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• The authors of the Montreal model report that a brief course of ketamine evokes psychological dynamics that resemble an accelerated short-term psychotherapy more closely than a course of electroconvulsive therapy (ECT).
• The Montreal model utilizes concomitant psychotherapy, which allows patients to continue conventional psychotherapy sessions semi-independently of the ketamine treatment process at regular or as-needed frequencies.
• The Montreal model requires patients to engage in at least one hour of weekly evidence-based psychotherapy, beginning at least two weeks before the initiation of ketamine treatments.
• The Montreal model of ketamine treatment integrates neurobiological and psychological benefits, frames psychoactive effects as opportunities for experiential learning, emphasizes the importance of "set and setting," and utilizes subanesthetic dosages of 0.5–1.0 mg/kg with clinicians present and concomitant psychotherapy.
• The Montreal model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, which are administered with psychedelic-inspired nonpharmacological adjuncts such as rolling preparative and integrative psychological support.
• The Montreal model for ketamine treatment seeks to enhance patient engagement in evidence-based psychotherapy by leveraging ketamine's pro-cognitive and anti-suicide effects, as well as the psychological experiences of dosing sessions.
• The Montreal model maintenance phase for treatment-resistant depression (TRD) consists of three forms: medication/neurostimulation, concomitant psychotherapy, and maintenance ketamine treatments.
• The Montreal model for ketamine treatment does not mandate a specific type of psychotherapy, but instead requires the use of any evidence-based approach, such as Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT), that the patient is willing to pursue.
• The Montreal model clinical team observed that ketamine treatment differs from electroconvulsive therapy (ECT) because termination of treatment is a critical consideration in psychotherapy, whereas it is generally only a subject of interest in psychiatry.
• The Montreal model for ketamine treatment preparation involves nine specific goals: (1) establishing a treatment frame, (2) cultivating a therapeutic alliance, (3) psychoeducation and management of expectations, (4) determining behavioral treatment goals, (5) optimizing medications, (6) framing the ketamine experience, (7) trial mindfulness exercise, (8) music discussion, and (9) arranging for concomitant psychotherapy.