An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression

Research over the last two decades has established ketamine as a safe, effective, fast-acting, and sustained antidepressant that significantly reduces adverse symptoms associated with depression, even in patients who are treatment resistant. Much of this research has evolved within the framework of...

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Autores principales:	Sherry-Anne Muscat, Glenn Hartelius, Courtenay Richards Crouch, Kevin W. Morin
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	integrative ketamine therapy treatment resistant depression NMDAR modulator normalized brain connectivity induced neural plasticity anti-inflammatory Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/a499c78a4b10447d8cf867dd4fa082f1
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spelling	oai:doaj.org-article:a499c78a4b10447d8cf867dd4fa082f12021-11-30T19:45:15ZAn Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression1664-064010.3389/fpsyt.2021.710338https://doaj.org/article/a499c78a4b10447d8cf867dd4fa082f12021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpsyt.2021.710338/fullhttps://doaj.org/toc/1664-0640Research over the last two decades has established ketamine as a safe, effective, fast-acting, and sustained antidepressant that significantly reduces adverse symptoms associated with depression, even in patients who are treatment resistant. Much of this research has evolved within the framework of several independent branches of scientific inquiry: in addition to the study of ketamine is a non-selective NMDAR antagonist with rapid antidepressant effects, it has also been found effective as a psychoplastogen that stimulates synaptogenesis and increases neuroplasticity, as a powerful anti-inflammatory that may improve inflammation-related depressive symptoms, as a substance that induces beneficial high entropy brain states, and as a subjectively impactful psychedelic agent. Each branch of inquiry has generated independent evidence of ketamine's efficacy but has advanced without substantive coordination or communication with other lines of inquiry. Integrative research that considers these branches of research together may lead toward a better understanding of ketamine's effects and improved treatment protocols and clinical outcomes. Such an overview can inform more comprehensive patient care through: (a) informed patient psychoeducation that encompasses all of ketamine's mechanisms of action; (b) calibration of optimal dosage to ensure induction and maintenance of high entropy brain states during each ketamine session utilizing EEG measurement; (c) Improved management of emergence side effects through proper care for set and setting; (d) inclusion of pre-selected appropriate music to enhance the emotional experience; (e) increased monitoring of ketamine effects on cortical activity, inter-hemispheric imbalance, and inflammation-related levels of cytokines to further improvements in ketamine protocols; and (f) appropriate timing of any adjunctive psychotherapy sessions to coincide with peak neurogenesis at 24–48 h post ketamine treatment.Sherry-Anne MuscatSherry-Anne MuscatGlenn HarteliusCourtenay Richards CrouchKevin W. MorinKevin W. MorinFrontiers Media S.A.articleintegrative ketamine therapytreatment resistant depressionNMDAR modulatornormalized brain connectivityinduced neural plasticityanti-inflammatoryPsychiatryRC435-571ENFrontiers in Psychiatry, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	integrative ketamine therapy treatment resistant depression NMDAR modulator normalized brain connectivity induced neural plasticity anti-inflammatory Psychiatry RC435-571
spellingShingle	integrative ketamine therapy treatment resistant depression NMDAR modulator normalized brain connectivity induced neural plasticity anti-inflammatory Psychiatry RC435-571 Sherry-Anne Muscat Sherry-Anne Muscat Glenn Hartelius Courtenay Richards Crouch Kevin W. Morin Kevin W. Morin An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
description	Research over the last two decades has established ketamine as a safe, effective, fast-acting, and sustained antidepressant that significantly reduces adverse symptoms associated with depression, even in patients who are treatment resistant. Much of this research has evolved within the framework of several independent branches of scientific inquiry: in addition to the study of ketamine is a non-selective NMDAR antagonist with rapid antidepressant effects, it has also been found effective as a psychoplastogen that stimulates synaptogenesis and increases neuroplasticity, as a powerful anti-inflammatory that may improve inflammation-related depressive symptoms, as a substance that induces beneficial high entropy brain states, and as a subjectively impactful psychedelic agent. Each branch of inquiry has generated independent evidence of ketamine's efficacy but has advanced without substantive coordination or communication with other lines of inquiry. Integrative research that considers these branches of research together may lead toward a better understanding of ketamine's effects and improved treatment protocols and clinical outcomes. Such an overview can inform more comprehensive patient care through: (a) informed patient psychoeducation that encompasses all of ketamine's mechanisms of action; (b) calibration of optimal dosage to ensure induction and maintenance of high entropy brain states during each ketamine session utilizing EEG measurement; (c) Improved management of emergence side effects through proper care for set and setting; (d) inclusion of pre-selected appropriate music to enhance the emotional experience; (e) increased monitoring of ketamine effects on cortical activity, inter-hemispheric imbalance, and inflammation-related levels of cytokines to further improvements in ketamine protocols; and (f) appropriate timing of any adjunctive psychotherapy sessions to coincide with peak neurogenesis at 24–48 h post ketamine treatment.
format	article
author	Sherry-Anne Muscat Sherry-Anne Muscat Glenn Hartelius Courtenay Richards Crouch Kevin W. Morin Kevin W. Morin
author_facet	Sherry-Anne Muscat Sherry-Anne Muscat Glenn Hartelius Courtenay Richards Crouch Kevin W. Morin Kevin W. Morin
author_sort	Sherry-Anne Muscat
title	An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
title_short	An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
title_full	An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
title_fullStr	An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
title_full_unstemmed	An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
title_sort	integrative approach to ketamine therapy may enhance multiple dimensions of efficacy: improving therapeutic outcomes with treatment resistant depression
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a499c78a4b10447d8cf867dd4fa082f1
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An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression

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