For people who have tried two, three, or more antidepressants without finding adequate relief, the phrase “treatment-resistant depression” can feel like a door closing. Research from the STAR*D trial suggests that roughly one-third of people with major depression do not respond sufficiently to standard first-line treatments. If you are in that group and you are living in Winchester or the surrounding Shenandoah Valley, Ketamine-Assisted Psychotherapy (KAP) may be worth an honest conversation — and we want to have that conversation with you in full transparency, including about what this treatment is, what it isn’t, and who it may or may not be appropriate for.
What Ketamine-Assisted Psychotherapy Is — and What It Isn’t
Ketamine is an anesthetic medication that has been used safely in medical settings for decades. In recent years, it has attracted significant research attention for its rapid effects on depressive symptoms, particularly in people who have not responded to traditional antidepressants. Unlike SSRIs and SNRIs, which work on serotonin systems and often take four to six weeks to show effects, ketamine acts on the glutamate system and can produce shifts in mood within hours to days.
KAP — Ketamine-Assisted Psychotherapy — is not the same as ketamine infusion therapy. In KAP, the medication is used in conjunction with psychotherapy, creating an altered state of consciousness that many people describe as expansive, introspective, or emotionally accessible in ways that ordinary waking experience is not. The therapeutic work happens both during and around those sessions — in the preparation beforehand and in the integration work that follows.
It is critical to be clear: KAP is not FDA-approved for depression or anxiety. Its use in this context is off-label, meaning it is based on clinical research and professional judgment rather than a formal regulatory approval for these conditions. This doesn’t mean it is unsafe or experimental in a concerning sense — ketamine has an established medical safety profile — but it does mean we hold it carefully and make prescribing decisions on a fully individualized basis.
How Leslie Lartey Approaches KAP at Life Works Winchester
All KAP prescribing at Life Works is handled by Leslie Lartey, PMHNP-BC, FNP-BC — our board-certified psychiatric nurse practitioner. Leslie brings dual training in psychiatric and family medicine, which means she evaluates each potential KAP client through a comprehensive lens: mental health history, physical health, current medications, cardiovascular factors, history with dissociative symptoms, and substance use history, among other considerations. There is no checklist that automatically qualifies someone. The evaluation is genuinely individualized.
Before any KAP sessions begin, Leslie conducts a thorough medical and psychiatric intake. If she determines that KAP is clinically appropriate for your situation, she works in close coordination with your therapy provider to build a preparation and integration structure around the treatment itself. The medication is one element; the therapeutic container is equally important, and arguably more so over the long term.
“I’ve heard ketamine can be misused. Is this safe?”
Ketamine does have abuse potential, and that is something we address directly rather than minimizing. In a supervised clinical setting with proper screening and protocols, the risks are managed carefully. We do not offer KAP to clients with active substance use disorders, significant cardiovascular disease, uncontrolled blood pressure, active psychosis, or a history of conditions that would make the dissociative effects of ketamine dangerous. Discuss with your provider whether your history raises any of these considerations — that conversation is part of the process.
What a KAP Course Typically Looks Like
After preparation sessions with your therapist and medical clearance from Leslie, a typical KAP course involves a series of medicine sessions — the number varies by individual and protocol — followed by integration psychotherapy sessions after each. The medicine sessions themselves are relatively short, typically sixty to ninety minutes, and take place in a carefully designed environment intended to support a sense of safety and openness.
During a session, you may experience shifts in how you perceive time, space, or your relationship to your thoughts and feelings. Many people describe a sense of expanded perspective — an ability to see their patterns, fears, or relationships from a different vantage point. Others experience vivid imagery or emotional release. The experience is highly variable, which is one reason the preparation and therapeutic container matter so much — what you encounter in the session needs somewhere to go.
Integration sessions in the days following each medicine session help you make meaning of the experience and bring insights into your daily life. Results vary by individual, and not everyone experiences the dramatic shifts that are sometimes reported in popular coverage of ketamine therapy. For some people, the effects are subtle and accumulative. For others, a course of KAP produces relief from depression that has persisted for years. We will never promise a particular outcome.
“This sounds intense. What if it brings up something I’m not ready for?”
This is a reasonable concern, and it is one reason we don’t move quickly into KAP with anyone. The preparation process is designed to help you build the internal resources and the therapeutic relationship needed to work with whatever the medicine sessions bring up. If at any point in the process you decide it’s not right for you, that decision is fully yours to make and we will support it.
Who Might Benefit from Exploring KAP
People who have tried multiple antidepressant medications without adequate relief, or who have found traditional therapy helpful but insufficient, or who are living with a level of depressive burden that is significantly impacting their quality of life — these are the kinds of presentations where KAP is most often discussed as an option. It is also sometimes explored as an adjunct for anxiety, PTSD, and existential distress, though again, those are off-label uses and are evaluated individually.
KAP is not appropriate for everyone, and it is not a first-line treatment. It fits best within a broader therapeutic context — which is exactly the kind of context Life Works is designed to provide. Your care here is not a single service but a relationship, and KAP would be one element within that relationship if it is ultimately determined to be right for you.
Frequently Asked Questions
What is the difference between KAP and SPRAVATO®?
SPRAVATO® (esketamine) is an FDA-approved nasal spray for treatment-resistant depression that is administered in a certified healthcare setting under observation. KAP, by contrast, uses oral or intramuscular ketamine and is specifically combined with psychotherapy sessions. Both are available at Life Works Winchester, and Leslie Lartey can help you understand which, if either, might be appropriate for your situation.
How many KAP sessions are typically needed?
This varies significantly based on the individual and the protocol. Some people see meaningful change within a short course; others benefit from a longer series. We discuss realistic expectations at the intake stage and reassess throughout the process.
Will my insurance cover KAP?
Insurance coverage for KAP is limited and highly variable. Many KAP services are paid out of pocket. We can discuss costs and options with you directly — please call our Winchester office at 434-577-8171 for current information.
Can I drive myself home after a KAP session?
No. Ketamine affects coordination and cognition for a period of time after a session, and you must have a trusted person available to drive you home. We will discuss the specific post-session protocols with you during preparation.
What if KAP doesn’t work for me?
This is a possibility we acknowledge honestly. If a full course of KAP does not produce the relief you hoped for, we continue working with you through other avenues. KAP is one tool — it is not our only offering, and we never treat it as the last word in anyone’s care.
Key Takeaways
- KAP at Life Works Winchester is an off-label treatment for treatment-resistant depression, not FDA-approved for this use — we are fully transparent about this.
- All prescribing is handled by Leslie Lartey, PMHNP-BC, FNP-BC, following a thorough medical and psychiatric evaluation.
- KAP is specifically designed to be combined with psychotherapy — the preparation and integration work are as important as the medicine sessions themselves.
- Results vary by individual, and KAP is not appropriate for everyone — a detailed intake determines whether it is a fit for your situation.
- SPRAVATO® is also available at Life Works Winchester as a separate FDA-approved option for treatment-resistant depression.
Conclusion
Treatment-resistant depression is one of the most difficult experiences in mental health — the demoralization of trying things that don’t work on top of the depression itself is genuinely heavy. At Life Works Winchester, we hold space for that reality and offer KAP as one serious, carefully administered option for people who have run out of easier answers. If you want to explore whether KAP makes sense for your situation, contact Life Works online or call us at 434-577-8171. We’re available Monday through Thursday 8:30 AM to 6:30 PM, Friday 9 AM to 5 PM, and Saturday 9 AM to 1 PM — because finding the right treatment shouldn’t require you to rearrange your entire week just to have a conversation.
References
Alnefeesi, Y., Chen-Li, D., Krane, E., Jawad, M. Y., Rodrigues, N. B., Ceban, F., Di Vincenzo, J. D., Meshkat, S., Ho, R., Gill, H., Teopiz, K. M., Cao, B., McIntyre, R. S., Rosenblat, J. D., & Lee, Y. (2022). Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review and meta-analysis. Journal of Psychiatric Research, 151, 693–709. https://doi.org/10.1016/j.jpsychires.2022.04.037
National Institute of Mental Health. (n.d.). Depression. https://www.nimh.nih.gov/health/topics/depression
National Institute of Mental Health. (n.d.). Major depression. https://www.nimh.nih.gov/health/statistics/major-depression
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., Sackeim, H. A., Kupfer, D. J., Luther, J., & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905–1917. https://doi.org/10.1176/ajp.2006.163.11.1905
Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., Summergrad, P., & Nemeroff, C. B. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405. https://doi.org/10.1001/jamapsychiatry.2017.0080
SPRAVATO® REMS. (n.d.). SPRAVATO® indication. https://www.spravatorems.com/
Yavi, M., Lee, H., Henter, I. D., Park, L. T., Zarate, C. A., Jr., & Mathews, D. C. (2022). Ketamine treatment for depression: A review. Discover Mental Health, 2, 9. https://doi.org/10.1007/s44192-022-00012-3
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. The services described, including individual therapy, medication management, and Ketamine-Assisted Psychotherapy, may not be appropriate for every individual and should only be pursued under the guidance of a qualified mental health or medical provider familiar with your full history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.