“I’ve Never Seen Anything as Effective”: Exploring the Combination of Psychedelics and Psychotherapy

While most psychedelic drugs remain illegal in the United States, ketamine has been legal for use by registered practitioners since the 1960s. With the recent recognition of the compound’s use as an antidepressant, more and more clinics are rolling out ketamine-assisted psychotherapy programs.

Among the providers in this space is Toronto-based Novamind. Through their networks of Cedar Psychiatry clinics, Novamind recorded more than 20,000 sessions in 2020.

“Ketamine is helpful as a medicine, but there’s so much more to be gained by adding the psychotherapy component,” says Dr. Reid Robison, Novamind’s chief medical officer, in an interview with Technology Networks.

Psychedelic-assisted psychotherapy sees a client undergo work with a trained counsellor after taking a psychedelic substance. While use of psychedelics as a salve for mood disorders is not confined to clinics, as studies of recreational microdosing show, Robison is clear that taking psychedelics with a trained therapist will prove most helpful to people with specific mental health problems to tackle. “For certain conditions, whether it’s substance use disorders, PTSD can certainly unearth difficult things, you need a skilled team on board.  I’m a big fan of ketamine if it's used in the right way, but it can certainly be a nightmare if used in the wrong way.  It can be a godsend if used in the right setting or therapeutic context,” he explains.

But therapy comes in many modalities and formats. These fall in and out of fashion, with cognitive behavioral therapy (CBT) particularly in vogue in 2021.

Robison, however, says that emotion-based and mindfulness therapies are most commonly used in Novamind’s clinics in tandem with ketamine. “We’ve even developed specific ketamine-assisted psychotherapy protocol called EF-KAP, emotion-focused ketamine-assisted psychotherapy.  We did a preliminary pilot study of it for depression and did a full-on clinical trial of it for eating disorders, for anorexia,” he says.

The use of mindfulness therapies is based, Robison says, on previous studies that have shown the benefits of this approach. One study that looked at ketamine’s effect on cocaine addiction showed that over a five-week monitoring period, volunteers with cocaine addictions treated with mindfulness and a single-infusion of ketamine were nearly five times as likely to remain abstinent as compared to people given a similar therapy course combined with a benzodiazepine.                                                                                         

Interestingly, when ketamine was approved by the FDA for treatment-resistant depression as the Janssen brand Spravato, therapy was not part of the equation, either in trial or in approval. Novamind’s clinics offer Spravato treatment as an option, in combination with a strong recommendation to engage with therapy. “Pretty much every dose we’ve given has been covered by insurance or patient assistance programs with leverage for the majority of folks through the manufacturer that makes it quite affordable.  It’s not a cure.  It’s not even a lasting solution for most, but it does seem to be in our experience a very important option that we now have available for people with severe depression or depression with suicidality,” says Robison.

Robison’s team are currently looking at data comparing the treatment potential of Spravato and ketamine and while conclusive findings aren’t yet available, Robison suggests that these drugs should be seen as a “bridge” to help shore up patients suffering from severe depression and get them to a place where they can more effectively engage in psychotherapy.

As much as the current focus is on the legal-to-prescribe ketamine, Robison expects other drugs to enter the scene very quickly. “The first FDA approved medicine plus psychotherapy combination will likely be MDMA.” Robison expects that this non-traditional psychedelic will be approved in the next year or two due to powerful evidence suggesting it can help with the symptoms of post-traumatic stress disorder (PTSD).

“I’ve never seen anything as effective as MDMA for PTSD,” says Robison, who points out that a recent study conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) found that 67% of PTSD patients given MDMA-assisted psychotherapy showed no symptoms after three treatment sessions, as compared to only 32% of those given a placebo.

With these levels of efficacy, soon the bottleneck in treatment might not be available compounds, but the availability of therapists who are able to deliver the treatment. MDMA remains unapproved, meaning that any therapists who undergo training for therapy assisted with the drug will have to wait to practice. Nonetheless, Robison believes that therapists who have the option should take it. “I think if you have the opportunity to participate in MDMA therapy training and the resources, great, go for it.  Having done the training myself, it’s a very meaningful, rewarding process that I feel like gives you new skills as a therapist even above and beyond the MDMA.”  

Reid Robison was speaking with Ruairi J Mackenzie, Senior Science Writer for Technology Networks