Integrative Psychiatry

Ketamine in Psychotherapy: Opportunities To Explore by Will Van Derveer, MD

By September 8, 2020 No Comments

Trying to understand the common conditions treated in integrative psychiatry is vital in figuring out what’s really happening and the root cause of treatment resistant depression.

Depression can be described as a cumulative result of multiple missing resources which is why we are having long term impacts of lacking the resources for our health.

The effects of meditation with the Default Mode Network shows during the meditative state different activity and connectivity is present in the DMN specifically the medial frontal and posterior cingulate cortices are relatively deactivated in experienced meditators across all types.

The use of Ketamine has been known to have very specific impact to the DMN. It has shown significant normalization of connectivity between the Insula and the DMN comparing without the controls which had reversals after 10 days of the testing period.

FULL TRANSCRIPT:

I like to think about our conditions, the common conditions that we treat in integrative psychiatry over time and try to understand what’s really happening here. We talk a lot in IPI about treatment resistant depression and the root causes. And as an overall summary, I gave it my best shot to summarize how I think about it at this point. I think depression can be summarized as a cumulative result of multiple missing resources. So these are the long term impacts of lacking the resources that we need for health.

The default mode network is a wandering mind that has negativity bias. So, this is a survival mechanism, this is a mechanism that protects us. This is what has us scanning the environment, scanning our email scanning our text thread scanning Facebook, scanning our families and the faces of the family members we have at home looking for what’s wrong looking for who’s upset at me or what’s not right in this situation.

The default mode network has also been studied in experienced meditators. This study by Brewer showed, that meditation experience is associated with differences specifically the medial frontal and posterior cingulate cortices were relatively deactivated in experienced meditators across all meditation types. The point in bringing up the default mode network in this talk is that the default mode Network really represents the self. It operates very subconsciously, so talk therapy, oftentimes, falls short of getting the job done with changing patterns in the default mode network.

We also know that ketamine has very specific impacts on the default mode network. In this study connectivity between the insula and the default mode network was normalized, compared with healthy controls two days after, and this change was reversed after 10 days, and didn’t appear in the placebo scan. So, insula is a part of the brain involved in shame and it’s also involved in physical pain.

Making changes to habitual patterns is not easy, it requires a lot of work. You can see from the direction of this talk that that my perspective is that, chronic depression is a multifactorial situation and ketamine offers a window into a deep possibility for change. But like our other medications, it’s really not addressing a root cause. It creates an opportunity but it doesn’t get to the bottom of things, which is what we need to do by supporting the virtuous cycles exploring new resources, journaling, exercising, diet upgrades, reworking relationships.