Ketamine Assisted Therapy
Improving Therapeutic Outcomes With Treatment Resistant Depression
Several medications are effective for treating depression; however, they take weeks or months to achieve their full effects. A more rapidly acting antidepressant that can have a significant impact on the management of persistent depression is Ketamine.
Ketamine is particularly effective in bringing fast relief to those suffering from depression, especially when acute symptoms, such as suicidal ideations are present. When partnered with Ketamine Assisted Psychotherapy, the treatment is similar to the research that is being done with psychedelic assisted psychotherapy. Dr. Bernadino partners with several KAP trained psychotherapists to provide a deep and profound psychotherapy treatment.
Ketamine Therapy
Ketamine Therapy can be effective for severe depression and other mood disorders which have not responded to first-line treatment options including medication, psychotherapy, and lifestyle modifications. These appointments do not include a psychotherapy component although you will have the option to set an intention at the beginning of your treatment and to share any insights you gained at the end of your treatment. Ketamine therapy is not FDA approved for any mood disorder and is not covered by insurance. The cost of these sessions varies between $250-400 depending on which staff is sitting with you during your treatment.
To learn more about Ketamine Therapy, please have your current prescriber send a referral to Dr. Bernadino’s office and we will reach out to you to begin the intake process.
Ketamine Assisted Psychotherapy (KAP)
When receiving Ketamine Assisted Psychotherapy (KAP) with a KAP trained psychotherapist, Dr. Bernadino will be present to administer the medication and monitor your response, as well as assess for the appropriate dose. The KAP trained psychotherapist will provide the therapy throughout the session to include intention setting and integration. These sessions are not covered by insurance.
If you would like to have your current therapist present to provide the psychotherapy component, that can be arranged. Please call the office for more details.
To learn more about Ketamine Assisted Psychotherapy, please have your current prescriber send a referral to Dr. Bernadino’s office and we will reach out to you to begin the intake process.
Rates:
$125 per 1 hour preparation session (1-3 sessions recommended before first treatment)
$550 per 2 hour treatment
$675 per 3 hour treatment
$125 per 1 hour integration session following treatment
Integration sessions are recommended but not required. You might also choose to meet with your current therapist the day after a ketamine treatment to maximize the increased neuroplasticity.
We recommended planning for at least 3 ketamine treatments before determining if it is beneficial.
Ketamine Assisted Psychotherapy allows the participant to unlock, access, and process difficult emotional memories with the assistance of a highly trained therapist.
Call our office to schedule your initial meeting. (207) 218-5067
Ketamine Assisted Psychotherapy
Our treatment team consists of a licensed therapist (who specializes in psychedelic integration) and Dr. Bernadino. You will meet with us approximately three times before your first ketamine administration. Typically the first meeting is with Dr. Bernadino for an intake. This meeting is followed by 1-2 meetings with a licensed therapist trained in KAP. In some situations, your own psychotherapist may serve on the treatment team.
As a team, we will plan to assess and discuss if KAP 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.
In the first meeting, Dr. Bernadino will gather information from you about your current and past symptoms, previous treatment attempts, and relevant life history. She will also review your medical history, including past medical and psychiatric problems, current and recent medications, social history including your current substance use.
In the second preparatory session, a licensed therapist will work with you to reflect on your goals for treatment and to help you set intentions for your experience. We may also offer and teach breathing exercises and other mindfulness meditation guidance in this session to address any anxiety you might have going into the experience.
If desired, your therapist will work with you to collaboratively create an invocation, a set of emotionally evocative and relevant statements to be read to you as the ketamine is administered, which is meant to induce a growth-oriented mindset for your journey.
We provide playlists designed to optimize your benefit from the journey. 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.
On the day of your ketamine administration, it is very important that you have nothing to eat for 3 hours prior to your treatment and nothing to drink for 1 hour prior. We encourage you to bring a blanket and small pillow such as a travel pillow for neck support. You may wish to bring a blindfold and small tokens or pictures related to people or places that have been significant to you in your life.
We will take some time when you arrive to discuss your current state and remind us all of your intentions for this work. We will also guide you through some gentle breathing and meditation exercises to help you settle into the room and identify anything that needs releasing prior to starting your session.
For sublingual dosing, we will begin treatment with one lozenge of either 50 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 10 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 (similar to MDMA) 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 will be offered a second dose of either sublingual ketamine or intramuscular ketamine. For intramuscular dosing, we will use a dose that we selected for you based on your height and weight, therapeutic goals, and other factors. The injection is given in the upper arm. You will not have to undress for the injection, although you may have to pull your sleeve up. Given this, it is best to come dressed in a short sleeve shirt with a cardigan over it.
The onset of the IM experience is generally swift, within a few minutes. You will be largely internally focused for the next 30-40 minutes.
Throughout the ketamine session, your providers will be present for support and to guide you through any recommended relaxation exercises, play soothing music, or read your personalized invocation if desired. During these sessions, you will be offered an eye mask to facilitate the and enhance the experience, and to help you maintain an internal focus. We recommend that you speak as little as possible while experiencing the active effects of this dose of ketamine, as it may be more beneficial for you to stay with the experience. You will have the opportunity to share once the effect of the medicine subsides.
We will reconnect with you (and potentially resume supportive psychotherapy) when 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 very powerful and full of new insights. Your therapist will be present with you to help make the most of this opportunity.
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 with us for at least two hours. People can vary greatly in terms of how quickly the effects clear, so your departure time might vary. Please arrange for some trusted person to pick you up and take you home. We cannot release you to a taxi, and we ask that you not drive at all on the day of your administration.
FAQs
What does the Ketamine experience feel like?
The ketamine experience is characterized by the relaxation of ordinary concerns and usual mindset, all while maintaining conscious awareness. 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.
What are the effects of Ketamine?
At lower doses, you will most likely experience anxiolytic, antidepressant, and mild 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 growth, and promoting a positive change in outlook.
How long until I’m back to normal?
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.