In this Post
- Ketamine as an Antidepressant
- Cognitive Behavioral Therapy
- Ketamine and CBT
- Ketamine Assisted Psychotherapy
- Determining the Best Option for You
Ketamine as an Antidepressant
Ketamine, originally and currently used as an anesthetic, is on the rise as a safe and effective treatment option for individuals with mood disorders. In subanesthetic doses, ketamine can significantly reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) for many individuals. Numerous clinical studies published in peer reviewed journals, and funded by the National Institutes of Health (NIH) have demonstrated its efficacy as an antidepressant. We go in depth on how ketamine therapy works as an antidepressant in our blog, Ketamine and the Psychedelic Movement in Psychiatry.
Individuals may use ketamine therapy to enhance the effects of the antidepressants they are on, or to try to get to a mental state where they can wean off of antidepressants. In any case, it is important to have a mental health provider to help navigate the different insights and experiences an individual has during their ketamine journey.
We are going to explore two kinds of therapies that are often used in conjunction with Ketamine treatments: Cognitive Behavioral Therapy (CBT) and Ketamine Assisted Psychotherapy (KAP).
Cognitive Behavioral Therapy
CBT was developed in the 1960s by Beck who determined that his patients’ thought patterns and processes were negatively impacting their mental health (6). CBT, now commonly referred to as talk therapy, “involves efforts to change thinking…and behavioral patterns” (1) through different strategies such as “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality…and… learning to calm one’s mind and relax one’s body” (1).
The theory behind CBT is “that inaccurate beliefs and maladaptive information processing (forming the bases for repetitive negative thinking) have a causal role in the etiology and maintenance of depression” (2) and when “maladaptive thinking is corrected, both acute distress and the risk for subsequent symptom return will be reduced” (2).
According to the National Alliance on Mental Illness (NAMI), CBT physically changes brain activity, “suggesting that this therapy actually improves your brain functioning” (3) . According to an NIH meta-analysis, CBT is the “best-known empirically-supported treatment for depression” (2).
CBT has become the mainstay of talk therapy. People with and without mental health disorders use it to gain strategies for coping with life’s difficult situations. Therapists individualize patients’ treatment plans based on their diagnoses. For example, some individuals with more urgent needs are on a weekly schedule, and others who need less support see their therapist monthly.
Ketamine and CBT
Art by Dylan Perez (Age 18)
A small NIH study showed that among individuals with treatment resistant depression (TRD) who responded to ketamine treatments, CBT helped maintain the antidepressant results (5). Because of CBT’s known high efficacy, we highly recommend that our patients undergoing ketamine therapy have a therapist that they trust and can open up to. At Avesta Ketamine and Wellness, and with permission, we communicate with our patients’ therapists to ensure they are receiving the most effective care.
If patients do not have a talk therapy practitioner, we can provide a list of recommended therapists that our patients use and recommend. We are also able to schedule a time with a therapist on site that can provide real time ketamine assisted therapy. Our collaborating practitioners, listed on our resource page, have the appropriate training to do so. What exactly is ketamine assisted therapy…
Ketamine Assisted Psychotherapy
KAP is a new and specialized form of therapy that takes place during ketamine infusions. It involves psychotherapists who have experience with and knowledge about ketamine and its effects on the brain. KAP is effective because “ketamine promotes a time-out from ordinary, usual mind, relief from negativity, and an openness to the expansiveness of mind with access to self in the larger sense. These effects enhance a patient’s ability to engage in meaningful psychotherapy during and after administration“ (4).
A study of 235 patients undergoing KAP used the Beck Depression Inventory and the Hamilton Anxiety Rating Scale to demonstrate that KAP led to a statistically significant decrease in mood disorder symptoms (4).
KAP treatments are designed specifically for the patient. Logistics, like dose of ketamine and length of the session, are determined prior to the session (4). Since it is so new, it is important to find a specialist that you feel safe with and can agree on a treatment plan with prior to your first session. At Avesta, we are able to recommend local ketamine integrative therapists who we work with for those who are interested, and can provide the service at our conveniently located clinics
Determining the Best Option for You
When deciding which form of therapy you want to proceed with during your ketamine treatments, it is important to fully understand your options. Contact us for a free phone consultation with one of our clinicians where we can answer questions you have about our process.
Coauthored, in alphabetical order by: Dr. Ladan Eshkevari, PhD, CRNA, FAAN, and Stephanie Gordon, BA
(1) https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral (2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933381/ (3) https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy (4) https://www.tandfonline.com/doi/full/10.1080/02791072.2019.1587556 (5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516265/ (6) https://www.foundationsrecoverynetwork.com/development-cognitive-behavioral-therapy/
Author Dr. Ladan Eshkevari, PhD, CRNA, FAAN Dr. Eshkevari is the lead clinician at Avesta, and is a long time researcher and educator in physiology, biophysics, and anesthesiology. She is passionate about assisting patients with retractable, difficult to treat mood disorders, and relies on the latest research to bring evidence to Avesta’s practice to better understand and serve patients.
