Alexandra Leinonen

I began as a yoga teacher and meditator, fascinated by the mind and consciousness. When I read about the effects of psychedelics—both as a potential treatment and as a way to explore and understand the mind—I decided to get involved in research. Inspired by Griffiths, Carhart-Harris, and others, I began studying medicine and eventually specialized in psychiatry.

I’ve been fortunate to work at a clinic that has been open to my ideas and has allowed me to stay engaged in research through my clinical work. At the same time, I’ve volunteered in psychedelic emergency care as part of harm reduction work at various events.

A few years ago, our clinic was preparing to start ketamine treatment for depression, and I began to study the field in depth. At the time, I thought ketamine was mostly an addictive anesthetic, but I came to understand that it can have consciousness-altering effects similar to psychedelics. After reviewing the literature and speaking with colleagues around the world and listening to presentations focused on ketamine for depression at conferences, I realized it had potential—but also risks.

For the past year, I’ve been a registered PhD student, conducting research on our psychedelic-informed ketamine treatment and working as a study physician in a clinical psilocybin trial. Consciousness still fascinates me, but right now, the patients are my priority, and my research is clinical. That is what I will present here at the conference.

Introducing a Psychedelic-Inspired Ketamine Treatment in Swedish Healthcare

Intravenous ketamine treatment has been used "off-label" for depression in Swedish psychiatry for over ten years. In 2023, we introduced ketamine treatment for treatment-resistant depression at Skaraborg Hospital. To reduce side effects, prolong the antidepressant effect, and help these long-term patients gain more agency and activation in their own recovery, we were inspired by the Montreal Model. This is a model that combines knowledge from “biomedical” ketamine treatment with more psychedelic-informed approaches.

According to this model, patients receive ketamine infusions over a few weeks while also engaging in therapeutic work with simple, individualized, and feasible behavior activation goals. We also use the acute psychoactive effects of ketamine as a potential basis for therapeutic conversation. To help patients allow and experience the acute subjective effects of ketamine more fully, they are offered mindfulness practice before the infusion, and an eye mask and music during the infusions.

Before and after the infusion, we talk about the experiences and how these affect the patient’s view of their illness and life—so-called “brief integration.” We currently have a few clinical studies ongoing and one pending ethical approval. These will be presented in brief, in addition to a presentation of how we introduced this treatment and what it has meant in everyday clinical practice.