Toward specific ways to combine ketamine and psychotherapy in treating depression
CNS Spectrums – June 19, 2019
Source: OpenAlex
Summary
For the Treatment of Major Depression, traditional monoaminergic antidepressants achieve only a 50% remission rate. Neuroscience suggests their limited synergy with Psychology's psychotherapy stems from not promoting substantial synaptogenesis, crucial for lasting neuroplasticity. Ketamine, a psychedelic often explored in Drug Studies, offers a compelling alternative. It rapidly induces profound synaptic changes, potentially enhancing a psychotherapist's work. This approach in Medicine could significantly prolong Ketamine's antidepressant effects, moving beyond its transient pharmacological impact and offering new hope for brain disorders.
Abstract
In major depression, remission rate in response to monoaminergic antidepressant is around 50%. The lack of strong synergies between classical antidepressants and psychotherapy may be due to the molecular effects of classical antidepressants. They modulate synapses but they do not substantially influence synaptogenesis. They also increase brain-derived neurotrophic factor (BDNF). However, for activity-dependent plasticity, BDNF release has to work in concert with activation of synaptogenesis. There has been considerable excitement about ketamine’s antidepressant effect. Ketamine leads to fast changes in synaptic function and plasticity that go well beyond effects of classical antidepressants. As a result, ketamine may turn out to have the capacity to considerably enhance the effects of psychotherapy. Such enhancing effects may become an important clinical indication for ketamine since its purely pharmacological effect is transient. This editorial outlines some mechanistic hypotheses, how Behavioral Activation, Trauma-Focused Psychotherapies and Humanistic Psychotherapy may specifically prolong ketamine’s antidepressant effects.