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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Hugh on July 19, 2020, at 13:22:40
A new clinic that will offer ketamine therapy to people dealing with treatment resistant depression and anxiety is open in Toronto.
Field Trip Health is billing itself as the country's "first medical centre dedicated exclusively to the administration of psychedelic-enhanced psychotherapy."
With weed legalization in the rearview, the movement to treat mental illness with psychedelics is gaining traction. This week, Toronto company Mind Medicine Inc., backed by former Canopy Growth CEO Bruce Linton, became the world's first publicly-traded pharmaceutical psychedelics company. Last year, researchers launched the University of Toronto Centre for Psychedelic Studies, where they are gearing up for a study that looks at the effects of microdosing psilocybin, the active ingredient in magic mushrooms. Meanwhile, the University of British Columbia Okanagan is conducting phase three of a study that looks at the impacts of MDMA on people with post-traumatic stress disorder; results have been promising so far.
But most psychedelics, including psilocybin and MDMA, are banned in Canada, with exceptions for clinical trials or research purposes.
Ketamine, a drug that's primarily used as an anesthetic during surgeries, is legal, which is why it will be offered to patients at Field Trip.
While the clinic isn't the first to offer ketamine treatments, medical director Michael Verbora said it is the first to incorporate psychotherapy services into treatments in an environment tailored to having a positive psychedelic experience. The softly lit space is decorated more like an upscale yoga studio than a doctor's office, with comfy chairs for lounging, a moss wall, treatment rooms with names like "mountain" and "sea", and a juice bar.
Here's everything you need to know about the clinic:
To qualify, a person needs a referral recommending ketamine therapy from a psychiatrist. Field Trip will have a staff psychiatrist that can see patients. Candidates who qualify will most likely be people dealing with treatment-resistant depression, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder. If a person meets the criteria, they will undergo a physical assessment looking at things like blood work and other medications they're on to make sure there's no reason they shouldn't be taking ketamine.
A typical patient would undergo 8-10 sessions of psychotherapy and 4-6 doses of ketamine. A session that involves both therapy and the ketamine treatment would run around two hours, starting with therapy, and a discussion about one's goals and intentions as well as drug tolerance. Then a patient would be injected with a dose of ketamine in their arm or leg.
The ketamine sessions take place in a treatment room equipped with a reclining armchair, noise cancelling headphones playing "introspective" music, and an eye mask.
Verbora said the ketamine will kick in within a couple of minutes and lasts about 45 minutes to an hour. Patients are monitored while they're medicated. Afterwards, they debrief on what they experienced in a post-treatment room.
"We want to provide your brain an opportunity to disassociate," Verbora said.
Though more research is needed, ketamine has been associated with an up to 85 percent reduction in symptoms for people with treatment-resistant depression; studies have also shown that it can provide fast relief for people with suicidal ideation.
In contrast, Verbora said many pharmaceutical drugs aren't effective for depression, and can cause side-effects or a numbness to all emotions.
He said that patients who take ketamine can expect to have their brains disassociate and have a euphoric out-of-body experience, or to feel their "ego dissolve."
Will other psychedelics be offered?
Not yet. But Verbora said he hopes more people will be able to access psychedelics as attitudes shift and research increases.
"If you come back in a year from now, we may be running psilocybin trials on anorexia or MDMA-assisted therapy for trauma."
Complete article:
Posted by Stargazer2 on July 21, 2020, at 0:04:22
In reply to Ketamine-enhanced psychotherapy, posted by Hugh on July 19, 2020, at 13:22:40
Hi, I had Ketamine infusions that are a continuous drip for 45 min-hour. When you said injection is it actually an infusion? An injection is different in my mind. Do you know the starting dose of Ketamine?
Are you having it done soon?
I had 11 treatments a year ago. It is a very unusual treatment as the dissociation can never be fully explained to you. It can be very traumatic but after a few treatments I learned how to give into it and relax.
Good luck and let us know your experience if you have chosen this treatment.
Posted by porkpiehat on July 21, 2020, at 16:23:18
In reply to Re: Ketamine-enhanced psychotherapy, posted by Stargazer2 on July 21, 2020, at 0:04:22
> Hi, I had Ketamine infusions that are a continuous drip for 45 min-hour. When you said injection is it actually an infusion? An injection is different in my mind. Do you know the starting dose of Ketamine?
> Are you having it done soon?
> I had 11 treatments a year ago. It is a very unusual treatment as the dissociation can never be fully explained to you. It can be very traumatic but after a few treatments I learned how to give into it and relax.
> Good luck and let us know your experience if you have chosen this treatment.Did you find this was helpful to you?
Posted by Hugh on July 22, 2020, at 11:47:00
In reply to Re: Ketamine-enhanced psychotherapy, posted by Stargazer2 on July 21, 2020, at 0:04:22
I'm more interested in trying ketamine combined with psychotherapy than I am in either treatment by itself.
What really intrigues me is the idea of trying MDMA-enhanced psychotherapy. Underground therapists who use this treatment say that in one marathon 4-6 hour session, a patient can achieve years' worth of talk therapy sessions.
It's likely that the FDA will approve MDMA for PTSD by 2022. If that happens, I'd like to try to get an off-label prescription for MDMA-enhanced psychotherapy.
Field Trip Health uses intramuscular injections of ketamine instead of IV infusions. I don't know what dose they use. This article discusses ketamine injections versus infusions:
https://www.lucid.news/ketamine-treatment-patent-challenged/
Posted by Lamdage22 on July 22, 2020, at 12:54:54
In reply to Re: Ketamine-enhanced psychotherapy » Stargazer2, posted by Hugh on July 22, 2020, at 11:47:00
Oh boy, make sure that the therapist is good and trustworthy. He or she could also really mess with your head.
Posted by Hugh on July 23, 2020, at 16:07:18
In reply to Ketamine-enhanced psychotherapy, posted by Hugh on July 19, 2020, at 13:22:40
Summary: Wired explores ketamine combined with therapy as a potential treatment for depression. Wired speaks to Phil Wolfson, M.D., and Julane Andries, LMFT, about their experiences administering ketamine-assisted psychotherapy to treat symptoms of depression, PTSD, and for "self-exploration and understanding." Michael, a patient who received treatment from Wolfson and Andries, discusses his experience undergoing ketamine-assisted psychotherapy. Michael's wife Lynn says "It's just been transformative," and calls Wolfson and Andries "miracle workers."
Then [Michael] discovered a psychiatrist in a small town north of San Francisco. His name was Phil Wolfson, and with his partner Julane Andries, a therapist, he'd pioneered what he called ketamine-assisted psychotherapy. The couple didn't see the drug solely as an antidepressant, but as a vehicle for self-exploration and understanding. They drew inspiration from folk-healing traditions as well as traditional psychiatry. Instead of intravenous delivery, they used ketamine lozenges or a quick injection into a shoulder. Their less medicalized, more humanistic approach appealed to Michael.
After the shot, Michael heard a buzzing noise that, as it pushed toward a crescendo, became almost intolerably loud. Then, all at once, the pressure of the noise seemed to release. He lost any sense of his body and felt completely at peace. No thoughts. No discrete sense of self. Just pure awareness. Behind the eyeshades Andries had given him, he saw a huge dome of sky, like a planetarium.
The session lasted maybe two hours. Afterward, the difference in Michael's mood was immediately apparent to Lynn. He was less irritable, more optimistic. She felt as if they'd been treading water for years in their marriage. But they started moving again -- making plans, working on problems. Long estranged from his mother, Michael called her and reestablished the relationship.
"It's just been transformative," Lynn told me. She calls Wolfson and Andries "miracle workers." Michael is not, by his own admission, cured. He still has bad days, and he still needs occasional ketamine "booster" sessions to keep his mood up. But he credits ketamine with bringing him back to life and, ultimately, with saving his relationship with his wife. "It's probably the only reason I'm still married," he says.
What impressed [Wolfson] about MDMA, which can induce feelings of deep emotional connection, was how it seemed to accelerate the therapeutic process, helping people achieve lasting transformation. (He and Andries are currently finishing up an FDA-approved trial on MDMA and anxiety in patients with life-threatening illnesses.) But after 1985, when it was classified as a "schedule I" substance, MDMA became illegal to prescribe.
It wasn't until 2015, when the couple met a Tasmanian therapist named Stephen Hyde, that they brought ketamine into their practice. Hyde introduced them to ketamine lozenges, which made the treatment cheaper for patients and obviated the need for intravenous delivery with its attendant "medical mumbo jumbo," as Wolfson puts it.
Wolfson and Andries see themselves as pioneering a new form of psychotherapy. They tend to describe ketamine not with the language of scientific articles but with more Buddhist-sounding phrasing, as giving patients a "time out from ordinary mind." They also send patients home with lozenges, something that the APA recommendations implicitly urge against. Wolfson disdains the recommendations, arguing that ketamine's safety record is far better than the APA authors imply.
Complete article:
Posted by Stargazer2 on July 23, 2020, at 21:15:33
In reply to Re: Ketamine-enhanced psychotherapy, posted by Hugh on July 23, 2020, at 16:07:18
Very interesting using Ketamine with psychotherapy. I wish this was available before my marriage crumbled.
Posted by Hugh on July 24, 2020, at 0:34:37
In reply to Re: Ketamine-enhanced psychotherapy, posted by Stargazer2 on July 23, 2020, at 21:15:33
> Very interesting using Ketamine with psychotherapy. I wish this was available before my marriage crumbled.
If I'd had ketamine-assisted psychotherapy -- or MDMA-assisted psychotherapy -- maybe I would have gotten married.
Posted by alexandra_k on July 24, 2020, at 18:42:37
In reply to Re: Ketamine-enhanced psychotherapy » Stargazer2, posted by Hugh on July 24, 2020, at 0:34:37
I think ketamine is a popular date-rape drug. I'm not sure if it does something to suggestability / compliance. Or if is more of an immobiliser.
I think of the time that I spent in psychotherapy having (what felt to me) important things that I wanted to say. But being too scared to say them. Afraid of judgment. Or afraid that they wouldn't be handled well, or for whatever reason. I think that a drug that made me feel calmer and more relaxed and more accepting of whatever... Would make it easier for me to have said some of those things. And saying those things could have sped up the proces of therapy, for sure.
But I would want to have a good relationship with a therapist and feel like my trust was well placed before doing anything like that.
When I had minor surgery to get what turned out to be only part of a surgical screw removed from my ankle they needed to knock me out for it because the nerves had grown around it inside in the bone. When I woke up from the surgery the next day I felt really really really really good. Like really relaxed. In my deep joints, somehow.
People used to say they felt better after having seizures. That was why they thought that inducing seizures might help.
I wonder if ketamine does something like that. A deep relaxant. So the anxiety / depression that you carry as a deeply furrowed brow and clenched teeth etc sort of falls out of you.
Posted by alexandra_k on July 24, 2020, at 18:46:27
In reply to Re: Ketamine-enhanced psychotherapy, posted by alexandra_k on July 24, 2020, at 18:42:37
I mean to say they knocked me out very briefly to do it. A minior surgery. In the afternoon. I think my sleep was a bit disturbed staying overnight in the hospital. But the next day I was feeling really good in my physical body.
Even learning about them not managing to get the screw out (so leaving a jagged edge crossing a mobile (arguably) joint, basically. Which made me angry... Cross... Annoyed... But I still felt calm in myself, somehow.
I don't know. Could have been the adrenalin or something from the new localised pain source...
Posted by alexandra_k on July 24, 2020, at 18:46:31
In reply to Re: Ketamine-enhanced psychotherapy, posted by alexandra_k on July 24, 2020, at 18:42:37
I mean to say they knocked me out very briefly to do it. A minior surgery. In the afternoon. I think my sleep was a bit disturbed staying overnight in the hospital. But the next day I was feeling really good in my physical body.
Even learning about them not managing to get the screw out (so leaving a jagged edge crossing a mobile (arguably) joint, basically. Which made me angry... Cross... Annoyed... But I still felt calm in myself, somehow.
I don't know. Could have been the adrenalin or something from the new localised pain source...
Posted by Hugh on July 26, 2020, at 0:32:04
In reply to Ketamine-enhanced psychotherapy, posted by Hugh on July 19, 2020, at 13:22:40
There are at least ten providers of ketamine-assisted psychotherapy in the US, and one in Canada (Toronto). This detailed description of the treatment is from a provider in San Francisco:
http://www.jessicakatzman.com/uploads/3/7/3/2/37322717/kap_-_information__3_.pdf
Posted by Mtom on July 27, 2020, at 19:13:40
In reply to Re: Ketamine-enhanced psychotherapy, posted by Stargazer2 on July 21, 2020, at 0:04:22
There is another clinic just outside of Toronto in Mississauga that opened in, I think, 2018 https://www.crtce.com/ . I'm not sure they include psychotherapy in their treatment protocol. Their page https://www.crtce.com/iv-ketamine-infusion-therapy/ explains the hypotheses of how ketamine may be working for depression (when it does, it apparently works very rapidly). I've done just a little investigating into both clinics - a course of treatments is expensive e.g. go to https://www.fieldtriphealth.com/faq and scroll down to "How much does the treatment cost". It is not covered by the Provincial Health Insurance. I haven't found much research on rates of response and remission and how long it lasts or if you have to periodically have follow-up treatments.
Would be great to hear from people who have tried it, especially long term reports.
Posted by Mtom on July 27, 2020, at 19:16:29
In reply to Re: Ketamine-enhanced psychotherapy, posted by Stargazer2 on July 21, 2020, at 0:04:22
There is another clinic just outside of Toronto in Mississauga that opened in, I think, 2018 https://www.crtce.com/ . I'm not sure they include psychotherapy in their treatment protocol. Their page https://www.crtce.com/iv-ketamine-infusion-therapy/ explains the hypotheses of how ketamine may be working for depression (when it does, it apparently works very rapidly). I've done just a little investigating into both clinics - a course of treatments is expensive e.g. go to https://www.fieldtriphealth.com/faq and scroll down to "How much does the treatment cost". It is not covered by the Provincial Health Insurance. I haven't found much research on rates of response and remission and how long it lasts or if you have to periodically have follow-up treatments.
Would be great to hear from people who have tried it, especially long term reports.
This is the end of the thread.
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