Do Redheads need a higher ketamine dose during Ketamine Assisted Therapy?

If you are a redhead, you have likely heard or personally experienced some interesting things when it comes to how your body interacts with medication, anesthesia or pharmaceuticals. I have seen this in my psychiatric practice many times. I had a patient come in recently to do a ketamine assisted psychotherapy session. One of their first questions was "Will I need a higher dose of ketamine since I am a redhead and have needed high doses of pain meds and anesthesia in the past." The technical, purely scientific answer is "yes." Yes however only if in a perfect world we were treating a human being in very strict isolated conditions which is absolutely not the reality of the human experience.

‍

The nature of the question becomes the most important element in the art of working with this individual. He is already coming in with a belief, based on lived experience that a higher dose is needed to obtain the result. This is where the art of the work comes in to healing with ketamine therapy sessions.

‍

There are genetic mutations and genes that redheads carry that make them susceptible to needing more of certain types of anesthesia-flurane gas anesthetics used in general anesthesia.

‍

There is no such data for ketamine specifically. Even if there were, it would still come down to the other factors which become as important as any given genetic variation in how one metabolizes ketamine.

‍

I have worked with countless individuals who had very deep introspective psychedelic ketamine experiences on extremely low doses of ketamine and some people needing much higher doses. I have found time and time again it goes back to "set and setting." The holy grail of psychedelic assisted therapy work. This is what dictates the dosage for someone to have a meaningful journey.

‍

Set, or mindset incapsulates the layers of readiness one enters the space with. Lets look at one example in the client I mentioned above. One important way to work with him was allowing him to feel heard and validated that his need for a higher dose was part of his experience. My job was also to continue to cultivate comfort, education and safety around the experience. Education on how the reality of feeling safe, feeling curious, letting go of control and being ready for the experience far outweighed any genetic differences he may carry. Doing this without invalidating his experience was important. Allowing room for starting with a bit of a higher dose to honor his desire, balanced with the knowledge and expertise I brought as well.

‍

‍

In the end he came in, and had a deep experience, held in relationship the entire time by one of our trauma therapists. They did preparation work to create readiness, comfort, safety and curiosity (he came in with a great mindset.) He was comfortable in the space, felt heard, felt confident that we were using a higher dose for him and felt attended to the whole time (great setting.)

‍

All of this had very little to do with the science but with the art of the human experience. So in short, no a dose does not need to be adjusted if you are a redhead but your questions in and of itself will be important to allowing you to feel comfortable dropping in, letting go and exploring within a session.

‍

Michael Yasinski MD, SEP

‍