|What Category Provider type are you?||Psychiatry|
|What board certifications do you hold?||ABPN|
|How many years have you been in ketamine practice?||4|
|What percentage of your work is clinical versus research?||80% clinical, 20% research|
|Please describe any connections you have to major universities, research institutions and pharmaceutical companies, both financial and advisory/board?||I am a full-time Assistant Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine. I have been a sub-investigator on industry and federally sponsored clinical trials including: esketamine (Janssen Pharmaceuticals, TRANSFORM/ASPIRE studies), SAGE-217 (Sage Therapeutics, Shoreline Study), and ELEKT-D (PCORI, ECT vs. IV ketamine non-inferiority trial). I have served on Scientific Advisory Boards for Janssen Pharmaceuticals.|
|What are your views regarding desirability and appropriateness of including and fostering the variety of practitioners who presently administer ketamine for mood disorders?||I believe there is a significant, widening gap in the availability of mental health resources that includes access to highly effective treatments like ketamine and esketamine. Given the ratio of physicians to patients in need, it is both desirable and appropriate to leverage the ability of well-trained and well-informed non-physicians to administer ketamine for mood disorders. However, I do believe that training with consistent standards of care for the off-label administration of ketamine remain lacking which has led to inappropriate and potentially harmful treatment practices, often by non-psychiatric providers. I also believe that coordination of care between primary psychiatric providers and those administering ketamine for mood disorders remains lacking, and that such coordination should be encouraged and supported by organizations, such as this, to ensure appropriate patients are ultimately being referred for treatment.|
|What is your preferred route of administration of ketamine for mood disorders. What are your thoughts about the appropriateness or therapeutic value of other routes?||My preferred routes of administration are intravenous (racemic ketamine) or intranasal (esketamine) in a monitored office setting. I believe the therapeutic value of alternative routes, such as oral or IM, remain promising though lack a sufficiently rigorous evidence-base for me to recommend to my patients off-label. I am enthusiastically supportive of research efforts around this additional routes of delivery, however I am very concerned about the misuse and diversion potential for these routes (including compounded IN ketamine) when provided for home use without direct practitioner supervision.|
|How do you approach the problem of integrating the transient altered state we induce into the patient’s overall psychic economy? What is the practitioner’s responsibility in this regard?||For many reasons, it has been challenging to approach ketamine administration from the same perspective of more “classical” psychedelic-assisted psychotherapy paradigms. Under the medical model of ketamine administration, dissociation is treated and managed as more a side- rather than main effect and it remains controversial whether a dissociative experience is necessary for efficacy (e.g. dissociation may be sufficient for efficacy, but not necessary). Indeed, it has been my experience that ketamine can be effective in many patients without significant dissociation having been achieved. I would argue that most practitioners do provide some degree of “Integration” in discussing the tolerability and efficacy of treatments in follow-up, but certainly not with the same rigor or structure of aforementioned psychadelic integration therapy.
I do strongly believe that the efficacy afforded by treatments like ketamine is greatly enhanced by some form of psychotherapy, but I am not wholly convinced that a dynamic processing of the experience itself is any more beneficial than alternative psychotherapy paradigms such as CBT. I believe both leverage the plasticity afforded by the medication and as such believe it is the practitioner’s responsibility to at least encourage patients to participate in some form of psychotherapy as part of an optimized treatment plan.
|Please describe your present clinical practice. How will it look different in 5 years?||I presently work in an academic practice that provides ketamine/esketamine treatments for severe mood disorders as one treatment among a suite of options (rTMS, ECT). Given that triaging patient’s to one of these treatments remains “guess work” at best, it is my hope that the next 5-years will see the development of prognostic factors to help better predict potential responders with predictive biomarkers in the next 10-15 years with improvements in things like digital phenotyping and neuroimaging (or EEG).|
|How do you envision ASKP3 growing over the next 4 years?||As ketamine/esketamine become more widely accepted and sought after treatments, I envision ASKP3 growing to provide more formal educational resources (in-person and especially online CME credit opportunities) with the potential to provide “certificate” training in the implementation and administration of these treatments in multiple practice settings. Given the reach and extent of membership among community practitioners, ASKP3 is also in a unique position to aggregate and a disseminate “real world”/naturalistic data from hundreds-of-thousands of treatments performed every year through development of a provider database.|