PHILADELPHIA (KYW Newsradio) – A woman who identified herself only as “Marie” had been struggling for years.
She had been in and out of therapy. She had tried meds. Nothing worked.
Her bouts with severe depression continued to come and go. The wounds from traumatic life events remained unhealed.
“Even though I have been relatively stable and off medications for seven years, I have found myself recently slipping hard and fast…with this impending feeling of sadness and doom,” she said in August.
Still, Marie wasn’t ready to give in.
“I have enough of a fight left in me that I don’t want to go down that road again,” Marie said.
So, at the end of the summer, she wanted to mix it up.
No more traditional therapy modalities. No more scripts that, at best, provided temporary relief for deep-rooted problems, and at worst triggered sleepless nights and extreme weight gain.
“I had a friend who had never been on medication before, and within six weeks, he killed himself,” said Marie. “I know numerous people who try [Western] medicines, and it makes them feel worse.”
That’s why, this time around, Marie decided to do something totally different: Ketamine-assisted psychotherapy.
“I’m feeling mostly excited, a little anxious, optimistic,” she said the night before her first session.
But the source of Marie’s optimism also led to some lamenting.
She couldn’t stop thinking, “What if this actually works? What if I actually get better?”
Most of all, Marie wondered if all the anguish and sorrow could have been avoided.
A potential game-changer
In the United States, ketamine is an FDA-approved controlled substance for use as a general anesthetic.
However, ketamine has not yet been approved for psychiatric treatment.
That’s because over the years, ketamine — despite its ability to reduce pain — has also become a street drug with hallucinogenic qualities.
“It really reminds me of when cannabis became legal,” said Dr. Sophia Brandstetter, who has a doctorate in psychotherapy and is certified in ketamine-assisted psychotherapy treatment.
“Everyone’s still calling ketamine a drug and then all of a sudden, it’s starting to be used as a medicine and it takes our culture and society years to be able to change the language around it. But the shift from drug to medicine creates a completely different perception of it. I think it’s going to take time for us to understand it as a medicine.”
Not Brandstetter, though. She’s sold.
She considers ketamine-assisted therapy to be a game-changer.
Brandstetter has seen the results in patients, and has also experienced them first-hand.
“I am from the position that I can’t ask my patients to do anything that I won’t do,” Brandstetter said. “I’ve taken a lot of psychedelics in my time to understand the impact the medicine can have, which is why I’m here because I know how it can change people’s lives.”
Brandstetter began practicing psychotherapy 15 years ago.
This past July, she set out on her own to open the Ko-Op, one of just a few ketamine-assisted psychotherapy centers in Philadelphia.
Brandstetter hopes the Ko-Op can distinguish itself by not only making this new-age treatment affordable and accessible for patients, but training like-minded clinicians who sign up to become members of the Ko-Op as well.
“[When] I was doing ketamine-assisted psychotherapy, I felt very alone. Where’s the community, especially in Philadelphia?” she said.
“There is tremendous support in the [Ko-Op’s] space. We’ve had patients that are in distress at times, and we have support for the therapist. There’s all these mechanisms put into place so not only the patient, but the therapist feels supported.”
The Ko-Op’s layout and setup both involved a lot of thought.
The facility is run out of a former residential brownstone in Philadelphia’s Graduate Hospital neighborhood.
“The idea is that this is your home away from home,” she said.
The homey vibe permeates throughout the Ko-Op.
There’s music playing and incense burning when patients walk in and take off their shoes; a kitchen that offers refreshments and a place to relax before sessions; and four treatment rooms, each one furnished with a chaise lounge-style sofa and different decors that give off different moods.
“This is something that people are coming to and they often don’t know what to expect,” said Brandstetter, “and so creating this ambiance is really important to what we refer to as the ‘set’ (mindset) and ‘setting’ (environment) of the experience.”
Inside the Ko-Op’s treatment rooms, where the ketamine is administered, holistic comfort is frequently juxtaposed with intense thoughts and emotions.
“Many of our patients are people that have tried so many different kinds of treatments, have been trying to navigate the mental health roller coaster – finding the right clinician, psychiatrist, treatments,” Brandstetter said. “These are people with treatment-resistant depression, anxiety, OCD, severe trauma, bipolar disorder. These are people that are turning towards this treatment as their last hope.”
While ketamine does not have the addictive properties of harder substances like heroin or cocaine — or even nicotine, alcohol, marijuana, or caffeine, for that matter — its ability to generate dissociative thoughts and hallucinations makes it a potential wild card of sorts.
“Let’s just take it at face value,” said Brandstetter. “You’re asking somebody to come into an office and have a psychedelic experience, to lower their protectors and to access information, content, feelings, thoughts, that feel very intimidating to them.”
That’s why Brandstetter founded the Ko-Op with a harm-reduction model in mind.
Even before patients begin ketamine-assisted psychotherapy, they must be 18 years old, meet certain psychological criteria, and participate in three preparation sessions to get their mind, body, and spirit ready.
Then, upon arriving at the Ko-Op for treatment, patients get their vital signs checked by a psychiatric nurse practitioner.
If the vitals fall within a certain range, patients proceed with treatment. If the vital signs aren’t in the right range, patients get sent home.
As for the ketamine itself, the Ko-Op gets it from the Art of Medicine, a compounding pharmacy in Philadelphia that does national business. Patients take the ketamine under their tongue in the form of a rapid dissolve tablet that disappears in about three minutes.
Brandstetter says patients typically feel the effects of ketamine for about 20 to 60 minutes, depending on how fast they metabolize it.
“Ketamine is short active, which is really unique to be able to offer a psychedelic medicine that doesn’t have to be on a journey for 15 hours.”
The Ko-Op’s ketamine-assisted psychotherapy program lasts six weeks. Sessions are three hours long from start to finish, and can be spread out week-by-week, or done at the preferred pace of patients.
“I think the simplest form to put it in is that in my own experience — and I often hear this with patients as well — is that when the [ketamine] journey starts to settle in, oftentimes we can see us sort of zooming out,” Brandstetter said. “We’re actually getting a bird’s eye view of the Earth, and you’re in the stars.
“What’s really interesting about that is this sort of immediate shift around perspective. We’re so zoomed in on our own lives, obviously, that we just can’t see it and it’s really hard to change. But when you zoom out, and you have a completely different perspective, not only of you but as we all relate to each other in this world, changes can happen.”
Perhaps a patient with agoraphobia (a fear of being in places that can lead to anxiety and panic attacks) starts going for walks outside. Maybe someone else finds a way to muster up enough strength to get out of bed and take a shower, after being bedridden by depression.
The turning points, Brandstetter says, tend to happen around the third session.
“We are seeing people be able to live a life that feels much closer to the life that they feel they were meant to live,” Brandstetter said.
Springboarding into a new mindset
How did things go for Marie, the patient who started her ketamine-assisted psychotherapy sessions in August after grueling bouts with depression and PTSD?
Really well by all accounts, except for the taste.
“It was like Tang mixed with metal shavings,” she said with a few chuckles.
But for Marie, it was worth it.
Sure enough, around the time of her third ketamine-assisted therapy session, she started to notice changes.
‘A lot of triggers that normally would have put me in a real bad space and taken me a while to get out of, or gotten me just in a funk, did not have the same effect,” she said. “The emotion…didn’t linger.”
During her fourth session, Marie had what she called a “breakthrough” journey.
“I had this vision. I was seeing myself standing on a balcony overlooking a green jungle and it was raining and I was drinking a cup of tea,” Marie described.
“There was this beautiful feeling, this beautiful version of me seeing the back of my silhouette. It felt like…this was like a rite of passage, a state of mind that I had accomplished. This was solidified, and I saw a beautiful version of myself in this moment. It was just gorgeous and simple. The depression I have experienced in my life has always blocked me from seeing the best of me.”
Finally, Marie saw it.
Dr. Sophia Brandstetter didn’t work with Marie directly. Marie picked another therapist who belongs to the Ko-Op.
But Brandstetter has been in enough treatment rooms to know how powerful these breakthrough moments can be.
“The lights are off, the candles are burning, the music is going, [a patient] is lying on your couch, and you’re up face-to-face with them as they are describing a scene of something that might have happened to them,” said Brandstetter.
“You are in it with them – you are in that long hallway, you are in that room…and their experience is happening with you. You are in it in ways that you cannot even imagine. I get the chills [thinking about it] because it brings me back to something so humbling: To sit in the room with somebody that’s having a journey like that.”
As fall began to arrive in September, Marie gained more and more momentum.
In the past, seasonal change was hard for her. Not this year.
By the time she finished her six weeks of ketamine-assisted psychotherapy, she felt transformed. She was actually looking forward to winter.
“It definitely feels easier to let go when something isn’t vibing in my life and to appreciate more the things that are going well,” Marie said, “and I didn’t gain 100 pounds with antidepressants, so that’s pretty lovely.”
After patients like Marie complete treatment, many of them go back to traditional modes of therapy.
Marie isn’t naive, though. She realizes that at some point down the road, some of the demons she squashed with the help of ketamine could bubble back up to the surface.
If they do, she’s open to returning to the Ko-Op for a follow-up.
“This has definitely springboarded me,” she said, “into putting a better netting in my life for my mental health.”