Ketamine Assisted Psychotherapy: Help or Hype?

Jessica van der Hoek, an advanced care paramedic at the Wayfound Mental Health Group in Alberta, Calgary, had a longstanding diagnosis of treatment-resistant PTSD.

“I wasn't getting any relief with traditional therapies or medications,” she says.

In 2019, she embarked on a trip to Mexico to take part in a week-long plant medicine psychedelic retreat.

“I came home a completely different person,” she says. “I was able to go back to work as a paramedic and function really well in the rest of my life.”

After her return to Canada, van der Koek was motivated to make psychedelic therapy accessible to other first responders and to the general public at her workplace, Wayfound Mental Health Group, which offers psychologists and social workers for people with different mental health injuries and illnesses, says van der Koek.

With ketamine being the only legal psychedelic in Alberta, the facility started offering ketamine assisted psychotherapy (KAP) on a trial basis in March 2021 in conjunction with psychiatrists and psychologists.  

Van der Hoek is now director of programming for the psychedelic division. “Here in Alberta, as an advanced care paramedic, ketamine is part of my scope of practice,” she says. “Traditionally, we’ve used it as an adjunct for intubation or for pain management. We’ve never used it in the mental health realm.”

Program Details

When van der Koek helped Wayfound Mental Health Group start the KAP program—which she says would be typically executed by a doctor or nurse—she advocated for using paramedics to do so.  

“Not only because we have to deal with our own mental health, but also that we are the ones who are called when people are having some type of mental health crisis and also dealing with psychedelic emergencies on the street. We have a huge amount of skill when it comes to be able to work in that space,” van der Koek shares.

The program specializes in treating first responders and law enforcement, but is open to everyone, says van der Koek. Those seeking treatment come into the clinic by referral from a family physician, nurse practitioner or registered psychologist who have identified them as treatment-resistant to medications and traditional therapies.

The two-step process starts with ketamine administered sublingually in what is a 2 to 2.5-hour experience that may include wanted and beneficial emergence phenomena such as psychedelic visions, very colorful experiences, out-of-body experiences, and mystical experiences, notes van der Koek.

Twenty-four to 48 hours later, the patient follows up with a psychologist who specializes in psychedelic integration.

Van der Koek notes that any side effects have a quick onset and are alleviated within a few hours. Other side effects may include nausea and dizziness. They typically wear off within 2–4 hours. It is recommended the patient doesn’t drive for about 12 hours after their treatment.

“The only long-term concern with ketamine is bladder irritation,” says van der Koek, adding liver and kidney function must be checked regularly.

Van der Koek notes a 70 percent effectiveness rate for KAP in her experience.

Paramedics also can refer patients to the Wayfound Mental Health Group through the emergency room staff if they deem the patient’s issue is a mental health one. Van der Koek notes that KAP is effective for major depressive disorder, complex PTSD, developmental trauma, PTSD, generalized anxiety disorder, suicidal ideation and obsessive-compulsive disorder.

‘I Can Move About My Day with Peace’

Since the program’s launch in October 2021, some 100 people have gone through it. The feedback has been positive, says van der Koek.

“Quite a few of our patients are homebound because of their trauma,” van der Koek notes, adding that after the therapy, clients report that they’re leaving the house to travel, go grocery shopping and spend time with others.

“The success stories we're hearing is, ‘I have my life back. I feel like I'm in control again, like I can look after myself. I can manage how I'm feeling. I don't have to react to things anymore. I can move about my day with peace.”

Family members echo that, she adds.

Van der Koek calls her own chronic buildup of complex PTSD “death by 1000 paper cuts” that started in the beginning of her career and accumulated through the years.

“I experienced quite a bit of childhood adversity, which did not set me up well to be able to handle the stress of the job,” she says.

Through a combination of dealing with traumatic calls and events and not having the resources or support to her process that, her resiliency had eroded along with her capacity to handle the tough calls. She burned out, unable to function on even a basic level.

In 2011, van der Koek took a year off after receiving her diagnosis of PTSD and major depressive disorder. She returned to work a year later, only to have a bad relapse two years later.

The region of 1.3 million people—which has an economy based on oil and gas production—has gone through some tough economic challenges, even prior to COVID, van der Koek notes.

“We’re starting to pull out of it,” she shares. “A huge amount of our calls are for mental health, opioids and other addiction-related ones such as alcohol. Heroin has made a comeback and methamphetamine has always been an issue here.”

In addition to ketamine, “we are trying to get psilocybin and MDMA approved through our government for mental health therapy,” notes van der Koek.

Currently, terminally ill patients in Canada can apply to use psilocybin to help process the end of life at a controlled site.

“I went to Mexico to work with ayahuasca and a few other psychedelics. Hopefully as time goes on, more can become legalized and used by the proper people in the proper settings for proper reason,” van der Koek says.

Idea Taking Hold

The approach has been well-received in Calgary, says van der Koek.

“People are understanding that what is available currently for mental health treatment wasn't doing enough,” she adds. “The antidepressants and traditional talk therapy isn't doing enough. I was actually surprised that most of our referrals are from family physicians.”

The idea is taking hold elsewhere in North America. Next year, the Oregon Health Authority will oversee magic mushroom consumption at service centers in the presence of licensed practitioners, the first state to do so.

The psychedelic drugs market is projected to grow at a compound annual growth rate of 16.3 percent, to reach $6.85 billion by 2027, according to Data Bridge Market Research in response to the increasing prevalence of depression and other mental health disorders in the U.S. and a growing acceptance of their use as a treatment.

Van der Koek advises those looking to start a similar program to find a psychiatrist who is on board with the approach and is willing to do the training. The best facilitators are those who have personally experienced trauma and have had their own psychedelic experiences, she adds. The Multidisciplinary Association for Psychedelic Studies offers training.

Van der Koek points to a 2019 Journal of Psychoactive Drugs article titled Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy, in which researchers note that data supports KAP efficacy “for a wide variety of psychiatric diagnoses and human difficulties, significantly diminishing depression, anxiety, and PTSD and increasing well-being.”

A January 2022 article from Frontiers in Psychiatry, A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers with PTSD and Depression, notes KAP is a promising solution for those deemed treatment-resistant amid an international pandemic and a worsening mental health crisis.

“People opposed to working with ketamine know it as a street drug,” says van der Koek. “They’re not really aware of all of the potential of ketamine or that somebody who comes from a medicine background like myself only uses ketamine for specific purposes. It’s a matter of educating people on what it does and being able to speak to the progress and the turnaround that a lot of our clients have been able to make as a result of this medicine.”