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Ketamine is a recognized pharmacological intervention for treatment-resistant depression, as evidenced by its clinical use [1], [2] and its role in specialized therapeutic frameworks like the Montreal model [3], [4]. Research further explores the biological mechanisms [5], [6] and clinical strategies [7], [8], [9] to optimize and sustain the antidepressant effects of ketamine in this patient population.
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The Montreal model: an integrative biomedical-psychedelic ... frontiersin.org 18 facts
claimKetamine is considered a putative psychedelic with several advantages, including a long medical track record, efficacy in treating severe Treatment-Resistant Depression (TRD) and suicidality, treatment sessions that are approximately 75% shorter than other psychedelic therapies, minimal drug–drug interactions, and safety in patients with bipolar affective disorder 1.
accountThe Montreal model was developed over 6 years and based on more than 500 ketamine treatments administered to inpatients and outpatients with severe treatment-resistant depression at two McGill University hospitals.
referenceS.T. Wilkinson, T.G. Rhee, J. Joormann, R. Webler, M. Ortiz Lopez, B. Kitay, et al. published 'Cognitive behavioral therapy to sustain the antidepressant effects of ketamine in treatment-resistant depression: a randomized clinical trial' in PPS in 2021.
claimThe Montreal model is an approach to integrating ketamine into a broader biopsychosocial intervention for treatment-resistant depression, designed to deliver feasible and robust clinical benefits.
referenceMathew et al. (2019) published the ELEKT-D study protocol in Contemporary Clinical Trials, which compares electroconvulsive therapy (ECT) to ketamine for patients with treatment-resistant depression.
referenceBrendle et al. (2022) analyzed the cost-effectiveness of esketamine nasal spray compared to intravenous ketamine for patients with treatment-resistant depression in the United States, utilizing clinical trial efficacy and real-world effectiveness estimates.
claimThe authors of the Montreal model suggest that establishing a 'psychotherapy-grade' therapeutic frame is vital for the safety and efficacy of ketamine treatment, especially when treating treatment-resistant depression (TRD) in patients with comorbidities like personality disorders.
claimThe Montreal model clinicians suggest that the psychological processes underlying psychedelic ketamine experiences are not specific to ketamine or Treatment-Resistant Depression, but may arise in any therapeutic situation where a patient receives a powerful psychoactive drug with psychological accompaniment.
measurementIn a cohort study of treatment-resistant depression (TRD) patients receiving ketamine under the Montreal model, all patients were willing to attempt benzodiazepine receptor (BZDR) discontinuation, nearly all achieved total abstinence during treatment, and the majority remained BZDR-free after an average follow-up of one year.
accountThe Montreal model of psychedelic therapy was evaluated in a randomized controlled trial (RCT) examining the effects of music on ketamine infusions in patients with treatment-resistant depression (TRD).
procedureThe Montreal model maintenance phase for treatment-resistant depression (TRD) consists of three forms: medication/neurostimulation, concomitant psychotherapy, and maintenance ketamine treatments.
referenceMcMullen et al. published a 2021 study in Advances in Therapy regarding strategies to prolong the efficacy of ketamine in adults with treatment-resistant depression.
claimThe antidepressant benefits of ketamine for treatment-resistant depression typically fade within days or weeks of administration.
claimThe Montreal model aims to facilitate experiential learning with ketamine treatments to cultivate engaged, collaborative, and flexible life orientations as a corrective force to the passivity, rigidity, and nihilism commonly found in Treatment-Resistant Depression (TRD).
claimA notable strength of the ketamine clinical literature is the frequent inclusion of real-world treatment-resistant depression (TRD) patients who are often excluded from other clinical trials due to severity and comorbidity.
referenceThe Montreal model is a comprehensive biopsychosocial approach to using ketamine for severe treatment-resistant depression that was refined over six years in public healthcare settings.
referenceThe Montreal model of ketamine for treatment-refractory depression is a biopsychosocial approach developed gradually over years of real-world clinical experiences and research endeavors.
claimThe most common strategy for prolonging the benefits of ketamine in treatment-resistant depression is the readministration of ketamine, despite a lack of evidence regarding the long-term safety, efficacy, and feasibility of this practice.
Effects of psychedelics on neurogenesis and broader neuroplasticity link.springer.com 4 facts
claimMuscat S-A, Hartelius G, Crouch CR, and Morin KW proposed an integrative approach to ketamine therapy in 2021, suggesting it may enhance multiple dimensions of efficacy for treating treatment-resistant depression.
claimHaile et al. (2014) investigated the relationship between plasma brain-derived neurotrophic factor (BDNF) levels and the response to ketamine in patients with treatment-resistant depression.
measurementIn treatment-resistant depression (TRD) patients, non-responsiveness to ketamine treatment is correlated with decreased brain-derived neurotrophic factor (BDNF) levels 7 and 14 days after a single 0.5 mg/kg ketamine infusion.
claimKetamine is a prescriptible treatment for treatment-resistant depression (TRD) in the USA and Israel, with many other countries implementing this treatment, according to Mathai et al. (2020).