Review of ketamine combined with psychotherapy: little proof the therapy part adds benefit

The question

Does combining ketamine with psychotherapy help people with mental health conditions, and does the psychotherapy part actually add anything beyond the drug itself?

What they did

The authors searched for studies published up to 2025 that combined ketamine treatment with some form of talk therapy for mental disorders. They included 64 articles reporting on 72 studies, and sorted the therapies into broad schools of thought such as psychodynamic, behavioural, humanistic, cognitive-behavioural and integrative approaches. They then described the findings and the quality of the evidence, including a historical overview of how the practice developed.

What they found

Only 11 of the 72 studies were randomized controlled trials, the design that gives the most reliable answers. The largest group of therapy approaches (24 studies) did not fit standard categories and were classed as ‘other’. Reported results were generally positive across major depressive disorder, post-traumatic stress disorder, obsessive-compulsive disorder, substance use disorders and eating disorders, and compared with psychotherapy alone, ketamine-assisted psychotherapy was linked to better treatment engagement, greater symptom reduction and longer-lasting response. However, only two studies randomly assigned people to receive psychotherapy alongside ketamine, and neither found that the psychotherapy added a benefit; one of these also randomized the ketamine itself and found no significant interaction between the two.

The fine print

The review pooled studies with very different designs, therapies and patient groups, and most were not randomized or controlled. Very few studies used a psychotherapy control group, so the apparent benefits could reflect ketamine alone, patient expectations or the type of people who enter these studies. Total participant numbers, doses and follow-up lengths are not given in the abstract, and this summary is based on the abstract only.

What it means

Ketamine paired with psychotherapy is widely practiced and often reported to help, but the small number of properly controlled studies does not yet show that adding psychotherapy improves on ketamine by itself.

Evidence grade: Low. A systematic review in which only 11 of 72 included studies were randomized trials, and the methods varied widely between studies.

This summary is based on the study’s published abstract.