WORKSHOP: A Pragmatic Approach to Ketamine Treatment for the General Psychiatrist
Presenting Author(s): Dr. Atul Khullar, MDD
Co-Author(s): Dr. R. Thomas
Date and time: 25 Mar 2023 from 15:20 to 16:20
Location: Wildrose Salon C
Learning Objectives
- Understand the two major paradigms of ketamine use in psychiatry - resistant mood disorders and ketamine assisted psychotherapy;
- Review the evidence and gain an accurate understanding of the true risks and benefits of ketamine treatments without stigma and bias;
- Discuss accessible and safe models of care to deliver ketamine treatment that follow the new Alberta requirements for psychedelic prescribing.
Abstract
The use of psychedelics in mental health has gained much awareness over the last number of years, with ketamine having the most consistent published evidence as well as being the most realistic for a psychiatrist to prescribe within a medical model.
The majority of current ketamine use is either as a biological treatment to improve mood disorders or to ketamine assisted psychotherapy (KAP). These are very different treatment paradigms, often leading to confusion among psychiatrists, patients and regulatory bodies. In addition, multiple dosing vehicles, enduring popular myths of ketamine usage, previously unregulated private clinics and overzealous media reporting have resulted in significantly inconsistent messaging to psychiatrists, patients and the public. Unfortunately, this has polarized views of ketamine, leading to either excessive use or requirements that both stigmatize and unnecessarily limit access to this helpful treatment in their own way.
This session will briefly review evidence of ketamine in mood disorders and KAP. Newer real life data on the safety and limited abuse potential of ketamine will also be presented. Context with other off label uses in psychiatry that may be less safe and effective will also be provided. Experience with 4 years of consultation with two intravenous ketamine programs and community sublingual and intransal usage will be discussed. New Alberta government requirements for psychedelic prescribing that clearly delineate between the two uses of ketamine will also be introduced. Potential safe, realistic and accessible models of ketamine treatment delivery in conjunction with these requirements will also be explored.
Literature References
- 1. https://www.alberta.ca/external/news/health-fs-psychedelic-assisted-therapy.pdf
- Swainson, J., McGirr, A., Blier, P., Brietzke, E., Richard-Devantoy, S., Ravindran, N., Blier, J., Beaulieu, S., Frey, B. N., Kennedy, S. H., McIntyre, R. S., Milev, R. V., Parikh, S. V., Schaffer, A., Taylor, V. H., Tourjman, V., van Ameringen, M., Yatham, L. N., Ravindran, A. V., & Lam, R. W. (2021). The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 66(2), 113–125.