Ketamine therapy

Ketamine is a dissociative drug that has been used medically since the 1970s primarily as an anesthetic agent but also for various psychiatric applications. Anecdotal reports and clinical research suggest substantial potential for ketamine as a treatment in conjunction with psychological interventions. Here, we review historical and modern approaches to the use of ketamine with psychotherapy, discuss the clinical relevance of ketamine’s acute psychoactive effects, propose a unique model for using esketamine (one isomeric form of ketamine) with Acceptance and Commitment Therapy (ACT), and suggest considerations for moving medication-assisted psychotherapy forward as a field.

Introduction

Ketamine emerged from the study of phencyclidine (PCP) derivatives suitable for anesthetic use in humans, and its discovery in 1962 is attributed to Parke-Davis Labs and Dr. Calvin Lee Stevens, a professor of organic chemistry at Wayne State University (Domino et al., 1965). Early clinicians recognized ketamine’s dreamlike and hallucinogenic properties, experienced by patients as feeling “disconnected” from their environment, and leading to its classification as a “dissociative anesthetic” (Domino et al., 1965; Reier, 1971). The subjective effects associated with ketamine were observed to be “pleasant” (Domino et al., 1965), and investigators soon began to consider its broader value as an antidepressant and psychotherapeutic agent (Yensen, 1973; Fontana and Loschi, 1974; Sofia and Harakal, 1975). The drug has since been explored for a growing number of psychiatric applications both as a standalone medication and in combination with supportive interventions.