Ketamine-Assisted Psychotherapy

Ketamine-Assisted Psychotherapy (KAP) is a modality of therapy in which ketamine is used as a complement to psychotherapy to help patients experience more frequent breakthroughs and sustained improvement in symptoms. Below is more information about KAP to help you navigate whether it may be a good fit for you.

What is ketamine?

Ketamine is a substance that was first synthesized in the early 1960s. It is commonly used in medical settings to induce anesthesia. At lower dosages, tt has recently been discovered to help with depression, anxiety, and post-traumatic stress disorder (PTSD) as well. Ketamine has been studied to see its possible benefits in helping to treat a number of mental health problems or nervous system disorders, including: substance dependencies, depression, PTSD, bipolar depression and chronic pain. 

Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hours 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, nasal spray, and sublingual lozenges. In my work, the only form of this medicine available for KAP sessions with me is sublingual lozenges taken orally.

How does ketamine feel and what is KAP like?

The ketamine session itself typically lasts 3 hours and I will be with you throughout the session. With sublingual lozenges, the effects begin to appear after about 15- 20 minutes, peak for about 40 minutes, and dissipate over the following 1-2 hours. During the process, it is possible to take additional lozenges to adjust the effect. The effects are found to be pleasant by most people though sometimes challenging content and emotions can come up, requiring support. These effects can make you feel far away 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 and have a hard time walking. Once these effects subsided, we will spend the remainder of the session giving you space to process and discuss your experience.  It is a lot like standard talk therapy, but you may find that you have access to more emotions, more memories that come up, and that connections that you have not made before in your life come easily. 

I am  there to support you and guide you through the process, having met with you, learned your challenges and issues, in order to  partner with you as you have this experience. While it may feel hard to articulate what happened during the experience, clients usually feel like the insights gained are clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the ketamine experience.

What is the process of undergoing KAP?

KAP is a multi-part process:

1. Initial consultation

   • First, you will be scheduled for an initial evaluation with Kathleen Manseau, ARNP-C, MN, BSN.
     
     If you have uncontrolled blood pressure or heart disease, ketamine can be dangerous. Similarly people with Grave’s disease can also potentially have problems with ketamine. If you have your own primary care provider, you can have them take your vitals, especially blood pressure, and then refer you to Kathleen for the final medical evaluation for KAP.
     
     Note that after November, 2023, federal rules requiring an in-person evaluation prior to any new prescription for a controlled substance (ketamine is a schedule III controlled substance) might be reinstated. If that federal rules change occurs, then in order to see Kathleen for the online evaluation, you will first need to see a medical provider for an in-person visit to gain basic "clearance" to proceed; that provider will then need to make a referral to Kathleen for her online evaluation.
     
     If it is not possible for you to see a provider in-person, then in some circumstances you may meet with Kathleen in person and she will do the evaluation in its entirety. She will go over your medical history with you and determine if you are medically eligible for KAP. These in person sessions are only available periodically and have a higher fee. See below for cost details.

   • If you are medically eligible for KAP, Kathleen will write a ketamine prescription for you, and a small amount of sublingual lozenges will be sent to your home from a pharmacy. These will be enough for one or two KAP sessions. 

2. Preparation sessions:

   • After you have been medically evaluated, we will schedule time together for our KAP preparation, dosing, and integration sessions. Preparation sessions will be scheduled just like regular therapy sessions prior to the KAP session where you take your prescribed ketamine. The goal of a preparation sessions are to align on the process and set intentions for the KAP sessions together so you can get the greatest benefit from them.

3. KAP session:

   • A typical ketamine session lasts roughly 2-3 hours and can take place either in-person in my office or, occasionally, remotely via telehealth. These sessions are done on a weekend day, either in the morning or the afternoon in West Seattle.

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

4. Integration sessions:

   • After our KAP session, we will meet for integration therapy sessions to review the memories, thoughts, and insights that arose during your dosing session in order to better integrate them into your life in a lasting way.

5. Repeat sessions:

   • If you choose to do repeated KAP sessions, we will continue preparation and integration work as above. The initial prescription from the medical provider will allow for ketamine doses sufficient for two additional sessions, as warranted, with additional doses sent from the pharmacy before each session. 

What is the cost of treatment?

Ketamine-Assisted Psychotherapy (KAP) is an affordable, accessible modality. For the preparation and integration sessions, my normal hourly rate for psychotherapy is $150/hr and we will have at least two preparation and two integration sessions before and after the actual KAP session. The KAP session will normally take three hours and the rate for that session as a whole is $650 as the overall timing of it can be a little unpredictable, depending on how you respond to ketamine. 

Medical Costs

1. New Patient Medical Evaluation: This occurs online with Kathleen Manseau, ARNP-C, MN, BSN, and is required for all new clients establishing care for the first time. This session can take up to 90 minutes. This includes an extensive evaluation and medical screening, and prescription if clinically indicated.  The cost for this is $300.
   
   In some circumstances, Kathleen might be available for an in-person visit in the Seattle area. The cost for this service is $750.

2. Follow-up Sessions: For established patients requesting new prescriptions or treatment plans. This includes subsequent minor dose adjustments if needed. This takes 30 minutes with a cost of $200.

3. Cost of Ketamine Lozenges: 3 lozenges (100 mg each) with a cost of  approximately $35.

Estimated Total Costs

KAP work is not currently covered by most insurance though this may change in the future.

1. Medical Evaluation - $300

2. Preparation sessions (2-3 hours)  at $150/hr - $300 to $450

3.  KAP session (3 hours) - $650

4. Integration sessions (2 hours) at $150/hr - $300

5. Ketamine lozenges through pharmacy - $35

Total: $1,585 to $1,735