Traditional antidepressants work on the monoamine neurotransmitters, mostly serotonin, norepinephrine and dopamine. Ketamine works in a completely different way, and helps reset the GABA and glutamate system of neurotransmitters. These receptors are closely linked to mood, anxiety, learning and memory. This is why some patients may have failed over a dozen different oral antidepressant medications, but still have a great response to ketamine infusions.
Ketamine is most effective against treatment-resistant depression, suicidal thinking, and post-traumatic stress disorder. At Initia Nova we also offer ketamine-assisted psychotherapy (KAP), in addition to ketamine infusions alone (KIT), We recognize these mental health conditions are best treated by a mental health professional, skilled in these areas as well as skilled in psychedelic therapies. By combining ketamine with therapy, our patients are able to not only harness the benefits within their session in our office, but integrate their breakthroughs in their day-to-day lives beyond their treatments.
In fact, many mental health conditions are so deeply ingrained in the mind and body that we have found that working with an experienced therapist can improve your success rate with a variety of conditions in addition to the above, including anxiety, OCD, eating disorders, and pain as these are often closely intertwined with depression and trauma.
Alcohol use disorder when comorbid with depression and anxiety can respond very well to ketamine infusions. Particularly when combined with oral medications such as naltrexone and baclofen, and therapy.
Certain neuropathic pain disorders such as complex regional pain syndrome (CRPS/RSD) and fibromyalgia, as well as migraine headaches can be quite responsive to ketamine infusions at higher doses than we typically use for depression, and we have found success with patients when including therapy (KAP) as well.
After your initial evaluation we can help you decide if ketamine-assisted psychotherapy (KAP) is the right option for you.
KAP stands for ketamine-assisted psychotherapy and refers to a patient receiving both ketamine medicine and concurrent therapy treatment as a catalyst for psychological healing and growth. This allows you to change thought and behavior patterns, gain perspective, process difficult experiences and emotions, and feel better overall. The KAP experience is one of relaxation – feeling relaxed in your body and mind. In the KAP session your mindset and defense systems soften, which allows you to explore new ways of thinking and feeling and gives you the ability to explore, process, and discuss difficult topics. You will also have the opportunity to experience the reduction of anxiety and depression within your session as these feelings are replaced with those of calm and relaxation, and sometimes love.
There are many different styles of KAP as different practitioners offer the therapy component at different times (before ketamine treatment, during, immediately after, in the days following). In our offices we provide the therapy component before, during, and immediately after as we have seen that this provides the most substantial and lasting change.
One of the many benefits of KAP is that your therapist will not only help you within your session – to feel safe, to explore what you want to explore – but will also help you to understand and integrate the insights, thoughts, and feelings that arise from your session into your day-to-day life, which will ensure the benefits of your ketamine session will live on after your session ends and impact your daily life for the better. KAP can lead to significant growth, change, and shifts in mood and overall well being. You may have done therapy before, but you’ve never done therapy quite like this!
Ketamine can be administered in several different routes of administration including oral, nasal, intramuscular (IM), and intravenous (IV). For oral ketamine you typically place a lozenge under your tongue and hold your saliva in your mouth for 10 or 15 minutes before spitting it out. This is often used by new practitioners or by those without the medical knowledge to perform infusions. Some drawbacks are the very bitter taste and the fact that you cannot talk due to a mouthful of saliva. This can provide some mild ketamine effects and can help with milder cases of depression and PTSD. Intranasal involves you spraying ketamine into your nose. This will differ each experience depending on how much medication is actually absorbed in your nasal mucosa. The effects come on more rapidly but don’t last very long. IM injections provide a rapid and more sustained effect. The biggest drawback is that once it’s in, it’s in. There is no pausing or adjusting the dose.
At Initia Nova we utilize IV ketamine infusions. This method of administration provides a slow, soft onset of the medicine, and allows us to stop, pause, or adjust the dose at any time, thus putting you in full control of your experience at all times. Because we can adjust the dose we can ensure you receive a strong, robust effect from the medicine – one where you achieve your treatment goals, but the dose remains at a level that is not anxiety-producing, scary, or “too much,” while on the flipside isn’t so mild you don’t get much out of it. As mentioned previously, because we offer therapy during your KAP session (as well as immediately following) we adjust your dose each session to reach the perfect amount that will allow you to feel ketamine’s psychedelic effects while still being able to talk to the therapist. This technique was developed and perfected by Initia Nova and Rena Beyer (Founder of Fostering Greatness) starting back in 2017 and has proven to be profoundly beneficial for our patients. IV ketamine infusions provide the most robust antidepressant and anti-suicidal properties, pair great with therapy, and the the effects wear off quicker than oral and IM (within about 5-10 minutes), with less side effects.
Whether doing KIT or KAP, you will start out doing your infusions twice a week for 3 weeks. The infusion itself (your time with the medicine) lasts for about 40 minutes, but is sometimes extended longer when treating anxiety, OCD, or PTSD to 50 or 60 minutes. Your total appointment time with KIT will last around 1 hour, KAP can run about 90 minutes as you have time following your infusion to speak with the therapist before then also getting time with the doctor to wrap up.
After your first 6 infusion appointments, if you have not made the kind of progress you are looking for, or are making great progress and want to continue the momentum, we will do two more infusion appointments in the fourth week. If you have made significant progress we start to spread out your sessions and have you come in once that fourth week. Then, from there, we can choose to have the eighth session the following week or skip a week and have you come in on week six. Many patients, after completing their initial series of eight ketamine infusions, opt to continue on maintenance infusions to maintain their progress (both in mood and in therapy progress). Maintenance infusions can range from every two weeks to eight weeks, with the average being around once a month.
This is a nuanced answer because it can be different for everyone. For this reason it is best to work with an experienced doctor and therapist who can ensure your experience feels safe and allows you the ability to get the most out of your ketamine experience. Since we use an IV administration of ketamine in our office, you will experience the onset of the ketamine as a slow, soft onset. You can think of the medicine experience much like a bell curve where the medicine gently enters your system and you begin to feel some of the effects within 5-10 minutes, reaches a peak after about 30 minutes, and then slowly leaves your system. Within 15-20 minutes of the ketamine IV finishing you will feel much like yourself again.
Some people report seeing shapes or colors. Some people report time feeling like it is moving slower or faster. Some people feel floaty. Most people report feeling more willing, able, and safe to discuss and process their thoughts and feelings.
It is normal to feel anxious before your first session, not knowing what to expect. Ketamine guides you into feeling relaxed. Your worries tend to float away or you may experience the feeling of caring about them less. Ketamine makes it much easier to discuss important or difficult topics, which is why combining therapy with ketamine is so useful. Many of our patients have reported being able to discuss traumatic events for the first time, or described KAP as being like 50 regular therapy sessions wrapped into one.
At the medicine’s ‘peak’ you may feel “weird” or “strange.” We embrace these feelings and in fact target our dosing to get you to that point – the point where you are experiencing the ketamine’s psychedelic properties, but are not in a fully psychedelic space.
The best part about doing KAP with IV infusions is the control and flexibility, we can always pause, slow down, or speed up an infusion if need be, which would either lessen, stop, or increase the ketamine’s experienced effects. Each session will be a little different as we adjust the dose and you explore further in your own mind. We will be there to guide you every step of the way!
Whether you are doing KIT or KAP, the medical cost of the infusions is the same, $3400. This includes your initial evaluation and your first 8 infusions. After your initial series, if you stay on maintenance infusions the cost is $450 per infusion. Initia Nova collaborates with the area’s most experienced, psychedelic-therapy trained therapists, and we work together to provide the most effective treatment possible. The cost of therapy is separate and paid directly to the therapist. Their cost will be listed on their website and detailed in your evaluation with them.
Getting started is quite easy! First, whether you are looking to begin KIT or KAP, you would begin with an initial medical evaluation with the doctor. If you are looking to receive your treatment in Cherry Hill, NJ, send an email to Dr. Sullivan at firstname.lastname@example.org. For Wilmington, DE, send an email to Dr. Dougherty at Initianovadelaware@gmail.com.
We can answer some basic questions over email, or schedule a brief phone call to answer your questions, learn about your background, and help you decide if ketamine treatment is a good option for you. During this appointment we can also discuss whether KIT or KAP is the better fit for you.
If you choose to move forward with treatment, we will schedule an in person full evaluation where we will discuss your medical and psychiatric history, all previous treatments, and describe your individual treatment plan in detail.
Following this medical evaluation, if you are interested in beginning KAP, the doctor will connect you with the appropriate therapist and you will have an initial consultation to answer any further questions you have, intake, and begin preparatory sessions prior to having your first KAP session with the medicine and therapy combined.