Efficacy of Oral Ketamine Combined with Psychotherapy for Treatment Resistant Depression

##plugins.themes.bootstrap3.article.main##

  •   Tatiana Zydb

  •   MIchael Hart

Abstract

Background: Treatment resistant depression (TRD) is defined as a major depressive episode that does not improve in response to at least two trials, each of a different class, of antidepressant medication. Pharmacotherapy of TRD with low dose ketamines has been shown as relatively successful in recent studies. Effects of such pharmacotherapy can be augmented by combining ketamine with psychotherapeutic interventions such as Zdyb’s Therapeutic Reset of Internal Processes (TRIP) protocol.


Method: 10 adult TRD patients (4 men, 6 women) were treated with low dose ketamines and were also receiving psychotherapeutic intervention as per TRIP protocol. All patients were administered the Patient Health Questionnaire, module 9 (PHQ9) which is a measure of a major depressive episode. The PHQ9 was administered twice: on baseline (i.e., prior to treatment) and after the treatment.


Results: On average, our patients fell in the moderate range of severity with respect to symptoms of TRD at baseline (pre-TRIP) as by their mean PHQ9 score of 17.9, (SD = 5.1). Their mean PHQ9 score decreased post TRIP treatment to 9.5 (SD = 6.6): the difference is significant in a t-test, t(10) = 4.3172, p = 0002 (two-tailed). The magnitude of the decrease amounts to 46.9% of the average baseline score.


Discussion and Conclusions: Our patients experienced significant reductions in symptoms of TRD in this pilot study. Research studies are now needed with control groups of TRD patients on a waiting list or also of those receiving only the ketamine pharmacotherapy. 


Keywords: ketamine, psychotherapy, treatment resistant depression, TRIP protocol

References

Kessler RC and Bromet EJ. The epidemiology of depression across cultures. Annual Review of Public Health. 2013; 34: 119-138. doi: 10.1146/annurev-publhealth-031912-114409.

Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. The Psychiatric Clinics of North America. 1996;19(2):179-200. doi: 10.1016/s0193-953x(05)70283-5.

Hart M. and Cernovsky Z. Ketamines for Treatment Resistant Depression in Patients with Chronic Pain and Opioid Use. Archives of Psychiatry and Behavioral Sciences. 2019;2(2):40-42.

RyanWC, Marta CJ, Koek RJ. Ketamine and depression: A review. International Journal of Transpersonal Studies. 2014;33(2): 40-72.

Dore J, Turnipseed B, Dwyer S, Turnipseed A, Andries J, Ascani G, Monnette C, Huidekoper A, Strauss N, Wolfson, P. Ketamine assisted psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy, Journal of Psychoactive Drugs. 2019;51(2):189-198.

Wallach J. Pharmacokinetics and pharmacodynamics of ketamine and related compounds. Paper Presented at the Kriya Conference, The Nueva School. Hillsborough, CA, November 2, 2018.

Greenway KT, Garel N, Jerome L, Feduccia A. Integrating psychotherapy and psychopharmacology: Psychedelic-assisted psychotherapy and other combined treatments. Expert Review of Clinical Pharmacology. 2020;13(6):655-670. https://doi.org/10.1080/17512433.2020.1772054.

Bennett R. Paradigms of ketamine treatment. MAPS Bulletin. 2019;29(1):48-49.

Rosenblat JD, Carvalho AF, Li M, Lee Y, Subramanieapillai M, McIntyre RS. Oral Ketamine for Depression: A Systematic Review. Journal of Clinical Psychiatry. 2019;80(3):18r12475. doi: 10.4088/JCP.18r12475.

Khorramzadeh E, and Lofty A. The use of ketamine in psychiatry. Psychosomatics, 1973;14:344-346.

Krupitsky E, Grinenko A, Berkaliev T, Paley A, Petrov V, Moshkov K, and Borodkin Y. The combination of psychedelic and aversive approaches in alcoholism treatment. Alcoholism Treatment Quarterly. 1992;9, 99-105.

Krupitsky E, and Grinenko A. Ketamine Psychedelic Therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs. 1997;29(2):165-183.

Dore J, Turnipseed B, Dwyer S, Turnipseed A, Andries J, Ascani G, Monnette C, Huidekoper A, Strauss N, and Wolfson P. Ketamine assisted psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of Psychoactive Drugs. 2019;51(2):189-198.

Hasler G. Toward specific ways to combine ketamine and psychotherapy in treating depression CNS Spectrums. 2020;25(3):445-447. doi: 10.1017/S1092852919001007.

Kolp E, Young SM, Freidman H, Krupitsky E, Jansen K, and O’Connor L. Ketamine-enhanced psychotherapy: Preliminary clinical observations on its effects in treating death anxiety. International Journal of Transpersonal Studies, 2007;26(1):1-17.

http://dx.doi.org/10.24972/ijts.2007.26.1.1

Zdyb T. Treatment Protocol for Psychedelic-Enhanced Psychotherapy: Therapeutic Reset of Internal Processes (TRIP) (publication forthcoming).

Souery D, Amsterdam J, de Montigny C, Lecrubier Y, Montgomery S, Lipp O, Racagni G, Zohar J, Mendlewicz J. Treatment resistant depression: methodological overview and operational criteria. Europen Neuropsychopharmacology. 1999;9(1-2):83-91. doi: 10.1016/s0924-977x(98)00004-2.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613.

Downloads

Download data is not yet available.

##plugins.themes.bootstrap3.article.details##

How to Cite
Zydb, T., & Hart, M. (2021). Efficacy of Oral Ketamine Combined with Psychotherapy for Treatment Resistant Depression. European Journal of Medical and Health Sciences, 3(4), 106–108. https://doi.org/10.24018/ejmed.2021.3.4.979