Information for Referring Clinicians

Referral Information

To access Ketamine-assisted Psychotherapy, patients must have a referral from their most responsible physician, nurse practitioner, or other regulated health professional with a PRACID.

Edgar Psychological is a private psychology practice in Edmonton composed of a strong team of mental health and medical professionals trained in Ketamine-assisted Psychotherapy (KaP). We offer group and individual KaP programming depending on a client’s specific needs and preferences as well as maintenance treatments for ongoing symptom management if required. 

Below you will find our eligibility criteria and a reference list.

Why Ketamine?

“Recent data suggests that ketamine, given intravenously, might be the most breakthrough antidepressant treatment in decades” - Thomas Insel, Director of National Institute of Mental Health

At sub-anesthetic doses, clinical research excitingly underscores ketamine's potential for various mental health conditions, such as treatment-resistant depression[1], major depressive disorder (MDD)[2], suicidal ideation[3], anxiety[4], and post-traumatic stress disorder (PTSD)[5], with ongoing research exploring its efficacy for other conditions[6]. Coupled with psychotherapy, ketamine is promising in allowing individuals to quickly reconnect with positive memories, shift negative thinking patterns, enhance cognitive flexibility, cultivate deep insight, reconnect with social supports, and process and regulate difficult emotions[2]. Several studies demonstrate that upwards of 70% of patients with depression will have alleviation from symptoms after one treatment[7]. Some patients with acute and chronic suicidal ideation report a total reversal in their symptoms[8]. For PTSD, ketamine can help to break the repetitive mental loop associated with past trauma[7].

At Edgar Psychological, we follow current best practices of providing rapid repetitive dosing of 6 infusions over 3 weeks, which is supported by preparation and integration psychotherapy[9]. With the direction of a physician and psychologist in a therapeutic environment, ketamine shows its efficacy as a profound treatment for various psychiatric disorders[2].

Theory for Mechanism of Action

Ketamine is a novel dissociative compound originally designed as an anesthetic. At lower doses, it distinguishes itself in mental health treatment through its unique mechanism targeting NMDA receptors and the glutamate system[10] with rapid-acting effects which promotes mood regulation and growth of new neurological connections. On a fMRI scan, ketamine appears to decrease connectivity in the default mode network in medial prefrontal cortex, which supports a reduction in PTSD, anxiety, and depression symptoms by being able to make new associations to the self, memories, relationships, experiences, and perspectives, which induces the potential for positive change when supported by psychotherapeutic mechanisms[10].

Safety & Considerations

Treatment eligibility determination involves a robust medical and mental health screening and intake process with our highly skilled nurses and psychologists and a final assessment and consultation with our Medical Director and psychiatrist Dr. Robert Mallett. 

Ketamine administration occurs in a safe, controlled setting designed to optimize the experience. Our KaP-trained psychologists and medical professionals ensure that ketamine sessions are safe, comfortable and meet safety requirements and psychedelic therapy regulations outlined by the Government of Alberta and the College of Physicians and Surgeons of Alberta.

Ketamine-assisted Psychotherapy

Our 10-week group ketamine-assisted psychotherapy (KaP) program aligns with current best practices in ketamine therapy which combines the unique therapeutic capabilities of ketamine with an intimate group experience, promoting not only individual treatment-related goals but also increased connection to self and others, interpersonal learning, relational flexibility, increased nervous system co-regulation through shared experience, and the safety of addressing personal challenges in a warm and supporting environment[12]. Group therapy mechanisms[12] are combined with preparation and integration sessions that include evidence-informed and session-specific education and skills building for in-between session support[13]. Upon completion of the program, participants have the opportunity to join psychotherapeutic integration group and individual maintenance sessions options[17].

Treatment Indications

Ketamine is receiving global attention for its ability to improve symptoms of mental health distress with a growing body of empirical evidence to support this. Research demonstrates that when coupled with psychotherapy, ketamine’s benefits on mood and behaviour are further enhanced. 

At this time, the strongest evidence, and primary indications for use of ketamine are for the following mental health conditions: 

  • Treatment-Resistant Depression

  • Major Depressive Disorder

  • Suicidal ideation

  • Generalized Anxiety Disorder

There is ongoing clinical research that also supports the use of ketamine as a beneficial treatment for other mental health conditions such as: 

  • Treatment-Resistant Depression

  • Post-Traumatic Stress Disorder (PTSD)

  • Substance Use Disorder

  • Obsessive Compulsive Disorder

  • Eating Disorders

  • Chronic Pain

Treatment Contraindications

Ketamine is NOT safe for use in people with the following: 

  • Hypersensitivity or allergy to ketamine  

  • History of ketamine abuse  

  • Psychosis  

  • Delirium or major neurocognitive disorder

  • Recent symptomatic acute brain injury (within 90 days of serious injury)

  • Uncontrolled cardiopulmonary or cardiovascular disease, or uncontrolled high blood pressure (consistently >140/90)  

  • Presence of implanted pacemaker

  • Severe obstructive severe sleep apnea (OSA) or central sleep apnea

  • Body mass index (BMI) ≥40 (assessed on a case-by-case basis)

  • History of hemorrhagic stroke

  • Liver failure  

  • Congestive heart failure

  • Kidney failure  

  • Acute angle glaucoma or ocular hypertension

  • Pregnancy

Ketamine MAY NOT be safe for use in people with the following: 

  • Age <18 or >65 years

  • Moderate obstructive sleep apnea (OSA)

  • History of cystitis (especially if ketamine-induced)

  • Active, untreated substance use disorder per DSMV criteria within past 3 months and inability to reduce usage

  • Uncontrolled or poorly controlled seizures or seizures of complex morphology even if stable

  • Uncontrolled thyroid disease

  • The following conditions will require clearance from a Cardiologist (and/or Neurologist) via appropriate testing such as results of recent cardiac stress test, echocardiogram and/or electrocardiogram:  

    • History of thromboembolic stroke (including TIA, particularly if involved loss of consciousness or was less than 90 days ago) or brain aneurysm or arteriovenous malformation (AVM)  

    • History of myocardial infarction (heart attack) and angioplasty with implanted stents 

A thorough evaluation of your patient’s medical and medication histories will occur at the time of medical screening to determine your patient’s risk stratification regarding current medical concerns, concomitant medication use, and substance use history. 

Next Steps

Thank you for your interest in our program.

Referrals can be faxed to our office at 780-784-8003.

For more information on KaP and our programming, we invite you to reach out to us by calling 780-784-8001 or emailing us at: pap@edgarpsychological.com.

References

[1] Muscat, S. A., Hartelius, G., Crouch, C. R., & Morin, K. W. (2021). An integrative approach to ketamine therapy may enhance multiple dimensions of efficacy: Improving therapeutic outcomes with treatment resistant depression. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.710338

[2] Kennedy, S. H., Lam, R. W, McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., Hasnain, M., Jollant, F., Levitt, A. J., MacQueen, G. M., McInerney, S. J., McIntosh, D., Milev, R. V., Müller, D. J., Parikh, S. V., Pearson, N. L., Ravindran, A. V., & Uher, R. (2016). CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments. Can J Psychiatry, 61(9):540-60. https://doi.org/10.1177/0706743716659417

[3] Witt, K., Potts, J., Hubers, A., Grunebaum, M. F., Murrough, J. W., Loo, C., Cipriani, A., & Hawton, K. (2020). Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Aust N Z J Psychiatry, 54(1), 29-45. https://doi.org/10.1177/0004867419883341

[4] Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., O Reed, M., Jakubovski, E., & Bloch, M. H. (2018). Ketamine for social anxiety disorder: A randomized, placebo-controlled crossover trial. Neuropsychopharmacol., 43, 325–33. https://doi.org/10.1038/npp.2017.194

[5] Feder, A., Parides, M. K., Murrough, J. W., Perez, A. M., Morgan, J. E., Saxena, S., Kirkwood, K., Aan Het Rot, M., Lapidus, K. A., Wan, L., Iosifescu, D., & Charney D. S. (2014). Efficacy of intravenous ketamine for treatment of chronic post-traumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 71, 681–8. https://doi.org/10.1001/jamapsychiatry.2014.62

[6] Martinotti, G., Chiappini, S., Pettorruso, M., Mosca, A., Miuli, A., Di Carlo, F., D’Andrea, G., Collevecchio, R., Di Muzio, I., Sensi, S.L., & Di Giannantonio, M. (2021). Therapeutic potentials of ketamine and esketamine in obsessive–compulsive disorder (OCD), substance use disorders (SUD) and eating disorders (ED): A review of the current literature. Brain Sci., 11, 856. https://doi.org/10.3390/brainsci11070856

[7] MacKay, M. A., Baker, G. B., & Dursun, S. M. (2020). Ketamine as an antidepressant: Overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol, 10. https://doi.org/10.1177/2045125320916657

[8] Wilkinson, S. T., Ballard, E. D., Bloch, M. H., Mathew, S. J., Murrough, J. W., Feder, A., Sos, P., Wang, G., Zarate Jr., C. A., & Sanacora, G. (2018). The effect of a single dose of intravenous ketamine on suicidal ideation: A systematic review and individual participant data meta-analysis. Am J Psychiatry, 175, 150–8. https//doi/org/10.1176/appi.ajp.2017.17040472

[9] Dames, S., Kryskow, P., & Watler, C. (2022). A cohort-based case report: The impact of ketamine-assisted therapy embedded in a community of practice framework for healthcare providers with PTSD and depression. Front. Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.803279

[10] Zacharias, N., Musso, F., Müller, F., Lammers, F., Saleh, A., London, M., de Boer, P., & Winterer, G. (2019). Ketamine effects on default mode network activity and vigilance: A randomized, placebo-controlled crossover simultaneous fMRI/EEG study. Human Brain Mapping, 41(1), 107–119. https://doi.org/10.1002/hbm.24791

[11] Ahuja, S., Brendle, M., Smart, L., Moore, C., Thielking, P., & Robison, R. (2022). Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: A retrospective descriptive cohort study. BMC Psychiatry, 22(1), 634. https://doi.org/10.1186/s12888-022-04268-5 PMID: 36192794; PMCID: PMC9528178.

[12] Tsang, V. W. L., Ragazan, D. C., Pamela Kryskow, P., Walsh, Z., & Dames, S. (2023) A pilot study comparing a community of practice program with and without concurrent ketamine-assisted therapy. Journal of Psychoactive Drugs. https//doi/org/10.1080/02791072.2023.2253798

[13] Bathje, G. J., Majeski, E., & Kudowor, M. (2022). Psychedelic integration: An analysis of the concept and its practice. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.824077

Additional Resources

Our reference list with additional resources is available as a downloadable PDF if you wish to explore more about Ketamine-assisted Psychotherapy in the literature. 

Acknowledgements

We acknowledge that the use of psychedelics have been used for therapeutic and ceremonial purposes by Indigenous communities spanning thousands of years who continue to be stewards and knowledge keepers of this sacred work. We aim to respect these lineages by respectfully integrating principles of neuro-decoloniality, diverse cultural wisdom, and cultural humility into a modern therapeutic framework appropriate for our community, acknowledging this is an ongoing process.

We are grateful for the ketamine-assisted psychotherapy research and evidence-informed programming developed by Roots to Thrive, as well as the knowledge and experiences shared from their participants, both of which have inspired our program development.