Ketamine is a medication that has been known for more than 50 years and was originally approved as an anesthetic. In the last two decades, it has been discovered that when administered in low doses under controlled conditions, it has a rapid and effective antidepressant effect, especially in patients who did not respond to conventional medications (so-called treatment-resistant depression, TRD) [1,2].

Who is it recommended for?

  • Patients who have not improved after trying at least two different antidepressant medications [3].
  • Individuals suffering from severe, long-standing depression, particularly when other therapies have failed [4].
  • Some studies suggest that ketamine may also be promising in the treatment of alcoholism and other addictive disorders, as it can ‘rewrite’ maladaptive drinking memories and reduce craving [5,6].

How does ketamine work?

Unlike traditional antidepressants, which usually take weeks to take effect, ketamine:

  • can improve depressive symptoms within hours,
  • stimulates the formation of new connections (synapses) between brain cells,
  • acts on the glutamatergic system, which plays a key role in mood regulation [2,7].

The effect usually lasts for several days or weeks, but can be prolonged with repeated treatments [8,9].

Important note: When ketamine infusion therapy is combined with psychotherapy, the results can be more durable. Therapeutic sessions can help:

  • reshape thought and emotional patterns,
  • modify maladaptive behavioral habits,
  • adjust dysfunctional defense mechanisms.

This approach is called Ketamine-Assisted Psychotherapy (KAP), and growing evidence supports that it may lead to longer-lasting improvement in depressive and anxiety symptoms [10].

How does the treatment proceed at our clinic?

1. Initial screening: medical documentation confirming treatment-resistant depression.
2. Psychiatric consultation: assessment of the patient’s condition and treatment suitability.
3. Preparatory psychological sessions (2–3 sessions).
4. Medical examinations: ECG, laboratory tests.
5. Infusion treatment: intravenous infusion over 40 minutes, typically at 0.5 mg/kg dose [7].
6. Integration sessions with a psychologist.
7. Repeated treatments: usually 3 infusions in total.
8. Follow-up: regular check-ups, Beck Depression Inventory monitoring for 3–12 months.

Safety and side effects

Ketamine can be safely administered under medical supervision, but temporary side effects may occur:

  • increased blood pressure and heart rate,
  • dizziness, nausea,
  • transient ‘out-of-reality’ experience or dissociation [1,11].

In rare cases, dependence may occur, which is why treatment is always carried out under strict medical supervision [2].

Why is it special?

  • Rapid effect: improvement may be seen within 24 hours.
  • New opportunity: can help patients who did not respond to other medications.
  • Promising in alcoholism: studies show it may reduce harmful drinking behaviors [5].
  • Longer-lasting effect with psychotherapy: ketamine provides a therapeutic ‘window’ that can be deepened with psychological work, resulting in more sustained recovery [10].

References

  1. Sanacora G. et al. (2017). A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders.
  2. Yavi M. et al. (2022). Ketamine Treatment for Depression: A Review.
  3. Yeung A. et al. (2023). Pharmacotherapy and Ketamine Assisted Psychotherapy for Treatment-Resistant Depression. J Clin Psychiatry.
  4. Morvai S. et al. (2016). Ketamine administration in severe, treatment-resistant depression.
  5. Das R. et al. (2019). Ketamine Can Reduce Harmful Drinking by Pharmacologically Rewriting Drinking Memories.
  6. Kolp E. et al. (2014). Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications.
  7. Andrade C. (2017). Ketamine for Depression: Dose, Rate, Route, Duration, Frequency. J Clin Psychiatry.
  8. Fava M. et al. (2020). Double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine in TRD.
  9. Bahji A. et al. (2021). Comparative efficacy of racemic ketamine and esketamine for depression.
  10. Dore J. et al. (2019). Ketamine Assisted Psychotherapy: Patient Demographics, Clinical Data and Outcomes.
  11. Underwood E. (2019). Listening to Ketamine. Knowable Magazine.