Written by Dr. Ladan Eshkevari
In this post:
- Screening Patients for Ketamine Safety and Eligibility
- Educating Patients on Ketamine Protocols, Mechanisms, and Dissociative Experiences
- Helping Patients Set Intentions
- Emphasizing Set and Setting
- Underscoring Self-Care and Support
- Planning Post-Infusion and Integration Therapy Sessions
- Educating about Ketamine’s Acute Side effects
- The Bottom Line
Mental health professionals play a crucial role in helping clients prepare for ketamine infusions, which differ drastically from typical antidepressants. Therapists must first assess whether ketamine is safe and effective for the client’s condition. Once they determine eligibility, therapists play an important role in helping patients understand ketamine’s unique pharmacological mechanisms and dissociative psychedelic potential. They can also help educate patients beforehand to maximize and help them integrate the insights afterward. This comprehensive approach to preparing clients for ketamine infusions can maximize the benefits and minimize harm.
Screening Patients for Ketamine Safety and Eligibility
Before therapists can prepare patients for ketamine infusions, they must determine eligibility. Patients with treatment-resistant depression, bipolar depression, suicidal ideation, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), substance use disorders (SUD), severe anxiety, anorexia, and personality disorders can drastically benefit from an infusion protocol. But these diagnoses don’t automatically make someone a good candidate for ketamine’s powerful effects.
To assess suitability, therapists should consider their patients’ mental health conditions and potential risk factors. They must also collaborate with their patients’ primary care physicians and ketamine clinicians to complete the screening process.
Once the care team has agreed on an infusion protocol, therapists must educate their patients about the dissociative ketamine experience and offer tools to maintain a sense of balance and emotional safety throughout.
Educating Patients on Ketamine Protocols, Mechanisms, and Dissociative Experiences
Providing clear and precise details about ketamine infusion therapy helps set expectations, reduce anxiety, and improve receptivity to the mind-altering experience.
IV Administration Protocol
Therapists should explain that patients will need roughly six infusions over two to three weeks to achieve a significant antidepressant effect. Each injection takes about 40 minutes, with the entire session lasting approximately two hours.
Ketamine clinics like Avesta will provide the most comprehensive details about the process, so therapists should refer patients directly to clinicians to answer further questions.
In terms of costs, therapists can explain that patients should expect to pay $400 to $1,000 per ketamine dose. Insurance won’t cover the total fee, but patients can contact their provider to request prior authorization or partial reimbursements.
Washington, DC, Virginia, and Maryland patients can also contact Avesta’s insurance experts to learn more about cost-saving options.
Dissociative Psychedelic Potential
Beyond logistics, therapists should prepare clients for the potential dissociative psychedelic effects. Ketamine doesn’t always induce profoundly altered states. However, higher dosages can ignite out-of-body experiences and dream-like visions shortly after the infusion commences.
During these episodes, clients might experience a sense of being “dissolved” or losing the usual boundaries of self and floating through disembodied spaces. Others might relive deeply personal memories. These experiences range from erratic to intensely introspective, sometimes offering unique perspectives on personal issues. However, patients can, and often do, have very different experiences from infusion to infusion.
Therapists may want to highlight that dissociative episodes are generally pleasant or neutral. But they can also be unsettling. Fortunately, patients don’t have to suffer through the discomfort because, unlike oral or intramuscular shots, IV ketamine acts fast, and the effects wear off very quickly upon stopping the infusions.
Clinicians can reduce the dosage or remove the IV, and the effects will immediately subside.
Biochemical Mechanisms
Therapists can aim to explain ketamine’s pharmacology in a way that allows patients to understand its antidepressant effects. They might start by clarifying that ketamine acts differently from traditional antidepressant drugs. Instead of directly targeting serotonin, ketamine interacts with NMDA receptors. This interaction triggers the release of glutamate, a neurotransmitter that plays a pivotal role in neural activation, mood, and plasticity-growing new neurons in the brain.
It may also be prudent for therapists to refer patients to ketamine experts like those at Avesta, who can comprehensively explain its mechanism of action and pharmacology.
Antidepressant Effects
Patients should understand that they will experience a mood boost from ketamine infusions alone. However, therapists should clarify that ketamine therapy works best when the patient actively participates in the process through preparation, intention setting, and integration.
Therapists play a crucial supporting role here alongside clinics like Avesta, which ensures patients have a safe space to experience the medicine and the support to integrate their experiences into everyday life.
Setting Intentions
Therapists can work with clients to set clear intentions for ketamine infusions. Intentions are clearly defined objectives or goals that reflect what patients hope to achieve or how they wish to grow through their experiences. This process helps patients establish a mental and emotional framework that guides the therapeutic journey.
Intention-setting has multiple benefits, including:
- Focusing the Mind: Intention-setting creates a mental blueprint for the therapy session, helping clients enter treatment with a clear purpose.
- Enhancing Therapy Effectiveness: Aligns the client’s mindset with desired outcomes, potentially increasing the therapy’s impact.
- Optimizing the Neuroplastic Window: Intention-setting directions the brain’s adaptability post-therapy towards achieving specific goals, aiding in significant psychological changes.
- Fostering a Sense of Agency: Empowers clients by involving them actively in their healing process, reinforcing their role in shaping outcomes.
Emphasizing Set and Setting
Therapists must discuss the importance of “set and setting” with patients before they choose a ketamine clinic and begin infusions. A positive mindset (set) and a supportive environment (setting) enhance the patient’s ability to engage with the therapy, facilitating deeper therapeutic insights and outcomes. Conversely, feeling anxious about the treatment or the clinic can elicit challenging experiences.
Therapists should introduce several techniques to help clients enter ketamine therapy with calmness and openness.
Mindfulness Practices: Therapists can guide clients in mindfulness exercises, such as focusing on their breath or engaging in guided meditation, to anchor them in the present moment. This practice reduces pre-session fear and cultivates a peaceful state of mind.
Breathing Techniques: Therapists can teach patients how to regulate the nervous system through deep breathing or specific patterns like the 4-7-8 technique.
Visualization: Encouraging clients to envision a successful therapy session or the realization of their goals can create a positive mindset and strengthen mental preparedness and emotional resilience.
Environmental Adjustments: Patients can’t explicitly control the environment but can choose a clinic like Avesta with warm and inviting treatment rooms. To feel more at ease, they can bring comforting items from home, like blankets, pictures, and trinkets, to create a personalized space.
Curated Music and Playlists: Music can evoke emotions, facilitate deep introspection, and create a therapeutic atmosphere. Some ketamine clinics provide playlists, while others may allow patients to bring their own. In the latter case, therapists can suggest clients curate a compilation that reflects their healing intentions.
Underscoring Self-Care and Support
Therapists must highlight the importance of self-care and social support throughout the ketamine therapy process.
Self-care is vital before, during, and after infusions because it primes the body and mind for the intense experience, ensuring a more grounded and positive journey. Self-care involves specific protocols designed to enhance physical, emotional, and mental well-being, such as adequate rest, scheduling downtime between sessions, improving diet, and incorporating movement into daily life.
- Getting a good night’s rest before sessions to ensure mental clarity and receptiveness.
- Maintaining a nutritious diet to support optimal brain function, energy levels, and mood, along with overall physical health and recovery.
- Engaging in regular, gentle exercise like walking or yoga to enhance health and mindfulness.
- Staying hydrated to assist the body’s natural processes, including ketamine metabolism.
- Scheduling downtime post-therapy for reflection and integration.
- Limiting exposure to stressful situations to maintain a calm mental state.
- Journaling to explore thoughts and feelings before and after therapy.
Support networks are also part of the self-care process because they provide emotional stability, reassurance, and safety. Therapists are part of this network. Still, they cannot replace close friends or family members who offer continuous, personal comfort and understand the person’s unique history and emotional landscape. Therapists may want to suggest that patients have a loved one they can rely on in the days and hours following treatment.
Planning Post-Infusion and Integration Therapy Sessions
Regardless of the patient’s support network, Avesta recommends therapists plan a structured session within two days of each infusion to harness the brain’s neuroplastic window.
During sessions, therapists can allow the patient to process the experience and discuss insights that may have arisen. These sessions also enable patients to reflect on challenging material that may have triggered feelings of guilt or shame and help them reframe it into a positive lesson.
Once the ketamine protocol is completed, Avesta highly recommends that the practitioner help the patient create meaning from the experience and identify the actions that can move the client closer to their mental wellness goals.
Practitioners can discuss this long-term framework with clients before the infusion process and establish a flexible schedule for integration work in the following months. This can ensure a seamless experience with maximum benefits for the patient.
Educating about Ketamine’s Acute Side effects
Finally, therapists can prepare patients for ketamine’s acute physiological side effects. Therapists may want to explain that these effects can be disorienting, but they are temporary and completely normal.
- Dizziness: Ketamine therapy can induce feelings of disorientation and lightheadedness, contributing to sensations of dizziness.
- Nausea: Ketamine’s impact on the gastrointestinal system may lead to sickness and discomfort, potentially resulting in nausea.
- Vomiting: Some patients may experience vomiting.
- Difficulty Speaking: Ketamine therapy may temporarily impair speech coordination, resulting in difficulty articulating words or forming coherent sentences.
Because of temporary impairment, patients must have a designated driver ready to pick them up after each session.
After providing an overview of ketamine’s side effects, therapists may want to refer patients to ketamine experts, like Avesta, for in-depth discussion and understanding.
The Bottom Line
Therapists are essential in preparing patients for successful ketamine infusions, both in preparation and in integration. They act as the first line of defense in the screening, education, and intention-setting process. They are also critical in integrating the experience into lasting mental health in the years following ketamine therapy.
Practitioners who want to learn more about ketamine therapy and partner with local clinics in Washington, DC, Bethesda, MD, and McLean, VA, can contact Avesta’s collaborative care team today.
