Ketamine/Psychedelics Clinics

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Mojito_15

Mojito_15

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Hi!

I practice in a state in which there is more openness to psychedelics & ketamine for the treatment of mental health concerns. I'm interested in if anyone has done this, pros and cons of working in this area, what your typical day looks like, & any suggestions for how to get into this practice area as a licensed psychologist.

Thank you!
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Mojito_15 said:
Hi!

I practice in a state in which there is more openness to psychedelics & ketamine for the treatment of mental health concerns. I'm interested in if anyone has done this, pros and cons of working in this area, what your typical day looks like, & any suggestions for how to get into this practice area as a licensed psychologist.

Thank you!
Click to expand...

First step, conversation with your liability insurance and healthcare attorney about any changes in policy or legal issues you may encounter,
 
From the continuing ed I've done on the subject, the current thinking is that you accept risk for referring for psychedelic treatment since they are still illegal under federal law. Someone who follows the area closely mentioned that no boards anywhere have policies in place yet and was told that even discussing it with patients might be grounds for a lawsuit. For ketamine, idk what you would do outside of regular psychotherapy as an LMP needs to run and monitor the procedure. I personally find the results of ketamine tx for depression incredibly underwhelming.
 
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I have participated in ketamine treatment administered by a physician. Not for me, but for my patients. That sounded wrong. This was when I was at a residential facility and we did this well and patients were also overseen by a psychiatrist. So as part of a team with psychiatrist, physician, and myself, I felt reasonably secure in this setup. Just today I started a conversation with the physician about connecting for these treatments now that I am in private practice. His perspective is that his ketamine treatments have been less effective without having a psychologist supporting for a variety of reasons. I concur and now we just need to figure out the logistics of how we will coordinate and collaborate on this.

Two key points right off the top of my head. First, I would not be involved in this without a physician as we are doing IV infusions and patient is sedated and vital signs are monitored closely and additional sedatives can also be administered when necessary. At times they are, especially for my patients with a history of trauma.

Second, the research on ketamine-assisted therapy is extremely limited and so being clear as to your role, level of knowledge, and overall treatment plan should be crystal clear. I actually had done some research for a presentation on ketamine treatment, but it was on a hard drive that ltierall burned up so before I get started again will definitely delve into the literature again.
 
I wont get into the psychedelic's part, because that has no accepted/routine use currently so I have no idea the potential there and dont read too far into it until more info is readily available

Ketamine I dont have strong faith in for many reasons:

1. We had a ketamine clinic during residency. Failed miserably. It was intranasal formulation, most people didnt follow up, others didnt tolerate it, and those that somehow made it past the first two barriers, it was hit or miss how much it made a difference. Then you have to hope insurance covers it

2. IV ketamine is a whole different ball game, that doesn't really have an accepted use, and I cant see how this would work in an outpatient setting

3. A large portion, maybe most, of the people with TRD have comorbid personality disorders, substance use disorders, or extreme life stressors. Ketamine doesnt fix those

4. There are so many different steps to take before considering ketamine, between medications, TMS, even ECT
 
DrAmazingishere said:
4. There are so many different steps to take before considering ketamine, between medications, TMS, even ECT
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The number of people that presented at the clinic last year with depression and a ketamine treatment history that had never tried a CBT protocol for depression was incredible.
 
R. Matey said:
From the continuing ed I've done on the subject, the current thinking is that you accept risk for referring for psychedelic treatment since they are still illegal under federal law. Someone who follows the area closely mentioned that no boards anywhere have policies in place yet and was told that even discussing it with patients might be grounds for a lawsuit. For ketamine, idk what you would do outside of regular psychotherapy as an LMP needs to run and monitor the procedure. I personally find the results of ketamine tx for depression incredibly underwhelming.
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Everyone I know who has done it probably doesn't have depression - rather it's glaring personality disorder stuff.
 
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This advice has been helpful! Thank you! I saw this when looking around- and it appears to offer work for therapists & prescribers- not sure if it's legit though...: Practitioners | Reconscious Medical

Honestly, I'm currently in community health, I'm burnt out, and I'm looking for an option where I can be independent with my schedule, work from home some, and that doesn't require me to be constantly obligated to patients as it seems like I would be if I did traditional private practice. The idea of I support someone going through Ketamine treatments- and then we're done is really appealing. But perhaps I'm romanticizing what the work could look like.
 
Ketamine is very popular where I am. Patients just self-refer themselves and they even do it for kids. The only issue it doesn’t work

*This is just for infusion therapy without any psychotherapy; perhaps there would be greater benefit combining the two and maybe places doing both are more promising. The types of patients who seek these treatments are interesting to say the least, but most of these are not patients with TRD (some do not even have depression) rather those looking for alternative treatments. To give you an example I have a mom who is now taking her child to Amen clinics after he failed ketamine therapy
 
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allantois said:
Ketamine is very popular where I am. Patients just self-refer themselves and they even do it for kids. The only issue it doesn’t work

*This is just for infusion therapy without any psychotherapy; perhaps there would be greater benefit combining the two and maybe places doing both are more promising. The types of patients who seek these treatments are interesting to say the least, but most of these are not patients with TRD (some do not even have depression) rather those looking for alternative treatments. To give you an example I have a mom who is now taking her child to Amen clinics after he failed ketamine therapy
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Just going even further down the rabbit hole of snakeoil?
 
R. Matey said:
The number of people that presented at the clinic last year with depression and a ketamine treatment history that had never tried a CBT protocol for depression was incredible.
Click to expand...

It's understandable selection bias, but I think y'all sometimes underestimate just how committed some people are to never engaging with meaningful therapy under any circumstances.
 
allantois said:
Ketamine is very popular where I am. Patients just self-refer themselves and they even do it for kids. The only issue it doesn’t work

*This is just for infusion therapy without any psychotherapy; perhaps there would be greater benefit combining the two and maybe places doing both are more promising. The types of patients who seek these treatments are interesting to say the least, but most of these are not patients with TRD (some do not even have depression) rather those looking for alternative treatments. To give you an example I have a mom who is now taking her child to Amen clinics after he failed ketamine therapy
Click to expand...

oh ive had a few decide that the Amen clinic was better suited for them, because they're the "leading experts". These kinds of patients are the patients that are never that fun to treat anyways, so in a small way, im glad the amen clinic exists, to divert the most extreme personality disorder patients to them instead of me.
 
DrAmazingishere said:
oh ive had a few decide that the Amen clinic was better suited for them, because they're the "leading experts". These kinds of patients are the patients that are never that fun to treat anyways, so in a small way, im glad the amen clinic exists, to divert the most extreme personality disorder patients to them instead of me.
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the unfortunate part is that they also continue to see me -_-
 
clausewitz2 said:
It's understandable selection bias, but I think y'all sometimes underestimate just how committed some people are to never engaging with meaningful therapy under any circumstances.
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Lol, I'll stand outside the ketamine clinic with surveys next time.
 
clausewitz2 said:
It's understandable selection bias, but I think y'all sometimes underestimate just how committed some people are to never engaging with meaningful therapy under any circumstances.
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Having worked in the VA, I will never underestimate this commitment in a sizable group of patients.
 
clausewitz2 said:
It's understandable selection bias, but I think y'all sometimes underestimate just how committed some people are to never engaging with meaningful therapy under any circumstances.
Click to expand...
We wouldn’t do ketamine treatment with a patient that wasn’t engaging in therapy. Adminsitering another treatment to fix someone who has a passive stance just reinforces that. When we excluded that and used ketamine for patients in incredible distress that wanted help but were so entrenched in negative behavioral and cognitive patterns. We had great results. As someone who has worked with some severe clinical presentations, I believe that ketamine works to support treatment, but I doubt very highly that it will do much by itself and would even support pathology when used injudiciously. Just my two cents.
 
I know that this thread has been mostly about ketamine but my recent adventures into the literature have highlighted that there is a lack of evidence that psilocybin is effective for treating depression and the supportive results have been overstated. Just a recent example:


Ketamine seems to be less problematic but the research is still very early. The studies differ in methods of deliver (e.g., nasal, oral, IV) and dosage. I think the studies only last a month at the longest. Results vs. placebo look good but I have a hard time figuring out what is the long game? Is it for people to get an IV once a month for their depression for life?
 
DrAmazingishere said:
oh ive had a few decide that the Amen clinic was better suited for them, because they're the "leading experts". These kinds of patients are the patients that are never that fun to treat anyways, so in a small way, im glad the amen clinic exists, to divert the most extreme personality disorder patients to them instead of me.
Click to expand...
There's nothing some SPECT scans, lengthy yet surprisingly non-specific reports, and large price tags won't fix.
 
DynamicDidactic said:
I know that this thread has been mostly about ketamine but my recent adventures into the literature have highlighted that there is a lack of evidence that psilocybin is effective for treating depression and the supportive results have been overstated. Just a recent example:


Ketamine seems to be less problematic but the research is still very early. The studies differ in methods of deliver (e.g., nasal, oral, IV) and dosage. I think the studies only last a month at the longest. Results vs. placebo look good but I have a hard time figuring out what is the long game? Is it for people to get an IV once a month for their depression for life?
Click to expand...


Edit: Posting his entire blog post here. It was a good read.
 
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I need someone tripping b@ll$ in my office like I need gonorrhea.

"Mr. Insurance auditor, I'm billing for a 3hr psychotherapy session because the patient took too much, and I couldn't get the him to shut up."

"Mrs. Insurance adjuster, my office was destroyed by a patient on psychedelics, who thought the stuffing in my couch was a rabbit that needed to be freed."
 
Just read an interesting study on kids with ADNP (highly associated with ASD) and low dose ketamine.
 
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