Is Ketamine a Horse Tranquilizer?
March 11, 2022
As our understanding of the human brain continues to evolve, so too does our approach to treating mental health disorders. One of the most promising recent developments in psychiatry is the use of ketamine, an anesthetic drug that, when given in specific dose ranges, has shown significant promise as a treatment for severe depression as well as for other mental health conditions. But ketamine's potential doesn't stop at direct symptom relief. Emerging research suggests that ketamine might act as a powerful adjunct to psychotherapy by inducing what neuroscientists call ‘metaplasticity’ in the brain. In this post, we will delve into this fascinating topic, examining how ketamine induced metaplasticity and “critical periods” may open new doors in the treatment of mental health conditions.
What is Neuroplasticity?
Plasticity is the remarkable ability of the brain to change and adapt over time. This flexibility allows neurons (nerve cells) in the brain to reorganize themselves by forming new connections or strengthening/weakening existing ones in response to learning, experience, or environmental changes. It is a fundamental property of the brain that enables us to learn new skills, remember new information, and adapt to new situations. Not all too long ago, the brain was thought to be a relatively static structure, but contemporary neuroscience has revealed that our brains are dynamic and constantly reshaping themselves. This plasticity occurs at various levels, ranging from cellular changes (involving individual neurons) to large-scale cortical reorganization (involving different brain regions). Whether it’s a child learning to read, an adult mastering a new language, or a patient recovering abilities lost after a stroke, plasticity is the underlying process that makes these adaptations possible.
What is Metaplasticity?
Metaplasticity is often referred to as ‘the plasticity of plasticity’. In essence, it is a higher-order form of neuroplasticity. Whereas neuroplasticity refers to the ability of the connections between neurons (synapses) to change in strength, metaplasticity is a more dynamic, adaptive process. It makes the brain more receptive and responsive to change, creating a window or “critical period” during which learning and memory (the fundamental processes underlying effective psychotherapy) are enhanced.
Ketamine’s Role in Inducing Metaplasticity
1. Resetting the Brain's Learning Pathways
Ketamine seems to 'reset' the brain's neural pathways, making them more malleable and open to change. This could be invaluable in a psychotherapeutic context, where the goal is often to ‘unlearn’ maladaptive thought patterns and behaviors and replace them with healthier alternatives.
2. Enhancing Synaptic Connections
Research suggests that ketamine increases the production of a protein called Brain-Derived Neurotrophic Factor (BDNF). BDNF plays a key role in the formation of new synaptic connections – the basis of learning and memory. This regrowth of and stabilization of new synapses restores synaptic connections and efficiency.
3. Stimulating Change
Not only does Ketamine increase BDNF production but it also directly binds to the receptor that BDNF binds to that stimulates neuroplasticity, tropomyosin receptor kinase B (TrkB). TrkB is a receptor for brain-derived neurotrophic factor (BDNF), a crucial molecule involved in the survival, differentiation, and growth of neurons. When ketamine binds to TrkB, it stimulates the receptor, thereby promoting the activation of downstream signaling pathways associated with neuroplasticity, growth, and synapse formation. This induced plasticity is believed to play a pivotal role in the antidepressant effects of ketamine, fostering a more resilient and adaptable neural network, which may counteract the pathophysiology seen in depressive disorders.
The Synergistic Effect: Ketamine and Psychotherapy
Imagine a scenario where the brain’s capacity to change is significantly enhanced – a sort of ‘hyper-learning’ state. When ketamine induces metaplasticity, it might effectively prime the brain for the work done in psychotherapy. Here’s how:
1. Deepening Therapeutic Insights
Under the influence of ketamine, patients may experience enhanced clarity or a deeper emotional resonance with their insights, allowing them to engage more profoundly with the therapeutic process.
2. Accelerating Progress
The “critical window” is believed to open during a Ketamine Assisted Psychotherapy session and close at approximately 48 hours after. During this time, if the therapeutic insights are further reflected upon, either through integration therapy or a more self-guided process such as journaling or meditation, the brain is in a state where change is more likely to occur.
3. Sustaining Gains
By fostering new, healthier and appropriately connected neural pathways, ketamine may help to make the gains of psychotherapy more enduring. In this way, ketamine can not only bring forth change but when the “critical window” closes these changes are more likely to stick around. When the treatments are stacked together weekly, there is durability and ongoing relief from depression.
Understanding Ketamine Induced “Critical Periods” After KAP Sessions
Psychedelic or ketamine induced critical periods refer to the unique ability of psychedelic substances, such as LSD, psilocybin, and ketamine, to temporarily create a state of heightened neuroplasticity in the adult brain that resembles the 'critical periods' of development observed in early life. During these critical periods in infancy and childhood, the brain is exceptionally receptive to new information and can change and adapt at an astonishing rate. As we age, these windows of profound plasticity largely close, and the brain becomes more stable and less malleable. Recent research suggests that psychedelic substances may have the power to re-open these windows of plasticity, even in adulthood. This allows for significant changes in neural circuits, potentially providing a valuable tool for the treatment of mental health disorders by enabling patients to unlearn maladaptive patterns of thought and behavior and establish new, healthier neural pathways. This concept has garnered significant attention in the field of psychiatry, as it could revolutionize treatment approaches for conditions like depression, anxiety, and PTSD.
Research suggests that the critical period for neural plasticity after a ketamine infusion is typically within 24 to 48 hours following the session. During this window, the brain appears to be in a highly malleable and receptive state, akin to the critical periods observed in early life development. This timeframe is thought to represent a unique opportunity for therapeutic intervention, as it allows individuals to potentially “re-wire” maladaptive neural pathways and establish new, healthier patterns of thought and behavior. Studies have shown that ketamine can rapidly and robustly increase the formation of new synapses in the brain, and this effect seems to be most prominent in the first day or two after administration. It is hypothesized that this period of enhanced plasticity could be an ideal time for psychotherapy or other behavioral interventions, as the brain may be more responsive to these treatments when it is in this highly adaptable state. The notion of leveraging this critical period for therapeutic benefit is an exciting area of ongoing research, as it offers the potential for transformative mental health treatments that capitalize on the brain's innate ability to change and adapt.
Due to these concepts, we recommend conducting a psychotherapy session within the 24 to 48 hour window following a ketamine infusion to maximize the potential therapeutic benefits. It is suggested that the therapy session be thoughtfully planned and structured to explore and integrate the experiences and insights gained during the ketamine infusion. The therapist should create a safe and supportive environment, encouraging the patient to openly discuss their thoughts and feelings. Special attention should be paid to any new perspectives or shifts in perception that arose during the infusion, as these could be key areas for further exploration and integration. The therapist may use various techniques, such as guided imagery, mindfulness practices, or cognitive restructuring, to help the patient consolidate and embody these new insights. The goal of this strategically timed psychotherapy session is to harness the enhanced plasticity induced by ketamine, facilitating the patient’s ability to establish new, adaptive neural pathways and promoting long-lasting positive change.
Conclusion
Ketamine is proving to be much more than just a fast-acting antidepressant. Its ability to induce a state of metaplasticity in the brain holds the potential to revolutionize its role in mental health treatment, turning it into a powerful tool for enhancing the effectiveness of psychotherapy.
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