Street users who abuse ketamine have called it by many names: Special K, Kit-Kat, purple, cat Valium, super acid, or simply K. Psychotherapist Sophia Brandstetter, Psy.D., LCSW, prefers the word “medicine.”
“We all walk through life with a defense structure that we build based on our previous experiences and trauma. Ketamine is a medicine that immediately lowers that defense structure,” says Dr. Brandstetter, founder of Philadelphia-based Growth Thru Change, a psychotherapy group practice that serves patients in Pennsylvania, New Jersey, Delaware, and Florida.
Dr. Brandstetter, who received her doctorate from The Chicago School in 2012, spent years monitoring the psychiatric profession for use of psychedelics while watching her own patients hit seemingly insurmountable walls with conventional treatments. She began offering ketamine-assisted psychotherapy to patients virtually during the COVID-19 pandemic. In 2022, she opened The Ko-Op, an association of allied practitioners in South Philadelphia who provide ketamine-assisted psychotherapy to the community through a collaborative approach.
“There are a lot of pieces to the puzzle that create barriers for clinicians to provide this service to their patients,” Dr. Brandstetter says. “The concept of The Ko-Op was to create a space that provided the tools and resources to local psychotherapists that would allow them the opportunity to become ketamine-assisted psychotherapists. In turn, this opens up the possibility for the community to have access to this kind of therapy.”
What is ketamine?
American scientist Calvin Stevens developed ketamine in his laboratory in 1962 while searching for a shorter-acting and less hallucinogenic alternative to the anesthetic phencyclidine, better known as PCP. At high doses, researchers found, ketamine can induce deep sedation and general anesthesia as well as dissociative and hallucinogenic sensations.
Ketamine “distorts perceptions of sight and sound and makes the user feel disconnected and not in control,” according to the Drug Enforcement Administration, which in 1999 classified ketamine as a Schedule III drug, meaning there is low to moderate risk of abuse and addiction.
Although it became a popular club drug in the 1980s and ’90s, ketamine eventually attracted as much attention from researchers as it did from ravers. In 2000, for example, scientists at Yale School of Medicine published the first randomized controlled trial showing that ketamine could improve the mood of people living with depression. Since then, hundreds of clinical trials have confirmed that ketamine can be a fast-acting antidepressant that lasts for days or even weeks.
Ketamine impacts the glutamate receptor in the brain that may contribute to symptoms associated with depression, anxiety, and various other diagnoses. Over time, people suffering from these symptoms experience a breakdown in neural connectivity in the brain’s prefrontal cortex. Ketamine is thought to restore that connectivity in ways that bring symptom relief.
The research on ketamine is so convincing that a growing number of doctors over the last decade have been prescribing it off-label to patients with severe depression, leading to the formation of ketamine clinics across the country and, in 2019, FDA approval of Spravato, a ketamine variant that’s designed for treatment-resistant depression and administered via nasal spray in a clinic or doctor’s office.
Targeting trauma with ketamine therapy
For people with treatment-resistant depression, ketamine therapy is often straightforward: Patients generally receive clinical ketamine through an IV for an hour in four to six sessions over the course of two to three weeks. The goal is symptom reduction, and the drug’s dissociative effects are minimized. When depressive symptoms return, patients receive a booster dose.
That’s called the biomedical model. The ketamine-assisted psychotherapy that Dr. Brandstetter and her peers practice at The Ko-Op practice is different. Designed for patients experiencing not only treatment-resistant depression, but also severe trauma or anxiety—including post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, and disordered eating—it marries low doses of ketamine with ongoing psychotherapy so patients can speak about their “journey” in the moment and work through their trauma.
Following several preparatory sessions, during which they set therapy goals and intentions, patients commence a series of ketamine-assisted psychotherapy sessions, each of which lasts three hours.
“You come in, you lie down on the couch, you’re wearing eye shades, and there’s music on. The therapist is sitting next to you and might be holding your hand. About 15 minutes after taking a rapid-dissolve tablet—the ketamine just dissolves in your mouth—you’ll start to feel really relaxed,” Dr. Brandstetter explains. “After another couple of minutes, your psychedelic journey begins. The therapist is guiding you throughout the session, and at the end of the session we’ll take all the material that came up and we’ll process it together.”
Although they remain present and aware, patients often describe it as a trance-like or out-of-body experience. The ketamine removes their inhibitions, softens their psychological defenses, and gives them a fresh perspective with which to see challenging memories, behaviors, relationships, and emotions.
“Imagine somebody who walks through life very angry because maybe they’re struggling with grief,” Dr. Brandstetter says. “With the help of ketamine, they can reduce their anger by seeing what they’ve been grieving about—the death of a parent, for example—and starting to process that.”
Unlike psilocybin, MDMA, and other psychedelics, which can cause intense hallucinations for a period of six to eight hours, ketamine typically metabolizes within approximately 45 minutes.
“When you have a six- or eight-hour journey, you experience so much that it can be really overwhelming,” Dr. Brandstetter says. “When you have 45 minutes of material, it’s a lot easier to process and integrate the content into your life.”
For many patients, the benefits of ketamine-assisted psychotherapy turn out to be much deeper than symptom reduction alone. “Everyone goes into this wanting to feel better,” Dr. Brandstetter says, “but after a couple of sessions, you realize that ‘feeling better’ might first mean feeling worse in some regard. Because in order to end up in a place that feels different from where you started, you’ve got to go to some really dark places and look at some really difficult things.”
The benefits aren’t just psychological but also physiological, according to Dr. Brandstetter, who says ketamine creates a 72-hour “neuroplastic window” during which the brain is more pliable and therefore more susceptible to change. If you struggle to have healthy relationships, for example, conventional psychotherapy can help you understand why. When you add ketamine to the mix, however, you have three days afterward during which it will be easier for you to actually change unhealthy relationships by breaking harmful habits and replacing negative thoughts and behaviors with positive ones.
A ‘cultural shift’ in psychedelic treatments
Unfortunately, the barriers to ketamine-assisted psychotherapy are as real as the benefits. Many health plans still do not cover psychotherapy, and those that do often will pay for only one hour per week. Given that the typical ketamine-assisted psychotherapy session lasts three hours, there’s a gap in coverage.
Then there’s the ketamine itself. Spravato aside, the FDA has approved ketamine only for use as an anesthetic. Insurance won’t cover its off-label use as treatment for anxiety and depression.
Nevertheless, Dr. Brandstetter has found ways to make ketamine-assisted psychotherapy more accessible. Virtual sessions are a lower-cost possibility for some patients. For other patients, no-cost therapy might be available if they’re willing to be treated by a student who’s enrolled in a training program at The Ko-Op.
“Access to care is a huge issue, so we try to work with patients to understand what they can afford and how we can make it work,” says Dr. Brandstetter, who believes the current hurdles to treatment are temporary. When more patients and practitioners come to understand the therapeutic benefits of psychedelics, she predicts, the walls around them will crumble. “Psychedelics were criminalized in the 1960s, but people who used to see them as drugs are finally starting to see them as medicine. What’s needed is an entire cultural shift, and that’s happening.”