Abstract
Background: Treatment resistant depression (TRD) is defined as a major depressive episode that does not improve in response to at least two trials, each of a different class, of antidepressant medication. Pharmacotherapy of TRD with low dose ketamines has been shown as relatively successful in recent studies. Effects of such pharmacotherapy can be augmented by combining ketamine with psychotherapeutic interventions such as Zdyb’s Therapeutic Reset of Internal Processes (TRIP) protocol.
 Method: 10 adult TRD patients (4 men, 6 women) were treated with low dose ketamines and were also receiving psychotherapeutic intervention as per TRIP protocol. All patients were administered the Patient Health Questionnaire, module 9 (PHQ9) which is a measure of a major depressive episode. The PHQ9 was administered twice: on baseline (i.e., prior to treatment) and after the treatment.
 Results: On average, our patients fell in the moderate range of severity with respect to symptoms of TRD at baseline (pre-TRIP) as by their mean PHQ9 score of 17.9, (SD = 5.1). Their mean PHQ9 score decreased post TRIP treatment to 9.5 (SD = 6.6): the difference is significant in a t-test, t(10) = 4.3172, p = 0002 (two-tailed). The magnitude of the decrease amounts to 46.9% of the average baseline score.
 Discussion and Conclusions: Our patients experienced significant reductions in symptoms of TRD in this pilot study. Research studies are now needed with control groups of TRD patients on a waiting list or also of those receiving only the ketamine pharmacotherapy.
Highlights
Cross-cultural studies by Weismann’s team estimated the lifetime prevalence of a major depressive episode from 1.5% to 19.0% [1]
Research studies are needed with control groups of treatment resistant depression (TRD) patients on a waiting list or of those receiving only the ketamine pharmacotherapy
The purpose of this study is to evaluate the efficacy of the Therapeutic Reset of Internal Processes (TRIP) protocol for enhancing ketamine therapy of TRD
Summary
Cross-cultural studies by Weismann’s team estimated the lifetime prevalence of a major depressive episode from 1.5% to 19.0% [1]. Individuals afflicted with severe treatment resistant depression (TRD) have likely undergone pharmacotherapy, electroconvulsive therapy (ECT), psychotherapy, neurofeedback, transmagnetic cranial stimulation, and/or combinations thereof resulting in little to no impact on the depressive episode. Treatment resistant depression (TRD) is defined as a major depressive episode that does not improve in response to at least two trials, each of a different class, of antidepressant medication. Pharmacotherapy of TRD with low dose ketamines has been shown as relatively successful in recent studies. Effects of such pharmacotherapy can be augmented by combining ketamine with psychotherapeutic interventions such as Zdyb’s Therapeutic Reset of Internal Processes (TRIP) protocol
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