When psychiatric medications are not enough,
Ketamine Assisted Psychotherapy can help
... Let the journey begin
What is Ketamine Assisted Psychotherapy?
Ketamine Assisted Psychotherapy --or KAP--is an innovative treatment that combines the off-label use of ketamine for psychiatric disorders with psychotherapy. Ketamine has been used for anesthesia (with FDA approval) since 1970. In lower doses, it can be helpful for depression that has not responded to traditional medications. In combination with psychotherapy, the effects can be powerful.
Ketamine, as a chemical, has an antidepressant effect. It falls under the rubric of psychedelic medicine, and the dissociative state that people experience can open doors that make it easier to talk in psychotherapy, and to facilitate change. After the ketamine experience, there is a period of neuroplasticity -- a 24-48 hour period where old patterns can be unlearned, and new ones can be learned. This can be very helpful in breaking negative thought patterns that fuel depression, such as feelings of inferiority or the sense that other people are better or deserve more. It can also be helpful in breaking behavior patterns or in seeing troubling ideas in a new light.
In addition to it's use for depression, ketamine has shown promise in treating anxiety, PTSD, eating disorders, compulsive behaviors and OCD. While ketamine is safe, it's use for psychiatric disorders is off-label and not evidence-based medicine, so we are only offering this treatment to people who have not had an adequate response to conventional therapies.
KAP is powerful on it's own, but I've found it is even more powerful to take ketamine and have the psychotherapy in a small group setting. Groups consist of 3 to 4 patients along with Dr. Miller and a second group facilitator, Barb Fowler, Ph.D. Dr. Fowler recently retired from working in Human Resources at Johns Hopkins.
Psychiatric disorders can be very isolating, and this treatment is about finding new ways to heal and grow. Ketamine does not work for everyone, but our hope is to provide a transformative experience that catalyzes a journey of change.
This is an individualized treatment where safety is the first priority and the patient's treatment team is consulted to get the best possible outcome.
Dinah Miller, M.D.
I'm a psychiatrist and writer with 30 years of experience helping people to overcome challenges. I have a private practice in Baltimore and have also worked in community mental health centers as both a clinician and an administrator. I am a past president of the Maryland Psychiatric Society. I trained at Johns Hopkins where I continue to supervise and teach residents, and I have a lot of experience with social media. I love new challenges!
Ketamine Assisted Psychotherapy, or KAP, is an innovative way to help people when their antidepressants are just not enough-- symptoms of depression or anxiety are still present, or people are just stuck in life. KAP may not be a cure, but a way of getting out of negative thought patterns, and finding a new perspective.
My groups are 5 sessions-- three of these include the administration of sublingual (under the tongue) ketamine lozenges, that will take you places you have never been.
The group experience is powerful and. group size is limited to 3-4 patients.
This experience is for people looking for ketamine treatment in a safe environment -- I am a physician and I'm present in the room for all of the sessions,.
I have had specialized training in KAP at the Psychedelic Research and Training Institute (PRATI) in Colorado.
Who should and should not have KAP?
Ketamine Assisted Psychotherapy has emerged as a ground-breaking treatment for a number of mental health conditions. People with depression, PTSD, and anxiety disorders who have not had an adequate response to traditional therapies may consider this as an innovative treatment. For those who are entrenched in thoughts or ruminations that leave them stuck, it can be very helpful.
Not everyone is a candidate for KAP. People with uncontrolled hypertension or uncontrolled thyroid disease can not have ketamine. Ketamine causes a rise in blood pressure and heart rate, so people with certain cardiac arrhythmias, a history of stroke, or vascular conditions may not be able to have ketamine safely. Our group does not offer KAP to women who are pregnant or breast-feeding. Anyone who has had a history of addiction to ketamine is exempt. Patients with a history of other substance use disorders may still be candidates for KAP with careful assessment. Ketamine can cause psychosis in people who are predisposed, so
so people with a history of hallucinations, delusions, or disorganized behavior should not have ketamine treatment. Finally, the dissociative state can worsen symptoms in people with severe personality disorders or a history of dissociative disorders.
Certain medications may interfere with ketamine's ability to work
There are 5 group sessions and sublingual ketamine is administered at 3 of the sessions -- all patients must have drivers (not Uber or taxis) for these 3 sessions.
Ketamine will be provided for office use only, at the end of the third session, any leftover lozenges will be melted. By limiting the use to the office under supervision, the risk of addiction or long-term adverse effects are minimal.
For a therapeutic experience, the setting is important, and we do everything possible to provide a comfortable and gentle environment.
It is also important that patients come to treatment with a prepared mindset: you will be asked to make some changes in your lifestyle for the two weeks before the beginning of group. Healthy eating, gentle exercise, adequate sleep, and beginning a meditation practice all help to get the best results.
Our office is only doing Group KAP, I am not taking new patients for ongoing ketamine treatment. If ketamine helps, but the results don't hold, you will be referred for treatment with Spravato, also called esketamine. This is the only FDA-approved formulation of ketamine and it has an indication for treatment resistant depression.
Better living through chemistry still requires better living!
Private Practice and Physician Career Coaching
Dr. Miller is not currently accepting new patients in her private psychiatric practice.
If you are a physician who is interested in career coaching, please contact me for more information.
Fees and insurance
Dr. Miller is not in-network for any insurance plans
Before joining a KAP group, we will have a brief 15 minute phone conversation and I will speak with your psychiatrist/prescriber -- there is no charge for this initial information exchange.
If KAP sounds to be an appropriate treatment, we will have one individual session for further assessment -- you may request an insurance claim to submit to your insurer.
KAP Groups are not covered by insurance and can not be submitted to insurance.
Initial evaluation: $350
KAP Group, 5 sessions with psychiatrist and co-facilitator: $1950 payable by check or Zelle
Ketamine will be prescribed through the Towson Pharmacy, the approximate cost is $70 for all 3 sessions.