Ketamine-Assisted Therapy: A New Frontier for Bipolar II Disorder

Bipolar II disorder basically differs from Bipolar in the severity of the elevated mood states. While people with Bipolar I experience full manic episodes, those with Bipolar II experience hypomania—elevated mood states that are less severe but still disruptive. However, what often makes Bipolar II so challenging is that people typically spend much more time in depressive states than in hypomanic ones.

These depressive episodes can last months or even years, and they frequently don't respond well to standard treatments. The traditional approach of combining mood stabilizers with antidepressants carries the risk of triggering hypomanic episodes or rapid cycling between mood states.

These treatment challenges leaves many people with Bipolar II feeling trapped between inadequate relief from depression and the risk of worsening their overall condition.

Enter Ketamine: A Different Approach

Ketamine, originally developed as an anesthetic, has emerged as a groundbreaking treatment for depression. Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine systems, ketamine works through a different mechanism: the glutamate pathway.

When administered in controlled, subanesthetic doses, ketamine appears to rapidly repair neural connections damaged by chronic stress and depression. This process, known as synaptogenesis, essentially helps the brain rebuild itself.

What makes ketamine helpful for Bipolar II depression is how fast it can help. While conventional antidepressants may take weeks to show benefit, ketamine can produce significant mood improvements within hours or days.

Promising Research for Bipolar Depression

Research specifically examining ketamine's effects on bipolar depression is still evolving, but early findings are encouraging:

• A 2012 study published in the journal Biological Psychiatry found that a single ketamine infusion produced a rapid antidepressant effect in patients with treatment-resistant bipolar depression.

• A 2017 review in the Journal of Clinical Psychiatry indicated that ketamine demonstrated rapid and robust antidepressant effects in bipolar depression without triggering manic symptoms when used in conjunction with mood stabilizers.

• More recent studies suggest that ketamine may temporarily reduce suicidal thoughts, a critical benefit given the elevated suicide risk in bipolar disorder.

Perhaps most importantly, ketamine appears to have a lower risk of triggering hypomania or mania compared to traditional antidepressants when properly administered and monitored—addressing one of the core challenges in treating Bipolar II depression.

Beyond the Medication: The Therapy Component

What truly differentiates modern ketamine treatment approaches is the integration of psychotherapy. This combined approach—ketamine-assisted therapy—leverages both ketamine's neurochemical effects and the psychological processing that can occur during and after treatment, leading to deeper change, healing and growth.

During ketamine sessions, many patients experience:

• Increased psychological flexibility, loosening of depressive thoughts

• Enhanced perspective on persistent negative thought patterns

• Less fixation on being depressed, feeling guilt about being depressed, and hopelessness

• Greater emotional openness and receptivity to therapeutic interventions, more hopeful and often more energized

These qualities create a unique therapeutic window where individuals can process emotions and experiences differently. When combined with a skilled, properly trained therapist, this can lead to insights and breakthroughs that may take years in traditional talk therapy realms.

Important Considerations

While the potential benefits of ketamine-assisted therapy for Bipolar II are significant, several important considerations must be addressed:

1. Medical screening and monitoring: Ketamine treatment requires thorough medical screening and follow up appointments with the prescriber.

2. Integration with mood stabilizers: Ketamine treatment for bipolar depression should generally be used as an adjunct to, not a replacement for, mood-stabilizing medications.

3. Individualized approach: Response to ketamine varies significantly between individuals, and treatment protocols must be tailored accordingly.

4. Therapeutic context: Appropriate and effective psychotherapy is crucial for maximizing benefits and processing the experiences that emerge during dosing sessions.

5. Insurance and accessibility: Many insurance plans still don't cover ketamine for depression, creating possible financial barriers to access.

As research continues and clinical experience grows, ketamine-assisted therapy represents one of the most promising developments for treatment-resistant bipolar depression in decades. Its novel mechanism of action, rapid effects, and potential for deeper therapeutic processing open new possibilities for those who have struggled with inadequate relief from conventional approaches.

I am excited to offer this modality to people who have lived with depression for far too long. Contact me today to talk more about how ketamine-assited therapy may help you.

Can Ketamine Assisted Psychotherapy Help Manage Depression?

Ketamine was originally developed as an anesthetic and has been used in medicine since the ’60s. But over the past two decades, researchers have discovered that ketamine is also able to relieve depressive symptoms when given in controlled, therapeutic doses. Unlike traditional antidepressants, which often take weeks to show results, ketamine can alleviate depressive symptoms within hours. This has led to growing interest in its potential as a treatment for depression, especially for those who have not responded well to more conventional therapies and medications.

How does ketamine affect the brain?

Depression is often associated with a reduction in the availability of neurotransmitters like serotonin and dopamine. Ketamine acts on a different neural pathway—the glutamate system. Glutamate is a neurotransmitter involved in many brain functions, including mood regulation and cognitive flexibility.

Ketamine is believed to stimulate the production of glutamate, which in turn promotes the growth of new neural connections in the brain. This process can help “reset” the brain’s neural circuitry, which reduces depressive symptoms quickly.

Ketamine also appears to reduce the activity of the brain’s default mode network (DMN), a system associated with self-referential thinking. Overactivity in the DMN has been linked to rumination, a common symptom of depression where someone gets trapped in negative thought patterns. By quieting this network, ketamine may help break this cyclical thinking.

What is ketamine-assisted psychotherapy?

In this approach to therapy, ketamine is used not as a standalone drug, the way we might use traditional antidepressants. The idea is that the altered state of consciousness induced by ketamine can open up new avenues for therapeutic exploration. This allows patients to access and process emotions and memories that might otherwise be difficult to confront.

Ketamine-assisted psychotherapy typically involves a series of sessions in which the patient receives a controlled dose of ketamine. The patient then has a therapy session with a licensed psychotherapist who’s trained in working with altered states of consciousness.

These sessions can be deeply introspective and emotionally intense, but they also offer an opportunity to heal deep wounds. Patients report feeling more open, less guarded, and more able to explore painful emotions without the overwhelming sense of fear or despair that might accompany them in a sober state. For many, this allows for breakthroughs in therapy that can lead to long-lasting changes in their mental health.

Who can benefit from ketamine-assisted psychotherapy?

Ketamine-assisted psychotherapy is not for everyone. It’s generally recommended for people with treatment-resistant depression, meaning they have tried at least two other antidepressants without significant improvement. Those with conditions like post-traumatic stress disorder (PTSD), anxiety, and even chronic pain can also benefit from this treatment.

However, it’s important to note that ketamine is a powerful drug and is not without risks. While it’s generally well-tolerated in a controlled clinical setting, some patients may experience side effects such as dissociation (feeling disconnected from reality), nausea, or an increase in blood pressure. Ketamine also has a history of being used recreationally, and there’s potential for abuse if not administered responsibly.

What does the research say?

The research on ketamine for depression is still in its early stages, but the results so far are promising. Several studies have shown that ketamine can rapidly reduce depressive symptoms, even in patients who have not responded to other treatments. In some cases, the effects of a single ketamine session can last for several weeks, though most patients require a series of treatments to maintain the benefits.

Finding a Therapist

Ketamine-assisted psychotherapy should only be conducted under the supervision of trained medical professionals in a clinical setting. If you have treatment-resistant depression and you’re looking for another method, consult a therapist licensed in ketamine-assisted psychotherapy today.

To learn more about how ketamine can help those with treatment-resistant depression, please reach out to us.

The Benefits of Ketamine Assisted Psychotherapy for Depression

Depression can be an all-consuming mental health condition. You might be more familiar with its traditional treatment methods. Most people respond well to prescription antidepressants, therapy, and lifestyle changes. However, some struggle with treatment-resistant depression, meaning the go-to options for healing depression don’t work for them. In recent years, ketamine-assisted psychotherapy (KAP) has become a viable option for those who need less conventional treatments for their depression. Here’s how it works and how you can benefit.

How Ketamine Changes the Brain

Ketamine, originally developed as an anesthetic in the 1960s, has gained attention in the psychiatric field for its antidepressant effects. Ketamine works by modulating the brain’s glutamate system, a neurotransmitter involved in mood regulation, cognition, and neural plasticity. By blocking NMDA (N-methyl-D-aspartate) receptors, ketamine helps release more glutamate, which in turn stimulates the growth of new neural connections. This neuroplasticity is thought to be behind ketamine’s rapid antidepressant effects. It helps “reset” the brain and form new neural pathways that may have been lost during long-term depression.

What Happens in a KAP Session?

During a KAP session, patients are typically given a low dose of ketamine under the careful supervision of healthcare providers. It can be ingested through a nasal spray, oral tablet, or IV infusion. Since the dissociative effects of ketamine can lead to altered states of consciousness, the patient should feel more open to introspection and processing their feelings. After the infusion, a trained therapist guides the patient through their ketamine experience by helping them navigate their thoughts and emotions. This is called integration—the therapist opens a dialogue to make sense of the patient’s insights that arose during their ketamine infusion session. They can then go on to integrate these discoveries into their daily life through better communication, healthier coping skills, and a stronger sense of self.

Benefits of KAP

• It strengthens neural pathways

The neuroplastic effects of ketamine help the brain form new connections. This builds resilience against future depressive episodes (and may stop their recurrence altogether). The therapy part of KAP also helps a person understand their emotions, develop healthy coping skills, and process negative experiences. These all give the brain a greater ability to deal with life’s stressors and stay mentally healthy.

• It works quickly

Compared to other medications and therapies, KAP can alleviate symptoms of depression quite fast. Many patients report feeling relief within a few hours rather than a few weeks or months. For those who have felt trapped by their depression, this fast-acting treatment can be life-changing.

• It reduces suicidal ideation

For those at a high risk of suicide, ketamine can be a great treatment option. Some antidepressants have suicidal ideation as a potential side effect (and can take weeks to begin working). Since ketamine works quickly and doesn’t have the potential for suicidal side effects, ketamine therapy can be lifesaving.

• It encourages big breakthroughs

Some people may take months or years to work up to certain topics during traditional therapy. However, the ketamine-induced altered state of consciousness can help a person access and process feelings and memories that may be difficult to deal with in a typical therapeutic setting.

Potential Drawbacks

While KAP has many benefits, it’s important to recognize that it’s not a one-size-fits-all solution. Ketamine does have side effects and potential drug interactions, so it may not work for people on certain medications. Also, it should only be administered by qualified professionals in a controlled setting, since ketamine has the potential for misuse and addiction.

Are you living with treatment-resistant depression?

If you’re one of the many people who haven’t found the right treatment for your depression, you still have options. To try KAP, talk to a licensed therapist trained in ketamine therapy. Together, you can discuss a treatment plan and determine whether KAP is right for you.

To find out more about the benefits of ketamine-assisted psychotherapy for those with depression, please reach out to me.

Things to consider when looking for a psychedelic assisted therapist.

Trigger warning: trauma memory.

It was during one of the first lectures of my psychedelic assisted therapy training program that I had a change of heart. A best selling author was slated to teach, and I was pretty psyched to learn from him. Granted he’s not a psychotherapist, but he is a damn good writer, and I was hoping to soak up new ideas and glean some wisdom. But when his Zoom screen came on, I was reminded that my expectations were different than the realities at hand. His big exposed, unmade, sheets-in-a-ball messy ass bed was the centerpiece behind him. Icky. Shortly into the lecture, his landline starts ringing, loudly; he commented his wife would probably answer it. OK, message received—he’s not going to be my guide or teacher. And because of my history, he didn’t even feel safe anymore—he felt creepy, uncaring, and unprofessional. I imagine his intention wasn’t to have that kind of impact. But it did.

Some people don’t care what their Zoom background looks like, and some don’t care what Zoom background they are looking at. And some people do. Some have, for example, painful memories attached to super messy beds and older men; and then when someone is not expecting to see a triggering image, it can be quite dysregulating, activating what is called an emotional flashback. Then, calming the nervous system takes the priority over learning and listening to a lecture.

So we have to take care of ourselves; honor and agree with ourselves—that our lived experiences can help dictate who we can have as a teacher or guide.

So how does this story connect with finding the right psychedelic therapist? Bottom line—we get to decide what works for us, what isn’t going to work for us. We can choose our teacher, mentor, therapist based on what our current wants and needs are. What may be a good fit for one person, isn’t going to be a good fit for another. What may be a good fit for a certain time in your life and healing, may not be a good fit for another time.

I really can’t stress enough how important it is to find the psychedelic guide, or therapist, you can trust deeply, you feel safe with, and that has what feels like ‘clean’ energy and clear relationship boundaries with you and themselves. Because during the psychedelic journey, we can be more open and less defended. We may feel expansive joy, deep fear; and to have a trusted person with us makes navigating those murky waters attainable.

Below are some ideas to consider when looking for the right person to work with and support you during your psychedelic journey:

• Do you have a person/people who could refer you to a psychedelic therapist, someone they can vouch for? Granted, what could be a good fit for one person may not be for another—and this could be a good place to start your search.

• We have our own responses and feelings to the behavior and choices other people make. When looking for a psychedelic therapist to work with, notice how you feel when you are consulting with them (and it’s a great idea to have a consultation call). Do you feel comfortable-enough talking with them? Do you feel like they ‘get’ your issues or concerns, and respect them? Listen to any initial, ‘wow, I’m excited to work with them’ or ‘hmmm something doesn’t feel quite right’. Trust that!

• Talk with a few psychedelic assisted therapists. That way you can start to get a feel for the different personalities, training, experience and orientation each therapist has.

• What kind of training do they have? Have they studied with a teacher, taken a course, completed a training program? How aware are they that this work has been part of a myriad of indigenous cultures for thousands of years? Have they studied with particular lineages?

• Do you sense you can become vulnerable with that therapist? Does the therapist seem able to set the conditions to help you feel comfortable-enough in going into the unknown?

• Does their fee fit with your current budget? Therapy is an investment, and yet if you are stressed about how you can afford their fee, that stress may impede your work.

• What is their philosophy on healing, change and growth? Do you click with their outlook and foundational perspectives?

• How much experience do they have working with your specific challenges and goals?

• Are you looking, for example, a gender affirming therapist, a therapist who is a member of your orientation, culture, or background?

• What modalities does the therapist use to help clients prepare for and integrate from the psychedelic journey?

• How much experience does the therapist have working with non-ordinary states of consciousness? Does the therapist have personal experience working with psychedelics?

• When having a psychedelic journey, our usual defenses are either lowered or not there. We can be more vulnerable in comparison to sitting and talking with a therapist. How does the therapist work with this component?

• Do you sense the therapist sees themselves as the ‘expert’? The power differential in psychedelic work can get exaggerated, so notice if you sense they feel like an authority figure to you. Sometimes that is not the most helpful of dynamics.

• If you are feeling confused or conflicted about joining with a teacher, therapist or guide, consider talking it through with a friend, group, family member etc..who can help be a sounding board.

Taking the time to consider and reflect on what you would like to get from the psychedelic work and what type of therapist fits you, sets you up well for this work.

Feel free to contact me with any additional questions or to learn how I work.

How to know if you are ready for psychedelic therapy

Before you have a psychedelic journey, it’s important to understand what to expect and how it may feel. Although it isn’t possible to fully predict what your ketamine (or other psychedelic) journey will be like, it is possible to feel prepared for it. Below are some important things to note when considering ketamine or psychedelic assisted psychotherapy.

How much experience do you have with psychedelics?

To engage in ketamine or psychedelic assisted psychotherapy, you don’t need to have past experiences with psychedelics. However, it is important to consider your level of understanding and comfort with non-ordinary states of consciousness. Like jumping into the deep end of a swimming pool, it’s a good idea to know some things about psychedelics before you dive in.

A psychedelic therapist can cover the questions, fears, concerns and hopes you may have about psychedelic treatment before the experience. This is part of what is called the preparation phase of psychedelic therapy, and is a slice of how you should be supported in order to have a safe and impactful experience.

Do you have a mindfulness practice?

Again, although not mandatory, it is helpful to reflect on current practices you have that help you stay in the present moment. Part of the psychedelic work is facing the hard stuff that can come up. Ways to stay with the possible difficult moments during a journey can be practiced ahead of time via meditation, yoga, movement, exercise, being in nature,etc… During the preparation phase of KAP or PAP treatment, I often lead clients through breathing exercises, simple yoga poses, and other mind-body-spirit connection activities. This builds up the capacity for interoception (perceiving what is going on internally). Since ketamine is a very internal process, it makes sense to get comfortable with inward directed focus ahead of time.

How comfortable are you with not being in control?

It’s normal to want to have control over the outcomes in our lives. Structure, routines, and helpful habits are great, and we can choose to utilize those things in order to thrive. Yet, in a psychedelic journey, the structure, habits and control strategies may very well be inacessible.

What do you feel when you consider the concept of surrender? I know the cliche “go with the flow” can be eyerolling. But cliches were born out of deep truths. How comfortable are you being in “places” you’ve never been before? (You could wonder about this literally or metaphorically). How are you with allowing things to happen, rather than making things happen?

What is your current support system?

Taking time to reflect on the helpful influences and actions you have presently in your life is important to note prior to starting KAP or PAP. This is because things can “come up” afterwards—and having a support plan created ahead of time can really help with your integration and growth goals.

Is there a person you can talk to about your psychedelic experiences, current challenges and future hopes? Do you currently work with a psychotherapist and/or medical provider? Do you belong to a support group? Do you have a supportive person, animal, object, spiritual practice, self care routine you can lean on during and after your psychedelic experience(s)? Are you open to developing some resources before you begin your psychedelic work?

How motivated are you to put in the work?

This can be tricky if you live with depression—depression can squash your energy, hope and motivation. KAP and PAP can be really helpful for some people who experience long-term depression, or cycles of. So if you identify as pretty low energy or motivation, that’s ok. Looking at ourselves with gentleness and love, and knowing that it may take a lot of motivation just to call a therapist IS motivation. For others, you may be bursting with excited/nervous/anxious/desperate energy to start making changes. There’s really not right or wrong answer to this question. It’s more about having the awareness of where your starting point is. And is isn’t uncommon for people to be at their absolute lowest, or coming up out of their absolute lowest, to reach out and ask for help. That is courageous warrior stuff, and we can use that as a motivating factor.

And if you aren’t sure if you really want to begin your psychedelic assisted psychotherapy work yet, that’s ok. It’s good to take an honest inventory of how much time, energy and investment you can do—prior to starting KAP treatment.

If you have more questions or interest, give me a shout.

If you are interested in talking more about if you are a good fit for KAP, contact me. I’d love to support!