Dose increase – Imagine yourself nearing the end of a therapy session with a client who appears to be on the edge of a breakthrough. They just need a subtle nudge of dissociation to really dig into what has been holding them back for years. You simply press the call button and a CIT Anesthesiologist visits the treatment room with a small 5mg IV bolus of ketamine. Your patient is able to explore the issues further, the session extends 15-20 minutes, and they are able to conclude a successful session that would have otherwise been unachievable had the Ketamine been administered orally or via intramuscular injection.
Dose decrease – Conversely, consider a PTSD patient that you have been working with for years: They are in the midst of a session when their experience begins to darken as past memories are re-visited. You press the call button and a CIT Anesthesiologist arrives to turn down the Ketamine infusion rate and explores the option to administer a small amount of benzodiazepine medication (Versed). A small dose is given, the experience softens for the patient, just enough so that they can continue exploring the thoughts and emotions that just surfaced. Compare this to a dark experience with oral or IM Ketamine whose administration cannot be rescinded.