This information has been adapted from The Sage Institute.About Ketamine-Assisted ThetaSoma™
ThetaSoma™ is an intuitive, transformative technology that integrates tools from somatic therapy, dreamwork, psychedelic medicine, yoga, meditation, ancestral healing, earth-based wisdom, and universal human codes for processing trauma into an experiential journey through the subconscious.
Our Psychiatrist prescribes oral ketamine treatment in conjunction with ThetaSoma™ Integration Therapy to offer therapeutic psychedelic experiences to those seeking healing from mental health disorders, physical pain, and/or those seeking spiritual transformation.
Our approach weaves elements from:
Yoga, Meditation, and Breathwork to explore the mind & body
Psychedelic Medicines to explore expanded states of consciousness
Dreamwork to cultivate awareness of the subconscious
Ancestral Healing to connect with nonlinear timelines & past lives
Art & Creativity to activate an inspired identity as Creator
Earth-based wisdom to restore a sacred role as steward of the earth
Psychedelics have always been a route of healing and awakening for humans, these medicines are our birthright. In this perspective, we want to support you to have the soul journey that you need. Our team is rooted in client-focused work, we take your whole person into account when determining the best treatment protocol for you. While this protocol is the standard clinical approach, we can tailor the process to your needs utilizing the gifts and skills within our community of healers.
What is Ketamine?
Ketamine is a synthetic pharmaceutical compound, classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. It was developed in 1963, FDA approved in 1970, and adopted by many hospitals and medical offices because of its rapid onset, proven safety, and short duration of action.
As an anesthetic, ketamine is most commonly used in surgical settings, including pediatric surgery, due to its excellent safety profile, particularly around breathing/airway management. It has also been utilized successfully in managing acute and chronic pain conditions due to its analgesic properties.
When a new drug is approved for medical use, the manufacturer produces a “label” to explain its use as approved by the FDA. Once a medication is approved by the FDA, physicians may use it “off-label,” meaning for purposes other than what is listed on the label, as long as the use is based on sound medical evidence. In the last two decades, ketamine has been increasingly used off-label to treat various chronic and treatment-resistant mental health conditions, such as depression, alcoholism, substance dependencies, post-traumatic stress disorder, anxiety disorders, and other psychiatric diagnoses.
How Ketamine Works
As mentioned, ketamine is classified as a dissociative anesthetic, where “dissociation” means a sense of detachment from one’s body, environment, ordinary reality, and usual sense of self.
The present understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system, as well as an opioid receptor agonist.
In depression, the spindly receptors on neurons that facilitate signal transmission may recede, and the amygdala and hippocampus (both of which help govern mood) may shrink. Animal research has shown that ketamine can stimulate neural growth within days (and sometimes hours). One hypothesis is that there is similar action in humans.
Another hypothesis is that ketamine affords a reprieve from habitual patterns of thought that underlie mood and behavior, thereby creating an opportunity for learning new and healthier patterns of thought. There is no current consensus on mode of action, and other mechanisms may be found central to ketamine’s effects.
Dosing Strategies and Route of Administration
Ketamine can be administered in a variety of ways, including as an intravenous infusion (IV), intramuscular injection (IM), a subcutaneous injection (SC), intranasally, or sublingually/orally as a dissolving troche or tablet. Routes vary in the onset, bioavailability and duration of active effects for each person.
Though research has demonstrated an antidepressant response to low doses that are minimally psychoactive or sub-psychedelic, this effect tends to be cumulative, requiring repeated administrations over short periods of time. Some practitioners view the psychedelic and dissociative experiences that occur at higher doses to provide a more robust and longer-lasting outcome.
Though experiences vary greatly, it is generally thought that lower doses provide empathogen-like (heart-opening) responses, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving peak experiences.
In our practice, ketamine is administered by sublingual (oral) dissolving tablets, a strategy which may allow for ThetaSoma™ Integration Therapy during the treatment, and an easier experience for those who are hesitant about injections. We use a range of dosing strategies to create a personalized approach for each client, adjusting the dose, frequency, and time in between sessions based on each individual’s needs.
The choice of dose depends on multiple factors, including client preference, therapeutic goals, prior exposure to ketamine and other psychedelics, body height and weight, and sensitivity. Those without prior experiences are advised to begin with lower doses to reduce anxiety and build familiarity with ketamine’s effects, while those who are experienced with psychedelics may begin with higher initial doses.
The Ketamine Experience
The ketamine experience is characterized by the relaxation of ordinary concerns and usual mindset. This tends to lead to a disruption of negative feelings and preoccupations. Some ketamine providers feel that this interruption, and the exploration of other possible states of consciousness, can lead to significant shifts in overall well-being.
At lower doses, you will likely experience mild anesthetic, anxiolytic, antidepressant, and psychoactive effects. You might experience increased sensitivity to light and sound, as well as an altered sense of time. Some people experience empathogenic (similar to MDMA) effects in this dose range. This state may also enhance participation in psychotherapy, as defenses are relaxed, yet communication with others is still possible.
Higher doses are more likely to produce psychedelic, dissociative states that are largely internal journeys away from the external world. Body sensations are greatly diminished. Such journeys may provide a more robust treatment effect, often assisting in the resolution of existential concerns, accelerating psychological and (and possibly spiritual) growth, and promoting a positive change in outlook and character that we refer to as a transformative response.
Sensory effects of ketamine may include distorted visualization of colors, feeling suspended in space or floating, experiencing out-of-body sensations, vivid imagery, and changes in visual, tactile and auditory processing. Synesthesia (a mingling of the senses) may occur. Familiar music may not be recognizable. An ordinary sense of time may morph into time dilation.
Some people report psychic experiences, which they perceive as bizarre or frightening, while others describe them as pleasurable, joyful, or fascinating. We have found that even frightening experiences can be of great value to your recovery process. Our team is trained in providing stability for those experiencing extreme states, and you will receive therapeutic help and ongoing guidance as to how to make the best use of these experiences.
The effects of ketamine typically start 5 to 10 minutes after ketamine dosing. The peak effects typically last 20 to 30 minutes, and then slowly diminish for the next hour. Some alterations in sensory perception, speech, and motor ability may continue for approximately 5 hours.
Two to three hours after ketamine administration, clients can return home with another driver. Driving an automobile or engaging in hazardous activities should not be undertaken on the day of the administration, and not until all effects have stopped.
Why Ketamine Assisted Therapy (KAT)?
The administration of ketamine may be most effective when paired with ThetaSoma™ therapy. We offer a ThetaSoma™ Integration Therapy program that will prepare you for your ketamine sessions, encourage you to explore your mind while within the ketamine space, and assist you in integrating your experiences afterwards.
This program emphasizes the potential for change, and such change is best facilitated within a structured, supportive therapeutic environment with Guides who are aware of your issues, hopes, desires, and struggles.
Ketamine has the potential to create a non-ordinary state of consciousness, facilitating a profound transpersonal or mystical peak experience. These sorts of peak experiences have been shown to expand one’s sense of self and understanding of existence, and may enable you to access your own healing wisdom. Your Guide serves and assists in processing the experience and its impact on your everyday life.
Ketamine’s altered state can create conditions of relational and psychological openness, and thus we believe that trust in your Guide enables the deepest possible work to occur. ThetaSoma™ Integration therapy sessions are meant to build a sense of connection and trust between you and your Guide.
Many have found it beneficial to set an intention for the experience. Intentions should be personal and focused, which could include alterations in habits (such as the use of alcohol or cannabis, exercising, etc.), shifts in self-defeating patterns of thought or social interactions, or exploration of spiritual/existential realms. Your Guide will work with you to formulate your goals, and will also encourage you to hold those lightly, as resistance or attempts to control the experience can produce anxiety.
Your experience will be unique to you, and each of your sessions will be different. All such journeys are adventures that cannot be programmed. They evolve from your own being in relation to this medicine, and it is best to relax into the path that unfolds. Many enjoy the journey, while others do not. Everyone comes through it, and often with greater insight into themselves and their lives. Our therapy program is designed to assist you in integrating these insights into your daily functioning.
As a byproduct of your experience, you may feel improvement in your emotional state and reduction in symptoms such as depression, anxiety, and post-traumatic manifestations. You may notice that you are a bit different after a ketamine experience, and that difference may feel liberating, allowing for new perspectives and behavior.
These shifts may happen during treatment, in the aftermath, and/or in the days and weeks that follow. Some experiences may be temporarily disturbing to you, and we will work to help you understand these in context of your healing process. Ultimately, we are working to assist you in changing patterns of mind, mood, and behavior that cause you difficulty and distress. This is a unique opportunity for growth and change, and so we encourage you to actively engage in the therapeutic process as well as the medication administration. While medication on its own provides symptom relief, it is most effective in the longterm when combined with therapy and your active participation in the process of integration.
Our Treatment Process
Preparation Sessions
Our treatment team consists of trained ThetaSoma™ Guides, therapist, licensed massage therapist, and a psychiatrist. You will meet with your Guide for a minimum of three times before your first ketamine administration. If you are in ongoing psychotherapy outside of ThetaSoma™, we will be in contact with your therapist and, in some situations, they may serve on the treatment team as well.
As a team, we will assess whether KAT is the right intervention for you at this time. We will also collaboratively decide on the most optimal arc for your treatment, including the number and frequency of ketamine and integration sessions, along with dosing suggestions.
In the first meeting, you will meet with the psychiatrist for a clinical intake, during which he will review your medical history, including current and past medical and psychiatric problems, current and recent medications, previous treatments, social history, and history of substance use.
In the preparatory session, you will meet with your Guide to prepare for your ketamine session, reflect on your goals for treatment, and set intentions for your experience. We may also teach breathing exercises or other mindfulness meditation guidance in this session to address any anxiety you might have going into the experience. The preparatory meetings are meant to build the sense of connection between you and your Guides, as we believe that the efficacy of this medication is tremendously enhanced by a safe setting in the context of trusting relationships.
We will also discuss the use of music during the ketamine experience. People often find music helpful, as it grounds them and gives them something familiar to hold onto, and can potentially enhance or direct the experience.
What to Expect
On the day of your ketamine administration, it is very important to follow the directions within this workbook about food and medication intake.
We will take some time when you arrive to discuss your current state, and remind us all of your intentions for this work. A 30-45 minute ThetaSoma™ session will be conducted to encourage your connection to the subconscious state, as well as pull up the relevant psycho-spiritual material for the journey.
A small ritual that is individualized to your particular preferences and spiritual practices may be performed as a way to initiate and open the space for the day’s work. (We have found that integrating ritual techniques into our work evokes powerful psychosomatic healing processes that aid recovery, and we will be sensitive to any preferences or suggestions you express for personal ritual.)
For sublingual dosing, we will begin treatment with one lozenge of either 50, 75, or 100mg. 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.)
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 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. Your preferences for engagement will be respected.
After 30 minutes, you may have the opportunity to self-administer a second dose (50, 75, or 100 mg) which you will be asked to keep in your mouth for 15 minutes. Each sublingual dose provides a peak effect of approximately 20 minutes.
Throughout the ketamine session, your Guide will be present for support and to guide you through any recommended relaxation exercises, play soothing music, or read your personalized invocation or other previously discussed materials, if desired. During these sessions, you will be offered an eye mask to facilitate and enhance the experience, and to help you maintain an internal focus.
Some people are talkative, but many find it beneficial to just stay with that 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. Your Guide will take notes of content you do choose to narrate, as it may be relevant to discuss during integration of the experience. You will have the opportunity to share once the effect of the medicine subsides.
Your Guide will reconnect with you 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 Guide regards this opportunity with the importance it deserves.
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 stay in with your Guide 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.
Please arrange for some trusted person to pick you up and take you home. We ask that you not drive at all on the day of your administration.
Your Guide can call you on the following day to check on your health and well-being, if requested. We will schedule a follow-up ThetaSoma™ Integration session within one week of the ketamine dosing session.
Therapeutic Touch
MORE INFORMATION TBA!
Virtual KAT
Due to the COVID-19 pandemic, ThetaSoma™ is offering virtual Ketamine-Assisted Therapy (KAT) treatment when appropriate. Below is information to help you prepare and engage in virtual KAT sessions with your Guide.
Prior to your first virtual KAT session, you will engage in at least three preparation sessions (sometimes more) where you and your Guide will discuss whether virtual KAT sessions are an appropriate option for you, and prepare you for the session(s), including creating a plan for remaining safe. Your Guide will collaborate with your prescribing psychiatrist prior to moving forward.
Your Guide will review with you the materials provided to you (Ketamine Assisted Therapy Information, KAT Preparation and Aftercare Guide, and KAT Integration Tips) prior to your first virtual KAT session and answer any questions you may have. You will have opportunities during each preparation session to discuss virtual KAT and any risks associated.
Prior to each virtual KAT session, you must identify a support person who can be available during the session should you need additional support for any reason including but not limited to in the event of a crisis or emergency (in the case of emergencies, 911 will also be called). You must agree to sign a release of information for this person prior to your session so your Guide can make contact with this person prior to and, if necessary, during your session. It is preferred if this person is in the home at the time of your session, but if this is not possible, this person must be within a 15-minute drive from your location for the duration of the session and accessible by phone during your session.
Your Guide will provide guidance on setting up a place in your home that will support your experience, including creating a comfortable and quiet place to lay down, using eye shades, and setting up and navigating technology (i.e. setting up music, using headphones, and using the video platform). Your Guide will also review safety protocols about going to the bathroom and the Guide’s responsibilities regarding when it is appropriate to contact your support person and/or emergency services.
If you have a recent history of high blood pressure, your prescribing psychiatrist may require you to get a blood pressure reading prior to your virtual KAT session(s). Your session may need to be postponed until you can see your doctor to treat any issues associated with your blood pressure.
You must agree to not drive any vehicles or operate any machinery after each session for the remainder of the day. Depending on your treatment needs, it may be required to have a brief phone and/or secure email check-in the following day if you do not have a full integration session already scheduled the next day.
When Will I See Positive Effects, and How Long Will They Last?
Ketamine treatment can result in a number of benefits, and there are now many studies demonstrating its efficacy; however, it is still a relatively new and experimental psychiatric intervention, and there are no guarantees of your outcome.
Ketamine is distinguished from other psychotropic medications by its rapid onset, often producing relief in as soon as a few hours. The literature indicates a 70% initial response rate to ketamine, as well as a remission rate (return of symptoms) for people with treatment-resistant depression of 40-50%.
Durable improvement generally occurs with more than one administration, and is most robust when part of an overall treatment program. It may not permanently relieve your condition. If your symptoms respond to ketamine, you may still elect to be treated with other medications and ongoing ThetaSoma™ Integration Therapy to reduce the possibility of relapse. Over time, you may also need additional ketamine booster administrations or other therapies to maintain your remission.
If you do not respond to ketamine after the first administration, repeated treatment will be offered. If you do not respond after a series of 8 dosings, additional ketamine will not be offered. Studies have shown it is not effective to keep treating with ketamine in those who do not respond to the first 8 doses. The treatment team will discuss with you other available options at that time.
Although a course of ketamine treatment typically provides only a few months of benefit, repeated treatments have been shown to have a cumulative effect, prolonging mood improvements, and current research is focused on how to sustain these benefits with an optimal dosing schedule and integration of ThetaSoma™ Integration Therapy.
***This is an effective medicine, and it is even more so when you work with it to create positive changes in your life that can sustain your recovery. For guidance on getting the most benefit out of your treatment, we offer a collection of Integration Tips to assist you in bringing insights gained during your journey into your life.***
Medical and Psychiatric Eligibility for KAT
Before participating, you will be carefully interviewed to determine if you are a good candidate for ketamine treatment. This will include discussing your medical and psychiatric history, and review of your medical and psychiatric records if necessary.
You are required to be under the care of a primary care physician to evaluate your overall health, and in particular your respiratory and cardiovascular status. You are also required to be under the care of a mental health provider, either a current psychotherapist, or someone you begin treatment with at the start of your ketamine treatment and will continue your care thereafter.
Some medical and psychiatric conditions need to be treated before you can safely take ketamine. These conditions include hallucinations, untreated mania, unstable angina (chest pain/heart disease), uncontrolled hyperthyroidism, increased intracranial pressure, or evidence of liver disease. A previously demonstrated allergy to ketamine excludes one from treatment.
An EKG may be required for those with a history of arrhythmia or a history of cardiovascular issues. Untreated or uncontrolled hypertension is a contraindication to ketamine use, as the substance causes a rise in blood pressure. This increase is typically comparable to normal increases in blood pressure that occur with heavy exercise.
Pregnant and nursing people are not eligible because of undetermined potential effects on the fetus or nursing child.
Those with a history of cystitis or other bladder issues may need to be cleared by urological consultation, due to the rare but potentially significant adverse effect of cystitis.
Those with a primary psychotic or dissociative disorder or who are currently in a manic or mixed episode are not eligible for treatment with ketamine. Please consult your treating clinician if you are taking Lamotrigine (Lamictal) or an anxiety medication such as benzodiazepines, pregabalin, or gabapentin as they may blunt the antidepressant effects of ketamine.
Information on ketamine’s interaction with other medicines is only partially available; any possible interactions will be assessed to help determine your eligibility for ketamine treatment.
Potential Risks of Ketamine
Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any other medication, there are also some potential risks and side effects to be informed of and consider.
The most common physical side effect is a short-term spike in blood pressure, pulse, or heart rate, which may be a risk to those with heart disease, and can be misinterpreted as a symptom of anxiety.
Other possible side effects include dizziness/lightheadedness, sedation, impaired balance and coordination, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to hear or to feel objects accurately including one’s own body, headache, anxiety, nausea, vomiting, and diminished awareness of physical functions such as respiration. These effects are transient and resolve as the active phase of the medication ends (generally within 4 hours).
Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction or cystitis in individuals using the drug too frequently. These adverse effects are much less likely in medically supervised ketamine treatment populations, but might include more frequent, painful, or difficult urination. Please inform your Guides immediately if you notice any of these side effects.
In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying psychological problems in people with severe personality disorders and dissociative disorders.
Management of Adverse Effects
Our setting and our client instructions (see KAT Preparation and Aftercare Guide for details) are intended to minimize ketamine's adverse side effects as much as possible.
It is very important to abstain from eating or drinking in the 4 hours prior to your treatment so as to avoid nausea or vomiting. Additionally, due to possible blurred and altered vision, we advise keeping your eyes closed or using the eye mask provided (as long as you are comfortable doing so) until the main effects have worn off. Excessive movement can exacerbate nausea and dizziness, so it is best to lie still during the active phase while balance and coordination are impaired.
Driving an automobile or engaging in hazardous activities should not be undertaken on the day of the administration, and not until all effects have stopped. You will be assessed for safety prior to leaving the office premises, and will be required to arrange for a responsible person drive you home.
We will check your vital signs before and after the administration, and be present throughout the session to monitor and treat any side effects. We will additionally reassure you prior to administration that the increase in heart rate is transient and due only to the effects of the medication, and not to anxiety or panic, nor any serious health condition.
We reserve the right to activate emergency response systems (such as calling 9-1-1) if it is determined by clinical judgment that your safety requires a higher level of care than can be provided in our setting.
Potential for Ketamine Abuse and Physical Dependence
Ketamine belongs to the same group of chemicals as phencyclidine (Sernyl, PCP, “Angel dust”). This group of chemical compounds is known chemically as arylcyclohexylamines and are classified as hallucinogens (also known as psychedelics). Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Medical evidence regarding the issue of drug abuse and dependence suggests that ketamine’s abuse potential is equivalent to that of phencyclidine and other hallucinogenic substances.
Phencyclidine and other hallucinogenic compounds do not meet criteria for chemical dependence, since they do not cause tolerance and withdrawal symptoms. However, cravings have been reported by individuals with history of heavy use of psychedelic drugs. In addition, ketamine can have effects on mood (feelings), cognition (thinking), and perception (imagery) that may make some people want to use it repeatedly. Therefore, ketamine should only be used under the direct supervision of a licensed prescriber. We have not had clients become dependent on ketamine.
Alternative Procedures and Treatments
ThetaSoma™ Integration Therapy without ketamine is available and can be effective. Major Depression (MDD), PTSD and Bipolar Disorders are usually treated with antidepressant medications, tranquilizers, mood stabilizers and psychotherapy. PTSD is often also treated with Eye Movement Desensitization and Reprocessing (EMDR). Electroconvulsive therapy (ECT) and the recently introduced Transcranial Magnetic Stimulation (TMS) are also in use for treatment-resistant-depression.
Voluntary Nature of Participation
Your decision to undertake KAT is completely voluntary. Once you indicate that you have understood the benefits and risks of this treatment, you will be asked to sign the Informed Consent Agreement in order to participate.
Please ask us any questions you may have concerning the procedure or effects of ketamine at any time. Your consent to receive ketamine may be withdrawn by you, and you may discontinue your participation, at any time up until the actual injection or lozenge has been given.
By signing the Informed Consent for Ketamine-Assisted ThetaSoma™ Integration Therapy, you indicate that you understand the information provided, that any questions or concerns you have regarding our services or this agreement have been answered and resolved, and that you give your consent to the therapeutic procedures to be performed during your participation in KAT.
Thank you for taking the time to read this important information!
