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KETAMINE IV INFUSION VS KETAMINE-ASSISTED PSYCHOTHERAPY

Co-authored by Resilience BHS’s Jennifer Montjoy

In general, there are two different approaches with which ketamine is being utilized to treat unremitting mental health conditions. One approach aligns with the traditional biomedical model and is typically offered in ketamine infusion clinics. In these settings, ketamine hydrochloride is administered intravenously (IV) over approximately 40 minutes in sub-anesthetic doses (e.g. 0.5mg/kg) [2]. Most, not all, IV ketamine infusion clinics are managed by providers certified in anesthesiology and/or pain management. At these clinics, patients are continuously monitored (e.g. blood pressure is automatically taken every 5 minutes; heart rhythm is monitored with 3- wires attached to the chest using adhesive pads).

Medical technicians, medical assistants or nurses are overseeing the medication administration, and medical equipment that remains chair-side and connected to the client. Patients are discharged approximately one-hour post-ketamine administration. Psychotherapy and psychotherapeutic support are not typically a consideration in IV ketamine infusion clinics. Researchers have reported reductions in depression severity and suicidal ideation using the medicalized approach in randomized control trials; however, the duration of these benefits remain unclear and have been reported as short-term (3-7 days) by most investigators [3].

The other approach is a more interdisciplinary, called Ketamine-assisted Psychotherapy or KAP; whereby, therapists and psychologists, in collaboration with psychiatric providers, work closely with patients during the post-administration or psychoactive phase of ketamine administration. KAP emphasizes integration (i.e. processing insights and employing these in daily life). KAP providers most commonly administer ketamine sublingually and/or intramuscularly; consequently, clients are not connected or tethered to medical equipment during their sessions. Instead, heart and respiratory rates and blood pressure are measured  pre-and post-ketamine administration. This psychotherapeutic approach seems to be growing in popularity as clinicians and patients realize the benefits with concurrent ketamine administration and psychotherapy…