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The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression

BACKGROUND: Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiat...

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Autores principales: Garel, Nicolas, Drury, Jessica, Thibault Lévesque, Julien, Goyette, Nathalie, Lehmann, Alexandre, Looper, Karl, Erritzoe, David, Dames, Shannon, Turecki, Gustavo, Rej, Soham, Richard-Devantoy, Stephane, Greenway, Kyle T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546328/
https://www.ncbi.nlm.nih.gov/pubmed/37795512
http://dx.doi.org/10.3389/fpsyt.2023.1268832
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author Garel, Nicolas
Drury, Jessica
Thibault Lévesque, Julien
Goyette, Nathalie
Lehmann, Alexandre
Looper, Karl
Erritzoe, David
Dames, Shannon
Turecki, Gustavo
Rej, Soham
Richard-Devantoy, Stephane
Greenway, Kyle T.
author_facet Garel, Nicolas
Drury, Jessica
Thibault Lévesque, Julien
Goyette, Nathalie
Lehmann, Alexandre
Looper, Karl
Erritzoe, David
Dames, Shannon
Turecki, Gustavo
Rej, Soham
Richard-Devantoy, Stephane
Greenway, Kyle T.
author_sort Garel, Nicolas
collection PubMed
description BACKGROUND: Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. METHODS: This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail. RESULTS: The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. DISCUSSION: Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model’s effectiveness and hypothesized psychological mechanisms.
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spelling pubmed-105463282023-10-04 The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression Garel, Nicolas Drury, Jessica Thibault Lévesque, Julien Goyette, Nathalie Lehmann, Alexandre Looper, Karl Erritzoe, David Dames, Shannon Turecki, Gustavo Rej, Soham Richard-Devantoy, Stephane Greenway, Kyle T. Front Psychiatry Psychiatry BACKGROUND: Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. METHODS: This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail. RESULTS: The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. DISCUSSION: Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model’s effectiveness and hypothesized psychological mechanisms. Frontiers Media S.A. 2023-09-19 /pmc/articles/PMC10546328/ /pubmed/37795512 http://dx.doi.org/10.3389/fpsyt.2023.1268832 Text en Copyright © 2023 Garel, Drury, Thibault Lévesque, Goyette, Lehmann, Looper, Erritzoe, Dames, Turecki, Rej, Richard-Devantoy and Greenway. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Garel, Nicolas
Drury, Jessica
Thibault Lévesque, Julien
Goyette, Nathalie
Lehmann, Alexandre
Looper, Karl
Erritzoe, David
Dames, Shannon
Turecki, Gustavo
Rej, Soham
Richard-Devantoy, Stephane
Greenway, Kyle T.
The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title_full The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title_fullStr The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title_full_unstemmed The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title_short The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
title_sort montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546328/
https://www.ncbi.nlm.nih.gov/pubmed/37795512
http://dx.doi.org/10.3389/fpsyt.2023.1268832
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