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Navigating the Confusing World of Ketamine Treatment

And how ketamine could be the right answer for your mental health

I know that by now, many people have heard of ketamine and they know about its availability for treating mental health issues but I also know that people are confused about where to look, where to start or whether or not this is the right thing for them. I'm going to do my best here to help provide some direction and clarity. I worked, for a time, in a medical clinic that provided ketamine treatments in tandem with mental health services and so I'm able to provide some direction on it as I've had some first-hand experiences with it.

What is ketamine?

Ketamine is technically a psychedelic substance though it doesn't seem to have some of the same strong effects that people might get from other powerful agents like ayahuasca or mushrooms. Ketamine works well and is effective, in part, because it stimulates neurogenesis which basically means that it helps create more neural connections in the brain. It helps stimulate neurons to generate new connections and so it promotes greater connections and a greater flow of communication in the brain. It might even be able to help different parts of the brain talk to each other when those parts of the brain don't usually communicate. It's because of this that people can experience a flood of sorts during their experience. When people report that they feel like their mind is expanding during a psychedelic experience it's because that's honestly what is actually happening.

Ketamine has been shown to be particularly effective for treatment-resistant depression. While it can also help things like PTSD, OCD and addiction, it seems to be the most effective for those whose depression is proving to be resistant to treatment. Ketamine can be administered in different ways. The most effective seems to be through an IV though some people administer it by a shot in a muscle, through an oral lozenge or even through a prescription nasal spray. Most places are charging around $250 to $300 a treatment or perhaps more. Usually, 6 to 8 treatments are what's recommended for getting the most out of it.

Psychedelic substances usually have some kind of halo effect or afterglow where the person using them experiences a prolonged benefit from using it even though the experience itself is over. Ketamine will get you high, in case you're wondering, but you're also likely to experience an afterglow effect for at least another week after treatment. Some people might experience it longer than that and while many ketamine providers recommend that you get one treatment a week, I tend to think that spacing them out longer than that is more likely to give you a prolonged effect. Instead of getting treatment for 6 to 8 weeks, it might be highly beneficial to do it over the course of 12 to 16 weeks. If I were the one seeking it out, that's how I would request that it be done. Doing it this way may help a person get further in their own transformation.

"Unfortunately, there are many accessibility issues with ketamine, especially if you don't have a ton of extra cash laying around"

For those who decide to undertake this process, I would like to strongly encourage and recommend that you approach it with the mindset that this period of time is for your mental health treatment. Some people will take accutane for acne, for example, and it's during that time that they're encouraged to do certain things and to take certain precautions like avoiding exposure to the sun so that they get the best possible outcome from the treatment. Before going into a ketamine regimen you might want to consider spending more time journaling and reading instead of watching TV or spending time on social media. In fact, I think social media is generally bad for mental health in general and I recommend deleting those apps from your phone. I really do believe, though, that in order to get the most out of ketamine, it's a good idea to treat life differently.

Because ketamine promotes neuroplasticity and neurogenesis, it's an agent that help you get some insight on your life and your habits. It can help you let go of bad habits and start new healthier ones. So before you start you may want to take an inventory of your life and what you'd like to change or how you'd like for it to be different.

What's it going to cost me?

Ketamine is fairly expensive. This is probably the biggest downside to seeking ketamine treatment. It's just frankly not affordable and it presents accessibility issues to those who might need it the most. Especially when you consider the current financial and political climate when it feels like everything is working against us. Ketamine can be an extremely effective approach to mental illness and yet it's quite unaffordable. It's mostly accessible to those who are wealthy or at least have a rainy day stash of money lying around. I've approached this concern with ketamine providers and they don't seem terribly concerned with making it more accessible to people. One individual that I talked to was really stuck on how healing it could be and that it was worth the financial sacrifice. She seemed... out of touch. The people who need it the most are the ones who can afford it the least which is more than just a bit frustrating.

There is a prescription version of ketamine that could be covered by your insurance but there are several factors that you have to take into account with that.

  1. You have to find a prescriber that's willing to prescribe it - This can be a big obstacle. Most of them would just rather give you Effexor or Zoloft or some other ineffective garbage instead. Your regular doctor probably isn't even going to be willing to consider it. You'll have to find a prescriber with a psychiatric specialty. Psychiatrists are becoming more and more rare. Some people are having better luck finding a nurse practitioner with a psychiatric certification. From what I've understood, it's required for a provider to include the necessary facility accommodations to administer the treatment and keep the patient on site for another hour while the ketamine does its thing. Many medical clinics just aren't equipped to give you a couch to lounge on so they can keep an eye on you.

  2. Your insurance has to be willing to pay for it - A lot of them may want you to go through the rounds of other treatments first. Some insurance companies aren't going to approve it unless everything else has failed and so they might insist that you go through the entire gambit of medications first which can honestly take months and months if not years. Your best shot is if you have good insurance that you like and you go to a good prescriber that you like and that you have a good relationship with. I was fortunate enough to work with a nurse practitioner who believed that things like ketamine and cannabis were preferable to things like opiates or benzodiazepines like Xanax or Valium which are all quite addictive and can come with nasty side effects and withdrawals. The process of getting the prescription ketamine approved can be an extremely tedious one and many doctor's offices aren't willing to jump through the extra hoops necessary to get paid by the insurance company. All too often we see insurance companies placing barriers to wellness instead of removing those barriers.

  3. The prescriber and/or insurance can yank the treatment at any time they want for any reason they see fit - If you go decide to seek out ketamine treatment, you should keep in mind that medical personnel and insurance companies have the right to decide what they think you should or should not have. I've had a lot of negative experiences over the years with insurance companies who don't mind making baseless claims about your mental health or mental illness in order to avoid having to cover specific treatments. In short, if you go the prescription ketamine route, you will be forced to introduce a lot of politics and red tape on it. Again, your best bet is going to have a lot to do with what insurance you have.

It's generally a good idea to receive ketamine treatments from a mental health clinic that has clinical staff under the same roof. It's probably a good idea to get a mental health assessment and/or some psychological testing first though not necessarily. If you already work with a therapist or psychologist that you like and prefer then all the better. I just think it's a good idea to go to a clinic that's mindful and appreciative of the mental health effects from the agent and they have someone with a clinical background that provides support or regulation to their practices. What I don't recommend is some hidden or back alley clinic that will charge you to get you loaded and send you on your way.

"Clinical application of psychedelic substances has shown to be extremely promising"

It's a good idea to do some research first and it's a good idea to get busy asking any and all questions that you might have before agreeing to ketamine treatments. You may also want to ask around for recommendations and talk to anyone that has been through the treatment and what their experiences were. If it seems like an organization is being shady for any reason then it's probably best to keep looking.

Accessing ketamine comes with a big warning and a big danger, particularly if you're trying to acquire it on your own through some kind of dealer on the streets. I do my best to steer people away from this for one main reason and it's called fentanyl. If you don't know what fentanyl is it's a super concentrated opiate, far stronger than heroin. It's not just insanely addictive, it's also extremely dangerous and lethal even at tiny doses. From what I've heard, fentanyl is being mass-produced in China and shipped in mass quantities to the drug cartels in Mexico who are lacing it with almost anything and everything they can especially if it's synthetic. Please, don't buy ketamine on the street. If you want to use it as a treatment then please seek it out legally.

If you want to use ketamine but you're not finding good options through a medical clinic then I would recommend that you skip it altogether. If you can't get legally, don't get it. It's not worth the risk. I don't encourage people to buy drugs illegally off the street but it's a completely different game now than it was even just 10 years ago. Fentanyl is everywhere and it's bad news. Even just microgram or two might be enough to kill you. Don't buy it illegally. You've been warned.

This is one of the biggest reasons why I often advocate that people seek the use of psilocybin if they want to undergo some kind of psychedelic therapy and can't access ketamine. I've never heard of anyone being exposed to fentanyl when they've taken mushrooms. That's not to say that it doesn't happen, I would imagine it has happened, I've just never heard of it happening. I've also never heard of anyone overdosing on mushrooms or psilocybin. Severe nausea or having a "bad trip" are the worst things that happen to people when they take high doses of it. Most of the time when people acquire mushrooms they find some dehydrated mushrooms that someone grew in their closet. Mushrooms are sustainable, relatively cheap, easy to find and most importantly: they're safe. I'm obviously not condoning illegal behavior or encouraging people to break the law here but I know that people are going to look for this stuff regardless of what I tell them and I would rather give them guidance in how to reduce the chances of them being harmed.

I realize that the expense is a big one and it honestly might be worth it to save some money away. I realize that times are tough financially for a lot of people but I also know that there are ways that people can cut back and save if they dedicate themselves to it. Try reducing your impulse buys on Amazon or skip the expensive and unnecessary costs that come with food delivery. It adds up over time. Discipline is good, it's good for your mental health. In recent times I've found a lot of personal positive and satisfaction with being more financially disciplined. It's been so good for me and it has just reinforced what I've already learned over the years about becoming more disciplined and how positive it is.

Integration is Key

Most people report getting the most out of their ketamine experience when they're working in tandem with some kind of guide or mental health professional who is familiar with the process. Psychedelic experiences can be strange and confusing. Most people experience a lot of difficult emotions that surface and they feel a need to push those emotions out. I don't believe that psychedelics cause people to feel negative emotions which is different from difficult emotions. Negative emotions are emotions like shame or rage. There aren't many emotions that I would consider to be negative though there are many that are difficult. The difficult emotions are healthy. Sadness might be uncomfortable but it's healthy and it's a necessary emotion.

Psychedelics are likely to bring up difficult emotions like sadness and grief. So much so that it can even be at least somewhat overwhelming. It's more likely to be overwhelming to those who consistently avoid these emotions and go out of their way to avoid these emotions. People who deal with these emotions are far more likely to be mentally healthy. Again, these emotions are healthy and necessary.

A lot of people experience fear and anxiety in the process. Their response to repressed grief can cause an anxious or fearful experience. It's not because the medicine has brought these emotions up, it's because this is how the person has learned to respond to the emotions. Even though it's much easier said than done, the best thing you can do is let go and just allow the experience to take place rather than put any resistance into it.

By leaning into grief and sadness, a person can learn a lot about what areas of their life need work. By allowing these emotions to take place, they can quickly and easily learn what types of issues are influencing them and need to be addressed. A lot of people will also experience a sense of being alone or loneliness which is important to discuss and explore. Most people don't want to look at it or talk about it. They'd rather go through life just looking the other way and pretending that it's not there when doing so is always going to work against your mental health.

Sorting these emotions out and making sense of the experience is a vital part of getting the most out of a ketamine treatment and anything like it. While some people can properly process, understand and integrate their experiences, most cannot. It just seems to be a byproduct of our woefully unaware culture and way of living. Proper integration can really help get your head on straight and help you keep your head up moving forward. All the ketamine treatments in the world aren't good for much if you don't put a heavy focus on the integration piece. It can't do much for your mood as long as your lifestyle and your habits continue to work against you.

If you'd like to discuss some of this further and if you'd like a therapist that can help you with this process I hope that you'll reach out.


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