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Why Use Ketamine When We Have Psilocybin Mushrooms?: The Case for Ketamine-assisted Therapy


In recent years, there has been a significant shift in the landscape of mental health treatment, marked by a resurgence of interest in psychedelic therapy. Psilocybin, derived from magic mushrooms, has garnered attention for its therapeutic benefits for a range of struggles. However, there is another psychedelic substance, ketamine, which, although less recognized, has emerged as a potent tool in the realm of mental health healing. Despite being one of the first psychedelic-like medicines used in recent years for mental health care and treatment of treatment-resistant depression, ketamine seems to have taken a backseat as psilocybin gains more prominence. While psilocybin undeniably offers profound healing properties, it's crucial not to overlook the power and accessibility of psychedelic healing that is available with Ketamine-Assisted Therapy. 


By exploring its historical context, therapeutic uses, and potential to transform mental health treatment, it becomes evident that this medicine is not only highly effective for some people but also more accessible, especially in a clinical setting. In order to truly recognize ketamine's unique potential and the impact it can have on mental health and healing, it is first important to understand what Ketamine is and how it is used for medicinal purposes.


What is Ketamine and How is It Used in a Medicinal Capacity?


The Basics of Ketamine

Ketamine, a versatile compound, traces its origins back to its development as an anesthetic in the early 1960s. Initially utilized for its powerful sedative properties and pain relief capabilities, ketamine quickly found its place in medical practice. Over the years, its applications have expanded far beyond its initial use.


Forms of Ketamine

  • Oral Use: Oral ketamine is typically available in the form of troches or lozenges that are made in local compounding pharmacies. The ketamine dissolves in the mouth and, combined with saliva, makes a liquid that ‘swishes’ around like mouthwash. The aim is to have the ketamine absorbed through the cheeks and spit out or swallowed after about 12-15 min of swishing.  When administered orally, this form of ketamine offers a less invasive and more accessible alternative to traditional intravenous ketamine therapy.

  • Intravenous Administration: Intravenous ketamine administration involves the careful infusion of the substance directly into the bloodstream. This method ensures a rapid onset of action, making it highly effective in emergencies or situations where immediate relief is necessary, such as for acute suicidality. The controlled dosage allows medical professionals to monitor the patient closely, adjusting the infusion rate as needed.

  • Intramuscular Injections: Intramuscular injections of ketamine offer an alternative method of delivery. Administered directly into the muscles, this form can feel subjectively more potent or “psychedelic” than oral lozenges. This method is often chosen for its balance between immediacy and duration, making it suitable for a range of mental health conditions.

What are the Benefits of Ketamine-Assisted Psychotherapy?


In the world of mental health treatment, Ketamine-Assisted Psychotherapy has offered a lot of hope to individuals with treatment-resistant depression, anxiety disorders, Post Traumatic Stress Disorder, and existential distress. While Psychedelic-Assisted Therapy is in and of itself an evolving field of study, Ketamine has held a spot at the table for quite some time which has resulted in the ability to effectively monitor its benefits on the patient. 


Here’s a closer look at some of the benefits of this innovative therapeutic method: 


A Holistic Approach: Ketamine-assisted therapy sessions, often conducted in a calming environment, combine the effects of ketamine with psychotherapy, providing a holistic approach to mental health healing.


Rapid Relief: One of the most significant advantages of Ketamine-Assisted Psychotherapy is its rapid onset of action. Unlike traditional antidepressants, which may take weeks to show results, ketamine often provides swift relief. For individuals grappling with acute suicidal thoughts or severe depression, this rapid response can be life-saving.


Enhanced Effectiveness: When ketamine is combined with psychotherapy, the synergy between the two amplifies the therapeutic effects. The introspective and emotionally freeing state induced by ketamine allows individuals to delve deep into the root causes of their mental health challenges under the guidance of a trained therapist. This enhanced effectiveness often leads to profound breakthroughs and lasting healing.


Improved Emotional Resilience: Through the process of ketamine-assisted psychotherapy, individuals develop improved emotional resilience and coping mechanisms. The therapy sessions provide a safe space to confront and process challenging emotions, empowering individuals to navigate life's difficulties with newfound strength and resilience.


Tailored Treatment: Every individual's mental health journey is unique. Ketamine-assisted psychotherapy recognizes this diversity and offers personalized, tailored treatment plans. Therapists work closely with patients to understand their specific challenges and goals, ensuring that the therapy is customized to meet their unique needs.


What is the Difference Between Ketamine and Psilocybin?


For most mental health practitioners, Ketamine is the first line of defense and the first medicine offered to people when they are experiencing treatment-resistant depression. The biggest thing to note about the differences between psilocybin and ketamine is that while both ketamine and psilocybin offer therapeutic benefits, they differ in their applications. Ketamine is often preferred in cases where a rapid response is crucial.


Ketamine differs from psilocybin additionally in the following ways:


Affordability and Accessibility: One of the key factors that tilts the scale in favor of ketamine therapy is its affordability. In a world where medical expenses can be overwhelming, ketamine treatment offers a more cost-effective alternative, making it accessible to a broader range of individuals. Moreover, the time factor cannot be overlooked. Ketamine therapy requires significantly less time commitment, allowing people to integrate this vital treatment into their busy lives seamlessly.


When considering accessibility, ketamine therapy shines even brighter. Its ease of administration and minimal disruption to daily routines make it a pragmatic choice for those navigating the challenges of treatment-resistant depression. Unlike psilocybin, which necessitates a substantial time investment and a controlled environment, ketamine therapy can be seamlessly integrated into one’s week or day, making it a practical option for many.


Compatibility With Existing Medications: It is a lot easier for people who are already on antidepressants to easily work with ketamine if you're on antidepressants you are going to have to edit your current medication regimen (always consult with your prescribing doctor before tampering with your medication regime) however ketamine is usually a home run as it's much more manageable for people who are on antidepressants or other medications. 


The Speed of Relief: When it comes to the speed of results, ketamine therapy emerges as the clear winner. In cases where rapid intervention is critical, such as acute suicidal ideation, the fast-acting nature of ketamine can be a lifesaver. While psilocybin undoubtedly offers therapeutic benefits, the time it takes to witness substantial changes can be discouraging, especially for those in urgent need. 


What Limitations Exist With Psilocybin-Assisted Therapy?


Certainly, delving into the realm of psychedelics, with the help of psilocybin, can be a transformative experience, but it's not without its challenges, especially for those who have never ventured into altered states of consciousness before. These challenges are not necessarily met with Ketamine which makes it a go-to choice for first time psychedelic explorers.


The limitations or challenges associated with Psilocybin-Assisted Therapy are as follows:


1. Intensity of Experience: Psilocybin  induces a profound altered state of consciousness. The intensity of this experience can be overwhelming, especially for individuals unfamiliar with the sensations and perceptions associated with psychedelics. Unlike ketamine, which often provides a more manageable and controlled experience, psilocybin's effects can be significantly stronger, leading to a sense of loss of control that might be distressing for some individuals.


2. Duration of the Trip: Psilocybin trips typically last several hours, often ranging from 4 to 6 hours or even longer. For someone new to altered states, this extended duration can feel like an eternity. The prolonged nature of the experience can be mentally and emotionally taxing, making it challenging for individuals to navigate such a lengthy altered state, especially if they are not prepared for it.


3. Potential for Challenging Experiences: While psychedelics can induce beautiful and insightful experiences, they can also bring forth challenging and difficult emotions or memories. For someone unaccustomed to handling these intense emotions, a psilocybin trip might become overwhelming, leading to anxiety or even panic. Such experiences can be psychologically distressing, especially for those who lack the tools to navigate and process these challenging emotions effectively.


4. Setting and Environment: The environment in which a psychedelic experience occurs greatly influences the trip. Psilocybin experiences are highly susceptible to the setting; an unfamiliar or uncomfortable environment can lead to a negative experience. Unlike ketamine, which can be administered in a controlled, clinical setting, psilocybin experiences often happen in less regulated environments, potentially increasing the risk of a challenging trip due to external factors.


5. Integration Challenges: After a psychedelic experience, integrating the insights gained and emotions felt during the trip into daily life is crucial. For someone new to altered states, comprehending and incorporating these profound experiences can be daunting. Without proper guidance and support, individuals might struggle to make sense of their journey, potentially leading to confusion or even existential distress.


What Are Psychedelic Practitioners Saying About The Growing Popularity of Psilocybin?


While advocates of psychedelic therapy unequivocally champion its efficacy, there exists a subtle hesitancy among some practitioners when it comes to endorsing the surging trend of psilocybin-assisted psychotherapy. This reservation stems from a genuine concern: the lack of comprehensive research and substantial experiential data to ethically justify the increasing popularity of psilocybin therapy. 


As a clinician well-versed in both mushroom and ketamine therapy, I'm finding strong evidence of what individuals in the underground mushroom scene have known for years. Despite the growing fascination with mushrooms, especially due to their novelty, they aren't always the first medicine practitioners will recommend for those dealing with depression or for first-time psychedelic experiences. This is because mushrooms can be tricky, and their outcomes aren't always predictable, especially concerning depression and its effects on the brain. While mushrooms are captivating and can be perceived as the more “sexy” alternative, ketamine continues to be the preferred starting point for individuals battling treatment-resistant depression and certain forms of anxiety.


There are however, certain conditions that mushrooms will be better for in the future such as obsessive-compulsive disorder (OCD), some eating disorders, and some forms of addiction, but the venues that are drawing attention to psychedelic mushrooms as a form of therapy such as Good Morning America are not providing all the facts or doing their due diligence of mentioning the profound effects of Ketamine.


Those of us who have been doing this clinical work for years still deeply believe in ketamine’s efficacy when it comes to treatment-resistant depression.  We really want people to consider that ketamine is often a first step in a psychedelic journey and it's a very good first step to begin your journey with. That doesn’t necessarily mean mushrooms won’t be an effective option, but some individuals may be disappointed by some of the drawbacks of psilocybin like the duration of the trip or the time it may take to uncover what they need to uncover.


Sometimes we need to spend multiple sessions figuring out the right amount of mushrooms someone needs to get to a place where they can begin to heal. This can become expensive and unnerving and in talking with underground practitioners, this is often met with frustration by the patient. 


Final Thoughts


In essence, Psilocybin-Assisted Therapy, while known for its profound benefits and countless testimonials, does come with limitations that demand careful consideration before embracing this treatment option. Despite its acclaim, it remains a relatively new therapeutic approach often presented with somewhat exaggerated promises.


The crucial truth is that Ketamine is a proven and effective treatment option that should not be overshadowed by the allure of a shinier, newer alternative. As with any medical choice, thorough research, consultations with professionals, and asking pertinent questions are imperative.


For those keen on exploring the intricate nuances of these therapies or practitioners aspiring to incorporate them into their practice, consider joining Elemental Psychedelics this June for our Ketamine-assisted Therapy training in Lyons, Colorado!



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