The Promising Future of Ketamine-Assisted Psychotherapy
One month ago, the FDA’s decision not to approve MDMA-assisted therapy for PTSD dealt a significant blow to those of us who have been advocating for broader access to psychedelic therapy. This ruling, while disappointing, highlights the urgent need to focus on transformative modalities like Ketamine-Assisted Psychotherapy (KAP), which remains a viable and effective treatment for many, especially those in underserved communities.
The landscape of psychedelic medicine is complex and often fraught with regulatory challenges. But with nearly 20% of adult Americans —that’s 50 million of us—experiencing a mental illness and an estimated 14.5 million suffering from at least one major depressive episode in 2021, ketamine stands out as a compelling breakthrough modality amid these uncertainties. Unlike MDMA or psilocybin, ketamine is a Schedule III substance. It is federally legal with a long, proven history of safety and efficacy in treating a range of mental health disorders. The National Network of Depression Centers (NNDC) recently endorsed KAP for depression treatment.
This is not just a temporary fix; ketamine is actively changing lives today and is laying the groundwork for the eventual acceptance and approval of other psychedelic therapies. Across the United States, highly skilled doctors and psychotherapists are achieving remarkable results with ketamine, making it an ideal medicine for many who have not found relief through traditional treatments. In particular, it can be a critical tool for treatment-resistant disorders and in reducing suicidality.
KAP research, as shown in this meta-analysis of KAP for PTSD, has shown an average of 69% decrease in PTSD symptoms. We are seeing similar results at Thank You Life, the nonprofit organization that I co-founded to provide financial assistance to underserved populations for KAP treatment: a 60% average symptom reduction of PTSD after KAP treatments, as well as a 53% symptom reduction for both depression and anxiety.
These treatment outcomes are uncommon for mental health and psychiatric treatment. Antidepressants, one of the most common treatments for depression and PTSD, need to be taken daily, yet only seem to provide a 20-30% symptom reduction in real world settings and have up to 50% of their effect attributed to placebo.
But these broad numbers are further complicated when we look at underserved populations. We know that in the U.S., racial, ethnic, economically-disadvantaged, and sexual minority communities are more prone to adverse experiences, which causes a significant disparity in mental health needs and access. This can range from financial constraints to a lack of culturally competent care providers. The clinical model of KAP is uniquely suited to meet the needs of these populations in several crucial ways.
1. Rapid Symptom Reduction
One of the most compelling aspects of KAP is its ability to produce rapid symptom reduction in a few sessions. For individuals suffering from severe depression, anxiety, or PTSD, the prospect of relief in just a few sessions can be life-changing. This is particularly crucial for underserved communities, where mental health issues often go untreated for years, if not decades, and for whom years of talk therapy is not feasible financially or timewise.
2. Local Clinics Enhance Access
The growing network of KAP clinics across the country means that more people can access this treatment close to home. For the underserved in suburban and urban communities, local clinics eliminate the need for costly travel that comes with out-of-country psychedelic retreats and allow patients to receive care within their own communities.
3. Comfort in the Clinical Model
Many people from underserved communities have had negative experiences with the healthcare system. KAP clinics, often led by practitioners trained in cultural competency, work to create a space where patients feel seen, heard, and respected. This approach helps to build trust and makes these communities more comfortable with seeking treatment.
4. Accessibility Through Short Duration
KAP sessions are typically short, often lasting just two to three hours, compared with eight hours for other types of psychedelic therapy, such as MDMA, psilocybin, or ayahuasca. This makes KAP treatment far more accessible to those who cannot afford to take time off work or to travel to a foreign country to seek legal treatment with other psychedelic medicines.
5. Legal and Available Now
Finally, ketamine’s federal legality sets it apart from other psychedelic therapies that, though promising, are still in the process of gaining approval. This means that KAP can be administered now, without the legal uncertainties that surround treatments like other psychedelic therapies like MDMA or psilocybin. For underserved communities, this immediacy is critical. They need help today, and ketamine is available to provide it.
Of course, as with any treatment, KAP is not for everyone, and the tragic death of actor Matthew Perry certainly underscores the danger of the unsupervised misuse and abuse of ketamine. In clinical practice with proper supervision, we rarely see ketamine abuse, as Dr. Phil Wolfson, a prominent doctor in the industry and co-editor of The Ketamine Papers, stated after Mr. Perry’s death.
The mental health crisis is pervasive, and only getting worse. Given the setback with MDMA, KAP treatment provides real hope to those for whom traditional treatments are insufficient. KAP is relieving people’s depression, taking them off the edge of suicidality, and putting PTSD into remission. However, just because KAP treatment is available doesn’t mean it’s financially accessible to many who need it, even if it saves money in the long run.
Ketamine and KAP need championing by our industry leaders, by our clinicians, by our medical and governmental institutions, by our philanthropists, by those who need new options for healing, by those who are affected by the suffering of our loved ones, neighbors, colleagues. In other words, all of us need to urge insurance carriers, employers, Medicaid, and Medicare to cover these treatments.
There are millions suffering, many in underserved communities who are often the last to receive transformative treatments. It’s time to start funding direct patient care. It’s time to start healing the people, together, with treatments that are available now.