Resources
Related Articles
Andrade, Chittaranjan - Ketamine for Depression
Dr. Andrade has published a series of 8 succinct and readable articles about Ketamine for Depression and Oral Ketamine for Depression that are foundational. All can be found in the journal Clinical and Practical Psychopharmacology:
https://pubmed.ncbi.nlm.nih.gov/?term=andrade+chittaranjan+ketamine+for+depression
Feifel, David - Safety of Repeated Administration of Parenteral Ketamine for Depression
Dr Feifel reports on the safety of IV treatment of depression in 6,630 patients. Only 1.2% had adverse events serious enough to discontinue treatment.
https://pubmed.ncbi.nlm.nih.gov/32668686
Mathai, David - Toward Synergies of Ketamine and Psychotherapy
Dr. Mathai provides a thoughtful analysis of the origins of KAP and proposes a model for measuring the efficacy of ACT as the psychotherapeutic approach.
Lawlor, Sean - Group Ketamine-Assisted Psychotherapy: Practice and Promise of a New Frontier
Addresses accessibility, assessment, structure and process, dosing, healing in community.
https://psychedelicstoday.com/2021/03/10/group-ketamine-therapy-practice-and-promise/
Sienknecht, Eric; Schwartz, Harvey; Gold, Veronica - Notes from the Frontier: Ketamine-Assisted Psychotherapy (KAP) in Clinical Practice
The founders of Polaris Insight Center present a brief, ground-level view of KAP in clinical practice.
https://psychedelic.support/resources/ketamine-assisted-psychotherapy-kap-in-clinical-practice/
This is the first review of a large data set from Mindbloom.
https://pubmed.ncbi.nlm.nih.gov/35809678/
Witt, Emily - Ketamine Therapy is Going Mainstream. Are We Ready?
A literate and entertaining history of the emergence of ketamine as a treatment for psychiatric illnesses.
Sanacora, Gerard - A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders
Dr. Sanacora presents the American Psychiatric Association’s more conservative position on the safety of ketamine in the treatment of mood disorders.
Importance: Several studies now provide evidence of ketamine hydrochloride's ability to produce rapid and robust antidepressant effects in patients with mood and anxiety disorders that were previously resistant to treatment. Despite the relatively small sample sizes, lack of longer-term data on efficacy, and limited data on safety provided by these studies, they have led to increased use of ketamine as an off-label treatment for mood and other psychiatric disorders. Observations: This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge. While ketamine may be beneficial to some patients with mood disorders, it is important to consider the limitations of the available data and the potential risk associated with the drug when considering the treatment option. Conclusions and relevance: The suggestions provided are intended to facilitate clinical decision making and encourage an evidence-based approach to using ketamine in the treatment of psychiatric disorders considering the limited information that is currently available. This article provides information on potentially important issues related to the off-label treatment approach that should be considered to help ensure patient safety.
Dore, Jennifer et al - Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy
In a seminal article on KAP, Dr. Dore and others describe practices and outcomes in 3 large outpatient ketamine practices.
Currently, ketamine is the only legal psychedelic medicine available to mental health providers for the treatment of emotional suffering. Over the past several years, ketamine has come into psychiatric use as an intervention for treatment resistant depression (TRD), administered intravenously without a psychotherapeutic component. In these settings, ketamine's psychedelic effects are viewed as undesirable "side effects." In contrast, we believe ketamine can benefit patients with a wide variety of diagnoses when administered with psychotherapy and using its psychedelic properties without need for intravenous (IV) access. Its proven safety over decades of use makes it ideal for office and supervised at-home use. The unique experience that ketamine facilitates with its biological, experiential, and psychological impacts has been tailored to optimize office-based treatment evolving into a method that we call Ketamine Assisted Psychotherapy (KAP). This article is the first to explore KAP within an analytical framework examining three distinct practices that use similar methods. Here, we present demographic and outcome data from 235 patients. Our findings suggest that KAP is an effective method for decreasing depression and anxiety in a private practice setting, especially for older patients and those with severe symptom burden.
Krupitsky, E.M. - Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research
A seminal paper from 1997 summarizing the significant improvement of 73 out of 111 patients with Alcohol Dependence whose treatment included ketamine psychedelic therapy.
Abstract - Ketamine is a prescription drug used for general anesthesia. In subanesthetic doses, it induces profound psychedelic experiences and hallucinations. The subanesthetic effect of ketamine was the hypothesized therapeutic mechanism in the authors' use of ketamine-assisted psychotherapy for alcoholism. The results of a controlled clinical trial demonstrated a considerable increase in efficacy of the authors' standard alcoholism treatment when supplemented by ketamine psychedelic therapy (KPT). Total abstinence for more than one year was observed in 73 out of Ill (65.8%) alcoholic patients in the KPT group, compared to 24% (24 out of 100 patients) of the conventional treatment control group (p
Drozdz, Sandra - Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature
This systematic review on ketamine-assisted psychotherapy (KAP) summarizes existing evidence regarding present-day practices. Through rigorous review, seventeen articles that included 603 participants were identified.
The use of Ketamine Assisted Psychotherapy (KAP) can potentially fulfil the unmet clinical need for an effective treatment for multiple complex and often comorbid pain, psychological, and substance use disorders. Ketamine’s demonstrated ability to produce antidepressant and anxiolytic effects likely interacts with the processes involved in psychotherapy, ideally as a conduit for rapid-change, increasing treatment engagement and adherence, building the therapeutic alliance, and lowering defensiveness by providing reprieves from distressing symptomology while inducing transpersonal experiences at higher doses. Continued engagement in psychotherapy after ketamine administration may prolong the often-transient effects of ketamine and allow for the integration of psychological insights into everyday functioning. While at present there is no standard approach to the application of KAP, it is important to prepare and support the patient during ketamine administration and to offer follow-up psychotherapy sessions to maintain positive effects and delay or eliminate relapse. As KAP research continues to evolve, a focus on increasing the duration of positive effects may lead to effective interventions and maintenance programs, improving KAP such that it becomes an effective, long-lasting treatment for complex, resistant, and chronic conditions for people living with pain, mental health, and substance use disorders.
Bennett, Raquel - Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches
The authors use composite clinical vignettes to illustrate different ways of working with ketamine to treat bipolar depression, and discuss a variety of clinical considerations for using ketamine with this population, including route, dose, frequency, chemical mitigators, and adverse events.
Bipolar disorder (type 1) is a serious and chronic psychiatric illness that can be difficult to treat. Many bipolar patients have refractory depressive episodes. Racemic ketamine, a glutamate modulator with prominent dissociate and psychedelic properties, has been demonstrated to have rapid acting antidepressant and anti-obsessional effects which may be useful for treating the symptoms of bipolar depression. Most of the existing research literature on unipolar and bipolar depression has looked at racemic ketamine in the sub-psychedelic dose range given by infusion as a stand-alone treatment (without concurrent psychotherapy). This article expands on the existing research by articulating three different paradigms for ketamine treatment: biochemical, psychotherapeutic, and psychedelic. The authors use composite clinical vignettes to illustrate different ways of working with ketamine to treat bipolar depression, and discuss a variety of clinical considerations for using ketamine with this population, including route, dose, frequency, chemical mitigators, and adverse events. Note that the conceptual paradigms could be applied to any ketamine treatment, with broad applicability beyond bipolar treatment.
This 28-day open-label proof-of-concept trial of daily oral ketamine administration is the first step in evaluating tolerability, potential efficacy, and time to potential efficacy of daily oral ketamine for treating symptoms of depression and anxiety in patients receiving hospice care. To our knowledge, this is the first clinical trial, albeit open-label, wherein ketamine was used to treat symptoms of depression and anxiety in patients receiving hospice care.
This 28-day open-label proof-of-concept trial of daily oral ketamine administration is the first step in evaluating tolerability, potential efficacy, and time to potential efficacy of daily oral ketamine for treating symptoms of depression and anxiety in patients receiving hospice care. To our knowledge, this is the first clinical trial, albeit open-label, wherein ketamine was used to treat symptoms of depression and anxiety in patients receiving hospice care. It is also the first trial to demonstrate the use of oral ketamine administration targeting depression and to demonstrate ketamine’s anxiolytic effects. It also adds to existing published data regarding use of repeated ketamine dosing. A significant improvement in depressive symptoms occurred with oral ketamine at a similar response rate (57%) to other published cases and studies (14%–85%), all of which utilized IV administration in patients with treatment resistant depression that were otherwise healthy;66 however, unlike what was previously demonstrated, this effect was more protracted (occurring over weeks rather than in minutes) and more sustained than found with IV infusions of ketamine ( > 2 weeks). A significant novel finding was a decrease in symptoms of anxiety in 100% of the cases. Few adverse events or increases in somatic symptoms were noted, as has been the case in previously reported trials; in fact, in this study, all somatic symptoms significantly decreased.
Rodriguez, Carolyn - Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept
A randomized, controlled study of the effects of ketamine, a non-competitive NMDA glutamate receptor antagonist, in adults with OCD -- the first paper documenting ketamine's potential efficacy in OCD.
There were three main findings. (1) Participants receiving ketamine first showed significant rapid reduction in obsessions during the infusion that persisted until 1-week post-infusion compared with participants receiving placebo first. (2) Half of participants receiving ketamine first met treatment response criteria at 1-week post-infusion. (3) There were significant carryover effects suggesting that ketamine’s effects on OCD symptoms last longer than previously reported. This is the first randomized, controlled trial to demonstrate that a drug affecting glutamate neurotransmission can reduce OCD symptoms without the presence of an SRI and is consistent with a glutamatergic hypothesis of OCD.
Bonnett, Carl - Intramuscular Ketamine to Treat Major Depressive Disorder: A Case Series of Forty Patients
While the use of ketamine to treat severe depression and post-traumatic stress disorder has been well documented in the literature, fewer studies have investigated the efficacy of Intramuscular (IM) ketamine to treat these conditions.
https://www.sciforschenonline.org/journals/psychiatry-mental-health/JPMH145.php
Methods: This case series included 40 patients with major depressive disorder who received this center’s standard treatment of six IM ketamine treatments. Patients completed the Patient Health Questionnaire (PHQ-9), PTSD Checklist for DSM-V (PCL-5), and the Generalized Anxiety Disorder-7 (GAD-7) before ketamine administration and prior to the sixth session. Results: Forty subjects (19 male, 21 female) participated in the study with a mean age of 36.9 years (range 18-67 years). On the measure of depression (PHQ-9), the mean score showed a 55% reduction, with a Cohen’s d effect size of 1.71 (F=84.4, P< 0.001). Measurement of PTSD (PCL-5) symptoms showed a 51% decrease in mean score, with Cohen’s d effect size of 1.61 (F=73.4, P < 0.001). The Generalized Anxiety Disorder (GAD-7) instrument showed a 51% mean score decrease, with Cohen’s d size effect of 1.63 (F=66.1, P
Jones, Jennifer - Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review
Despite advances in behavioral and pharmacotherapy interventions, substance use disorders (SUDs) are frequently refractory to treatment. Ketamine is a potent N-methyl-D-aspartate (NMDA) glutamatergic receptor antagonist which has been found to be effective in the treatment of severe depression. Here we review the literature on the efficacy of ketamine in the treatment of SUDs.
Methods: A systematic review of the PubMed, Scopus, and ClinicalTrials.gov databases was undertaken to identify completed and ongoing human studies of the effectiveness of ketamine in the treatment of SUDs between January 1997 and January 2018. Results and conclusion: Seven completed studies were identified. Two studies focused on alcohol use disorder, two focused on cocaine use disorder, and three focused on opioid use disorder. Both cocaine studies found improvements in craving, motivation, and decreased cocaine use rates, although studies were limited by small sample sizes, a homogeneous population and short follow-up. Studies of alcohol and opioid use disorders found improvement in abstinence rates in the ketamine group, with significant between-group effects noted for up to two years following a single infusion, although these were not placebo-controlled trials. These results suggest that ketamine may facilitate abstinence across multiple substances of abuse and warrants broader investigation in addiction treatment. We conclude with an overview of the six ongoing studies of ketamine in the treatment of alcohol, cocaine, cannabis, and opioid use disorders and discuss future directions in this emerging area of research.
© 2023 by DMVKTC.
