Influenced by celebrities, social media, and technology Patients are going to creative and extreme lengths to heal their mental health. From darkness immersion for self-reflection to SPECT scans for brain mapping, here’s what your patients could ask about next. 

 

Darkness therapy

 

Recently, Green Bay Packers quarterback Aaron Rodgers said he went on a darkness retreat,

Kafanov L. NFL star Aaron Rodgers went to a darkness retreat to contemplate his future. What is that and how does it work? CNN.

where he sat in complete darkness for several days to contemplate his thoughts.

 

According to Skycave Retreats

Welcome to sky cave dark retreats. SKY CAVE RETREATS.

, his darkness therapy provider, spending several days in total darkness is said to potentially encourage the release of endogenous N, N-Dimethyltryptamine (DMT), which is often used as a hallucinogenic, ritualistic drug when ingested through plant matter.

Barker SA. N, n-dimethyltryptamine (Dmt), an endogenous hallucinogen: past, present, and future research to determine its role and function. Front Neurosci. 2018;12:536.

According to researchers, psychedelic-assisted psychotherapy, including the use of DMT, shows promise for mental health care.

Gründer G, Jungaberle H. The potential role of psychedelic drugs in mental health care of the future. Pharmacopsychiatry. 2021;54(4):191-199.

 

 

To access DMT, people have long engaged in spiritual ceremonies utilizing ayahuasca (in which DMT is the main ingredient), made from the bark of the Banisteriopsis caapi vine and the leaves of the Psychotria viridis bush. A review in Current Neuropharmacology found that while ayahuasca may be beneficial for the treatment of various psychiatric disorders, more research is needed.

Hamill J, Hallak J, Dursun SM, Baker G. Ayahuasca: psychological and physiologic effects, pharmacology and potential uses in addiction and mental illness. Current Neuropharmacology. 17(2):108-128.

Other research has said that the role of endogenous DMT in mental health management is still unclear.

Rodrigues AV, Almeida FJ, Vieira-Coelho MA. Dimethyltryptamine: endogenous role and therapeutic potential. J Psychoactive Drugs. 2019;51(4):299-310.

 

 

So was Rodgers able to access the potential therapeutic benefits of DMT by sitting in total darkness for a prolonged period of time? The jury is out, and there’s no firm science indicating whether or not this is true.

“The idea behind darkness retreats is to provide an atmosphere of total relaxation and introspection so that the person can explore their thoughts and feelings without distraction,” she says.

“Since the main purpose of darkness retreats is to help us slow down and become more mindful, they may benefit those who suffer from anxiety or depression. However, as an alternative form of therapy, darkness retreats are relatively new and lack a great deal of scientific evidence to support their efficacy.”

 

SPECT scans

 

You know that single-photon-emission-computed tomography (SPECT) imaging is nothing new, but its use shows more and more potential, according to an article in Frontiers in Psychiatry. “Functional neuroimaging can be a powerful tool helping to show that other factors are aggravating or are the primary cause of neuropsychiatric syndromes,” the journal states.

Amen DG, Easton M. A new way forward: how brain spect imaging can improve outcomes and transform mental health care into brain health care. Front Psychiatry. 2021;12.

 

 

The article’s examples included a patient with ongoing mental health conditions—including “crippling anxiety, extreme mood swings, recurring panic attacks, negative thinking patterns, anger issues, and difficulty sleeping”—utilizing SPECT imaging to map their brain. The scans found that they’d been living with “significantly decreased overall cerebral blood flow, most pronounced in the prefrontal cortex (PFC) and temporal lobes…. indicative of a past head injury and exposure to toxins.”

If you’re considering referring a patient for imaging, this choice may offer a deeper look at the root of their health concerns and elucidate potential best treatment options. “Adding neuroimaging tools like SPECT to day-to-day clinical practice can help move psychiatry forward by transforming mental health care, which can be stigmatizing and often shunned by the general public, to brain health care, which the authors argue will be more likely to be embraced by a larger group of people in need,” the article’s authors write. 

 

Ketamine therapy

 

Ketamine—once known more as a recreational drug nicknamed “Special K”—has become increasingly popular, especially in boutique healthcare settings.

Fast facts about ketamine for depression.

 

 

There is science behind the drug’s efficacy. In a study, 4,334 cases of sublingual, at-home administration of ketamine-assisted therapy (KAT) for depression and anxiety were examined.

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. Journal of Affective Disorders. 2022;314:59-67.

The results showed that KAT offered clinically meaningful improvement and demonstrated a desirable safety and risk mitigation profile.”

 

Some patients may be better suited for KAT than others. According to April Krowel, Ph.D., HSPP, and a licensed clinical neuropsychologist, “Ketamine is a good potential option for treatment-resistant depression. Ketamine or esketamine have been found to rapidly improve depressive symptoms in those who have treatment-resistant depression.” 

Krowel says the main difference between ketamine and esketamine is how they’re administered. Typically, ketamine is taken by infusion and esketamine is intranasal spray (Spravato). 

“In my clinic, where we are getting ready to start esketamine, there are very specific guidelines to follow to ensure patient safety, including two hours of observation and three blood pressure checks,” Krowel says. “Patients can dissociate, become confused and/or agitated, and can become sedated. There is also risk of nausea and vomiting for patients.”

“I think when we talk to our patients about this medication option, we should talk about their current symptoms, how they [may not be] resolving with treatment as usual, and that KAT is a true efficacious treatment that has shown a lot of promise with improving symptoms,” Krowel says. 

That said, the treatment doesn’t come without risks and side effects—and these needs to be made clear to patients. “There are contraindicated medical and mental health conditions that could be problematic, such as uncontrolled high blood pressure or dissociative disorders,” Krowel adds. 

Your patients need to know that ketamine isn’t a one-time fix. Patients will likely need multiple doses and use KAT as part of a comprehension management strategy. Some experts believe it’s best paired with cognitive behavioral therapy (CBT).

Fast facts about ketamine for depression.