What follows is the process paper I submitted to Vital as my Experiential Elective. This was a treatment plan and project chosen by myself, not only as an attempt to help with my personal battle with Anxiety, but also to gain insight into what current treatment models are offering at this time.

Introduction
The decision to venture into an elective involving ketamine marked a departure from the familiar, as I entered uncharted territory with no prior experiences with the compound, either recreationally or medically. Driven by genuine curiosity and a quest for a nuanced understanding of ketamine’s therapeutic applications, I chose the path of self-administration at home. This decision wasn’t a pursuit of recreational escapism but a deliberate effort to explore the legally available therapeutic dimensions of using a psychoactive substance for anxiety and depression treatment.

In embracing this elective, my goal was to gain firsthand insights into the experiences of both the patient and the practitioner. This unique opportunity allowed me to intimately explore the effects of ketamine, a compound gaining attention for its potential in mental health treatment. This paper documents my journey, from the decision to engage in this novel experience to its execution over four months, shedding light on the complexities of incorporating ketamine into a therapeutic context for mental health. Through this exploration, I aim to provide a personal perspective on the intersections of legality, treatment efficacy, and the broader implications of utilizing psychoactive substances in a therapeutic setting.

Anxiety and Its Impact
My journey with anxiety commenced at the age of 15 when I was first diagnosed with an anxiety disorder. Trauma in my childhood landed me ensnared in the clutches of frequent panic attacks in my young adult life. Seeking relief, I briefly ventured into the realm of medication, a six-month period that offered a temporary respite from the relentless grip of anxiety. However, recognizing the need for more profound changes, I chose to navigate the path of medication-free intervention, addressing the underlying issues that fueled my mental distress. Taking charge of my life involved a pivotal decision to leave home at a young age. This transition, though challenging, proved transformative, leading to a cessation of panic attacks. Yet, the specter of general anxiety lingered throughout my life, casting a persistent shadow over the landscape of my existence. Coping with hyper-vigilance forged by past traumas, I found myself grappling with the formidable task of trusting those who entered my life. This mistrust not only complicated personal relationships but also hindered my ability to flourish as an individual.

The enduring struggle with anxiety remained a constant companion, infiltrating daily existence and posing barriers to connection and personal development. Over the years, therapy, personal determination, and the use of psychedelics have facilitated breakthroughs in overcoming this trauma. Unfortunately, unhealthy coping mechanisms unconsciously employed to avoid further trauma often had the opposite effect, resulting in setbacks. Personal growth involved therapy, soul-searching, and learning about behavioral patterns, attachment styles, and psycho-social patterns. The journey, challenging yet rewarding, allowed me to unlearn unhealthy subconscious tactics for safety and adopt new healthier mechanisms.

Acknowledging the uniqueness of my experience, anxiety’s pervasive influence on countless other individuals is recognized, especially in the challenging times we face. The ubiquity of anxiety underscores the need for innovative approaches to its management, offering hope and understanding to those navigating its intricate terrain. There’s no one-size-fits-all approach to anxiety, and diverse options, coupled with education and resources, should be available to individuals seeking relief. Since different paths work for different individuals, fostering a range of options ensures a more personalized and effective approach to managing anxiety.

Ketamine Therapy for Anxiety
Ketamine’s efficacy for anxiety is a subject of growing interest in the field of mental health. Traditionally known as an anesthetic, ketamine has demonstrated unique and rapid-acting antidepressant and anxiolytic (anxiety-reducing) properties, particularly in treatment-resistant cases. This is particularly noteworthy for patients with severe anxiety that haven’t responded well to other interventions. Moreover, ketamine is known for its dissociative properties, inducing a temporary altered state of consciousness. This dissociation, characterized by a sense of detachment from one’s surroundings, contributes to the compound’s diverse range of effects in mental health therapy.

One of the distinctive features of ketamine is its rapid onset of action. Traditional antidepressants and anxiolytics often take weeks to months to show significant effects, whereas ketamine can sometimes produce noticeable improvements within hours to days. Ketamine works by modulating the neurotransmitter glutamate in the brain. This is different from the mechanisms of most standard antidepressants, which usually target serotonin, norepinephrine, or dopamine. Like many other psychedelic compounds, Ketamine is believed to promote neuroplasticity. The brain’s ability to reorganize itself and form new synaptic connections. This process may play a role in repairing and enhancing neural circuits, contributing to its antidepressant and anxiolytic effects. Ketamine has also been associated with a rapid reduction in suicidal ideation, which is crucial in treating severe anxiety and depression. This effect is particularly noteworthy in emergency situations where quick intervention is necessary.

For those undergoing a course of ketamine therapy, the journey may be likened to a gradual unfolding of therapeutic benefits. Each session contributes to a cumulative effect, building upon the progress made in previous treatments. This phenomenon aligns with the emerging paradigm in mental health treatment, emphasizing the importance of a holistic and process-oriented approach rather than relying solely on acute interventions.

While the effects of a single ketamine infusion may exhibit a transient nature, marked by a relatively short-lived duration, emerging evidence suggests that the potential for longer-lasting benefits becomes more pronounced with a series of treatments. The therapeutic trajectory of ketamine therapy unfolds as a process, with cumulative sessions contributing to durability of treatment and sustained relief from anxiety symptoms for some individuals.

The notion of sustained relief from anxiety symptoms underscores the potential transformative impact of ketamine therapy on individuals grappling with mental health challenges. It opens avenues for exploring not only the immediate alleviation of symptoms but also the more profound and enduring changes that can enhance overall well-being. As research in this field advances, further understanding of the optimal frequency and duration of ketamine treatments will likely refine and optimize the therapeutic approach, providing individuals with a more comprehensive and effective toolkit for managing anxiety.

It’s important to note that individual responses to ketamine can vary, and not everyone experiences the same level of benefit. The reasons for this variability are not fully understood, and ongoing research aims to identify factors influencing treatment outcomes. While ketamine shows promise as a treatment for anxiety, it’s crucial to approach its use with caution. The field is evolving, and more research is needed to fully understand the long-term effects, optimal dosages, and potential risks associated with ketamine therapy for anxiety. It’s important to consult with qualified healthcare professionals when considering ketamine treatment to ensure it aligns with individual health needs and circumstances.

Ketamine Administration at Home
Ketamine at-home therapy refers to the administration of Ketamine, a dissociative anesthetic with emerging therapeutic applications, in a non-clinical setting such as one’s home. While traditionally administered in medical or clinical settings under the supervision of healthcare professionals, some individuals, with proper guidance and precautions, may opt for at-home use for various reasons. It’s important to note that at-home therapy should only be considered under the supervision and guidance of qualified healthcare professionals, as misuse or unsupervised use can pose serious risks.

This is where some of my concerns began with the current model. For someone like me, I have extensive knowledge and experience with the use of psychoactive substances. For many others, these experiences will be brand new. Such experiences can, by all means, leave one feeling even further lost in their struggle with mental health without proper support systems and integration coaching. As well, there are some concerns around safety and potential contraindications which I will address later.

In general, I am in favor of this option for mental health treatment, but I’d like to see a bit further access to support systems that ensure the best possible outcomes for potential clients. There are a number of providers able to be found on the internet for the current model, and only a fraction of the states allows for treatment legally as well. I cannot speak to if each individual treatment “brand” is doing a better or worse job at addressing these concerns, as my experience was only with the one organization I chose, which I will leave un-named. The at-home model certainly lowers costs as compared to clinical IV infusion clinical models, but both scenarios often seem to be missing Follow up care and integration services.

Cost is another key factor to consider when looking into at home Ketamine treatment. Prices can get near to a thousand dollars for a month’s worth of treatment with some providers, which will certainly be out of the price range for many to be able to afford. With legality still in the gray zone, unfortunately insurance won’t cover most treatment options. Furthermore, if a company was providing comprehensive post session integration support with a therapist or a coach, I can imagine the cost would be increased by quite a bit. Luckily, I was able to do enough digging to find a clinic that was able to use my insurance and get my personal costs down to a mere $75/month. If not for finding this option, I certainly would not have been able to participate.

My Ketamine Treatment Plan
My journey with ketamine started with filling out a basic online form. The obvious questionnaire about who I am, where I live, age, weight, etc. Secondly a brief questionnaire on my medical background and medication list to rule out any potential contraindications. Lastly of course there was a section for why I was seeking at home ketamine therapy, which included a series of questions regarding my mental health and state.

Once the form was submitted, I received an email within a few days requesting a free consultation to go over my forms and see if proceeding with treatment would be right for me. My consultation took place via a video conference call where I met my practitioner and answered a series of further questions as well as had the opportunity to ask many of my own. My practitioner determined I was a good candidate for treatment and proceeded to go over the details of receiving and administration of the medication. I was informed of which conditions I should set in place for medication days as well as how best to take the medication. My options were slow dissolving Troche’s or rapid dissolving tablets (RDT). I chose to go with the RDT which allows the medication to come on more directly rather than the slowly dissolving tablet which can have a slightly more drawn out and milder effect.

Next, we went over dosage. Taken sublingually, Ketamine’s efficacy is diminished by up to 70%. So, the dosage amounts may seem high as compared to other routes of administration. I explained to my practitioner that I’d typically have a high natural tolerance to most substances, so we chose to start me out at 150 mg RDT, instead of the usual 100 mg, to be taken once every three or so days. This would prove to still be a fairly low dose, but a good place to start to see how my body as well as my mind handled the substance. Some may have nausea or may not enjoy the sensations of the substance, which will certainly not be helpful in their pursuit of feeling well. I was given leeway to move forward or backwards treatment days as necessary when required by my schedule, so long as sticking to an average 3-day interval. As the treatment plan went on, it was explained that if my anxiety was improving, we may start to space treatment days further and further apart and eventually land at just an occasional maintenance dosage when needed or complete removal of treatment.

As for the experiences themselves, I was directed to take the medication in a prone position, with a blindfold if possible. Setting the stage for a pleasant experience, low light and soothing music was also suggested. The RDT would dissolve under the tongue immediately and the resulting liquid held in place for as long as possible. Then I could either spit or swallow the liquid, which would have a slight effect on the intensity of the experience. After about 45 minutes, the medicine would take effect and the total duration of the journey would last from about 20-30 minutes. Post journey, it is recommended not to drive or operate heavy machinery. As well, speech and motor skills may be impaired for a few hours inhibiting much of normal activity. I’d recommend setting aside a minimum of four hours for each session, start to finish.

As my treatment plan went on, we titrated up my dosage, first to 200 mg, then 300 and then finally landing at the maximum of 600 mg per session. In general, my body handled the substance seemingly well, and the vast majority of the experiences were pleasant and enjoyable. However, I did have some challenging experiences on occasion, where either something traumatic came up from my past that I struggled to grapple with as if it were presently happening again, or when a subconscious component of an experience would convince me something was happening in my reality that was not.

It was in these moments that I’ve felt the most blessed not only to have my past experiences with other substances to understand what I was experiencing and have built in integration processes for handling these moments, but also grateful for my continuing education as a student at Vital. If it were not for those factors, I can imagine how some of the overwhelming experiences, both good and bad, might have landed someone else further lost in, spiritual emergence or emergency, or general safety turmoil.

Efficacy Of My Personal Experience
In general, I have been quite pleased with the efficacy of my treatment plan. For the most part, I have had a massive decrease in my general day-to-day anxiety. Additionally, I’ve resolved many of my usual negative coping mechanisms and behavioral patterns. As well, it seems I find myself correcting issues in my behavior that I hadn’t even considered to be issues prior to choosing this treatment plan. For those reasons I consider the treatment a success, but it wasn’t without its flaws and even some potentially dangerous side effects.

Towards the later end of my treatment, amongst the holiday bustle, I had one particularly bad experience with my ketamine treatment. Ketamine can be a hypertensive drug for many, increasing one’s blood pressure slightly or in some cases significantly, therefore individuals with unregulated high blood pressure need to tread lightly. I myself was on the borderline of hypertensive stage 1 and for the most part since I’m making lifestyle changes to address that, was deemed safe for treatment. However, on one particularly stressful day, I proceeded with treatment with the thinking that the usually relaxing aspects of the session would help me decompress. Unfortunately, it spiked my blood pressure which was likely already elevated from stress and landed me in a state where I was slightly tachycardic and in a hypertensive crisis for about 24 hours. Luckily, I played it safe and went to the ER and subsequently had follow up visits to rule out any issues or underlying problems, as of now. This was a gentle reminder for further education, support and guidance needed in this area, as even someone like me with my knowledge base can make a mistake like this.

This is why I still feel my treatment was successful but also find myself conflicted about this sort of treatment plan for other individuals without further support, integration coaching and safety precautions. At the end of the day, I find myself still advocating for further access, but with better regulation and legality so that individuals may be treated safely and keep costs to a minimum.

Challenges and Future Directions
Engaging in ketamine therapy introduces a set of challenges, stemming from the potency and intensity of its effects. While some individuals may find the experience transformative, for others, the powerful psychoactive nature of ketamine can lead to overwhelming and distressing situations. Managing and harnessing these effects for therapeutic benefit is a delicate balance that demands careful consideration.

Integration support and coaching emerge as critical elements in mitigating the challenges of ketamine therapy. Following a session, individuals often grapple with the task of integrating their profound experiences into their daily lives. In my opinion professional support becomes imperative to navigate and comprehend these unique and sometimes challenging mental states. At minimum, I’d like to see potential clients have an existing relationship with a regular therapist or coach who is ready and willing to help their clients integrate their experiences, so that they may have the best potential positive treatment outcomes.

A significant challenge arises from ketamine’s association with transient increases in blood pressure, potentially leading to hypertensive states. For individuals with pre-existing cardiovascular conditions, this poses a considerable risk. Careful monitoring and consideration of individual health factors are crucial to mitigate these risks and ensure the therapy’s safety. Experiencing an overly hypertensive state, as demonstrated by my visit to the emergency room, highlights the unpredictability and potential risks associated with ketamine therapy. The physiological responses, coupled with the intense psychoactive effects, can induce its own anxiety and panic, underscoring the importance of meticulous supervision and emergency preparedness. Individual variability in responses to ketamine adds another layer of complexity.

Another factor worth considering, is unlike most other drugs classified as psychedelics, Ketamine has the potential for addiction and abuse. While the amount provided by any responsible practitioner would prohibit any direct abuse, there is obviously a black market for procuring substances if one were so inclined.

What proves therapeutic for one individual may be distressing for another. Navigating this variability and tailoring the therapy to suit individual needs presents ongoing challenges for healthcare professionals and individuals alike.

Conclusion
In conclusion, my exploration into ketamine therapy has been a journey into uncharted territory, a departure from the familiar realms of conventional mental health interventions. The decision to delve into the therapeutic dimensions of ketamine was driven by a desire for understanding and alleviating anxiety and depression under the current legal models both as a potential practitioner and as a patient.

My journey with anxiety, rooted in childhood trauma, led me through various interventions, from medications to a courageous decision to forge a medication-free path. While this path transformed my life and mitigated panic attacks, the lingering shadow of general anxiety persisted, hindering personal growth and connection. Enter ketamine therapy, a novel approach gaining attention for its rapid and unique antidepressant and anxiolytic properties. The paper details the distinct features of ketamine, its modulation of glutamate, and the potential for neuroplastic changes that contribute to sustained relief from anxiety symptoms. The emphasis on a series of treatments as a gradual unfolding of therapeutic benefits aligns with the evolving paradigm in mental health treatment.

However, the paper also underscores the variability in individual responses to ketamine, the need for cautious exploration, and the importance of ongoing research to understand long-term effects, optimal dosages, and potential risks. The complexities of incorporating ketamine into mental health treatment are highlighted, with a call for careful consideration and professional guidance. The exploration extends to the at-home administration of ketamine, raising concerns about support systems, safety, and potential contraindications. While the at-home model offers cost advantages, the absence of comprehensive post-session care and integration services poses challenges. The need for further access to support systems and better regulation is advocated, ensuring a balance between affordability and safety.

My personal treatment plan, detailed from the initial consultation to dosage adjustments, highlights the efficacy of ketamine therapy in reducing day-to-day anxiety and addressing negative coping mechanisms. However, it doesn’t shy away from acknowledging flaws and potential dangers, such as hypertensive episodes. The importance of education, support, and safety precautions is emphasized, especially for individuals without a similar knowledge base.

In essence, my journey with ketamine therapy serves as a testament to its transformative potential, yet it raises critical considerations for its responsible incorporation into mental health treatment. As we navigate this uncharted terrain, the call is for a balance between accessibility, safety, and ongoing research to unlock the full therapeutic potential of ketamine for those grappling with mental health challenges.