Ketamine-Assisted Mindfulness-Based Cognitive Therapy for Depression: A Pilot Study

Inclusion Criteria:

• Adults age 18-65
• A current diagnosis of major depressive disorder according to DSM-5 criteria per MINIinterview
• Moderate to severe level of current depressive symptoms (MADRS score ≥20)
• Failure of at least one adequate trial of antidepressant medication (defined as:therapeutic doses of antidepressant medication for ≥ 6 weeks)
• No adverse reactions to ketamine
• Capacity to consent and comply with study procedures, including sufficient proficiencyin English

Exclusion Criteria:

• Meets DSM-5 criteria for bipolar disorder, schizophrenia, any psychotic illness,including substance-induced psychosis, active PTSD, dissociative disorders and currentsubstance-induced mood disorder, OCD, eating disorder, panic disorder.
• Suicide attempt in the past 4 weeks or current risk of suicide
• Current alcohol or drug substance use disorder according to DSM-5
• Cognitive- or intellectual impairments which would interfere with participation inMBCT or assessments including meeting criteria for Delirium, Dementia, Amnesia,Cognitive Disorders,
• Personality Disorders (borderline, antisocial, paranoid, schizoid, histrionic) thatmay interfere with treatment
• Previous participation in MBCT or MBSR group
• Pregnant or planning to become pregnant during the study period
• Heart disease as indicated by history, abnormal ECG, previous cardiac surgery.
• Hypertension (>160/100)
• Unstable physical disorders which might make participation hazardous such as historyof AIDS, known lab abnormalities, active hepatitis or other liver disease withelevated transaminase levels (< 2-3 X upper limit of normal will be consideredacceptable if PT/PTT is normal), renal failure (creatinine > 2, BUN >40), or untreateddiabetes.
• Previous history of ketamine misuse or abuse, or a history of an adversereaction/experience with prior exposure to ketamine
• BMI > 32
• History of documented obstructive sleep apnea
• On psychotropic or other medications whose effect could be disrupted by participationin the study or not allowed during the study (such as monoamine oxidase inhibitors).
• Patient unable or unlikely to comply with the study protocol or for any otherconditions that might indicate that the patient is unsuitable for the study as judgedby the investigator
• Positive urine drug screen, except for marijuana or benzodiazepine if prescribed.