Clinic ketamine-assisted psychotherapy results published

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I’m excited to share my recent publication on ketamine-assisted psychotherapy done here in my clinic in Los Angeles. I partnered with a colleague at Stanford university, Boris Heifets, M.D., Ph.D., to help analyze all the data. It follows patients with depression (and often addiction as well) that I’ve treated over a period of up to 6 years, with combination intramuscular ketamine and psychotherapy that I provided, first in the initial phase of six sessions over a month, and then maintenance phase during this time (approximately monthly). As expected, over time people moved or discontinued treatment, but despite attrition we have enough long term data here to get a look at the good and the bad of ketamine over a long period of time. A few findings and thoughts:

  • ketamine assisted psychotherapy works well: around 80% of people respond, in terms of significant and meaningful improvements in depression

  • tolerance wasn’t a consistent finding; i.e. it continued to work well for many, for years

  • it’s mostly safe: nausea, sedation, and dizziness were most common. A minority of people had emesis (threw up) but anti-emetic medications helped.

  • addiction to ketamine is possible, and can be severe: One person with a history of polysubstance abuse went on to develop a ketamine use disorder, using to excess, losing their job, and suffering a number of other problems. This illustrates the intriguing duality of ketamine as a compound that can both treat depression addiction as well as cause it, and makes the case for keeping such ketamine-assisted psychotherapy as an in-office treatment.

Check it out at the links below. I’ve got a link to the paper as well as video talk I gave on it at the University of Oxford, UK, Ketamine international journal club.

JAMA Psychiatry, "A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders"

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Earlier this month JAMA Psychiatry published a consensus statement on ketamine for mood disorders (such as depression and bipolar depression) jointly written by a number of physicians from prominent academic centers across the United States.  While somewhat conservative in it's interpretation of available data, it is notable that academics who have been historically opposed to the clinical use of ketamine, seem to be gradually coming around and while not concretely endorsing its use, do seem to agree on ketamine being a viable treatment option.  As described in the article, plenty of data exists to support the short-term use of ketamine for depression, but the field is still developing in terms of high quality randomized controlled trials exploring ongoing maintenance treatment.  This is not uncommon in psychiatry--that medication treatments are studied for shorter periods of time--though as the data accumulates in favor of ketamine we will eventually see more such long-term studies.  Until that time, clinical experience, case studies, open label trials, and related treatments (such as maintenance ECT) guide the use of ketamine for maintenance of mood disorders.

YaleNews summary: http://news.yale.edu/2017/03/01/ketamine-eases-severe-depression-questions-dosage-duration-remain

JAMA Psychiatry article: http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2605202