Bottemanne H, Baldacci A, Muller C, Boyreau A, Claret A
Paris Brain Institute - Institut du cerveau (ICM), Sorbonne University/CNRS/Inserm, UMR 7225/UMRS 1127, Paris, France; Sorbonne University, Department of Philosophy, UMR 8011, CNRS, Paris, France; Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, AP-HP, Paris, France.
Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, AP-HP, Paris, France.
Encephale. 2022 Jun;48(3):304-312. doi: 10.1016/j.encep.2021.08.011. Epub 2021 Dec 4.
Ketamine, a non-competitive NMDA receptor antagonist, is used as a fast-acting antidepressant therapy in depressive disorders. This treatment provokes dissociative effects associating derealization and depersonalization, and a synaptogenic signaling cascade promoting brain plasticity. Despite several preliminary studies suggesting the usefulness of its combination with psychotherapy, administration of ketamine isn't generally combined with per- and post-infusion psychotherapy protocols in its clinical antidepressant use. However, the phenomenology of psychodysleptic experiences and the synaptogenic effect could potentiate cognitive and behavioral therapies (CBT). In this article, we purpose a practical protocol to Ketamine Augmented Psychotherapy (KAP) synthesizing contemporary data from the literature and our clinical experience. We detail proposals for clinical practice, and propose four important steps for the use of a psychodysleptic molecule for antidepressant purposes: preparation, administration, integration, and prolongation. Finally, we discuss the limits and prospects of this combination in the management of mood disorders.
氯胺酮是一种非竞争性N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，在抑郁症中用作速效抗抑郁疗法。这种治疗会引发与现实解体和人格解体相关的分离效应，以及促进大脑可塑性的突触生成信号级联反应。尽管有几项初步研究表明其与心理治疗相结合有用，但在临床抗抑郁应用中，氯胺酮的给药通常不与输注前和输注后的心理治疗方案相结合。然而，致幻体验的现象学和突触生成效应可能会增强认知和行为疗法（CBT）。在本文中，我们提出了一种氯胺酮增强心理治疗（KAP）的实用方案，综合了文献中的当代数据和我们的临床经验。我们详细介绍了临床实践建议，并提出了将致幻分子用于抗抑郁目的的四个重要步骤：准备、给药、整合和延长。最后，我们讨论了这种组合在情绪障碍管理中的局限性和前景。
