Ketamine Psychotherapy: Treatment Resistant Depression by Will Van Derveer, MD


Tremor resistant depression is very common which affect about 100 million people all over the world. Unfortunately, there have been no new mechanism in Psychiatry since the development of SSRI in the 1980s.

Psychiatry is the only specialty in the world of medicine where the rates of illness significantly increase over time compare to other type of illness.

How does Ketamine play into this scenario? Studies have consistently shown an average of 70% response rate which is much higher than conventional antidepressants available. Although a catalyst, Ketamine, when provided as a treatment does not really address underlying cause but temporarily fix the situation.

Psychotherapy entails a situation in which someone has a thought jail in them and are presented with a door opened. With this Ketamine helps open up people who are stuck and begin to actually execute the lifestyle changes which we know are critical to long lasting well-being to start happening.

FULL TRANSCRIPT:

Treatment resistant depression is common. 100 million people in the world have treatment resistant depression. We really haven’t seen new mechanisms in psychiatry since this 80s. One thing that Thomas Insel has said is that, psychiatry is the only specialty where the rates of the illness are increasing over time. You look at cardiology or oncology, you see big changes in terms of how those specialties are controlling the illnesses that they’re working with and depression is really out of control and we need better tools. In a nutshell, depression can come from anywhere on that map, whether it’s from diet, exercise deficiencies, dysbiosis, food sensitivities, and cold infections, toxic exposures, autoimmune problems, psychological issues like disconnection, spiritual problems, unresolved grief.

The studies on IV ketamine show consistently show a 70% response rate. This is much higher than what you see and study for conventional antidepressants. And the other advantage of ketamine is that, like MDMA, you’re looking at a handful of exposures for most people. We don’t really like the idea of ketamine as a chemical treatment by itself, but we think ketamine is a catalyst. It’s a tool. But when it’s provided as a standalone treatment, and then the person is now getting maintenance, ketamine, it’s a little bit like pumping up somebody’s tire but not patching the hole. You can go down the road for a few days or a few weeks, a few months, and then you’re using the tool again, so I think that should be a lesson to us that we’re not getting to the bottom of things. We’re not addressing what needs to be addressed. And what are the underlying causes.

As a psychotherapist, I do about half of my practice is psychotherapy. I prescribe quite a bit I do a lot of integrative work.The most ideal situation for psychotherapy is someone who has fertilizer in their brain and their rumination or their obsessive locked in thought jail that they’re in has a door that’s open. So we can actually look at what’s going on with them and what are their assumptions about reality. How does reality work? What do they want? Who are they?

Ketamine acts like a catalyst. Its chemical impacts are short lived, but it does open up an opportunity for people who are very stuck, who don’t have any motivation to actually begin to execute on the lifestyle changes that we all know are critical for long lasting well-being  to start to happen Ketamine is not a substitute for the lifestyle changes. So, I’m just going to leave you the question How does ketamine fit into your integrative psychiatry perspective? And we want to encourage you to consider for people who are really stuck, that this can be an amazing opportunity for opening. If you’re not interested in providing ketamine yourself, that’s fine. But get to know people in your community who might be well trained and who are doing ketamine therapy in a safe and effective way.