We get into the nitty-gritty of ketamine-assisted therapy with Dr. Kyle Greenway.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of

every issue. The last two episodes of this podcast might have left a bad taste in your mouth

about psychedelic assisted therapy. If that's the case, we've got some mouthwash. In our June-July issue, we featured an interview with Kyle Greenway,

who runs a ketamine-assisted therapy center at McGill University.

And I promise this episode is going to be more boring than our forways into MDMA therapy in a good way.

There's no therapeutic touch, no spirit animals, and no shadow

shelves in this work. Dr. Greenway takes a straightforward approach that addresses some of the common

problems we all encounter when our patients go to get ketamine. First, there is no end in sight. Ketamine works quickly, but it doesn't last,

which means many patients end up on chronic maintenance ketamine therapy. The longer they take it,

the less it seems to work, and the harder it is to stop. Dr. Greenway prepares patients with an

end date in sight. Next is that therapy is not

optional in his approach. In Dr. Greenway's Montreal model, ketamine is there to reduce the symptoms

so the patient can start active therapy, which is where the lasting changes occur.

He does not start ketamine until the patient is fully on board with all this,

which means they formed a therapeutic alliance and they're starting to make behavioral change in their own lives.

Like a dangling carrot, ketamineita started after the patient begins their behavioral change.

Finally, benzos are cut. Around 50% of patients with treatment-resistant depression take a benzodiazepine.

We know that chronic benzo use is not therapeutic. Yes, acute use might reduce depression,

but chronic use is associated with possible greater depression. So what is the sense of adding

...