Ketamine Assisted Psychotherapy

 

In addition to psychodynamic talk therapy, I also offer a therapeutic modality called Ketamine Assisted Psychotherapy (KAP), which makes use the medicine ketamine as a complement to psychotherapy.

I partner with Dr. Carrie Griffin, DO through the Center for New Growth. Dr. Griffin and CNG have a specialized medical team that determines eligibility for KAP, creates customized treatment plans, prescribes ketamine lozenges, and supports me in monitoring outcomes. Through our partnership, Center for New Growth handles all the medical aspects of KAP, and I provide the psychotherapy side of KAP.

There’s been an explosion of websites offering ketamine with little oversight or discrepancy in prescribing it.  I want you to know I see ketamine as a very powerful medicine and take its use as a part of treatment very seriously. Even for those medically-eligible for a ketamine prescription, KAP is not a fit for everybody and we would have a thoughtful assessment period before starting KAP.

 

  • Ketamine is a legal, safe, and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and PTSD. Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hour after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.

    Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using dissolving lozenges. In my practice we will only use the lozenge form.

  • The effects of ketamine, which most patients find pleasant, last for approximately 45 minutes. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. Once these effects subside, we’ll spend the remainder of our appointment giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, patients feel like the insights gained are none-the-less clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the ketamine experience.

  • 1. Initial psychotherapy consultation

    You and I will have in-depth, thorough conversations about your interest in KAP. We’ll explore what you are looking to get out of it, your expectations and hopes, your history with therapy and substances, family dynamics, your support system, and much more. This usually happens over 2-3 meetings but may be longer. If my practice and KAP seems like a fit for you, I will refer you to Center for New Growth for a medical evaluation and potential prescription.

    2. Initial medical consultation with Center for New Growth/Dr. Griffin

    You’ll schedule an initial evaluation with the Center for New Growth medical team via Zoom. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are medically eligible for KAP.

    If their medical team determines that you are eligible for KAP, they will develop a personalized Ketamine prescription and outcome monitoring plan for you.

    CNG’s medical staff will write a ketamine prescription for you and will send it to a compounding pharmacy to be filled. When the prescription is ready, the pharmacy will contact you about payment and pick up/delivery options.

    3. Preparation sessions

    Once you receive your ketamine lozenges, we will schedule time together for our KAP preparation, dosing, and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on the process and set intentions for our KAP sessions together.

    4. KAP Dosing Session

    A typical ketamine dosing session lasts between 2-3 hours and can take place either in-person at my office, or remotely via telehealth. If we are just beginning a course of KAP, I ask that we meet in my office for in-person sessions.

    During a dosing session, you will self-administer your ketamine lozenge either in my office or in your home. You will be in a comfortable, reclining position wearing an eye mask and listening to music. Although a KAP dosing session may be largely an internal experience, I will be present with you the entire time to hold space and provide support as needed.

    5. Integration Sessions

    After our KAP dosing session, we will meet for integration sessions to review the memories, thoughts, and insights that arose during your dosing session, and to prepare for the next dosing session.

    6. Follow-up consultations with Center for New Growth

    If there are any adverse side effects, potential needs of dosage adjustments, or any other medically-related questions or concerns, I will reach out to CNG to let them know, and you will follow up with them to schedule another medical meeting.

    If we reach the end of your prescription and assess further KAP sessions may be helpful, you’ll also meet again with Center for New Growth for their ongoing evaluation around medical necessity.

  • It can be hard to estimate the total cost of a course of KAP as your treatment plan will be specific to you. However, I can provide some general fees and durations that you may find helpful.

    Ketamine-Assisted Psychotherapy

    My hourly rate is $250/hr. Before a KAP dosing session we would have several preparatory meetings; these are very important to make sure you have a helpful experience with KAP. The dosing session itself is typically 3 hours. After the dosing session, we will have a follow up (integration) session while the window of neuroplasticity is open to try to “lock in” the gains that can come from KAP. Typically, a course of KAP is 6-8 dosing sessions with integration sessions in between.

    Medical Costs

    First-time patients

    Initial medical consultation with Dr. Griffin: Sliding scale from $250-$375

    Cost of medication: $75 - $125; typically 6 sessions prescribed

    Ongoing treatment

    Follow-up medical consultation with Dr. Griffin for refills: $125 (30 minutes)

  • If you would like to explore the possibility of working with me on KAP, please e-mail me at dr.nicholashack@gmail.com to discuss eligibility and next steps.

    1. Potential Risks of Ketamine: https://www.sciencedirect.com/science/article/abs/pii/S0165032723013095

    2. Paradigms of Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS

    3. Huberman Labs Podcast:Ketamine - Benefits and Risks

    4. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy - research study by Jennifer Dore et al, 2018

    5. Ketamine for Depression and Mood Disordersby Erica Zelfand, ND for Townsend Letter

    6. Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression by goop

    7. Ketamine Assisted Psychotherapy with Jonathan Sabbagh of Journey Clinical - Psychology Talk Podcast