{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:14:10Z","timestamp":1790018050891,"version":"4.0.1"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Ketamine-assisted psychotherapy is a promising new treatment for a variety of mental disorders of adolescence. There is currently an adolescent mental health crisis, with a high prevalence of disorders, diagnostic complexity, and many adolescents failing to respond to conventional treatments. While there is strong evidence for the use of ketamine in adults for a variety of treatment-refractory mental illnesses, research in adolescents is in its early stages. Ketamine-assisted psychotherapy (KAP) has been described in adults with promising results and here we present the first published cases of the use of KAP in adolescents. The four cases include adolescents aged 14\u201319 at the initiation of treatment, each with a variety of comorbid diagnoses including treatment-resistant depression, bipolar disorder, eating disorders, anxiety, panic, and trauma-related symptoms. They each initially received sublingual ketamine, followed by sessions with intramuscular ketamine. Their courses varied, but each had symptomatic and functional improvements, and the treatment was well-tolerated. Subjective patient reports are included. Rapid resolution of symptomatology and suffering often occurs within months as the result of the application of KAP to adolescent psychiatric care but is not inevitable. Family involvement in the treatment process appears to be essential to success. The development of this modality may have a singularly positive impact that will expand the psychiatric toolbox and its healing potency.<\/jats:p>","DOI":"10.3389\/fpsyt.2023.1141988","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T11:39:27Z","timestamp":1680176367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":30,"title":["Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses"],"prefix":"10.3389","volume":"14","author":[{"given":"Philip E.","family":"Wolfson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julane","family":"Andries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ahlers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Whippo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"B1","article-title":"\u2018Its Life or Death': The Mental Health Crisis among US Teens","author":"Rachtel","year":"2022","journal-title":"NY Times"},{"key":"B2","doi-asserted-by":"publisher","first-page":"k2608","DOI":"10.1136\/bmj.k2608","article-title":"Adolescent mental health in crisis","volume":"361","author":"Gunnell","year":"2018","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1001\/jamapediatrics.2021.2479","article-title":"Addressing the global crisis of child and adolescent mental health","volume":"175","author":"Benton","year":"2021","journal-title":"JAMA Pediatrics."},{"key":"B4","doi-asserted-by":"publisher","first-page":"888","DOI":"10.15585\/mmwr.mm7024e1","article-title":"Emergency department visits for suspected suicide attempts among persons aged 12\u201325 years before and during the COVID-19 pandemic \u2014 United States, January 2019\u2013May 2021","volume":"70","author":"Yard","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/jamapediatrics.2021.2482","article-title":"Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis","volume":"175","author":"Racine","year":"2021","journal-title":"JAMA pediatrics."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/S0006-3223(01)01129-5","article-title":"Mood disorders in children and adolescents: an epidemiologic perspective","volume":"49","author":"Kessler","year":"2001","journal-title":"Biol Psychiatry."},{"key":"B7","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1192\/bjp.188.3.216","article-title":"Longitudinal investigation into childhood-and adolescence-onset depression: psychiatric outcome in early adulthood","volume":"188","author":"Dunn","year":"2006","journal-title":"Br J Psychiatry."},{"key":"B8","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1111\/j.1469-7610.2006.01615.x","article-title":"Adolescent suicide and suicidal behavior","volume":"47","author":"Bridge","year":"2006","journal-title":"J Child Psychol Psychiatry."},{"key":"B9","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jad.2018.06.015","article-title":"Societal burden of adolescent depression, an overview and cost-of-illness study","volume":"241","author":"Bodden","year":"2018","journal-title":"J Affect Disord."},{"key":"B10","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jpeds.2018.09.021","article-title":"Prevalence and treatment of depression, anxiety, and conduct problems in US children","volume":"206","author":"Ghandour","year":"2019","journal-title":"J Pediatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1001\/jamapsychiatry.2019.2360","article-title":"Clinical stage transitions in persons aged 12 to 25 years presenting to early intervention mental health services with anxiety, mood, and psychotic disorders","volume":"76","author":"Iorfino","year":"2019","journal-title":"JAMA Psychiatry."},{"key":"B12","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jad.2010.10.046","article-title":"Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample","volume":"130","author":"Jonsson","year":"2011","journal-title":"J Affect Disord."},{"key":"B13","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1001\/2013.jamapsychiatry.55","article-title":"Prevalence, correlates and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication \u2013 Adolescent Supplement (NCS-A).","volume":"70","author":"Nock","year":"2013","journal-title":"JAMA Psychiatry."},{"key":"B14","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1089\/cap.2017.0077","article-title":"National patterns of commonly prescribed psychotropic medications to young people","volume":"28","author":"Sultan","year":"2018","journal-title":"J Child Adolesc Psychopharmacol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/jcpp.13202","article-title":"Annual Research Review: Defining and treating pediatric treatment-resistant depression","volume":"61","author":"Dwyer","year":"2020","journal-title":"J Child Psychol Psychiatry."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1017\/S0033291716000064","article-title":"Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety, and time trajectories","volume":"46","author":"Kishimoto","year":"2016","journal-title":"Psychol Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.jad.2020.09.007","article-title":"A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009\u2013January 2019","volume":"277","author":"Marcantoni","year":"2020","journal-title":"J Affect Disord."},{"key":"B18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1080\/02791072.2019.1587556","article-title":"Ketamine assisted psychotherapy (KAP): patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy","volume":"51","author":"Dore","year":"2019","journal-title":"J Psychoact Drugs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.jpsychires.2021.02.058","article-title":"The effectiveness, safety and tolerability of ketamine for depression in adolescents and older adults: a systematic review","volume":"137","author":"Di Vincenzo","year":"2021","journal-title":"J Psychiatr Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e067194","DOI":"10.1136\/bmj-2021-067194","article-title":"Ketamine for the acute treatment of severe suicidal ideation: double blind, randomized placebo controlled trial","volume":"376","author":"Abbar","year":"2022","journal-title":"BMJ."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1007\/s00787-020-01542-3","article-title":"A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders","volume":"30","author":"Kim","year":"2021","journal-title":"Eur Child Adolesc Psychiatry."},{"key":"B22","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.jad.2012.08.040","article-title":"Clinical experiencing intranasal ketamine in the treatment of pediatric bipolar disorder\/fear of harm phenotype","volume":"147","author":"Papolos","year":"2013","journal-title":"J Affect Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1089\/cap.2018.0030","article-title":"Intravenous ketamine for adolescents with treatment-resistant depression: an open-label study","volume":"28","author":"Cullen","year":"2018","journal-title":"J Child Adolesc Psychopharmacol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.jaac.2017.01.006","article-title":"Ketamine as a treatment for adolescent depression: a case report","volume":"56","author":"Dwyer","year":"2017","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B25","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1089\/cap.2019.0028","article-title":"Successful use of ketamine for the treatment of psychotic depression in a teenager","volume":"29","author":"Zarrinnegar","year":"2019","journal-title":"J Child Adolesc Psychopharmacol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1089\/cap.2022.0013","article-title":"Letter to the Editor: antidepressant and antisuicidal effects of esketamine in adolescents with major depressive disorder and suicidal ideation: a case series.","volume":"32","author":"Faria-Guimar\u00e3es","year":"2022","journal-title":"J Child Adolesc Psychopharmacol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1176\/appi.ajp.2020.20010018","article-title":"Efficacy of intravenous ketamine in adolescent treatment-resistant depression: a randomized midazolam-controlled trial","volume":"178","author":"Dwyer","year":"2021","journal-title":"Am J Psychiatry."},{"key":"B28","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1177\/0269881120928203","article-title":"Brain entropy and neurotrophic molecular markers accompanying clinical improvement after ketamine: preliminary evidence in adolescents with treatment-resistant depression","volume":"35","author":"Roy","year":"2021","journal-title":"J Psychopharmacol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1007\/s10803-020-04542-z","article-title":"Brief report: intranasal ketamine in adolescents and young adults with autism spectrum disorder-initial results of a randomized, controlled, crossover, pilot study","volume":"51","author":"Wink","year":"2021","journal-title":"J Autism Dev Disord."},{"key":"B30","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1515\/ijdhd-2015-0003","article-title":"Ketamine and the core symptoms of autism","volume":"15","author":"Kastner","year":"2016","journal-title":"Int J Disabil Hum Dev."},{"key":"B31","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/164_2018_148","article-title":"1, 2-diarylethylamine-and ketamine-based new psychoactive substances","author":"Wallach","year":"2018","journal-title":"New Psychoactive Substances."},{"key":"B32","doi-asserted-by":"publisher","first-page":"l6459","DOI":"10.1136\/bmj.l6459","article-title":"Does general anesthesia affect neurodevelopment in infants and children?","volume":"367","author":"McCann","year":"2019","journal-title":"BMJ."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2518","DOI":"10.1097\/CCM.0b013e31825ae442","article-title":"Neurotoxicity of ketamine: known unknowns","volume":"40","author":"Soriano","year":"2012","journal-title":"Crit Care Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1093\/toxsci\/kfm084","article-title":"Ketamine-induced neuronal cell death in the perinatal rhesus monkey","volume":"98","author":"Slikker Jr","year":"2007","journal-title":"Toxicol Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"9375910","DOI":"10.1155\/2018\/9375910","article-title":"Case report of subanesthetic intravenous ketamine infusion for the treatment of neuropathic pain and depression with suicidal features in a pediatric patient","volume":"2018","author":"Weber","year":"2018","journal-title":"Case Rep Anesthesiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1111\/pan.13203","article-title":"Interventions for postoperative pain in children: an overview of systematic reviews","volume":"27","author":"Boric","year":"2017","journal-title":"Paediatr Anaesth."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1016\/j.ajem.2020.05.094","article-title":"Intranasal ketamine for acute pain management in children:analysis","volume":"38","author":"Oliveira JE Silva","year":"2020","journal-title":"Am J Emerg Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/S0196-0644(99)80051-1","article-title":"Inadvertent ketamine overdose in children: clinical manifestations and outcome","volume":"34","author":"Green","year":"1999","journal-title":"Ann Emerg Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/0002-9378(72)90774-0","article-title":"Study of ketamine as an obstetric anesthetic agent","volume":"113","author":"Little","year":"1972","journal-title":"Am J Obstet Gynecol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.expneurol.2015.03.028","article-title":"Neurodevelopmental implications of the general anesthesia in neonate and infants","volume":"272","author":"Lee","year":"2015","journal-title":"Exp Neurol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/ANA.0000000000000027","article-title":"Dual effects of ketamine: neurotoxicity versus neuroprotection in anesthesia for the developing brain","volume":"26","author":"Yan","year":"2014","journal-title":"J Neurosurg Anesthesiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1111\/bcp.12094","article-title":"Ketamine for chronic pain: risks and benefits","volume":"77","author":"Niesters","year":"2014","journal-title":"Br J Clin Pharmacol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1016\/j.neuron.2019.02.005","article-title":"Ketamine: a paradigm shift for depression research and treatment","volume":"101","author":"Krystal","year":"2019","journal-title":"Neuron."},{"key":"B44","author":"Hyde","year":"","journal-title":"Ketamine for Depression 2015 XlibrisAU"},{"key":"B45","author":"Wolfson","year":"","journal-title":"The Ketamine Papers 2016"},{"key":"B46","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1002\/wps.20089","article-title":"Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis","volume":"13","author":"Cuijpers","year":"2014","journal-title":"World Psychiatry."},{"key":"B47","doi-asserted-by":"publisher","first-page":"103637","DOI":"10.1016\/j.brat.2020.103637","article-title":"Double trouble: do symptom severity and duration interact to predicting treatment outcomes in adolescent depression?","volume":"131","author":"Lorenzo-Luaces","year":"2020","journal-title":"Behav Res Ther."},{"key":"B48","doi-asserted-by":"publisher","first-page":"868103","DOI":"10.3389\/fpsyg.2022.868103","article-title":"Toward synergies of ketamine and psychotherapy","volume":"13","author":"Mathai","year":"2022","journal-title":"Front Psychol."},{"key":"B49","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1089\/cap.2021.0078","article-title":"Parental attitudes toward use of ketamine in adolescent mood disorders and suicidality","volume":"31","author":"Mathai","year":"2021","journal-title":"J Child Adolesc Psychopharmacol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1177\/0269881110378371","article-title":"The safety and efficacy of {+\/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study","volume":"25","author":"Mithoefer","year":"2011","journal-title":"J Psychopharmacol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/j.jad.2021.12.097","article-title":"A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings","volume":"301","author":"McInnes","year":"2022","journal-title":"J Affect Disord."},{"key":"B52","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1192\/bjo.2021.1061","article-title":"Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review","volume":"8","author":"Walsh","year":"2021","journal-title":"BJPsych Open."},{"key":"B53","doi-asserted-by":"publisher","first-page":"648691","DOI":"10.3389\/fpsyg.2021.648691","article-title":"Intranasal ketamine for depression in adults: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials","volume":"12","author":"An","year":"2021","journal-title":"Front Psychol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/bcp.12264","article-title":"The absolute bioavailability of racemic ketamine from a novel sublingual formulation","volume":"77","author":"Rolan","year":"2014","journal-title":"Br J Clin Pharmacol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1002\/bdd.336","article-title":"Plasma concentration profiles of ketamine and norketamine after administration of various ketamine preparations to healthy Japanese volunteers","volume":"24","author":"Yanagihara","year":"2003","journal-title":"Biopharm Drug Disposition."},{"key":"B56","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jad.2022.07.004","article-title":"At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: findings from a large, prospective, open-label effectiveness trial","volume":"314","author":"Hull","year":"2022","journal-title":"J Affect Disord."},{"key":"B57","doi-asserted-by":"publisher","first-page":"992624","DOI":"10.3389\/fpsyt.2022.992624","article-title":"Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: a retrospective study of off-label, at-home use","volume":"13","author":"Hassan","year":"2022","journal-title":"Front Psychiatry."},{"key":"B58","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jad.2022.08.090","article-title":"At-home ketamine; still a lot to learn","volume":"318","author":"Wilkinson","year":"2022","journal-title":"J Affect Disord."},{"key":"B59","first-page":"10","article-title":"Parental alienation syndrome (PAS): sixteen years later","volume":"45","author":"Gardner","year":"2001","journal-title":"Academy Forum."},{"key":"B60","first-page":"53","author":"Kahn","year":"2019","journal-title":"Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41380-022-01757-7","article-title":"International pooled patient-level meta-analysis of ketamine infusion for depression: in search of clinical moderators","author":"Price","year":"2022","journal-title":"Mol Psychiatry."},{"key":"B62","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.wpsyc.2012.01.006","article-title":"Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients","volume":"11","author":"Baldessarini","year":"2012","journal-title":"World Psychiatry."},{"key":"B63","author":"Branje","year":"2022","journal-title":"Adolescent Identity Development in Context C286urrent Opinion in psychology VV.45"},{"key":"B64","doi-asserted-by":"publisher","first-page":"e20183766","DOI":"10.1542\/peds.2018-3766","article-title":"Adolescent connectedness and adult health outcomes","volume":"144","author":"Steiner","year":"2019","journal-title":"Pediatrics."},{"key":"B65","first-page":"5","article-title":"On programming psychedelic experiences","volume":"9","author":"Metzner","year":"1967","journal-title":"Psychedelic Rev."},{"key":"B66","doi-asserted-by":"publisher","first-page":"2050324516683325","DOI":"10.1177\/2050324516683325","article-title":"Constructing drug effects: a history of set and setting","volume":"3","author":"Hartogsohn","year":"2017","journal-title":"Drug Sci Policy Law."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1141988\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T11:39:35Z","timestamp":1680176375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1141988\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":66,"alternative-id":["10.3389\/fpsyt.2023.1141988"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2023.1141988","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]},"article-number":"1141988"}}