The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression

Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting both excitement and debate. Many unanswered questions surround ketamine’s mechanisms of action its integration into real-world psychiatric care, diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need clinical approaches to are tailored unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach severe TRD refined over 6 years public healthcare settings. To contextualize development, we review as biomedical psychedelic treatment depression, emphasizing each perspectives’ strengths, weaknesses, distinct methods utilization. We then describe key experiences research findings shaped model’s various components, which presented detail. Results The implemented recent randomized trial, aims synergistically pair infusions with care. Ketamine broadly conceptualized brief intervention can produce windows opportunity enhanced well powerful occasions psychological growth. model combines structured care concomitant psychotherapy six infusions, administered psychedelic-inspired nonpharmacological adjuncts including rolling preparative integrative support. Discussion Our bridge biomedical-psychedelic divide offer feasible, flexible, standardized TRD. learnings from developing implementing this severe, patients two academic hospitals may valuable insights ongoing roll-out range therapies. Further needed assess effectiveness hypothesized mechanisms.