Guest Spotlight: Ellie Barch, Psy.D. Explains Ketamine Treatment & Ketamine Assisted Psychotherapy
Ketamine Treatment and Ketamine Assisted Psychotherapy: What’s the Difference and Which Might be Right for You?
Ketamine and its derivatives have been getting a lot of hype in the news lately as breakthrough therapies for “treatment resistant” forms of depression, anxiety, post-traumatic stress disorder and other intractable mental health disorders. But understanding the differences in treatments using intravenous (IV) ketamine, intranasal esketamine, and ketamine combined with psychotherapy is key to knowing what form of ketamine (if any) is right for you.
IV Ketamine Infusions: The most studied form of ketamine treatment is the IV model wherein a client receives a series of ketamine infusions over a relatively short period of time (most often 6 sessions within two or three weeks). These sessions occur in a medical clinic where the client can be monitored but they are not typically supported by a therapist. IV ketamine treatment provides relief by temporarily altering the brain’s neurotransmitters which both enhances mood and allows neurons to form new connections. However, critics of this model note that sometimes symptom relief lasts only days to weeks, requiring maintenance infusions which can be costly and time consuming.
Benefits of IV Ketamine: quick acting relief, ketamine can easily be titrated up or down to reach the desired effect, medical monitoring
Drawbacks of IV Ketamine: the most expensive option, a high time commitment over a few weeks, requires follow up care for lasting benefits, not FDA approved
Most Appropriate for: adults experiencing suicidal ideation or other intense symptoms who have been non-responsive to other treatments, those with medical comorbidities
Intranasal Esketamine: The only form of ketamine approved by the FDA, intranasal esketamine (i.e., Spravato) is another standalone treatment for treatment resistant conditions. Intranasal ketamine is self-administered in a physician’s office (typically twice a week for the first month followed by weekly appointments) where the client is then monitored for the next two hours before being allowed to leave. Ketamine in this form works similarly to IV infusions by altering the brain’s biochemistry, however, the research shows that intranasal esketamine is most effective when used in conjunction with an oral antidepressant. Critics of this model cite limitations in insurance coverage due to needing to meet specific criteria, the need for ongoing maintenance care and a less robust treatment response when compared to IV treatment.
Benefits of Intranasal Esketamine: quick acting relief, less invasive mode of administration, FDA approved, possible coverage by health insurance
Drawbacks of Intranasal Esketamine: time commitment, possibly less effective than other forms of ketamine, requires follow up care for lasting benefits
Most Appropriate for: adults who take an oral antidepressant and still have depressive symptoms despite participating in other treatments, short-term use for adults with suicidal ideation
Ketamine Assisted Psychotherapy: Ketamine assisted psychotherapy (KAP) is when a client receives ketamine using any form of administration (i.e., IV, intramuscular, intranasal, sublingual) and works with a therapist to support this process. Some clinics have psychotherapists on site to offer KAP, but often one must seek a therapist in the community for this treatment. In the community, a therapist might refer you to a medical provider to gain a prescription for sublingual ketamine which can then be taken in their office.
In addition to the biochemical changes that accompany ketamine treatment, KAP offers additional psychological benefits that might offer more lasting symptom relief than just ketamine alone. Specifically, ketamine allows for an individual’s psychological defense structures to relax while under its influence which can help one access subconscious material without getting overwhelmed. By coming to understand the roots of their mental health symptoms, clients undergoing KAP make greater treatment gains than seen in typical talk therapy or ketamine treatment alone. Critics of KAP note that the lack of standardization in training for this mode of treatment makes it difficult to assess quality of care, which is particularly important given a client’s increased vulnerability when in an altered state.
Benefits of KAP: facilitates deeper psychological processing, more long-term benefits, possible partial coverage by health insurance
Drawbacks of KAP: potential psychological distress, longer term treatment, lack of standardizations for care
Most Appropriate for: adults who want to understand and work through the roots of their mental health symptoms, adults with ongoing mental health distress despite trying different types of therapy