The term Psychedelic was derived from two Greek words that together mean “mind-manifesting.”Psychedelic substances, originally derived from natural plants, have been used for centuries by various cultures in spiritual ceremonies to promote healing and wellbeing. They include psilocybin (the psychoactive compound in magic mushrooms), LSD, Ibogaine, and DMT and, more recently, have included psychedelic-like substances such as Ketamine and MDMA. When used in a controlled and safe environment with proper support, they can be powerful tools to help treat many mood disorders such as depression, anxiety, PTSD, OCD, alcoholism, opioid addictions, eating disorders, and many other ailments of the spirit. This form of medicine has been studied for many years at some of our top medical institutions such Johns Hopkins, Harvard, Yale, and NYU to name a few. Most of these substances, except for Ketamine, are not currently legal for general use in the United States, however, the FDA has allowed controlled studies to take place for many other psychedelic substances.
Psychedelics mainly include psilocybin (magic mushrooms), LSD, DMT, Ibogaine, MDMA and Ketamine. Only Ketamine is currently legal in the United States. While there are promising studies that suggest a possible legalization for therapeutic use of the others, they still remain illegal. Nushama clinics only use Ketamine and will layer on other compounds if and when their legality changes.
Most psychedelic drugs are actually not addictive when used in a therapeutic environment supervised my physicians especially compared to other drugs/habits/compounds like cigarettes, cannabis, alcohol, heroin, or other drugs.
Ketamine is a compound that was discovered in 1962 and found to be an extremely safe and short acting dissociative anesthetic and analgesic (pain reliever). It is FDA-approved for many indications including its use among children in emergency and operating rooms. For psychedelic journeys or mood disorder treatments, sub-anesthetic doses of Ketamine that are a fraction of what would be administered to an infant during a surgical procedure are given. When administered at these very small doses, Ketamine allows the patient to experience different planes of consciousness in a similar manner to other classical psychedelic medicines. Often, it provides for “ego dissolution” which is viewed by many psychiatrists and other mental health practitioners, as the doorway to healing.
Ketamine is generally considered safe when administered in a clinical environment by medical professionals. Ketamine is contraindicated for individuals with diagnosed or suspected psychiatrically unstable conditions. Increases in blood pressure and heart rate can occur but rarely require any medical intervention at sub-anesthetic doses. Also rare at subanesthetic doses are slowed breathing and hypercapnia (elevated carbon dioxide levels in the blood) (Tyler et al., 2017).While dissociative, or “psychedelic”, properties may be present even at low doses, a number of studies point to these experiential components as positive mediators of the molecule’s antidepressant effects. Indeed, research on psychedelics such as Ketamine (and psilocybin) suggests that the experiential components of the treatment may be integral to enhancing and sustaining clinical outcomes (Luckenbaugh et al., 2014).
According to research studies, infusions of Ketamine to treat depression can be effective for 70-80% of individuals. Although the effects of Ketamine usually last for several weeks, some people can remain depression free for months. We believe that success rates increase dramatically when patients come into their infusions with proper preparation, specific intentions and when they follow their infusions with ongoing psychiatric care.
There are four main ways of administering Ketamine: (1) intravenously (IV), (2) intramuscularly (IM), (3) via lozenge, and (4) intranasal spray (often referred to as Spravato). At Nushama, we primarily use IV as we believe this is the most efficacious and safest method. For group therapy, we do IM which is a close second in efficaciousness but is slightly more flexible in terms of administration in group settings.
While there are four aforementioned ways to deliver Ketamine, only IV and IM have well-studied track record of success. The data, published in hundreds of research papers from the National Institute of Mental Health and many other prestigious medical centers and universities like Yale and Mt. Sinai, have confirmed IV and IM ketamine’s safety and efficacy in treating a multitude of mood disorders like treatment resistant depression, PTSD, major anxiety and others. The safety and efficacy of other forms of ketamine delivery, whether via lozenge or intranasal spray, remain unproven.
With oral ketamine, absorption and the resulting blood levels are highly erratic and unpredictable. When large doses are used at home — unsupervised by a qualified medical professional — safety becomes a serious issue with the potential for disturbing dissociative experiences that cannot be well-managed or treated. Oral ketamine administration at home is not a substitute for the safe and more effective IV administration that can only be found in an office setting with experienced caregivers.
Nasal ketamine absorption into the body can also be quite erratic, leading to unintended consequences and decreased effectiveness. When administered nasally, ketamine is absorbed into arteries in the back of the nose that carry the drug directly to the middle of the pre-frontal cortex which is rich in opiate receptors. This results in a completely different experience than IV ketamine treatments, and leaves patients more prone to repeated use and abuse if allowed for home use.
Our core values at Nushama are:1. Safety: Stringent screening, thoughtful patient preparation, and medically monitored experiences. We will not treat a patient unless it is safe and in the best interest of the patient.2. Science: Focus only on scientifically proven modalities and we use the most efficacious protocol using intravenous administration.3. Experience: Dr. Ocher has been using Ketamine for over 30 years and is one of the most experienced physicians in the world using Ketamine. She has completed over 10,000 infusions with Ketamine alone.4. Access: We believe that this treatment should be available to all regardless of the ability to pay. As such, we will frequently treat marginalized groups in need at discounted or pro bono rates.5. Spiritually informed: Our treatments foster transcendence and inspiration that treat ailments of the spirit as opposed to symptoms. This treatment allows for patients to recognize the power within themselves.
There are 3 general stages to our program, each is important for you to have a safe, meaningful and effective experience:Preparation:This starts well before your actual day of treatment and involves a thorough medical and psychological screening to make sure that Ketamine treatment is safe and right for you. Even if you have worked with psychedelics before, it is normal to feel uneasy before your experience. We will explain in detail what to expect at every stage of your journey, answer any questions or concerns you may have. We want you to be well informed and comfortable during the entire process. - Pre-visit assessment: All pre-visit forms will be available on your patient portal and must be reviewed and signed before an appointment is arranged. If you were referred by you psychiatrist, psychologist, primary care doctor, therapist, or neurologist the clinical team will Review these referrals - If there are any medical concerns, we may ask for a medical clearance from your doctor or if you don’t have one, one of the Nushama doctors may provide this service.- You will be asked to complete standardized depression and other related screening assessments.- Pre-visit mindset work: being in a centered and calm mindset before your journey and thinking about what you want to get out of the experience really helps you have a meaningful and effective journey. We will provide you with a journal and guidance on setting personal intentions and goals. You can review this with a therapist if you work with one. - The week prior try to avoid negative, scary, dark movies, news, TV, social media content. Going into the journey with a clear and positive mindset will help your experience and focus on your own inner challenges - and not be distracted by others’ challenges - real or fictional. - Avoid red meat 1 day prior to the treatment.- Avoid all solid food and caffeine 4 hours prior and all liquids 1 hour prior to your visit. This helps reduce the chance of nausea during treatment.- Do not drink alcohol or use medicinal marijuana 48 hour before the treatment.- Avoid taking any stimulants (such as Adderall, Vyvanse, Ritalin, Concerta) on the day of treatment to avoid unnecessary agitation or increase in your blood pressure- Avoid benzodiazepines (such as lorazepam, clonazepam, alprazolam) on the morning of treatment unless absolutely necessary. This may diminish the effectiveness of ketamine.- Continue taking all your medication as you normally would, other than those mentioned above. Diabetic medications such as insulin should be dose adjusted based on dietary intake that day. This will be discussed prior to your visit.The treatment / journey:Before treatment: (0-15 minutes) After your initial check in, you will be assigned a guide who will work with the doctor to help you through your journey and answer any questions or concerns that may come up during your time at the Nushama clinic. The guide will show you to your suite where you will have time to get comfortable. The doctor will review all your medical information, make sure you are ready for the treatment and describe exactly what you dose and potential admixtures (i.e., other medications that could help with potential side effects) will be receiving and what to expect from the experience. We will then guide you through a 5 minute breathing meditation to help you feel more relaxed and calm before your journey. This is the time to try to really let go of any expectations, fears, even the intentions we prepared. You will be given an eye mask, wireless headphones, carefully selected music and diffused essential oils are used to enhance your experience, if you choose. You will be asked to lie flat on the journey bed with a blanket. The nurse will then come to insert the intravenous catheter. Please let us know if you have a fear of needles before so we could take measures to help you through this. You will always be monitored to make sure you feel comfortable, safe and supported throughout your entire experience at Nushama. We will check your blood pressure, pulse, oxygenation level, and temperature before we start. Depending on these readings and your medical history, we may check your blood pressure periodically or connect you to a heart monitor during your experience.The experience: (45-60 minutes)Once you are comfortable, we will connect the Ketamine solution and begin the infusion. The benefit of an IV infusion is that it is given as a gradual drip which can be adjusted at any time should you become uncomfortable or stopped if you request that we do so. The effects of the infusion usually can be felt within a few minutes. Every person has a slightly different experience and the experience itself can change during repeat infusions. Initially you may feel deeply relaxed, calm, a heaviness in your body, a change of your usual sensations. You may experience different colors or visual patterns. This may be followed by a separation from your usual state of thinking, and it may feel like you are awake but on a different plane of consciousness. You may feel a separation from your body and your verbal expression may become limited. Some patients may revisit people, places, or events from their past. There tend to be three general responses to the infusion: You don’t feel like much has changed: at lower doses, some don’t feel much different. You may feel more relaxed, at ease, calmer. Just because you don’t have a typical ‘psychedelic’ experience does not mean it is not helping to improve your condition. You feel great, the best you’ve felt in years: you feel like you’ve had a couple of drinks, disinhibited, relaxed, and slightly euphoric. Everything feels lighter.You’ve never had an experience like this before. A more ‘psychedelic’ or ‘spiritual’ experience, you may feel separated from your body, a deep connection with others. You may have vivid daydreams (these are not hallucinations but more like dream sequences) where you may receive guidance or messages from those important or unknown to you. At times, these situations may bring up some deep emotions or situations that may be helpful to letting go of past traumas. We do not see any of these altered experiences as side effects but an expected and important part of your healing process. Some may experience ‘breakthroughs’ after the first journey, with a rapid relief of dark, depressive, obsessive thoughts. These effects may last hours to weeks. Most often a series of treatments are needed for longer lasting effects. Depending on your response, the dose of Ketamine will likely be adjusted as you progress through subsequent treatments.Immediately following the treatment: Once the infusion is over, the unusual sensations fade gradually over the next 20 minutes. Occasionally patients may feel a little nausea or dizziness, which is relieved with time and can also be treated with medications if appropriate. We will allow you to rest and when comfortable your guide will have you slowly sit up and offer you an herbal tea. You may feel a bit groggy. Your coordination may not be back to normal. This may be a good time to discuss with your guide or if you prefer to journal what you recall from your journey. This may help you make sense, reflect, integrate these experiences into your healing process. Once you are comfortable and the Nushama team feels it’s safe for you to leave, we will contact your chaperone to help you get home safely.You should not drive any motorized vehicle, bike, scooter. Take it easy. Have a light meal if you are hungry. Avoid alcohol. After having a good night's sleep, you should feel refreshed and back to (your hopefully ‘new’) normal. Integration and After CareThis is where some of the real work starts and can be more important than the journey itself. Integration is a process of reflecting on what you experienced during your journey, trying to extract the messages, find their meaning and then come up with a plan to apply these to your life moving forward. This work begins soon after your journey and should be a continuous process moving forward. Without this reflection and work, the effects of these journeys can be like a dream, simply fade away over time. We are looking for permanent transformation back to your true inner self. This can awaken your inner healer, freeing you from the limiting beliefs that anchor you to your past and prevent you from seeing your path forward. The Nushama team, with your permission, will be in contact with your integration team, sending them detailed reports from each of your journeys and asking for feedback from your integration process. After each journey you will receive periodic psychological assessments through your patient portal so that we could see how well the treatments are working for you. We will use this information together with feedback from your integration team to determine what treatment path is best for you moving forward. When we emerge from our journey - we may feel awakened to a new version of ourselves- one more aligned with who we truly want to be. We should work on making changes not only in how we see ourselves but also how we treat our new self - consciously and physically. This means treating ourselves with more love - eating healthier, exercising more, starting a meditation practice, finding a spiritual path, forgiving others, keeping a gratitude journal. Making small changes in the way we live our lives can help solidify the new thought patterns we have acquired in our journey. Ketamine treatment is only an opening, we need to continue the work to make the changes we want to see last.
No, any licensed mental health care professional or physician can refer you. You may also come to us directly and, assuming you have no contraindications or conditions that would make you ineligible, you can go through a course of infusions.
Nushama sees patients as young as 15 years old.
Dr. John Krystal, chief psychiatrist at Yale School of Medicine and a leading ketamine researcher referred to Ketamine as the “anti-medication” medication. He explains that “with most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take Ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes the effect.”Standard antidepressants work on the ‘monoamine’ neurotransmitters (serotonin, norepinephrine and dopamine). Ketamine has wide ranging effects in the brain, affecting multiple neurotransmitters (neurotransmitters are often referred to as the body’s chemical messengers.) systems and pathways that help regulate mood, memory and attention. It plays an essential role in how we learn, remember and respond to our life experiences. Ketamine’s main effect is on glutamate, the most common messenger in the brain. It modulates and creates balance between excitation and inhibition. Studies have shown that through these effects Ketamine helps stimulate a process in the brain called neuroplasticity. Simply, this is a process where neurons in the brain ‘rewire’ - break old connections and create new ones. Depression, anxiety and other mental health issues often arise from past experiences or traumas, that cause certain fixed nerve connections in parts of the brain that regulate our emotions. Over time we get entrenched in these painful thought patterns and Ketamine helps us ‘let go’ and rewire these painful neural connections into healthier and happier ways of thinking. Ketamine is considered a dissociative form of anesthesia. This means it causes a separation or disconnection from how we normally perceive ourselves and the world around us. The effects and sensations, how fast you feel them and how long they last depend on how Ketamine is given (IV, IM, oral), the dose, as well as your prior experience with Ketamine or other psychedelics. As mentioned, dosages used in our treatment are far lower than that used for anesthesia. At these lower doses you will generally be in control, aware, awake and able to express how you feel. Although it is best to remain lying down comfortably during the treatment, you will be able to get up, with assistance, if you feel you need to move or go to the bathroom. The onset of action and how long the experience lasts is quite consistent: the medication starts to work within a minute for the IV route, 1-5 minutes for the IM route, less than 15 minutes for the sublingual route, 30 minutes for the intranasal route. These effects are short lived generally lasting 45-60 minutes before you start to return to your usual state of mind.
We focus on using evidence-based research to administer and treat our patients with ketamine infusion therapy. Our primary focus is to help treat mental illness and provide an option to those who have not had success with traditional medicines or psychotherapy. Promising data has demonstrated robust effects in treating severe, chronic, treatment resistant depression. Thus, anyone diagnosed with major depression, bipolar depression, postpartum depression, or dysthymia could benefit from Ketamine infusions. Research has also shown that Ketamine can also be effective in treating Fibromyalgia, post-traumatic stress disorder (PTSD), and suicidal ideation. In addition, ketamine shows promise in alleviating symptoms of obsessive compulsive disorder (OCD), alcoholism, opioid addictions, eating disorders, and a number of anxiety disorders.
Yes. If you are experiencing the following: Uncontrolled high blood pressure (hypertension); Unstable heart disease (arrhythmias, congestive heart failure, chest pain etc.); Untreated thyroid disease; Active substance abuse; Active manic phase of bipolar disorder; Active delusions and hallucination symptoms (not on medications or while taking street drugs). If you have any of the above the day of your infusions, you, unfortunately, will not be able to receive your infusion.
Please avoid any kind of solid foods and/or milk for 6 hours prior to your ketamine infusion. You may drink clear liquids (i.e. water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee) up until 2 hours before your infusion. Absolutely avoid alcohol or the use of any illicit drugs. These substances are extremely dangerous in combination with ketamine.
Loose, comfortable clothing. Sweats, workout clothes are appropriate.
Mood disorders treatments require a very low dose, so hallucinations and any uncomfortable side effects that may come with much higher doses are extremely rare. Ketamine has few other side effects.
No. The dose of ketamine you will receive does not cause any loss of consciousness but will make you feel that you are on a different plane of consciousness.
Yes. We have curated a specific playlist to help guide you through your journey. We do not recommend listening to your own music as this can take you into a certain frame of mind that is familiar to you. This therapy is all about taking you into unknown territory of areas of your consciousness that have been suppressed for years.
Once the infusion is over, a Nushama team member will ensure that you are complete “out” of your experience and then will sit down with you to ask you a few questions. This 5-10 minute session is referred to as integration where by you will discuss your key take aways from your journey and what you experienced physically, mentally, and emotionally. This will be generated into a report that will be shared with your referring therapist/physician who will assist in continuing to help you integrate what you learned.
Yes. Absolutely. This is for your safety. We also recommend refraining from operating heavy machinery, avoid watching small children, participating in strenuous activities, or making any major life decisions for at least 24 hours after your infusion.
Prior to your first treatment, we will ask you to fill out a few brief questionnaires that will provide a baseline. We will then follow up after each infusion to determine response. If needed we can adjust the treatment accordingly to maximize benefits and minimize any adverse effects. After the infusion, you may notice positive effects as soon as 30 minutes post infusion but typically improvements begin several hours post-treatment.
The effects of a single infusion typically last up to two weeks. After a series of six infusions, some people could remain symptom free for several months. We also offer the option of a booster infusion (usually administered two months later) included and additional boosters which can be given monthly or a few times per year as needed.
A total of six infusions is recommended within a 3-4 week period in order to maximize the effects of Ketamine. The repair and growth of new nerve cells over time is what can lead to long lasting improvements in symptoms. However, the total length of treatment depends on each individual’s unique circumstances.
We recommend that our patients continue working with their outpatient providers for medication management and/or psychotherapy. If you do not have a psychiatrist or therapist, Nushama can facilitate a referral.
Ketamine, also called "Special K", "Kit Kat", or "K", has been used as a recreational drug and like many pharmaceuticals, can be dangerous if not administered properly under the care of trained medical professionals. Ketamine infusions at Nushama are carefully dosed with a set duration in a soothing setting under medical observation to prevent any risks associated with over-use or abuse.
No, ketamine has been proven safe in humans. It has been used for years as a surgical anesthetic in children and in trauma management. Although it has been abused recreationally at much higher doses as a club drug, there is no evidence that ketamine is addictive. In addition, Ketamine will be administered under medical supervision at subanesthetic doses.
Our package of 6 infusions within a 3-4 week period cost $4000 and includes a seventh booster session (usually administered on an as needed basis two months following the conclusion of the 6 infusions). Insurance can cover infusions if there’s a dual diagnosis of a pain condition but will not if the diagnosis is only for a mood disorder like depression, PTSD, or addictions. We do offer financing plans and please contact our patient care coordinator for more information.
Yes, ketamine infusions are an outpatient procedure. The infusion itself if one hour and it takes 15-20 mins to “come down” from their journey. Then, you are free to relax either in the treatment room or our lounge for as long as practical.
Patients should not take benzodiazepines or any prescribed narcotics on the day of their infusion.
No, there is no need to stop any of the medications you are currently taking.
Three main reasons:1. Comfort with administering the medication: outside of anesthesiologists, few other medical specialists are trained in administering ketamine.2. Awareness of this alternative uses: While ketamine is widely known for its effectiveness in the operating room, many doctors are simply not educated on its success with mental illness and pain management.3. Acceptance of this treatment: In addition to the doctors who are unaware of the full spectrum of ketamine's benefits, there are others who are bound to the traditional model of pharmacology and are not willing to consider alternatives despite the growing evidence.