Ketamine is a psychoactive drug classified as a dissociative anesthetic. It's used in a variety of medical situations because of its safety. Ketamine has been used off-label in sub-anesthetic doses to treat chronic pain, depression and other mental health issues for over 20 years. Ketamine is now used off-label in conjunction with psychotherapy to treat depression, anxiety, suicidality, and other psychological conditions.

We generally begin ketamine treatment with the administration of sublingual lozenges of 50-100

mg. The lozenges dissolve slowly, and in order to receive the best results, we ask you to let the

lozenges dissolve in your mouth for fifteen minutes. Ketamine will penetrate the oral

mucosa (lining of your mouth) and is rapidly absorbed in this manner. This will assist us in

accurately measuring your responsiveness to ketamine. After 20 minutes, you may choose to take an

additional lozenge.

Your first session will be a "dose finding" session, as people respond differently to the medicine. We use lozenges containing 100 mg of ketamine each. Twenty minutes after your first dose, you may choose to take an additional dose to deepen and lengthen your session. Based on your experience, we'll collaborate to adjust the dosage as needed in following sessions.

1) Medical/Psychiatric Intake: After an initial consultation to determine whether KAP is likely to be a good fit for your treatment goals, you'll complete a medical intake with our physician, Dr. Jessica Yoos. Jess will determine whether there are any medical contraindications or areas of concern before prescribing your ketamine.

This 60 to 90-minute session includes:

• an evaluation of your current concerns, needs, and goals;

• a medical history and physical exam (if possible);

• a review of your medical/psychiatric history;

• a review of current or past psychological/psychiatric history and treatment;

• and possibly the administration of brief psychological tests to assess your current level of functioning.

Based on the findings in this session, our treating physician may also recommend additional diagnostic testing, including, but not limited to: blood and/or urine laboratory tests, EKGs, or other tests.

2) Preparation Sessions: Next, you'll work with one of our two therapists, Lisa Yeager, MSW, LICSW or Laurel Watjen, MA, LMHC, to prepare for your ketamine sessions. Over the course of several sessions, we'll get to know each other, explore your symptoms, clarify your goals, and create your treatment plan together. We'll discuss the variety of experiences you may have during the ketamine sessions and ways to navigate them. Our goal is for you to feel as prepared and comfortable as possible going into your first medicine session.

3) Medicine Sessions: You'll arrive at our downtown Bellingham clinic and we'll spend 15-30 minutes checking in, reviewing your intentions for the session, and getting you settled into our reclining chair or couch. You'll take your first ketamine lozenge and hold it in your mouth for 15 minutes, swishing the medicine so it absorbs through the skin, then swallowing it. Twenty minutes after taking your first dose, we'll offer you a second dose to deepen and prolong your experience. The effects will last approximately 90 minutes to two hours, after which we'll check in again and perhaps do some brief integration work before your ride takes you home.

You should arrange to take the rest of the day off from work or other responsibilities or stressors. When possible, it's helpful to keep the following day gentle as well. Integration begins as the ketamine effects wear off, so having time for reflection and self-care will help you make the most of your experience.

4) Integration Sessions: 1-3 days after your medicine session, we'll meet for integration counseling. Your therapist will support you in reflecting on your experience, making meaning of it, and exploring how to integrate insights and shifts in patterning into your life for meaningful change. Depending on your experience and other factors, you may decide to do more than one integration session after a medicine session.

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5) Repeat Steps 3 and 4 according to your treatment plan. On average, our clients find symptom relief and feel "complete" after five to eight medicine sessions.