients towards conscious, intentional lives and relationships. I consider early life and relationships to be integral in the formation of the personality and of patterns of behavior later in life.

I have recently expanded my practice to include psychedelic therapy. The use of psychedelics in a therapeutic setting gives clients the unique opportunity to distance from ingrained ways of thinking, connect with their own healing intuition, and dissolve the boundaries of self that are no longer serving them. The transformative shifts we are seeing in Ketamine treatments are the result of— the creation and reorganization of pathways in the brain (neurogenesis and neuroplasticity). These are the same processes therapists have been using traditionally to support their client’s growth and healing. I like to think of it as automating what has traditionally only been achievable manually.

Occupying altered states can be scary at first. My role as a psychedelic therapist is to lay the grounds for a safe and revelatory journey. In our preparation sessions we will build essential trust, explore your history, and collaboratively set your intention for your psychedelic experience. We will use our integration sessions post- treatments to synthesize and apply the wisdom gleaned from your journey to affect lasting, meaningful change. Whether you are experienced with psychedelics or exploring psychedelia for the first time, I am with you every step of the way.

Jeffrey Shralow

Jeffrey Shralow

Not available for booking
Support Staff
HARM REDUCTION SPECIALIST
MSN, CRNP, PMHNP-BC, MA

I am a licensed and certified Psychiatric Mental-Health Nurse Practitioner, with a M.S.N. from University of Pennsylvania.  I have a Master of Arts in Buddhist Studies from The Naropa University.  My clinical work is integrative and holistic, with a harm reduction ethical framework. I am trauma-informed and person-centered; these are the foundations for my practice.  I am committed to informed decision making as well as providing clear and understandable educated answers to any question that might arise.  I am committed to the highest levels of professionalism and to ensuring a safe and therapeutic experience.  I am trained and experienced in providing psychedelic integration therapy and Ketamine Assisted Psychotherapy (KAP).  I consider access and inclusion within diverse populations and expressions of the highest priority.

I have been studying and practicing healing and growth processes within the intersection of psychiatry, neuroscience, trauma theory, psychology, and spirituality for several decades.  I have focused on actualizing treatment approaches at the cutting edge of the rapidly expanding and evolving paradigms within psychiatry and consciousness studies. I am particularly excited to be expanding into the field of psychedelic-assisted therapies

My clinical work includes psychotherapy, coaching, and education within a wellness orientation.  Therapeutic specialties include mood dysregulation, anxiety, trauma, psychiatric symptom management, spiritual emergencies, global climate crisis related dysregulation, as well as insight and growth aspirations and psychedelic integration. Integrative elements of psychodynamic/Jungian/Gestalt and transpersonal psychologies, eco-psychology, Buddhist psychology and the mindfulness sciences, as well as Eastern/Asian medicine theory and energy psychology are the foundations of my clinical work.

Stephanie Josephson

Stephanie Josephson

LCSW

I am a Licensed Clinical Social Worker with 20+ years of experience working with people in Philadelphia, New York City and San Francisco.  I am certified in Psychedelic Assisted Therapy and practicing Ketamine Assisted Psychotherapy at the Ko-op.  My client may be a person who currently feels stuck in their life, dealing with chronic health issues, issues related to being queer, trans or non-binary,  concerns about use or mis-use of substances, or dealing with depression or anxiety.  My focus is to work collaboratively with clients to foster growth and personal development in a supportive, judgement-free environment. We can develop skills to deal more effectively with overwhelming feelings, identify your strengths, and work together to overcome challenges in your life.
Psychedelic Assisted PsychoTherapy is a tool to help feel unstuck, expand your perspective and deal with events in your life that, in the past, you have been unable to fully address.  I offer Preparation sessions where we build rapport, gain an understanding of what to expect during a medicine session, and set intentions for what you would like to achieve. I also offer Integration Sessions, weaving the insights gained during your psychedelic journey into your conscious living.
I look forward to speaking with you, and discussing how we can work interactively so that you can better navigate your way forward
Megan Remsen

Megan Remsen

Licensed Social Worker (LSW)

I am a psychodynamic therapist trained in the analytic tradition with specialization in integrated trauma treatment. My practice is grounded in using psychedelic psychotherapy to promote relational and internal acceptance and stimulate growth in spaces that previously seemed stagnant. My kaleidoscopic background and diverse trainings in social work, anthropology, native plant medicine and community healing support my practice. I value and feel curious about the use of dreams, mythology, and intangible heritage as insights into our construction of Self. I embrace the use of non-ordinary states to support the work of engaging with these inner realms.

Psychedelic journeying provides expansive opportunities to engage with and feel curious about the events and beliefs that have shaped our experiences. Our sessions will prioritize interpreting and integrating the insights from your journey into your conscious experience, in support of your relationship with new ways of being. The elasticity of journeying benefits from a secure and stable holding relationship, I will provide collaboration and witnessing through every step, and I recognize and will respond to the vulnerabilities of these new states.

Much of my work centers on supporting the effects of transitions and change on the mind, spirit and body. In our sessions, we will examine the systems, early childhood experiences and deeply internalized messaging that continues to constrain the expansiveness of who we are. Together, we will move towards illuminating those spaces and undoing their harm.

I recognize the oppressive impact of contemporary conditions on the human experience, and I strive to hold the complexity of the treatment I offer and meet clients where they are. I collaborate on a course of treatment that fosters a sense of physiological, emotional, and relational security, while addressing economic realities. I offer a sliding scale and I am happy to consult on a course of treatment to meet unique needs. I center social justice in my work, welcome all sexual and gender identities and make an LGBTQ+ affirming space a priority. Whether you are new to Ketamine Assisted Psychotherapy or returning to continue your insights, I offer a constructive space to work through the subconscious to foster connectedness and curiosity in support of relief from severe depression, attachment injuries, PTSD and anxiety.

Dr. Sophia Brandstetter

Dr. Sophia Brandstetter

LCSW, PSYD CLINICAL DIRECTOR

I am a licensed psychotherapist who is rooted in psychoanalysis and psychodynamic and relational theories. In recent years, as a compliment to my psychotherapeutic approaches, I’ve shifted my training to include psychedelic medicines as a method for integrating the mind, body, and soul. In many ways we are rediscovering verifiable facts about the impact of psychedelic medicines on our neurochemistry, physiology, and psychology. I have witnessed plant medicine as a power catalyst for change for my patients.

At this time our work must center around Ketamine Assisted Psychotherapy. Ketamine is renowned for uncovering our intrinsic healing capacity while transporting us to a place of higher consciousness. The ketamine psychotherapy experience can bring attention to deep-rooted emotions, patterns, narratives, and/or experiences that could be unconscious sticking points or barriers to our growth. Ketamine sessions often access an abundance of material that might take months or years to uncover in traditional psychotherapy. Previous patients have stated, I have felt in a couple of hours, I have learned more about myself than I have in several years of psychoanalysis. Confirmations like this are common and the insight the ketamine sessions impart can remain long after the effects of the ketamine have dissipated.

At higher dosages, psychedelic medicines have the capacity to allow for significant disruptions of self‑consciousness, a phenomenon known as medicine-induced ego dissolution. Using your experience with the medicine as a guide, we can collaborate in understanding the experience of dissolution to create opportunities for regeneration and integration.

As you can see, I believe providing therapeutic support to be a vital part of the curative mechanism of the psychedelic experience. Together we will work on building a therapeutic relationship founded on trust, safety, and mutual respect for the sacred work the medicine can help facilitate. The approach we co-create can enhance the experience and make way for relief and change.

If you’re entering treatment to address trauma or if you’ve experienced trauma, it’s important to understand the healing significance of the therapist as a witness. Research on treating trauma explores how the witnessing (experiencing the presence of another) is considered an essential prerequisite for our capacity to narrate our experiences. One of the crucial impacts of a trauma is the damaging effect caused by the absence of a witness: without a witness we may have lost touch with how to make sense of what has happened, but when we gain a witness, the experience becomes more possible to know and understand, and healing can begin. As your witness in your psychedelic journey my role is to be visible in all the necessary ways to offer support.

My intention is to design a program that meets your expectations. I’m open to the many possibilities of what may work for you and want to invite you to imagine and share your hopes and needs for the journey. A psychedelic experience is a personal process and I welcome the opportunity to meet for a free consultation to answer all your questions and provide you with a comprehensive understanding of the possibilities

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