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Integrative Psychiatry

Ketamine Psychotherapy: Treatment Resistant Depression By Will Van Derveer, MD

By August 31, 2020November 18th, 2020No Comments

Getting proper training in Ketamine psychotherapy practice in order to help decide when patients might be appropriate for referral and to consider offering of Ketamine in the practice.

Ketamine has been known to have low and tolerable risks with common dosing ranges. It is not just a chemical treatment by itself but is considered as a tool which means its impact is short-lived and is not to be considered as a substitute for lifestyle changes.

Psychiatry is the only specialty wherein the rates of the illness increase overtime compared to other specialties where the illness has become more controlled.

FULL TRANSCRIPT:

Our goal here today is to really give you information that will help you decide, when your patients might be appropriate for referral for ketamine psychotherapy. We are also going to talk about how you can be inspired to consider offering ketamine in your practice. It really is not that complicated to set up. It is a good idea however to get some good training, as you know, listening to one lecture on ketamine therapy is probably not enough to get started. But if you are interested in training, we could put one together if there’s enough group of people interested in that.

Treatment resistant depression is common. 100 million people in the world have treatment resistant depression. We really haven’t seen new mechanisms in psychiatry since this 80s. One thing that Thomas Insel has said is that, psychiatry is the only specialty where the rates of the illness are increasing over time. You look at cardiology or oncology, you see big changes in terms of how those specialties are controlling the illnesses that they’re working with and depression is really out of control and we need better tools. In a nutshell, depression can come from anywhere on that map, whether it’s from diet, exercise deficiencies, dysbiosis, food sensitivities, and cold infections, toxic exposures, autoimmune problems, psychological issues like disconnection, spiritual problems, unresolved grief.

Treatment resistant depression are really interesting thing for us to work with in integrative psychiatry because it calls on us to use every tool that we have every place on the map we need to look into. The studies on IV ketamine show consistently show a 70% response rate. This is much higher than what you see and study for conventional antidepressants. And the other advantage of ketamine is that, like MDMA, you’re looking at a handful of exposures for most people. We don’t really like the idea of ketamine as a chemical treatment by itself, but we think ketamine is a catalyst. It’s a tool. But when it’s provided as a standalone treatment, and then the person is now getting maintenance, ketamine, it’s a little bit like pumping up somebody’s tire but not patching the hole. You can go down the road for a few days or a few weeks, a few months, and then you’re using the tool again, so I think that should be a lesson to us that we’re not getting to the bottom of things. We’re not addressing what needs to be addressed. And what are the underlying causes.

The most ideal situation for psychotherapy is someone who has fertilizer in their brain and their rumination or their obsessive locked in thought jail that they’re in has a door that’s open. So we can actually look at what’s going on with them and what are their assumptions about reality. How does reality work? What do they want? Who are they?

Ketamine acts like a catalyst. Its chemical impacts are short lived, but it does open up an opportunity for people who are very stuck, who don’t have any motivation to actually begin to execute on the lifestyle changes that we all know are critical for long lasting well-being  to start to happen Ketamine is not a substitute for the lifestyle changes. So, I’m just going to leave you the question How does ketamine fit into your integrative psychiatry perspective? And we want to encourage you to consider for people who are really stuck, that this can be an amazing opportunity for opening. If you’re not interested in providing ketamine yourself, that’s fine. But get to know people in your community who might be well trained and who are doing ketamine therapy in a safe and effective way.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.

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