Psychologists discuss the therapeutic side of ketamine

SWEET SPOT: Signi Goldman, left, and Sandra Newes administer ketamine at their mental heath clinic. Photo courtesy of Newes

Ketamine rocketed to public awareness after the October death of actor Matthew Perry. Local therapists and psychiatrists have been trying to tamp down misconceptions about the drug ever since.

Asheville psychologist Sandra Newes, along with her colleague, Signi Goldman, say ketamine is a versatile, safe and effective treatment for mental health issues and addiction if administered by skilled practitioners. Their team at Concierge Medicine and Psychiatry offers these services. They also train therapists and medical professionals through the Living Medicine Institute. 

Concierge Medicine and Psychiatry uses ketamine therapy for treating depression, anxiety, posttraumatic stress disorder, obsessive-compulsive symptoms and chronic pain. According to Newes, ketamine also helps ease the detox process for those struggling with substance dependence.

At high doses, ketamine works as an anesthetic. At midrange it can be a psychedelic, which can help with therapy breakthroughs. At lower doses, it has a mild dissociative effect, which helps reduce symptoms of depression and other mental health issues.

“It’s part of the psychedelic renaissance,” Goldman says.

Xpress spoke with Newes and Goldman to learn more about the pros and cons of the drug. 

This interview has been edited for brevity and clarity. 

Xpress: What’s a common misconception about ketamine?

Newes: The fact that it’s used in clinical settings doesn’t mean it’s safe to use recreationally. Ketamine use for therapy and recreational use are nothing alike. Treatment involves preparation, integration and goal setting. 

Goldman: Ketamine should only be used in a clinical setting in the presence of a professional. Then it’s used with intention. 

Does ketamine have adverse effects? 

Newes: Like a bad trip? That’s more common with recreational abuse. We can control the dose. It’s an IV drip. The staff members that facilitate sessions monitor patients very carefully, and we can stop it at any time. Its effect is much, much shorter than LSD or longer-acting psychedelics, which can be a 12-hour dose. Ketamine treatment is about 50 minutes, and we have control over the IV. If someone get anxious, within minutes, the effects of ketamine disappear.

Then there is caretaking after treatment. We don’t let people leave our office without them being emotionally and physically well. Bad trips can happen in recreational settings where people take more than they intended … and they experience something they hadn’t planned for and without support. The effects are not what they intended. This can be terrifying because ketamine is a very powerful psychedelic. If you go into that without intention, it catches you off guard. 

How does ketamine work in therapy? 

Goldman: You can use ketamine to treat depression or trauma without it being a psychedelic. But as a psychedelic, it opens people up to new ways of seeing and helps shift patterns, so people make more progress in therapy.

Are there concerns about addiction?

Newes:  Recreational use is on the rise, and ketamine can be addictive. Tolerance can build up, and you can get cravings or preoccupations. It’s particularly prevalent with nasal sprays or oral lozenges.

What about its use in emergency services? Two paramedics in Colorado were convicted of criminally negligent homicide in December in the death of Elijah McClain, who died in 2019 after he was injected with ketamine and then restrained. 

Goldman: Ketamine can be used [by first responders in some states] to calm combative people. [Emergency services] sometimes use it to sedate people. But the doses we use are vastly lower. I read that they gave [McClain] 500 milligrams. We typically use between 35 mg and 70 mg. 

What should you look for in providers if you think ketamine would be helpful for you?

Goldman: As ketamine gets more widespread, we’re going to see more people misuse it. Choose a provider with a high level of ethics. For example, we don’t send people home with psychedelic doses. The Living Medicine Institute also trains providers in the safe use of ketamine. Practitioners have to hone their skills. 



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