Ketamine assisted psychotherapy
Mental health treatment with medication is almost always thought to be benefitted by psychotherapy and in many cases therapy alone is the best and only needed intervention. When the experience with ketamine is combined with psychotherapy the idea is that the space created by the ketamine can be leveraged to give a person the opportunity to do work in an internal or social space that was otherwise difficult to access.
Elements of therapy
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Neuroplasticity
An also apparently increasingly popular notion amongst those interested in the potential of these medicines: neuroplasticity. A number of studies have shown that ketamine can increase the production of brain-derived neurotrophic factor (BDNF), which plays a role in neuroplasticity, synaptic connectivity, and resilience to stress. This is thought to be one of the ways that ketamine may allow for some psychotherapies to help in modifying perspectives that may contribute to an unwell state. [4]
Inflammatory pathways
Ketamine has been shown to prevent the activation of inflammatory pathways and reduce the release of pro-inflammatory cytokines, or put more simply seems to prevent inflammation and reduce inflammation. This is not the first time we have seen inflammation associated with depression.
Rapid acting
The benefit from treatment with ketamine can often be seen quickly, as quickly as by the time the treatment session is completed or within the next few days. While not everyone responds to ketamine treatment, preliminary data suggest a response rate of at least 50%. Although the response can be rapid, sometimes the effects do not. To extend response, some people will return for "maintenance" medication treatments or when combined with psychotherapy, may provide longer-term benefit.
Conclusion
While there are several areas of investigation as to how the medication is effective for mental health conditions, it remains theoretical as the "monoamine hypothesis" was. In psychiatry, there don't appear to be many silver-bullet-like options and the approach needs to include a multivariate perspective or approach. As complex as the human body is, it seems more reasonable to consider that instead of being due to any one or the other of these things, the effectiveness can be found in the synergistic effect produced by all of these known and potentially more unknown factors working together to create the result.