Ketamine Assisted Psychotherapy

By Sarah Jones

What is Ketamine?

Ketamine was originally developed as an anesthetic in the 1960s, and while its antidepressant and hallucinatory effects were noted at the time, it became popular for its use in surgeries both in hospitals and as a field anesthetic and analgesic during the Vietnam War. Unlike other anesthetics, Ketamine could be safely administered by fellow soldiers with very low risk of overdose. The psychedelic effects of the drug noted early on were called the “emergence phenomenon”, and ketamine was dubbed a “dissociative anesthetic”.1

Ketamine for Psychiatric Treatment

Ketamine was incorporated in psychotherapy treatments in different countries following the discovery of its anti-depressive effects. In the US, the National Institute of Mental Health (NIMH) began studying ketamine for treatment of depression in the late 1990s, but focused on trying to eliminate the hallucinatory effects as they were seen as undesirable. They soon found ketamine to be very effective in patients with treatment-resistant depression (TRD), or those who’s depression persisted after treatment with 2 or more pharmaceutical drugs, and for acute suicidality1. In the NIMH pharmacologic model, ketamine is administered intravenously in hospital or clinical setting without psychotherapy or integrative support. This model is still used today in most clinics, typically consisting of an induction phase of 4-6 infusions in 2 weeks, followed by weekly infusions.

Since the late 1990s, numerous studies have been conducted using ketamine for treatment of various mental health disorders with very positive results. Ketamine has been studied for use in TRD, PTSD, major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, and in the alleviation of depression and anxiety in patients with terminal illness2,3,4. While few studies have been conducted on long-term effects on mental health symptoms, short-term studies have shown its use to be both safe and effective with few adverse effects.

Ketamine Assisted Pyschotherapy (KAP) Model

While the pharmacologic approach views the psychedelic quality of ketamine as an adverse effect, patient reports have shown that it likely plays a role in its anti-depressive effect. One study found a positive correlation between improvement in depressive symptoms and stronger psychedelic experiences.5 For the last 10 years, practitioners have been using the KAP model, which seeks to use this quality for patient benefit, in combination with psychotherapy. In KAP sessions, Ketamine is administered sublingual or intramuscular, and dose is typically gradually increased over several sessions until optimal effect is reached. As Dore, et al. note in an article summarizing use of KAP in the Journal of Psychoactive Drugs,

“KAP's effectiveness lies in several factors. Depending upon dose, ketamine promotes a time-out from ordinary, usual mind, relief from negativity, and an openness to the expansiveness of mind with access to self in the larger sense. These effects enhance a patient's ability to engage in meaningful psychotherapy during and after administration. Ketamine is potent for respite, analysis, and meditative presence, and potent for recovery from depression and the lingering effects of trauma.”1

Using the Ketamine Assisted Psychotherapy model, the positive psychedelic effects of ketamine are used as a tool to open and deepen the effects of psychotherapy. While few studies have evaluated efficacy of KAP compared to pharmacologic ketamine therapy, case reports and aggregated data from KAP clinics show great benefit for patients with a range of mental health disorders. This approach encompasses a more holistic, patient-centered treatment plan that aims to alleviate suffering by not only offering therapeutic support, but lifestyle interventions and tools to help patients in the long run.

1. Dore J, Turnipseed B, Dwyer S, et al. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy. J Psychoactive Drugs. 2019;51(2):189-198. doi:10.1080/02791072.2019.1587556

2. Schimmel N, Breeksema JJ, Smith-Apeldoorn SY, Veraart J, van den Brink W, Schoevers RA. Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review. Psychopharmacol 2021 2391. 2021;239(1):15-33. doi:10.1007/S00213-021-06027-Y

3. Kritzer M. Ketamine for treatment of mood disorders and suicidality: A narrative review of recent progress. Ann Clin Psychiatry. 2021;(Volume 33, No. 4). doi:10.12788/acp.0048

4. Serafini G, Howland R, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: a systematic review. Curr Neuropharmacol. 2014;12(5):444-461. doi:10.2174/1570159X12666140619204251

5. Sumner RL, Chacko E, McMillan R, et al. A qualitative and quantitative account of patient’s experiences of ketamine and its antidepressant properties. J Psychopharmacol. 2021;35(8):946-961. doi:10.1177/0269881121998321

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