A longitudinal analysis of the clinical practice of ketamine assisted psychotherapy with adolescents and young adults

Introduction: Ketamine Assisted Psychotherapy (KAP) is a developing modality with broad impact on humans suffering with a variety of emotional and relationship difficulties that encompass many diagnostic entities. Our application of KAP has extended to and included the treatment of adolescents and young adults in a family therapy format. Given the increasing scope and complexity of the adolescent mental health crisis and the frequent failures to respond to conventional treatment, the promise of KAP deserves thorough investigation.

Methods: We previously described the process of KAP in our adolescent population that included four case reports exemplifying our approach. Here we report on the longitudinal clinical experience of 19 adolescents and young adults (ages 14–24; mean age 19.3 ± 3.1 years; 11 female, 7 male, 1 non-binary) who completed three or more KAP sessions at a single community outpatient clinic.

Results: BDI-II scores declined by an estimated 0.65 points per visit (95% CI: -0.90, -0.40) and HAM-A scores by 0.21 points per visit (95% CI: -0.44, +0.01), based on linear mixed-effects models. Approximately 63.2% of patients (12/19) achieved medium or large individual treatment effects on BDI; 47.4% (9/19) on HAM-A. Physician and patient reports indicated overall benefit in 68.4% of cases (13/19), including marked reductions in suicidality in at-risk patients. Ketamine was well tolerated across 167 documented sessions; nausea was the only notable adverse event, occurring in 5.4% of sessions and largely manageable with standard antiemetics. No hospitalizations, substance misuse, or evidence of neurological harm occurred over a median individual follow-up of 5.6 months (mean 10.1, range 0.9-36.4 months).

Discussion: These findings suggest that KAP is feasible and well tolerated in a diagnostically complex adolescent population, with clinically meaningful reductions in depression and a similar trend for anxiety associated with continued treatment. To our knowledge, this is the first report to provide longitudinal quantitative data for office-based KAP in adolescents and young adults, and it establishes a foundation for and supports the design of future controlled trials in this population.