Psychedelic medicine gains momentum in Sonoma County; ketamine clinic returns to Sebastopol

A psychedelic assisted therapy center in Sebastopol that uses ketamine to help people who suffer from depression, suicidal ideation, post-traumatic stress disorder, drug addiction and anxiety has reopened its doors after closing down during the pandemic.

Evolve Mind Wellness opened in 2018, part of a growing trend in behavioral health that foresees wider use of psychedelics to help patients do a deeper dive into psychological issues, said Dr. German Ascani, a psychiatrist and co-founder of the center.

Evolve reopened its doors in November 2021 but celebrated its official open house Saturday.

Ketamine has been around for decades and is mostly known for its use as an anesthetic. But it also has uses treating pain and in palliative care, intensive care and procedural sedation.

“We're using it in a psychotherapeutic context, which means you take the medicine to enhance or catalyze a process of further exploration into the psyche, into the psycho-spiritual world,” Ascani said.

Ketamine is currently the only legal psychedelic substance that can be used by behavioral health professionals for the treatment of psychological and emotional issues.

But Ascani and others involved in ketamine-assisted psychotherapy hope to one day offer therapy services that involve MDMA (or ecstasy) and psilocybin (the psychoactive compound in “magic mushrooms”) once they’re approved by the Food and Drug Administration.

Ascani said the use of psychedelics is simply a different tool that allows people to explore their psyche from a different perspective than traditional forms of therapy or treatment with widely used mental health medications.

“It allows you to be a witness of your own process, Ascani said. “Psychedelics lend themselves well to working with trauma because it gets at a certain somatic experience of self and being … it can be helpful at retrieving memory and reconsolidating memory in a nonreactive way.’’

In traditional therapy, trauma is sometimes reactivated or relived, he said.

Ascani, who got his ketamine training from Dr. Phil Wolfson at the Center for Transformational Psychotherapy in San Anselmo in Marin County, co-founded Evolve Mind Wellness with Celeste Monnette, a licensed clinical social worker who worked as a therapist for about 25 years.

Ketamine doses at Evolve are either given via lozenges or intramuscular injections administered by a physician. Monnette said most people are started off on lozenges, because it’s a more gradual experience.

“It's a nicer way to start because they're kind of still more in themselves, like they start feeling it coming on, we have conversations about it,” she said, adding that injections are faster acting and offer a “stronger, more profound” experience.

Because ketamine is an anesthetic, many people have a relaxing, “gentle experience,” she said, adding that the experience can last between 30 minutes to an hour.

Monnette said she did her first training in ketamine-assisted therapy about four years ago. The training included an “experiential component” that for her was transformative in terms of what the medicine could offer when coupled with psychotherapy.

Monnette soon began working with Ascani at the San Anselmo clinic, and when Ascani left to start a clinic in Sebastopol, Monnette joined him.

“It’s been a really remarkable and exciting experience, and it’s really an interesting kind of work,” Monnette said. “I’m really hopeful in terms of my experience of what it can offer clients … basically reducing suffering.”

The treatment involves a number of sessions that include a 60-minute medical intake, a 60-minute psychological intake, a 60-minute ketamine preparation session, about 2.5 hours of ketamine-assisted therapy, and more. The first treatment costs about $2,075 and $1,200 for subsequent treatments.

Dr. Suegee Tamar-Mattis, a staff physician at Evolve, said most people will need between three to six treatments. The sessions, she said, are an “intensive treatment model.”

“The costs are really about the amount of time spent with the therapist, so you can look at this as paying a therapist over a period of a year, or paying it over the period of 6 sessions in 6 or more weeks,” Tamar-Mattis said in an email.

The cost of treatment is comparable to that of Temenos Center for Integrative Psychotherapy in Petaluma, which opened four years ago and also offers ketamine-assisted therapy.

Jessica McIninch, clinical psychologist and co-owner of Temenos, said an entire treatment protocol, which includes a preparation session, intake and medicine treatment, can cost anywhere between $4,000 to $8,000. But McIninch said the clinic does its best to not deny people service, so if they can’t do a whole protocol they might be given the chance to do portions of it.

Payment at both centers is out-of-pocket, since insurance companies do not yet cover the treatment. McIninch said she welcomed the arrival of the second psychedelic-assisted therapy center — as far as she knows — in the county.

“We're happy to see this work proliferating,” McIninch said. “Many of the people at Evolve are our colleagues, some of them we train together with … Of course, Sebastopol, and Petaluma are near but it's not the same demographic region. We have people who fly from other states to come to get this work.”

McIninch said the treatment at centers like Temenos and Evolve essentially lowers clients’ defenses, “their defensive structures enough to do very deep work.” In traditional therapy, she said, clients are getting reactivated when they talk about their trauma.

With ketamine, McIninch added, people are in a relaxed state of mind where they can more quickly do the work that can take a couple of years in traditional therapy.

“People will call it a game changer often,” she said. “It's the single most effective tool I've had as a psychologist in the 20-plus years I've been doing my work. I can't imagine doing psychotherapy now without it … it’s like going from two-dimensional therapy to three-dimensional therapy.”

Ascani said the Evolve clinic will continue to specialize in comprehensive mental health treatment using psychedelics, as they come online following approval by the federal government.

“Psychedelics are not a panacea or silver bullet yet, he said, but are an “amazing added modality to mental health care that will help many and may destabilize some.”

Evolve founders are hoping to become an expanded access site for MDMA. Tamar-Mattis said the certification process takes some time, but the majority of Evolve’s providers have completed the required MDMA training, and Ascani is involved in MDMA research.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.