Psychedelic-Assisted Therapy: A Novel, Yet Effective Approach to Treating Mental Health Disorders

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Article

By combining the administration of psychedelic compounds with therapeutic support, ketamine-assisted therapy is proving remarkable efficacy in treating mental health conditions.

Psychedelic-assisted therapy is a novel mental health treatment that deviates from traditional pharmacological interventions. However, clinical data are showing that psychedelic compounds, including ketamine, can be effective in relieving symptoms of severe anxiety, depression, and post-traumatic stress disorder (PTSD), among a range of behavioral health conditions.

By combining the administration of psychedelic compounds with therapeutic support, ketamine-assisted therapy is proving remarkable efficacy in treating mental health conditions that are often resistant to conventional medications and treatments. For this reason, the acceptance and advancement of psychedelic-assisted therapy is bringing hope to millions.

By combining the administration of psychedelic compounds with therapeutic support, ketamine-assisted therapy is proving remarkable efficacy in treating mental health conditions that are often resistant to conventional medications and treatments. Image Credit: © Jeniffer - stock.adobe.com

By combining the administration of psychedelic compounds with therapeutic support, ketamine-assisted therapy is proving remarkable efficacy in treating mental health conditions that are often resistant to conventional medications and treatments. Image Credit: © Jeniffer - stock.adobe.com

Addressing a National Health Crisis

The United States is experiencing a mental health crisis that affects 22.8% of US adults (57.8 million) and significantly impacts the workplace in terms of employee wellness, attendance, and productivity.1,2 Mental health factors have been found to contribute to an increase in employers’ direct and indirect health care costs.3 The National Alliance on Mental Illness estimates that untreated mental illness costs US companies up to $300 billion annually.4

According to a KFF survey, nearly 4 out of 10 employers have changed their benefits to better expand mental health services to employees, and yet two-thirds of employees report not receiving the mental health care they need.5 This is not necessarily because they don’t have access to mental health services and treatments, but because traditional approaches and medications are, in some cases, statistically ineffective and inadequate. Specifically, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), have been shown to only work for approximately 15% of those prescribed, with 44% of patients choosing to discontinue their medication within 2 months of initiating treatment.6,7 Additionally, data have shown 50% of all patients treated for depression fail initial therapy.7

How Does Psychedelic-Assisted Therapy Work?

The psychedelic-assisted therapy approach combines the administration of psychedelic substances in a controlled setting accompanied by clinical support with a structured and supportive psychotherapy framework. Psychedelic substances encourage the growth of new connections between neurons in the brain. During use, patients have reported feeling strong emotions and vast alterations in mood, thought, and perceptions. Following administration, patients have reported experiencing a restoration of their sense of rhythm and balance.

The addition of the therapeutic framework in psychedelic-assisted therapy accelerates the therapeutic process by facilitating deep introspection, emotional breakthroughs, and heightened states of consciousness. The psychedelic experience has been reported to help individuals gain new perspectives, access repressed memories, and confront underlying emotional traumas. This accelerated process can potentially lead to profound insights, personal growth, and lasting therapeutic benefits.

Therapeutic Use of Ketamine

Developed in 1963, ketamine is a synthetic pharmaceutical compound with a history of safety and efficacy.8 As one of the most widely used drugs in modern medicine, ketamine is among the World Health Organization’s List of Essential Medicines. Ketamine was initially approved by the FDA for certain surgical procedures in 1970 and then was adopted by hospitals and medical offices because of its rapid onset. With a proven safe and short duration of action, ketamine is commonly used clinically for induction and maintenance of anesthesia and associated pain management.8,9

During the 1990s, investigators at the National Institute of Mental Health explored the antidepressant potential of ketamine while looking for alternatives to SSRIs and SNRIs. The research found that sub-anesthetic doses of ketamine may be effective to treat a variety of mental health conditions. In conjunction with this growing body of research, ketamine clinics and clinicians proliferated across the United States, offering ketamine sessions for psychiatric disorders either using ketamine-only treatments or ketamine in conjunction with psychotherapy.

In 1999, ketamine became a Schedule III non-narcotic substance under the Controlled Substances Act. Ten years later, the FDA approved the nasal spray esketamine (Spravato;Janssen Pharmaceuticals), which is a S(+) enantiomer of ketamine, for treatment-resistant depression. With this approval, esketamine became available at certified physician’s offices or clinics.

In low doses, ketamine was found to serve as a helpful adjunct to psychotherapy, as it provides an opportunity for the temporary softening of psychological defenses, which may result in deeper self-reflection and psychotherapeutic processing. This helps break long-standing, deeply ingrained thinking patterns associated with a variety of mental health conditions and, in turn, can lead to the development of new ways of thinking and being.

Clinical research reports dramatic improvements and reduction of mental health symptoms after just one ketamine therapy session. In comparison, traditional use of antidepressants can take 4 to 6 weeks to take effect, and for some patients, they don’t work at all. While no long-term data are available, in early small studies, ketamine therapy significantly and rapidly reduced depression symptoms in approximately 50% to 70% of patients.10

Advancing Ketamine Access
Clinical advancement and acceptance of ketamine-assisted therapy in particular comes at a critical time when our nation’s mental health crisis is significantly impacting patients. However, currently ketamine therapy in the clinic setting is prohibitively expensive for most patients, as payment is mostly or entirely out-of-pocket due to a lack of coverage by insurance carriers.

For this reason, third-party administrators (TPA) of psychedelic health care in the United States, such as Enthea (the first and only licensed TPA in the country) have stepped into address this need. This TPA is helping to develop pathways for patients to access psychedelic health care safely and affordably, starting with ketamine therapy.

Cost Savings
While the cost-effectiveness of psychedelic therapy is still being studied, early analysis suggests that employers will see a 3.5x return on what they invest in psychedelic health care. By reducing the need for long-term medication use, ongoing therapy sessions, hospitalizations, and the cost of comorbid illnesses, psychedelic therapy has the potential to alleviate the financial burden on individuals, employers, and health care systems.

“The effectiveness of ketamine-assisted therapy has been demonstrated through multiple research studies and more than 20 years of accumulated clinical experience,” says Dan Rome, MD, chief medical officer, Enthea. “Numerous studies show that, among individuals with chronic health conditions, those who also suffer from mental health disorders are 2 to 3 times more costly to the health care system than those without.”


Therapy session costs are dependent on location, provider, and type of service; however, a typical session can range from $150 to $500 per session. The crucial differentiator here is that with ketamine therapy, a complete course of treatment can last 3 months or less with guidelines typically recommending a minimum of 6 sessions for treatment.

Employer Adoption

Dr. Bronner’s

Dr. Bronner’s, a natural brand of soap in North America, is an early adopter and advocate of psychedelic medicine. The US-based, family-owned company expanded its health care benefits as a first step in prioritizing support of employee mental health and wellness. Its partnership with Enthea was the first arrangement between a health plan administrator and a large employer to offer ketamine-assisted therapy as a workplace benefit.

Through this arrangement, Dr. Bronner’s employees and their dependents receive assistance, either electronically or by phone, in connecting with a ketamine-assisted therapy provider. Once a patient/provider relationship is established, the ketamine-assisted therapy services are entirely covered for eligible employees.

“The health and wellbeing of our employees is the primary driver in how we think about benefits and compensation. Offering coverage for ketamine-assisted therapy is in the interest of providing tools to our workforce to have the best quality of life and best options for mental health care,” said Michael Bronner, president of Dr. Bronner’s. “Our family and company are no strangers to depression and anxiety. We are deeply concerned about the mental health crisis society is facing, especially in the context of the COVID-19 pandemic. Considering all our advocacy on this issue, this employee benefit is the next logical step.”

Following one year of covering ketamine-assisted therapy, Bronner's found that employees with a PTSD diagnosis reported an average of 86% symptom reduction. Additionally, employees with a major depressive disorder diagnosis reported an average of 67% symptom reduction, and employees with a generalized anxiety disorder diagnosis reported an average of 65% symptom reduction.

Revolutionizing Mental Health Care

Mental health is being prioritized and integrated into every aspect of health care, from prevention to early intervention to accessible and evidence-based treatment options. The long-term benefits that alternative approaches to mental health have on our health care system are immense given a shared understanding that psychedelic-assisted therapies are highly effective and should be accepted into standard mental health care practice.

Psychedelic therapy also aligns with modern health care’s emphasis on personalized, holistic medicine and patient-centered care. The treatment is tailored to the individual's unique needs, focusing on their personal experiences, traumas, and aspirations. The treatment also helps to address the underlying causes of mental illness rather than merely suppressing symptoms. Psychedelic therapy holds the potential to revolutionize mental health therapy.

About the Author

Sherry Rais, CEO and co-founder of Enthea, has helped dozens of startups, non-profit organizations, academic/research institutions, and small businesses raise funds, operate according to their mission and values, and implement processes that enhance their overall efficiency. In addition to being Enthea's CEO, Rais is the executive director of the Boston Psychedelic Research Group and the Grants Manager for CIIS.

REFERENCES

  1. White House Press Secretary. FACT SHEET: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union. Whitehouse.gov. March 1, 2022. Accessed November 29, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/
  2. Mental Health By the Numbers. National Alliance on Mental Illness. Last updated April 2023. Accessed November 29, 2023. https://nami.org/mhstats?gclid=Cj0KCQiA7bucBhCeARIsAIOwr-_mryPgVr3hp8Lz9-i-aijtm5GJWQeY_Q8IM0faz9DI722oo2Q2TFAaAjFGEALw_wcB
  3. Coe E, Cordina J, Enomoto K, Mandel A, Stueland J. National surveys reveal disconnect between employees and employers around mental health need. McKinsey & Company. April 21, 2021. Accessed November 29, 2023. https://www.mckinsey.com/industries/healthcare/our-insights/national-surveys-reveal-disconnect-between-employees-and-employers-around-mental-health-need
  4. Gillison DH, Keller A. 2020 devastated US mental health — healing must be a priority. The Hill. February 23, 2021. Accessed November 29, 2023. https://thehill.com/opinion/healthcare/539925-2020-devastated-us-mental-health-healing-must-be-a-priority/?rl=1
  5. KFF, Claxton G, Rae M, et al. Employer Health Benefits. KFF. 2021. Accessed November 29, 2023. https://files.kff.org/attachment/Report-Employer-Health-Benefits-2021-Annual-Survey.pdf
  6. Piore A. Antidepressants Work Better Than Sugar Pills Only 15 Percent of the Time. Newsweek. September 21, 2022. Accessed November 29, 2023. https://www.newsweek.com/2022/09/30/antidepressants-work-better-sugar-pills-only-15-percent-time-1744656.html
  7. Rush AJ, Fava M, Wisniewski SR, et al. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004;25(1):119-142. doi:10.1016/s0197-2456(03)00112-0
  8. Rosenbaum SB, Gupta V, Patel P, et al. Ketamine. [Updated 2023 May 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK470357/
  9. Du R, Han R, Niu K, Xu J, Zhao Z, Lu G, Shang Y. The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis. Front Psychiatry. 2022 Mar 9;13:813103. doi: 10.3389/fpsyt.2022.813103. PMID: 35356723; PMCID: PMC8959757. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959757/
  10. Zarate CA, Singh JB, Carlson PJ, et al. A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Arch Gen Psychiatry. 2006;63(8):856–864. doi:10.1001/archpsyc.63.8.856. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/668195

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