RESEARCH
Welcome to Daydream MD!
We are honored to be a part of your healing journey, please read the following information as it is valuable in making your experience with the medicine safe and meaningful!
Our aim is to cultivate a safe and comfortable environment for you to journey inward and connect with your own inner healing intelligence. Ketamine therapy targets a novel chemical system in the brain to affect structural change in the form of new and stronger connections between nerve cells, a process termed synaptogenesis. These new connections allow the brain to engage centers with more sophisticated processing capabilities when presented with problems or stress. Engaging these higher cortical centers during thought processing is called neuroplasticity. Neuroplasticity allows for new perspectives to be taken on old habits, thought loops, and issues, as well as an increase in ability to process trauma.
It is our view that ketamine, while a powerful medication, does not in and of itself cause a life-changing transformation after a session or two. Ketamine opens a window of transformation that can be utilized to evoke profound change and healing. Ketamine creates new pathways of nerve connections that allow for negative, ruminative thought patterns to be replaced, but it is up to you to fill these paths by connecting with any of a variety of healing practices including talk therapy, meditation, nervous system regulation, journaling, yoga, sound baths, art therapy, ecotherapy and many more. We recommend ketamine assisted therapy and/or ketamine integration therapy to all of our clients, if they are able. We also support any community integration that may already be a part of your mental health support system.
Please contact us at (619) 937-2055 if you are curious to know more about our integrative therapeutic offerings.
Daydream MD shares space with LifeForce Chiropractic at 3455 Ingraham Street. San Diego, CA 92019. If you see big white letters on top of a building that read “chiropractor” you’re in the right spot!
Day prior to the experience:
Reflect on what it is that you are seeking from ketamine treatment. Try your best not to focus on an outcome, but rather some knowledge that you hope to gain by turning inward toward your subconscious self-association.
Eat foods that you know to “agree” with your constitution, and hydrate!
Develop a plan for transportation to and from the clinic
**Absolutely no driving for a minimum of three hours after discharge from the clinic**
We recommend that you abstain from alcohol, marijuana, and other intoxicants, including prescribed benzodiazepine medications, on the day prior to your journey, if you are able.
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Benzodiazepine medications compete directly with the synaptogenic properties of ketamine. While these medications do not cause concern for safety in combination with ketamine, we strongly encourage you to take a 24-hour holiday from them prior to ketamine dosing. Benzodiazepine medications include
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Alprazolam (Xanax)
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Diazepam (Valium)
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Clonazepam (Klonopin)
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Lorazepam (Ativan)
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If you have questions or concerns about medication recommendations, please send them to medicalteam@daydreammd.com
Day of the experience:
If this is your first experience with ketamine, please abstain from solid foods for three hours and liquids for one hour prior to your appointment time.
If it is your second treatment or later, and you did not have a nauseous reaction to your previous treatments, you may eat lightly up to three hours prior and drink up to 90 minutes prior to appointment start time.
Wear loose-fitting, comfortable clothing to the clinic. If you will be getting treatment via intramuscular (IM) injection, please wear clothing that will make it simple to expose a shoulder for medication administration.
We encourage you to bring an item of meaning with you to the session to assist in setting the energy of your journey. It can be something that you place near to you or something to hold. Additionally, we welcome you to bring a blanket or pillow that you find especially comfortable with you on the day of treatment.
When you arrive:
If the infusion room is still being set up, please wait in the front lobby area and begin some interpersonal grounding exercises (see below).
Once the room is ready you will be invited into the space by one of our nursing staff.
**Ketamine stimulates the bladder muscle. We highly recommend using the restroom before starting your treatment session. Having the urge to pee during the journey can be very distracting and uncomfortable, something to avoid!**
Have a seat in the reclining treatment chair. While the nurse takes your vital signs and starts to set up, start to dial in your physical comfort (temperature, pillows, whether you would like your shoes on or off, any bits of clothing that are itching, poking, or prodding).
You and the nurse will then have a conversation regarding your ketamine dose for that session, as well as any need for anti-nausea medication pre-treatment.
Ketamine dosing is unique to each person from session to session, to be discussed in detail at the end of this document
Nausea is the most common side effect of ketamine treatment, affecting 10-15% of clients (especially those prone to motion sickness). While symptoms are typically mild, they can be distracting during the journey and are easily treated. Zofran is a safe, mild, and commonly used anti-nausea medication that we use as pre-treatment for individuals for whom nausea is an issue.
It is difficult to predict which clients will have a nausea reaction to the medicine prior to their first session. If you are prone to nausea or motion sickness (while in cars, boats, planes etc) we recommend taking 4mg of Zofran sublingual prior to your first session (given by the nurse at the beginning of the appointment). We also have injectable Zofran for more severe nausea reactions.
If you are getting an intravenous treatment, at this point the RN will place an IV in an area that is most comfortable for you. Please let them know if there is an arm or area in which IV placement is contraindicated.
The RN will then set up the prescribed dose for that session, either for intravenous (IV) or intramuscular (IM).
If you are working with a therapist during your session, they may want to take some time after the medical preparation has been completed to do some emotional preparation and grounding prior to medication administration.
The journey:
The non-ordinary state of consciousness elicited by ketamine can take different forms for different people, and for the same individual from session to session. It may be calm and blissful, it may be challenging, it may be both at different points in the journey. It is important to remind yourself that no matter what form the journey takes, you are safe, and meant to feel whatever it is that you feel for the duration of the trip. The main takeaway: There is no wrong way to do it! As your experience with the medicine grows, you will develop a relationship with the ketamine mind-state. For your first session, a curious and open mind is the goal, to be open to what comes without judgment.
Your nurse will leave a pulse oximeter on a finger of your choosing for the duration of the medicine session. This will monitor the effectiveness of your breathing along with pulse rate and rhythm, for safety.
Eye-shades: A ketamine journey is an inward, interpersonal experience (It produces a greater change to your inner world, rather than the world around you). To facilitate this inward journey, we recommend wearing an eye-shade during the experience. This is a suggestion, do what is most comfortable for you!
Headphones: As with the eye-shades, listening to music through headphones (provided, though you may bring your own if you prefer) helps to facilitate an inward journey. We are also able to play the music throughout the room, if you wish.
What does it feel like?
Like any mind-altered state, the ketamine experience is difficult to describe, but it may feel like
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Floating on a bed of energy
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Boundless consciousness, feeling connected to the universe
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Loss of the sense of time, loss of spatial awareness
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You may see colors, patterns, and shapes, you may not
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Many describe a fuzzy or tingling sensation of their lips, tongue, and mouth
The experience will differ based on dose, along with route of administration.
The Intravenous route is delivered through an IV line as a drip over 40 minutes, the sensation of the medicine will increase to a plateau over about 5-10 minutes before leveling off for the remainder of the 40 minutes. When the infusion finishes, the medicine will start to metabolize and you will slowly return to your body. This takes about 10-15 minutes post infusion completion, on average. Think of a plane that slowly climbs to its cruising altitude (about five minutes), cruises (35 minutes), then descends (10-15 minutes).
Because the ketamine mindspace can feel like the passage of time is distorted, your psychedelic nurse or therapist will gently tap your ankle ten minutes after the infusion has finished. This does not mean that the experience is over and you need to come out of your eye-shade and headphones, it is only to offer some reorientation to the current time. If you are at all averse to touch, let your nurse know prior to the treatment and work with them to come up with a different plan for reorientation.
The intramuscular route is delivered as an injection, much like a flu shot. Because the entirety of the IM dose is delivered at once as opposed to dripped in, the “ascent” portion of the experience is quicker, starting as early as 60 seconds after the injection and reaching a psychedelic peak after about three minutes.
The peak experience will last anywhere from 10-20 minutes (varies depending on person and dose), before you will start to drift slowly back to normal consciousness back in your body and space.
This time of gentle descent is a valuable piece of the experience, and we encourage you to stay in a mindspace of inward reflection for as long as it feels productive and comfortable to do so. The nurse will give your foot a tap an hour after injecting the medicine. Again, this is only to assist in the reorientation to time and body, it does not mean that you must stay “in” the mask and headphones for the entire hour, nor that you must come “out” at that time.
Music has a powerful impact on a psychedelic experience. Sometimes referred to as “the other therapist in the room”, the ketamine experience often follows the “flow” of the playlist. To facilitate a personal experience, it is recommended to listen to relatively mellow, flowing music with a variety of tempos and textures and little if any lyrics. Your nurse or therapist will choose the music for your journey with your suggestion/preferences in mind. If you would like to bring your own music and/or headphones to the session you are welcome to do so.
Post session:
You may experience some mild dizziness, visual disturbance (like seeing double), and altered coordination for a brief time (20-30 minutes) after coming out of the medicine, this is totally normal. Take things slow, sitting entirely upright and taking a few deep breaths to get your bearings before standing.
The nurse will take your blood pressure one last time, when you are ready.
After the experience you may be in a heart-opened state and ready to share aspects of your journey, or you may need more time to “unpack” the experience. Both are normal, both are welcomed!
You may find it difficult to articulate the experience into words. This, too, is completely normal.
In an effort to safely and accurately guide your individualized, progressive dosing plan (see below) your nurse will ask you a few questions regarding your experience. This will help inform the dosing plan for future sessions.
You are free to eat and drink now! We have a variety of light snacks to choose from, please inform your nurse of any food allergies.
Just as the medicine experience will look different for everyone, so does the time post-infusion. While there are no absolute “do nots”, other than driving, for the time period after you leave the clinic, we recommend the following activities to maximize integration of the journey into regular consciousness.
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Spend time in nature. Our clinic is surrounded by Mission Bay, a lovely place to sit and reflect!
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Take some protected time to write down some of the feelings, ideas, phrases, or memories that came up during your session. It can be helpful to look back on these notes at a later time.
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Relax and focus on yourself. The ketamine experience is about connecting with and honoring your inner healing intelligence, listen to your body and take what you need!
We have an email monitored daily for any questions or concerns that you may have following treatment. If any arise send them to us at medicalteam@daydreammd.com
The next day: It is very rare that we see much, if any, decrease in depression or anxiety symptoms after a first dosing session. Do not fret if you do not feel like a whole new person the morning after your first treatment. The major effects of ketamine on mental health compounded during a dosing series, it may take three or four sessions before we see robust effects.
Dosing
Our goal is to deliver a ketamine experience that is comfortable, productive, and therapeutic. Be patient, as this may take a couple sessions to “dial in” given the multitude of variables that affect the experience (route, bioavailability, metabolism, experience, relationship with the medication, etc.)
Ketamine works on an entirely different neurotransmitter system than the classic psychedelics (psilocybin, LSD, DMT, ayahuasca, mescaline). Even if you are comfortable navigating a heroic dose of a classic psychedelic, this experience may not translate to ketamine consciousness.
Dosing is based on weight. We view this first encounter with the medicine as a “dose discovery” session. We will then use our knowledge of best practices to guide a conversation on when to increase the dose for future sessions, and by how much, a progressive dosing strategy.
Progressive dosing strategy: Progressive dosing (small dose increases for subsequent treatment sessions) is a strategy deployed in psychedelic therapy to maximize benefit. Our aim is to titrate your dose until we find the treatment experience that is the most beneficial, while remaining comfortable and productive.
If you are coming to us for your first ketamine session, we will start you at a dose near the bottom of the dose “ladder”. This is to facilitate a comfortable first experience, a handshake with the medicine. After each session, you and the nurse will discuss your experience and they will use their expertise to recommend a dosing regimen for your next treatment.
As your relationship with the non-ordinary state of consciousness develops and becomes more familiar, we will recommend small and safe dose increases to facilitate a deeper, more expansive experience.
At some point it may be productive and beneficial to decrease dosing as well. For example, if you find that you are unable to recall large parts of the experience, or the intensity causes pervasive fear or anxiety, a dose reduction is in your best interest. Let your nurse know if you feel like you are unable to remember or “bring anything back” from large portions of your journey.
At some point, you may want to switch from one route to another. Because of the difference in the way ketamine moves through the body after differing routes of administration, finding an equivalent dose from one route to another is not an exact science. We will use our knowledge and experience to recommend doses that we believe will capture the desired effect, and we will work together to secure it.
In our experience, putting undue pressure on having the “perfect” psychedelic journey can hinder having the journey that you are meant for on that particular day. Our staff is trained and experienced in facilitating ketamine journeys and will use that expertise to help guide you into the experience in a safe and comfortable manner.
The ketamine works to produce synaptogenesis and neuroplasticity no matter if the experience is euphoric, challenging, cheerful, or tearful. Trusting in this knowledge can assist in removing some pressure from the details.
If you have any questions or concerns regarding your dosage strategy, please send them to medicalteam@daydreammd.com
Dosing main takeaways
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You are safe. Dr. Azam and our nursing staff commonly give doses of ketamine that are several factors higher in the hospital setting than what we use for mental health or pain indications. We will not recommend a dose that has any potential to do harm
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Your first session is a handshake with the medicine, designed to help facilitate a comfortable “meshing” with the experience
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Any first session, be it first ever or first of a new route, is a dose discovery session, after which you will work with the nursing staff to dial in the dose that is right for you
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Ketamine works as a medicine, regardless of experience. No sessions are wasted, nor unproductive
Term Directory
Window of transformation - Our term for the time during a ketamine treatment course when your thought patterns, self-associations, traumas, and emotions are ripe for reprogramming. Starting hours to days after your first ketamine session, your thinking brain will transform from rigid to a more malleable, influenceable state. Coupling this window with things that challenge your rote thought patterns and habits is key to transformation. Some things that you can engage in to utilize this window.
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Spending time in nature (ecotherapy)
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Meditation
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Talk therapy
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Journaling
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Support groups
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Nervous system regulating practices (grounding techniques)
Ketamine-assisted psychotherapy (KAP) - KAP therapists have completed a training program, beyond their therapist education/credentialing, in leveraging non-ordinary states of consciousness (NOSC) for healing and emotional blockage processing. We recommend KAP to clients that hope to process complex trauma, along with those that are anxious about what the NOSC will bring up. KAP therapists help to prepare for the medicine session, stay with you during the journey, and help to integrate the experience into regular consciousness afterward/in between sessions.
Ketamine Integration Therapy (KIT) - KIT is the term used to define talk therapy engagement in between medicine sessions. For many, ketamine is an inward experience that makes more sense to “unpack” in a therapy session that happens a day or two after the journey. Our KIT therapists have extensive experience using their therapeutic skills to integrate the emotional opening that is elicited by the medicine to help you to weave the insights gained from the window of transformation into your daily life.
Grounding exercises - In short, a grounding exercise is a technique that can be used to bring your awareness into the current space and time, not thinking forward in anticipation nor backward in regret. These exercises also stimulate the “rest and digest” part of your nervous system, helping you relax! The following are a few of many grounding techniques that can be used to settle nerves at any time during the experience.
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Box breathing - Inhale and fill your lungs for a count of four, hold your breath for a count of four, exhale for a count of four, hold with empty lungs for a count of four. Focus on the counting and sensation of your breath.
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Body scan - Start by placing all of your focus on one of your big toes, and take note of as many sensations in that area that you are able. After a few moments, move your focus to the arch of your foot and do the same. Slowly move your focus from place to place in your body and make mental note of the sensations.
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Single point of focus - Find an object that you can hold in your hand, and look to discover as much as you can about the object. The shape, texture, weight, color et cetera. Then, close your eyes and continue to examine the object using only your sense of touch. Can you picture the object with your eyes closed? Is there anything new that you notice about it now that you are unable to see?
These are very basic practices designed to help you regulate your body’s “fight or flight” response and bring you back to a calm state, from which you have a greater ability to process information. This is called nervous system regulation.
We offer an educational series at Daydream MD designed to teach you all about your nervous system, what can cause it to malfunction, and how to regulate it yourself! Please call us if you are interested in learning more about this offering.
Psychedelic Nursing - The role of the nurse in our clinic is unique to any other typical nursing care area. Our nursing staff has the medical acumen to safely administer ketamine in any form for any indication necessitated. Additionally, they are in tune with the emotional vulnerability that comes with a NOSC. They will be there to run the equipment and keep you safe, AND work with you to cultivate a setting of calm and expansive healing.
Community Integration - In this context, community integration is anything that you do outside of Daydream MD that helps to integrate the psychedelic experience into your life. Including, but not limited to:
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Working with your regular therapist
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Talking through the experience with trusted friends and family
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Sound healing ceremonies
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Walks in nature
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Breathwork classes
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Exercise (in a class format, or solo)
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Reiki/Healing Touch
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Float tank experience
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Acupuncture/acupressure
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Massage therapy
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Calling a peer-support specialist at THE FIRESIDE PROJECT
The Fireside Project: A peer-support line staffed by individuals trained and experienced in talking though euphoric psychedelic experiences, challenging experiences, and all in between!
Call or text 62-FIRESIDE (623-473-7433) to speak with them and mention that you are a Daydream MD client!
We hope you find this information helpful in preparing for your experience at Daydream MD.
We cannot wait to get started!
