Ketamine and psychotherapy for the treatment of psychiatric disorders: systematic review

Abstract

Background Ketamine is an effective short-term treatment for a range of psychiatric disorders. A key question is whether the addition of psychotherapy to ketamine treatment improves outcomes or delays relapse. Aim To identify all studies combining psychotherapy with ketamine for the treatment of psychiatric disorders to summarise their effects and make recommendations for future research. Method The review protocol was prospectively registered with PROSPERO (registration number CRD42022318120). Potential studies were searched for in MEDLINE, Embase, PsycINFO, SCOPUS, the Cochrane library and Google Scholar. Eligible studies combined ketamine and psychotherapy for the treatment of psychiatric disorders and did not use case reports or qualitative designs. Key findings relating to psychotherapy type, diagnosis, ketamine protocol, sequencing of psychotherapy and study design are reported. Risk of bias was assessed using modified Joanna Briggs critical appraisal tools. Results Nineteen studies evaluating 1006 patients were included in the systematic review. A variety of supportive individual and group, manualised and non-manualised psychotherapies were used. The majority of studies evaluated substance use disorders, post-traumatic stress disorder and treatment-resistant depression. Ketamine protocols and sequencing of ketamine/psychotherapy treatment varied substantially between studies. Outcomes were largely positive for the addition of psychotherapy to ketamine treatment. Conclusion The combination of psychotherapy and ketamine offers promise for the treatment of psychiatric disorders, but study heterogeneity prevents definitive recommendations for their integration. Larger randomised controlled trials using manualised psychotherapies and standardised ketamine protocols are recommended to clarify the extent to which the addition of psychotherapy to ketamine improves outcomes over ketamine treatment alone.

Multidisciplinary development of guidelines for ketamine treatment for treatment-resistant major depression disorder for use by adult specialist mental health services in New Zealand

“…There are studies that suggest additional benefits from combining psychotherapy and ketamine treatment for TRD. 27 This evidence base is expanding, but given that moderate-to-large effect size improvements result from oral ketamine treatment for TRD alone, 23 specifying that psychotherapy be required did not appear justified. However, we do require patients receiving ketamine to be managed by SMHS.…”

The rise (and possible fall) of ketamine treatment in New Zealand

“…Researchers in the University of Otago have evaluated the pharmacokinetics and dosing of ketamine, 2 predictors of ketamine response and cross-diagnostic indications for ketamine treatment, 3 and the role of adjunctive psychotherapy. 4 The University of Auckland's research includes a focus on the challenges associated with expectancy and blinding with ketamine and psychedelic research, 5 qualitative aspects of ketamine associated antidepressant response 6 and neuroimaging. 7 A key challenge for clinicians is translating the evidence for ketamine treatment of depression into usual care.…”

Clinical case report: considerable improvement of severe and difficult-to-treat obsessive-compulsive disorder with comorbid depression under treatment with esketamine and concomitant psychotherapy

“…One interesting therapeutic approach that has recently gained momentum is the combination of ketamine treatment with concurrent psychotherapy in order to maximize and prolong the (often only short-lived) clinical improvements brought about by administration of ketamine alone ( 12 , 13 ). Preliminary research indeed supports the idea that psychotherapy before, during, or following ketamine sessions can induce and extend clinical improvements in depression, anxiety, and addiction and further therapeutic rapport and treatment engagement ( 12 , 13 ).…”