Active mechanisms of ketamine-assisted psychotherapy: A systematic review

Background: Few studies have evaluated the efficacy of ketamine-assisted psychotherapy (KAP) in the treatment of treatment-resistant depression (TRD) and substance use disorders (SUD). Methods: A systematic review of clinical trials reporting on the efficacy of KAP and discussing mechanisms of action, identified on PubMed and PsycInfo. Results: Five randomized-controlled trials reported on the efficacy of KAP treatment and discussed active mechanisms. Four of the studies treated adults with SUD and a single study treated adults with TRD. Overall, KAP had a significant positive effect on primary outcome measures compared to controls, however, the data is mixed. The study examining KAP for TRD found no benefit. Limitations: Lack of large, replicated clinical trials. No studies actively examining mechanisms of action. Conclusion: Evidence suggests that temporary neural changes caused by ketamine such as n-methyl-D-aspartate receptor (NMDAR) inhibition and increase of synaptic neuroplasticity affect treatment outcomes of KAP. Based on reports of preliminary findings, we speculate that adjunct psychotherapy, changes in perspective, and spir-ituality may also play a role.

Automated summary

This article evaluates the efficacy of ketamine-assisted psychotherapy in the treatment of treatment-resistant depression and substance use disorders. Several clinical trials show that ketamine-assisted psychotherapy has a positive impact on primary outcome measures, although the data is mixed. The mechanisms of ketamine, such as NMDAR inhibition and increased synaptic neuroplasticity, are believed to contribute to its therapeutic effects.