Ketamine and Teletherapy: where are we now?
With the COVID-19 epidemic, telemedicine has become a central tool to help guarantee safer, quicker, and more accessible healthcare. While telemedicine’s history is relatively short, its massive development took place during the years of the pandemic, as social distancing and isolation measures required the use of telematic communication.
“Telemental health” or “telepsychiatry”, aka telemedicine for mental health, was already recognized in various studies as a useful practice for patients dealing with mental health conditions. Now that psychedelic-assisted therapy is becoming increasingly popular, these treatments are being translated to the world of telemedicine.
Quite a few psychedelic companies now offer a teletherapy service, such as Reconscious Medical, or have formed partnerships with companies providing telecommunication tools, like Field Trip Health & Wellness, partnering with telehealth platform Nue Life to offer ketamine treatments and support to patients.
But what’s the evidence for the effectiveness of teletherapy using psychedelics?
Recently, at-home administration of sublingual ketamine with the aid of teletherapy was evaluated in a study conducted on a large population of patients affected by mood disorders (more than a thousand individuals). The study made use of Mindbloom, a telemedicine platform offering psychedelic therapy. Apparently, the results were very promising, but let’s take a moment for a deeper look.
How does teletherapy with ketamine work? And, most of all, is it safe?
The treatment doesn’t simply consist of taking the drug on your own at home. In the study just mentioned, patients first had a session with a guide to build the correct set (patient’s attitude or mindset) and settings (the surrounding environment) for the psychedelic experience. The treatment is indeed named “ketamine-assisted therapy” or KAT.
Here, the guide is not a licensed psychotherapist, but instead, a trained individual that listens to the patients and helps them to integrate their experience, as well as monitoring symptoms and side effects during and after the psychedelic experience.
In the medication session of the study, patients would take dissolving ketamine tablets sublingually in doses of 300 mg to 450 mg and hold them in their mouth without swallowing for some minutes, to reduce the risk of side effects like nausea. Items supporting a safe and appropriate treatment would be delivered together with the drug before beginning the treatment: a digital blood pressure cuff, eye mask and instructions for the session, just to mention a few. The eye mask, together with a pair of headphones, are used to make the settings optimal, as psychotherapy with psychedelics is usually done in the dark and while listening to music provided with the treatment.
Throughout the treatment, the patient is never alone; several written and recorded materials are provided, plus a text messaging service with the guide in case needed. Once an hour has passed, patients would make a reflective personal report and have another video call with the guide to discuss the experience. A couple of days later, they would have another meeting with a clinician to discuss the first experience and decide on the proper dosage and other details to build a proper treatment plan to follow in the next psychedelic sessions.
Again, during and after the sessions the patients would communicate with the guide for progress monitoring and integration, as well as completing surveys to evaluate possible side effects and treatment progress.
Is it that easy to get a ketamine treatment?
The answer is no. Not just anybody can receive treatment, only people with a diagnosed mental health disorder, as there is a pretty serious screening procedure. In the study, before starting treatment, potential patients would have to complete multiple questionnaires and paperwork; if the results scored higher than reference values for certain scoring systems (for example, higher than 10 on the PHQ-9 or GAD-7 questionnaire scales, used to diagnose depression and anxiety respectively), they were considered eligible. But that’s not enough. A video interview with a clinician is also required for a proper and complete diagnosis of the disorder. In addition to this, individuals diagnosed with a mood disorder are further examined in an extra video session with the clinician to make sure they’re suitable for this kind of treatment.
Why is this study important for the future of teletherapy? What are the advantages?
The positive results reported from the study show that ketamine-assisted teletherapy is safe and effective, and overcomes limitations usually encountered with in-person therapy, not only for the COVID-19 distancing rules, but also for the costs, which are considerably lower than therapies with ketamine infusions on-site (from 20% to 70% lower).
And, as we know, psychedelic therapy with ketamine was shown by various studies to be more convenient to patients than the regularly prescribed monoamines, in terms of remission rates and speed of action.
However, despite the large number of participants of this study, more follow-up research is needed, to investigate possible side effects of a prolonged administration of the drug, aimed at defining more specifically the safety of at-home ketamine treatments with different frequency and extent of use. Ketamine addicts, for instance, are known to be more prone to bladder and brain damage. Nevertheless, the doses usually prescribed in these kinds of treatments are significantly lower than the ones thought to trigger addictive behaviours, and therefore not considered dangerous.
Conclusion and editor’s note
The last few decades in mental health and neuroscience research have shown that psychedelics represent an innovative solution to the alarming mental health crisis. The ketamine study presented here supports existing treatment programs and combines telemedicine — already considered efficient, accessible and feasible — with psychedelic-assisted psychotherapy, also increasingly shown to be safe and effective.
Yet while the benefits are many — lower costs, increased access to treatments — we must tread carefully. At-home therapies present potential opportunities for gaming the system and patient abuse or misuse. Furthermore, commercial incentives might motivate companies to lower their screening requirements and go the route of “ketamine mills”, a reality that could be dangerous both to patients and the future of the entire industry. We must remain diligent.
