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The new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 14 (25 August 2022)
KetaMIND now offers virtual consultations and therapy with our in-house 'mental wellness' team...
KCSA recognizes the importance of an integrated approach to mental health. Ketamine infusions can be an important element in the treatment of patients with resistant mood disorders and suicidality, and can kick-start recovery and remission like no other agent. But ketamine therapy cannot exist in isolation.
Our new national in-house mental wellness team addresses this issue by providing patients who need their services with rapid access (via virtual consultations) to an experienced specialist psychiatrist and a choice of clinical and counselling psychologists, all familiar with the use of ketamine. In addition, this panel stands ready to remotely assist and guide KCSA clinic doctors who may need to draw on their expertise in the field of mental health from time to time. Recommendations from our specialist panel will also be fed through to patients’ own GP’s, to guide ongoing prescribing and management, when required.
Our preference remains treating patients referred and managed by their own psychiatrists (with whom we will maintain contact and dialogue) - however we cannot ignore the needs of several patients who present without such immediate professional mental health care... and our 'mental wellness' team aims to address this need at several levels.
Scroll down to 'meet' the KetaMIND mental wellness team...
Breaking news!
SASOP officially recognizes ketamine infusion therapy (KIT) for the management of treatment-resistant depression (TRD).
As did their North American counterparts the APA in 2021, the South African Society of Psychiatrists (SASOP) has just released its official position statement and guidelines on ketamine infusion for Treatment Resistant Depression, citing a "good level of evidence for efficacy."
Importantly, SASOP has also adopted the statement on KIT released by the South African Society of Anaesthesiologists (SASA) in 2021, finally aligning the disciplines of psychiatry and anaesthesiology on this issue. Importantly, SASOP does not endorse administration of ketamine for TRD by the im, sc or oral routes citing insufficient evidence. Intravenous ketamine infusion must be administered in a monitored clinical environment by an anaesthetist or doctor with the appropriate training and life-support skillset, as per the SASA guideline. TRD management must be led by a psychiatrist.
At KetaMIND clinics we embrace the guidelines of both SASA and SASOP. Our clinics are accredited by SOSPOSA and we acknowledge the need for management of TRD by a specialist psychiatrist. We remain committed to ongoing academic research in this field through our partnership with the UKZN Department of Psychiatry.
DADS CAN BE SAD - the reality of paternal perinatal depression...
"In up to 3.18% of couples, both parents may concurrently
experience perinatal depression. Perinatal health care must consider the mental health needs of parents, both as individuals and as a parental dyad".
In a recent systematic review and meta-analysis of 23 studies with 29 286 couples, up to 3.18% of parental dyads (both mothers and fathers) experienced perinatal depression and prevalence was higher in the late postnatal period (3-12 months).
In a previous newsletter, we examined the role of ketamine infusion for postpartum depression. It is wise to remember Dad as well.
A recent JAMA article examines how both parents may be affected by perinatal mood disorders.
KetaMIND clinics currently offer outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CAPE TOWN (WC)
Re-opening soon!
UMHLANGA (KZN)
HILTON (KZN)
Dr Maria Dobreva is a specialist psychiatrist with over 20-years’ experience in private practice. She is a strong advocate for the use of outpatient ketamine infusions in psychiatry and serves on the board of the Society of Ketamine Practitioners of South Africa (SOKePSA).
Dr Dobreva offers virtual consultations at medical aid rates for KetaMIND patients without their own attending psychiatrists. Consultations can be booked online through the KetaMIND website, or through any KetaMIND clinic.
Meet KetaMIND's in-house 'mental wellness' panel of experts...
Our team of clinical and counselling psychologists each bring something special to the table. All offer support and containment sessions on a virtual platform (or face-to-face if geographically feasible) at enrolment, during and after ketamine infusion therapy (KIT). Pre-KIT sessions focus on relaxation techniques and alleviating anxiety. Post-KIT sessions address meaning-making and emotional release.
Read the bios for each of our team members by clicking on the link below. Therapy sessions on a virtual platform can be booked online through the KetaMIND website, or through any KetaMIND clinic. Medical aid rates are charged.
From left to right: Dr Doug Mansfield, Lerato Msimanga, Lauren Calder
"Given the association between the dorsal hippocampus and cognition and ventral hippocampus and mood, our results provide a possible explanation for ketamine’s predominantly mood-related effects..."
'Happy mice' help us understand how ketamine works...
Ketamine activates adult-born immature granule neurons (ABINs) to rapidly alleviate depression-like behaviours in mice.
Fascinating research out of the Department of Neurology at NW University, Chicago published in Nature Communications identifies a specific cell population in the hippocampus that mediates the antidepressant action of ketamine.
The research found that the dentate gyrus of the hippocampus contributes to both
the acute and the sustained mechanisms of ketamine action.
Ketamine & Lamotrigine: can we finally settle the debate?
In a previous newsletter, anaesthetist P.J. Allen from our Umhlanga Clinic compared data from 63-patients, specifically looking at PHQ-9 outcomes in those taking lamotrigine and/or benzodiazepines while simultaneously receiving ketamine infusions.
Is there perhaps a beneficial synergy between ketamine and lamotrigine in patients with bipolar TRD? It seems the jury may still be out on this one. Link to a recently published systematic review on this issue. You decide.
In the next newsletter..
Palliative and 'end-of-life' care ... what can ketamine offer? Allodynia and hyperalgesia are troublesome elements of refractory pain syndromes and NMDA-receptors have been shown to play a crucial role in central sensitization. Studies show that low-dose ketamine may reverse an unfavourable opioid response and assist opioid switching. In a previous newsletter we discussed ketamine's role in Cancer-related Neuropathic Pain (CNP). In the next newsletter we will link to a retrospective analysis from a palliative care unit and an article from Frontiers in Pharmacology. |
How did KCSA start in South Africa?
KetaMIND Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019. To read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry click on the link below. |
