Dr Melanie Babooram is a Clinical Psychologist, currently practicing at the Black Dog Institute – a not-for-profit, mental health research organization – and private practice, in Sydney, Australia. Over the course of her career, Melanie has worked extensively in trauma, complex trauma and chronic pain management, and has practiced Schema Therapy in these areas since 2006. She is also a Board Approved Clinical Supervisor for early career psychologists. On the way, Melanie developed a keen interest in the interplay between psychology, neurobiology, psychiatry and medicine, as well as promoting Schema Therapy in interdisciplinary and multidisciplinary teams.
As part of the institute’s Clinical Services Team, Melanie regularly works with clients, is involved in teaching activities at the institute, and actively collaborates with the Black Dog Institute’s Neuromodulation (Neurostimulation) Clinic, who specialise in novel treatments for treatment-resistant depression, including ketamine.
The Interplay between Schema Therapy and Ketamine for Treatment-Resistant Depression: Case studies
Ketamine, a dissociative anaesthetic, has been used in surgery and pain management since the 1970’s. In the last 20 years, ketamine has received considerable attention by the psychiatric community for its antidepressant and psychedelic properties, and especially for the management of treatment-resistant depression (TRD). In 2021, the Australian Therapeutic Goods Administration (TGA) approved a ketamine intranasal spray known as Spravato for the management of TRD. Research studies examining the use of ketamine for managing TRD have shown some interesting results – rapidly improving mood to the point of remission, increasing positive emotion, reducing suicidal tendencies, and increasing both synaptic connectivity and neuroplasticity. Despite such promising findings, the antidepressant effects of ketamine as a standalone treatment for TRD are temporary (often only lasting from 24hrs to 7 days).
Psychotherapy has been put forward as a means of prolonging the effects of ketamine and make positive use of its dissociative elements. Formal research studies in this area are still in their infancy and have focused on Ketamine Assisted Therapy and the combination of ketamine and Cognitive Behavioural Therapy. However, childhood trauma and attachment injuries are often at the core of TRD, and more durable change requires trauma and attachment informed psychotherapy. Schema Therapy is applicable and effective for TRD, and is a promising candidate for combination with ketamine therapy. Despite this, no studies or case studies so far have examined the interplay between Schema Therapy (ST) and ketamine delivered specifically by subcutaneous means.
This presentation aims to address this gap by:
1) outlining the ketamine treatment protocol for TRD used at the Black Dog Institute in Sydney, Australia,
2) present two compelling case studies showing the positive outcomes achieved using ST and ST techniques with depressed clients receiving concurrent ketamine treatment at the Black Dog Institute,
3) emphasising the need for a biopsychosocial understanding, and treatment of TRD, and, as such,
4) propose an expanded role for ST in a multidisciplinary model of care for this condition.