Episode 46 - The Clinician's Guide to Ketamine Therapy (Episodes from the Vault)
The comprehensive clinical foundation for medical professionals - covering ketamine's evolution, mechanisms, and evidence-based protocols for depression, PTSD, anxiety, and chronic pain treatment.
We're taking a break from our regularly scheduled programming for the holidays to bring you something a bit different: a foundational episode that covers everything you need to know about ketamine therapy in one comprehensive resource.
Sam originally delivered this presentation to the UCLA and Betty Ford Addiction Medicine Fellowship, and it's become one of those episodes that medical professionals, curious physicians, and anyone seriously exploring this field have come back to. It covers ketamine's complete story, from its fascinating medical history to current research and real-world implementation protocols.
Whether you're considering ketamine therapy for your own practice, trying to understand this rapidly evolving field, or just want a solid clinical foundation, this is your starting point. We bridge the gap between academic research and practical clinical application, breaking down complex pharmacology and patient selection in a way that's actually accessible.
This is part of our "Episodes from the Vault" series, bringing back content that continues to serve as a go-to resource for healthcare providers across specialties. For those who may recall, this was originally released as Episode 31. The presentation format lets us go deep on each topic while keeping everything practically relevant for actual clinical decision-making.
This episode is especially valuable if you're evaluating ketamine therapy integration, seeking to understand the evidence base, or looking to enhance your patient education and staff training.
What You'll Learn in This Episode:
Ketamine's journey from battlefield anesthetic to breakthrough mental health treatment
Evidence-based mechanisms of action and clinical research findings
Practical patient selection criteria, dosing protocols, and safety considerations for clinical practice
Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.
Episode 46 show notes:
00:00 - Teaser : Mental health crisis statistics and ketamine's role
00:27 - Introduction to Episodes from the Vault series
01:19 - Sam's presentation introduction and off-label use disclosure
01:52 - Presentation Overview: Three-part structure: mental health/history, mechanisms/studies, patient selection/protocols
02:19 - Part 1: Current State of Mental Health - Depression, PTSD, anxiety statistics and the need for ketamine therapy
04:07 - The Need for More Treatment Options: Healthcare arsenal expansion with ketamine
04:20 - A Brief History of Ketamine: From phencyclidine to FDA approval and Vietnam War battlefield use
09:36 - Part 2: How Ketamine Works - NMDA receptor mechanisms and neuroplasticity effects
12:11 - Types of Patient Ketamine Experiences: Four levels of non-ordinary states of consciousness
14:49 - A Review of Scientific Studies: Yale study through recent research and meta-analyses
22:43 - Part 3: Ideal Patient Selection, Dosing & Scheduling: Contraindications, protocols, and safety considerations
32:33 - Episode wrap-up with YouTube resources, and more
Thanks for listening!
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“Depressive Disorder (Depression).” World Health Organization, World Health Organization, www.who.int/news-room/fact-sheets/detail/depression. Accessed 25 Sept. 2024.
Forster, Peter. “Default Mode Network and Depression Treatment - Ketamine and TMS.” Gateway Psychiatric, 24 June 2021, www.gatewaypsychiatric.com/default-mode-network-and-depression/.
Kolp, Eli & L. Friedman, Harris & Krupitsky, Evgeny & Jansen, Karl & Sylvester, Mark & Young, Matthew & Kolp, Anna. (2014). Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications. International Journal of Transpersonal Studies. 33. 84-140. 10.24972/ijts.2014.33.2.84.
Depression:
Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, Krystal JH. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000 Feb 15;47(4):351-4. doi: 10.1016/s0006-3223(99)00230-9. PMID: 10686270.
Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord. 2020 Dec 1;277:831-841. doi: 10.1016/j.jad.2020.09.007. Epub 2020 Sep 7. PMID: 33065824.
Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med. 2023 Jun 22;388(25):2315-2325. doi: 10.1056/NEJMoa2302399. Epub 2023 May 24. PMID: 37224232.
Jha MK, Wilkinson ST, Krishnan K, Collins KA, Sanacora G, Murrough J, Goes F, Altinay M, Aloysi A, Asghar-Ali A, Barnett B, Chang L, Costi S, Malone D, Nikayin S, Nissen SE, Ostroff R, Reti I, Wolski K, Wang D, Hu B, Mathew SJ, Anand A. Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2417786. doi: 10.1001/jamanetworkopen.2024.17786. PMID: 38916891; PMCID: PMC11200139.
Anxiety:
Glue P, Medlicott NJ, Harland S, Neehoff S, Anderson-Fahey B, Le Nedelec M, Gray A, McNaughton N. Ketamine's dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. J Psychopharmacol. 2017 Oct;31(10):1302-1305. doi: 10.1177/0269881117705089. Epub 2017 Apr 26. PMID: 28441895.
PTSD:
Feder A, Parides MK, Murrough JW, Perez AM, Morgan JE, Saxena S, Kirkwood K, Aan Het Rot M, Lapidus KA, Wan LB, Iosifescu D, Charney DS. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014 Jun;71(6):681-8. doi: 10.1001/jamapsychiatry.2014.62. PMID: 24740528.
Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, Horn SR, Kautz M, Corniquel M, Collins KA, Bevilacqua L, Glasgow AM, Brallier J, Pietrzak RH, Murrough JW, Charney DS. A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. Am J Psychiatry. 2021 Feb 1;178(2):193-202. doi: 10.1176/appi.ajp.2020.20050596. Epub 2021 Jan 5. PMID: 33397139.
Chronic Pain:
Orhurhu V, Orhurhu MS, Bhatia A, Cohen SP. Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2019 Jul;129(1):241-254. doi: 10.1213/ANE.0000000000004185. PMID: 31082965.
Addiction:
Active/Lethal Dose Ratio and Dependence Potential of Psychoactive Drugs. Data source is Gable, R. S. (2006). Acute toxicity of drugs versus regulatory status. In J. M. Fish (Ed.),Drugs and Society: U.S. Public Policy, pp.149-162, Lanham, MD: Rowman & Littlefield Publishers.
Substance Use Disorder:
Jones JL, Mateus CF, Malcolm RJ, Brady KT, Back SE. Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Front Psychiatry. 2018 Jul 24;9:277. doi: 10.3389/fpsyt.2018.00277. PMID: 30140240; PMCID: PMC6094990.
Alcohol Use Disorder:
Ruminski, Emma. “Exeter University Trial Using Ketamine to Break Alcohol Addiction.” BBC News, BBC, 9 Aug. 2024, www.bbc.com/news/articles/c5ylw4wnee8o.