Psychiatrists Utilizing Ketamine-Assisted Psychotherapy

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This article is a response to the article “Doing It Together: Ketamine-Assisted Psychotherapy in a Small Group” by Dinah Miller, MD.

Excellent nuanced points made by Dinah Miller, MD.

I am another doctor who utilizes ketamine-assisted psychotherapy (KAP) in her private psychiatry practice. I believe that for the most part, psychiatrists utilizing KAP come to the practice with curiosity and determination to try to help our patients who struggle chronically and who have, in most cases, tried myriad other pharmacological and sometimes interventional alternatives. I worked as a psychiatrist for over a decade before exploring this treatment modality.

I was trained in KAP in 2020 and entered the training (a 5-day in-person retreat with didactic and experiential components) with a healthy dose of skepticism; even after training, it took me several months to conclude that I wanted to give this a try in my own practice. Almost 4 years later, I can say I am glad I went there. In my practice, 75% to 80% of patients have noteworthy benefit.

While we have little evidence-based data regarding KAP for reasons Dr Miller described, we do have evidence that psychotherapy helps patients, and that the specific type of psychotherapy is less important than the therapeutic alliance. So to my mind, combining a good therapeutic alliance (in a safe and intentional setting, with ample preparation) with the generic form of a medicine we know to be helpful for depression is not a huge clinical or ethical leap; in fact, patients of mine who have done a Spravato protocol and then come to my practice for KAP report that compared with the Spravato REMS protocol, the KAP approach feels like a completely different and much-improved version of treatment. The biggest hurdle here is affordability; like Dr Miller I sit with my patients for the 3-hour sessions and most insurance companies will only reimburse very minimally, if at all, for this non-FDA approved version of ketamine treatment.

The views and practices expressed in these commentaries are solely those of the author and do not necessarily represent the position of Psychiatric Times or its editors.

Dr Schultz is a clinical associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford School of Medicine.