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• The Montreal model of ketamine treatment for Treatment-Resistant Depression (TRD) occupies a middle-ground between biomedical and psychedelic approaches to ketamine administration.
• The 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.
• The Montreal model was developed to create a structured approach to ketamine treatment that is applicable to complex, real-world Treatment-Resistant Depression (TRD) patients and feasible for implementation in resource-limited public healthcare systems.
• The 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.
• The 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.
• In the Montreal model, as patients with treatment-resistant depression improve, treatment goals evolve from evidence-based lifestyle changes to 'committed action' goals that align with an individual's unique values, consistent with Acceptance and Commitment Therapy (ACT).
• The 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.
• The Montreal model for treating patients with treatment-resistant depression (TRD) often involves setting goals such as 20 minutes of daily walking and establishing fixed sleeping hours to address irregular routines and behavioral deactivation.
• In 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.
• The Montreal model clinical team recommends reducing the use of benzodiazepines and related sedatives (BZDRs) for patients with treatment-resistant depression, citing evidence of tolerance, potential harms, and questionable long-term efficacy.
• 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 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).
• The 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.
• The Montreal model of ketamine for treatment-refractory depression is a biopsychosocial approach developed gradually over years of real-world clinical experiences and research endeavors.
• The Montreal model researchers hypothesize that their 'slower-but-steadier' endeavor is better suited to complex patients suffering from severe and chronic treatment-resistant depression (TRD) because the six treatment visits provide multiple opportunities to engage in the treatment process, revisit behavioral goals, and consolidate insights.