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Effectiveness of ketamine-assisted psychotherapy as a treatment for treatment-resistant depression: a systematic review.

Rebecca J Simpson, Mario F Juruena

Psychopharmacology February 7, 2026 DOI: 10.1007/s00213-026-07003-0 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Systematic review Randomized Peer reviewed
Population Patients with TRD receiving KAP
Intervention Ketamine-assisted psychotherapy
Topics Depression Ketamine Esketamine Psychedelic-assisted therapy
Keywords Combine treatment Psychotherapy Treatment resistant depression
Citations 1
Key findings Ketamine-assisted psychotherapy was associated with reductions in depressive symptoms, with some improvements sustained up to six months, but no significant differences were found between KAP and control conditions in the three studies with control groups.

Abstract

Major Depressive Disorder (MDD) is a common and debilitating condition. Current treatments fail to provide adequate relief in roughly one-third of individuals, resulting in treatment-resistant depression (TRD). Ketamine has emerged as a promising intervention for TRD, offering rapid and sustained antidepressant effects. However, benefits often require maintenance dosing, and long-term outcomes remain unclear. This has promoted interest in adjunctive approaches such as ketamine-assisted psychotherapy (KAP), which combines ketamine with structured psychological support. A comprehensive literature search was conducted via the OVID platform using Embase, Medline, Global Health, and APA PsycInfo. Keyword clusters related to "Ketamine," "Diagnosis," and "Psychotherapy" yielded 768 results. Screening followed PRISMA guidelines, resulting in 11 studies meeting inclusion criteria. The selected studies clustered into two thematic categories: structured, protocol-based interventions and individualized, experiential approaches. Across all studies, KAP was associated with reductions in depressive symptoms, with some improvements sustained up to six months. However, among the three studies with control groups, no significant differences were found between KAP and control conditions. Methodological heterogeneity-including variability in treatment protocols, outcome measures, and study designs-limits the ability to draw firm conclusions or identify mechanisms driving KAP's effects. KAP shows promise as a treatment for TRD, potentially offering meaningful and sustained symptom relief. However, limited evidence and methodological variability underscore the need for more rigorous research-particularly randomized controlled trials-to better understand its efficacy and mechanisms.

Comparable studies

Other systematic reviews and meta-analyses on ketamine and psychedelic-assisted therapy, most cited first.

Study Year Design Participants
A comparison between psilocybin and esketamine in treatment-resistant depression using number needed to treat (NNT): A systematic review. Adults with treatment-resistant depression 2024 Systematic review
Meta-correlation of the effect of ketamine and psilocybin induced subjective effects on therapeutic outcome. Patients with depression or substance use disorder 2024 Systematic review and meta-analysis n = 654
Ketamine and Ketamine-Assisted Psychotherapy for Psychiatric and Existential Distress in Patients with Serious Medical Illness: A Narrative Review. Patients with serious medical illness in a palliative care setting 2025 Systematic review
Psychedelic-Assisted Therapies for Psychosocial Symptoms in Cancer: A Systematic Review and Meta-Analysis Adults with cancer 2025 Systematic review and meta-analysis n = 455
How Do People Who Undergo Ketamine Treatment for a Psychiatric Problem Subjectively Experience This Intervention? A Meta-Synthesis of Qualitative Studies. People who received ketamine treatment for a psychiatric problem 2025 Systematic review and thematic meta-synthesis n = 24

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