Ketamine Therapy in NJ  – Dr. Jarrett Tosk

Whereas Western medicine has a tendency to rely on suppressive therapies (those that delay or avoid unpleasant memories), ketamine-facilitated psychotherapy is an evocative technique that allows for the identification and understanding of more deeply rooted causes of psychiatric symptoms.

In the state of NJ, ketamine therapy is very rare. Those who have the most enduring response to ketamine therapy tend to be the ones that understand that ketamine is not the healing agent, but rather, it can be a catalyst that facilitates transformation, self-healing, and over time, sustained wellness.

What conditions can ketamine help?

Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent now used for treatment of Depression (unipolar & bipolar), Anxiety, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorders (OCD), Substance Use Disorders, and pain syndromes such as fibromyalgia and complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD).

Within this framework, the combination of psychotherapy and ketamine therapy maximizes the ability to utilize this new-found understanding of the self for personal growth and transformation.

We take advantage of several key qualities of the ketamine experience, including:

1. A relaxation of normal psychological defenses and utilization of a more emotionally accessible state to work through past trauma.
2. Experiencing a state of mind that is free from anxiety and past obsessional burdens may allow the mind to be more open and therefore, able to understand positive aspects of the self and its relationship to the world.
3. A slowing of mental activity that fosters a heightened awareness and increased ability to move back and forth between states of mind, which allows for the separation of depression, anxiety, and obsessional states from the healthier aspects of the mind.

Utilizing psychotherapy, we take measures to strengthen the liberated mindset that is experienced in the ketamine session, focusing on the retention and repetition of novel insights that may help the patient to remember what it feels like to live free from suffering.

What happens during the ketamine session?

After it is determined that ketamine therapy is appropriate for you, you can then plan your first two-hour in-office session. During the session, you will be accompanied by a therapist, phsychiatrist, or both. After taking the ketamine lozenge, you will be asked to lie down on a couch or in a recliner while the effects of ketamine are experienced. Ambient and classical music will play in the background while you safely relax with eyes closed or wearing eyeshades. You are welcome to have a friend or family member accompany you throughout the sessions.

What are the effects?

Ketamine is a dissociative anesthetic that can induce antidepressant, anxiolytic, and psychedelic effects which can potentially decrease the level of inner tension. Ketamine may also reduce emotional isolation, improve self-esteem, and cause a positive change of emotional attitudes. Patients who have been treated with ketamine therapy have experienced significant existential and spiritual growth, often considered “transformative”.

Essential to the ketamine experience is “a pause” from the usual mindset that can torment you with anxiety and obsessional thoughts. This experience typically lasts between 30 to 90 minutes. Prior to your ketamine experience, it is advisable to set an intention for your journey, although you may find that your mind will travel to places you had no idea existed prior to the session. It is important to recognize that you are in a safe environment, supervised by a doctor, thus it is best to let go, embracing the experience and where it takes you. When you return, we will work with you to process the meaning of your journey and its impact upon your outlook.

Beneficial psychiatric effects are usually seen during and immediately following treatment, though some patients will notice effects up to 48 hours later. Undoubtedly, your experience will be unique to you and each of your sessions will be different.

Is ketamine a psychedelic?

Ketamine is an extremely interesting substance and it is the only legally available substance in the United States that can reliably induce a psychedelic state. Eli Kolp, M.D., a physician who has been working with ketamine for nearly two decades, described the importance of ketamine’s psychedelic effects as follows:

“As a psychiatric medication, ketamine offers a wide range of applications, from mild doses alleviating depression (at least in the short-term) to psychedelic dosages offering the possibility of transpersonal healing. The fact that ketamine is the only psychedelic that can legally be prescribed in the United States makes it unique at this time, and we encourage its responsible use within the medical context for providing access to deep and profound healing experiences that may be difficult, if not impossible, for many to achieve without the aid of such a substance.” – Eli Kolp et al. “Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications.” The Ketamine Papers. MAPS, Santa Cruz, CA, 2016, (p. 167)

How is ketamine administered?

Ketamine may be administered via a variety of different ways including oral, sublingual, intranasal, intramuscular, and intravenously. We prefer the sublingual route over the IV approach for its ease of administration, safety, and convenience. When administered sublingually, ketamine lozenges are placed in between the cheek and gums and held in the mouth until they dissolve completely. This entire process takes about 10 minutes, but lighter effects of the medication can be felt within the first few minutes.
The sublingual method is equivalent in effect to the intravenous (IV) method and much less expensive and cumbersome. We believe that IV infusions needlessly medicalize the procedure; therefore, we overwhelmingly use the sublingual method of administration.

Is ketamine safe?

More than 10,000 published reports have described ketamine’s effectiveness and its safety in most cases, although like all drugs there is the possibility of some adverse effects in some people.
The physiologic effects of sub-anesthetic ketamine provide a large margin of safety in the treatment of psychiatric conditions through the preservation of consciousness, cardiac stimulation, and maintenance of respiratory function and the gag reflex. In addition, ketamine has advantages over other psychedelic compounds because of its rapid onset, and short duration of action.

Is ketamine the same as Spravato?

Spravato is an FDA approved drug that is derived from ketamine, but does not contain all the chemical components of ketamine. Ketamine is a complex molecule that is made from a combination of right-handed and left-handed forms of the same chemical that are mirror images of each other. Spravato is the left-handed portion of the ketamine molecule (known as esketamine), but it does not contain the right-handed portion. As a result, Spravato does not provide the same robust results as ketamine.

Is ketamine a drug of abuse?

There have been no published reports of abuse, dependence, or addiction arising from properly supervised medical prescription of ketamine, as opposed to the evidence that 5-10% of individuals who use ketamine “recreationally” can go on to develop dependence and addiction.

What are the side-effects?

Ketamine appears to be well tolerated by the majority of individuals who receive it for short-term treatment of psychiatric conditions. Nausea and occasional vomiting are the most common negative effects, which are minimized by fasting 4-6 hours prior to treatment or through the use of ondansetron.

Blood pressure increases of 5–10 mm/hg diastolic and 5–15 mm/hg systolic are routine while heart rate increases of 10–20 BPM are common.

Ketamine and other dissociative drugs have been reported to exacerbate psychotic symptoms and schizophrenia.

In chronic recreational use of ketamine, lower urinary tract symptoms have been identified as an important adverse effect, but there have been no reported cases of this in controlled treatment at doses typically administered in the course of psychiatric treatment.

What if I already have a psychiatrist or therapist?

We are happy to work along side your existing treatment team to help you conquer your symptoms. It is best to inform your doctor and/or therapist about your plans to pursue ketamine-facilitated therapy in order to maintain a treatment alliance with existing providers.

How many sessions are typically required?

Most research has shown that 2 – 3 sessions per week for the first two weeks is ideal, but you may notice some improvement in your symptoms after your first session. Thereafter, maintenance sessions can be used to provide continued benefit, but no more than twice per week. There are no long-term studies that show how long ketamine can safely be used.

Do I need to stop my medications before taking ketamine?

Most medications are perfectly safe to continue taking while undergoing ketamine therapy. We are particularly interested in learning if you are taking:

• Wellbutrin (generic name Bupropion) – may cause observed anxiety and mild agitation during treatment, thus we advise that you allow at least 6 hours between taking Wellbutrin and the ketamine session.
• Lamictal (generic name Lamotrigine) – may block the psychological effects of ketamine, thus we advise that you allow at least 6 hours between taking Lamictal and the ketamine session.
• Stimulants–for similar reasons as bupropion and blood pressure elevation.
• Patients taking large doses of benzodiazepines may have a reduced response to ketamine, so we may ask you to skip a dose on the day of your treatment. Some common brand names are Xanax (Alprazolam), Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam).
• SSRIs, SNRIs and tricyclic antidepressants do not interfere with ketamine. There is no need to stop them.

Who should avoid ketamine?

Ketamine should be avoided if you have any of the following conditions:

• Uncontrolled hypertension
• Untreated hyperthyroidism
• Congestive heart failure
• Other impaired cardiac status
• Severe COPD
• Severe obesity
• Increased intracranial or cerebrospinal pressure
• Schizophrenia and schizoaffective disorder
• Severe or primitive personality disorders
• Pregnant women and nursing mothers
• An active substance use disorder

Does ketamine cause bladder damage?

There has been zero link between therapeutic ketamine use and bladder damage, or Lower Urintary Tract Symptoms (LUTS). The only known reports of bladder damage caused by ketamine are based on the abuse of street ketamine at doses 10-20 times the amount we administer, taken daily, over the course of years.

Is ketamine therapy covered by insurance?

At this time, ketamine therapy is not covered by any insurance providers.