Ketamine-Assisted Therapy for Treatment-Resistant Mental Health Disorders

In this video, Heather Flint, senior digital managing editor, Psych Congress Network, talks with Psych Congress Steering Committee Member Andrew Penn, MS, PMHNP about ketamine-assisted therapy for treatment-resistant mental health disorders. This interview took place at 2021 Psych Congress.

Read the Transcript:

Heather Flint: Going into this idea of treatment-resistant depression, or treatment-resistant mental health disorders and diagnosing, how is it that ketamine-assisted therapy, psychedelic-assisted therapy, is able to break those barriers and become an actual treatment?

Andrew Penn: One of the things that's interesting about the neuroscience behind psychedelic-assisted therapies is that...This may speak to the earlier question about how these conditions are similar and different, is that Robin Carhartt-Harris, who spoke at Sana, has posited this idea that some of these conditions may represent a state of what he calls low entropy in the brain.

Entropy, in physics, of course, is the likelihood that something is going to change or a system is going to decay. Things that have low entropy, they're unlikely to change. A rock has low entropy. It's still going to be a rock next week, probably. Fog is very high entropy. It's going to dissipate very quickly.

A lot of our psychiatric states, you can think of as being states of low entropy. Another way of looking at it is states of excessive rigidity. By rigidity, I mean that the probability that that condition is going to change in the near future is low.

If you ask somebody who has depression, "Do you think you'll still be depressed next week?" They're going to say, "Of course I am. I've been depressed for five years. Why would I not be depressed next week?" If you ask somebody who has an alcohol use disorder, "Do you think you'll still be drinking next week?" They'll say, "Yeah. Probably."

This reflects this low probability of change. To back up a little bit. You can think about conditions as different as depression, OCD, addiction, chronic pain, eating disorders, anxiety. All of these things have a high probability of being there in the near future. They're resistant to change.

What's interesting about psychedelics is that what they appear to do in the brain is introduce this state of high entropy for a brief period of time. The brain is doing unusual things as it's communicating with itself.

Looking at things like fMRI studies, looking at the way that the brain talks to itself, usually, it's in a very predictable way. It's like a route map on an airline. If I want to go from San Francisco to Boise, I probably have to go through Denver, if I'm flying United.

In a psychedelic state, what happens is the brain starts talking to each other in different, and heretofore, unusual ways. It becomes more like Southwest. If I want to fly from San Francisco to Boise, I can probably do that directly on Southwest.

They disrupted the system by coming in and saying, "We're going to do these previously not done routes." What this does is it introduces a state of high entropy into the brain and when the drug wears off -because, of course, you got to remember that these drugs don't persist for that long and a few hours at most. That the brain may reset itself in a more flexible way.

Robin talks about it being more supple, being more able to change. That's reflected in this behavioral change, in this symptomatic change. That people feel a little less stuck, maybe, in their depression.

One of the other areas of study for psychedelic therapies is in addiction medicine. That they're more able to make a change with regards to their substance use. That's the conceptual model that we're looking at with these treatments.