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

Summary & key facts

Researchers collected every study they could find where people were given ketamine together with psychotherapy for mental health problems. They found 19 studies with about 1,000 people. Most studies showed that adding psychotherapy to ketamine often helped, but the studies used very different types of therapy and ketamine plans. Because the methods were so mixed, we can’t say for sure that adding therapy is better than ketamine alone. The authors say bigger, carefully controlled studies using the same therapy methods and ketamine plans are needed to answer that question.

Key facts:

• The review included 19 studies and about 1,000 people in total.
• Most studies looked at substance use problems, post-traumatic stress disorder, and hard-to-treat depression.
• Researchers found many kinds of psychotherapy were used: individual or group sessions, and some followed a manual while others did not.
• Ketamine doses and the timing of therapy versus drug sessions varied a lot across studies.
• Overall results were mostly positive when psychotherapy was added to ketamine, but the mix of methods makes those results uncertain.
• The authors recommend larger, carefully controlled studies that use the same psychotherapy manuals and standard ketamine plans to know if therapy adds real benefit beyond ketamine alone.

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.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Research Topics Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Clinical psychology Ketamine Law Medicine MEDLINE Political science Psychiatry Psychology Psychotherapist

Substances

Ketamine

Conditions & symptoms

Depression PTSD Substance abuse disorder Addiction or harmful habbits Feeling disconnected from others Sadness or low mood