Uptown Psych's ketamine-assisted therapy (KAT) program was founded by a licensed clinical psychologist with extensive clinical and research experience using ketamine (and other psychedelic medicines) as an adjunct to therapy and a psychiatrist who has completed certification in psychedelic-assisted psychotherapy and in psychodynamic psychotherapy. Our team consists of other therapists and psychiatrists with training in psychedelic-assisted therapy, and a wonderful support staff who help with logistics and communication.
After contacting Uptown Psych or going on the website, you will fill out a brief questionnaire to get a sense for whether KAT might be a good fit for you. After completing this form you will be able to schedule a brief consultation call with either a psychiatrist or clinical psychologist to discuss the program, answer any remaining clinical questions, and discuss if the treatment may be appropriate for you.
You will then be scheduled for an intake session which will be conducted with your prescribing clinician (an MD or NP) and clinical psychologist in tandem. This intake will be a time to get to know your treatment team, who will be following you through the process, and also provide background on your experience, treatment history, and goals. This session will also be used to review your medical history, including past medical and psychiatric problems, current and recent medications, and social history including current substance use.
Our team will meet after this intake to review information gathered and determine if KAT is the right intervention (and if we are the best providers) for you at this time. We will collaboratively decide on the optimal program for your treatment, including the number and frequency of preparation, KAT, and integration sessions, along with dosing and route of administration (i.e. sublingual lozenges or intramuscular injection). We will also determine which provider(s) you will work with, based on both availability and your preferences.
In 1-3 preparatory sessions, your provider will work with you to continue exploring current and past symptoms, previous treatment attempts, and relevant life history. We will use this time to help develop goals for treatment and set intentions for your experience. We may also teach mindfulness exercises to help address any anxiety you may feel before or during the experience. We will also discuss what to expect on the day of the KAT session, and how to best prepare to get the most out of it. We hope to take as much unknown out of the experience, to reduce as much anxiety as possible going into the first session.
On the day of your ketamine administration, it is very important to follow the directions given on the KAT Preparation and Aftercare Guide about food and medication intake, as well as any specific instructions that were given to you by the treatment team.
When you arrive to the KAT session, we will take 30-60 minutes to discuss your current state, explore feelings around the treatment (including any fears, apprehension, or excitement), check in about your intentions for this session, and prepare for the medicine session.
We find it useful in this time to collaborate on making this feel like a special and meaningful occasion, which can help to break out of our common mental routines and improve mental flexibility to do deep therapeutic work. We often provide a meditation that helps to mentally prepare and includes tools for the session. We also often include sensory elements like scents and sounds that can signal to your brain that this is a different occasion than any normal day. We hope to collaborate with each client to create a preparation ritual/experience that is meaningful to them, and we invite clients to bring meaningful items or practices from their own traditions that would help to create this space. We are open to any preferences or suggestions about how to create this experience, and would like it to be a collaboration with each client. We find that when certain scents, sounds, or other elements are used before each KAT session that people often find those things useful in helping to relax and get into a calm mindstate in other parts of their lives as well.
If indicated as necessary, the physician may wrap a blood pressure cuff on your wrist/arm and place a pulse oximeter on your finger. These may be used to take your vital signs during the session to assure your safety.
For sublingual dosing, we will begin the medicine portion of the session with the patient self-administering the first lozenge dose. It will dissolve slowly, and as the ketamine is being absorbed through the lining of your mouth, you will be asked not to swallow your saliva for at least 15 minutes. (It is safe to swallow ketamine, although it may not be absorbed as well if you do so, resulting in less bioavailable medicine.) We will give these directions during the session as well.
The first dose will give us a measure of your responsiveness to ketamine, and enable us to witness the effectiveness of the lozenges and adjust the dose if needed. Some people experience empathogenic (similar to MDMA) effects in this dose range, and engaging in therapeutic exploration can be quite fruitful. Others find speaking too difficult and prefer an internal focus, even at this lower dose. We follow your lead in how to engage during the medicine portion of the session. We are with you through the duration of the session, and are available to process whatever comes up for you, or to provide silent support while you are in an internal journey.
After 30 minutes, you may (if previously agreed on) be offered a second dose, which you will also be asked to keep in your mouth for 15 minutes. Each sublingual dose takes between 20-45 minutes to reach peak effect, and tends to last between 1 and 1.5 hours.
For intramuscular (IM) dosing, we will use a dose that we selected for you based on your height and weight, therapeutic goals, and other factors. We use doses that vary from 30mg to 150mg. This is a single injection, much like getting a vaccine. You may choose to have the injection in your upper arm or in the upper part of the buttocks. (You will not have to undress for the injection, although you may have to pull your sleeve up or the waist of your pants down slightly.)
The onset of the IM experience is generally swift, within a few minutes. Each dose lasts from 45 to 90 minutes, and you may remain under its influence at a lesser level for at least a subsequent hour. Even at the higher dose levels, people are able to communicate as needed, and would be able to get up and use the restroom if needed. We are there to provide support to ensure any needs are safely met during the session.
(We also have the option of providing a tiered IM dosing protocol, much like the sublingual regimen, which allows for gradual movement into the medicine’s effects, and might prove most beneficial for a psychotherapeutic process, or those feeling cautious about a larger experience. This may add an additional hour to the session. It is common in the first session for us to use a tiered approach, where we start with a smaller amount to gage response before deciding if going deeper would be useful.)
Throughout the ketamine session, your provider(s) will be present for support and will facilitate the experience through music and other interventions, such as mindfulness exercises. Your eyes will remain closed most of the time, or you may be offered an eye mask to help you maintain an internal focus.
Some people are talkative during the medicine, and like to describe their experience, what is coming up, and go through therapeutic material. Others may find it beneficial to just stay with an internal focus, as forming words can be challenging while under the influence. You are welcome to share whatever you like, but there is no pressure to narrate your journey. Know that you will have the opportunity to share once the effect of the medicine subsides.
We will reconnect with you (and potentially engage in psychotherapy) as you return from the most active phase of your journey, and are ready and willing to communicate with the outside world. The moments following an altered state can be exquisitely poignant and powerful in their ability to evoke and reshape how we attach to others, and your providers regard this opportunity with the importance it deserves. Many people find this time just after the session to be useful for having a therapy process, and might have increased access to deep internal material that may be hard to reach normally.
You will be welcomed to share about your experience and discuss any insights or alternative perspectives that you discovered; however, some choose to contemplate their experience quietly and discuss at a later integration session. Whatever decision you make in these moments will be respected.
Following each of the ketamine administrations, you will need to remain in the clinic space for at least two to three hours. After two hours, we will check on how you are metabolizing the medicine and if you are safe to return home. (We generally set aside four hours for the process, though people can vary greatly in terms of how quickly the effects clear, so your departure time might vary.)
Please arrange for some trusted person to pick you up and take you home. We prefer not to release you to a taxi or car share service (i.e. Uber/Lyft) driver, and we ask that you not drive at all on the day of your administration.
We will schedule a follow-up psychotherapy and integration session (with one or both providers, depending on prior arrangement), usually within one week of the ketamine dosing session.