Figure 3 - from "Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy"

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**Clinically significant decrease in both HAM-A and BDI after treatment (p<0.0001)** Figure 3. Average BDI and HAM-A scores at baseline compared with follow-up reveal a statistically significant decrease in anxiety and depression with treatment. Intake BDI scores on average fell in the range of moderate depression (20-28) and decreased an average of 11.24 points to mild depression range. Intake HAM-A scores fell in the moderate anxiety category and decreased or average 5.5 points to the mild anxiety category. KAP Significantly Decreases Depression and Anxiety

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Table 2. The ketamine signature. the truth of being, outside of time and space, as if observing our being in different realities. At times, this may be confusing as the experience may be intense with only the observing mind connecting to a sense of self.

Figure 1. Distribution of most common diagnoses in our sample population. At intake, patients underwent a full psychiatric evaluation by licensed mental health providers (MD/NP/therapist teams) who assessed whether patients meet diagnostic criteria according to the DSM-V. Diagnosis are listed: Major Depressive Disorder (MDD), Developmental Trauma (cPTSD), Attention Deficit Hyperactivity Disorder (ADHD), Post Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), Substance Use Disorder (SUD including Alcohol n = 14, Cannabis n = 11, Opioid n = 3, Inhalant n = 3, Cocaine n = 1, Nicotine n = 1, Stimulant n = 1, and Other psychoactive n = 5), Other anxiety disorder (Unspecified, Due to physiological cause, SAD, Agoraphobia, Panic), Other mood disorder (Bipolar Disorder, Unspecified, Premenstrual Dysphoric Disorder, Dysthymia).

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Figure 2. The most common side effects seen in our KAP population are nausea, vomiting, and agitation, which occur only in a small percentage of patients undergoing KAP treatment and rarely lead to discontinuation of the treatment.

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Phil Wolfson

Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy

Abstract: 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.

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Abstract: Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail. Results The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. Discussion Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model’s effectiveness and hypothesized psychological mechanisms.

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Glenn Hartelius

Hartelius G, Muscat S-A and Bartova L ( ) Editorial: Bridging the gap: an interdisciplinary perspective on ketamine in psychiatric disorders. Front. Psychiatry : . doi

Abstract: While ketamine has emerged as a promising therapeutic for treatment-resistant depression (TRD) and psychiatric emergencies, including suicidality occurring in the course of major depressive disorder (MDD), several issues pertaining to clinical efficacy remain not fully elucidated. These issues include the role of ketamine-assisted psychotherapy (KAP) in enhancing or prolonging antidepressant effects; the therapeutic value of the so-called psychedelic protocols that value the state-altering properties of ketamine; the therapeutic potential of ketamine as a first-line treatment for MDD, other mood diseases, and potentially other psychiatric diagnoses; and the safety and efficacy of home treatment with self-administered ketamine.

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Michelle Weiner

Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: a pilot study of two approaches

Abstract: Chronic pain and depression diagnoses are skyrocketing. There is an urgent need for more effective treatments. Ketamine was recently established to alleviate pain and depression, but many gaps remain in the scientific literature. This paper reports the findings of an observational preliminary study that explored the efficacy of ketamine-assisted psychotherapy (KAPT) for chronic pain/major depressive disorder (MDD) comorbidity. Researchers evaluated two KAPT approaches to determine optimal route of administration/dose. Ten individuals diagnosed with a chronic pain disorder and MDD receiving KAPT were recruited: five individuals pursuing the psychedelic approach (high doses administered intramuscularly 24 h before therapy) and five individuals pursuing the psycholytic approach (low doses administered sublingually via oral lozenges during therapy). To evaluate differences between altered states of consciousness each approach induces, participants completed the Mystical Experience Quest...

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