Ketamine-Assisted Therapy (KAT) – A New Option for Treatment-Resistant Depression

Ketamine has been known and safely used as a medication for more than fifty years, originally applied as an anesthetic. Recent scientific findings indicate that Ketamine-Assisted Therapy, when administered under controlled medical conditions, offers an evidence-based option for individuals who have not responded to traditional antidepressant treatments (Sanacora et al., 2017; Yavi et al., 2022). Therapeutic response varies among individuals; however, several studies and clinical experiences show that improvement may be noticeable after just a few sessions. The combined approach of ketamine and psychological support — commonly referred to as Ketamine-Assisted Therapy (KAT) — appears to contribute to the long-term maintenance of therapeutic benefits and improved outcomes (Dore et al., 2019).

KAT and Reduction of Suicidal Ideation

Treatment-resistant depression frequently involves heightened suicidal thoughts, which require rapid and effective intervention. Research shows that ketamine can significantly reduce suicidal ideation within 24 hours, even in cases where previous treatments have been ineffective (Wilkinson et al., 2018). The rapid symptom relief induced by ketamine can create a “sensitive window,” during which patients become more receptive to therapy, and integration sessions may lead to longer-term stability (Reinstatler & Youssef, 2015).

Safety considerations

  • Ketamine does not replace emergency crisis intervention.
  • Only patients whose psychiatric condition can be continuously monitored are eligible for treatment.

Based on current evidence, KAT represents a promising adjunctive option for depressive patients who struggle with suicidal thoughts and have not responded to other treatments.

Who May Benefit from Ketamine-Assisted Therapy (KAT)?

The treatment is recommended for patients who:

  • Have not achieved lasting improvement with at least two different antidepressant medications (Yeung, Lin & Pahwa, 2023).
  • Experience severe, long-standing depression for which other treatment modalities have been ineffective (Andrade, 2017).
  • May benefit from adjunctive treatment for alcohol or other substance use disorders, as ketamine can reduce cravings and support behavioral change (Das et al., 2019; Kolp et al., 2014).

How Does Ketamine Work?

Ketamine influences the functioning of synapses—the connections between brain cells—supports the formation of new neural pathways and thereby plays a role in mood regulation (Yavi, 2022; Taraku, 2024).

Research shows that ketamine:

  • Can relieve symptoms within hours,
  • Promotes the regeneration of neural connections,
  • Has effects lasting days or even weeks, which can be extended with repeated treatment (Fava, 2020).

The Therapeutic Process at Our Clinic

1. Medical Consultation and Evaluation

The process begins with a detailed medical examination, during which:

  • EKG and laboratory testing are ordered,
  • Anesthesiology pre-screening is conducted,
  • The patient receives comprehensive information about the treatment protocol and the role of each specialist.

Initiating the therapy is the responsibility of a psychiatrist, who determines the patient’s eligibility.

2. Psychiatric Consultation

A psychiatric assessment is required to confirm treatment-resistant depression. The psychiatrist:

  • Conducts a detailed evaluation,
  • Determines suitability for treatment,
  • Provides recommendations for coordinating psychological and pharmacological care.

3. Preparatory Psychological Sessions

Before the first ketamine-assisted session, two preparatory meetings take place to establish psychological readiness, safety, and clear therapeutic goals. Standardized questionnaires are used to assess baseline status.

4. Ketamine-Assisted Therapy (KAT) Series

The therapy consists of multiple intravenous ketamine sessions administered under medical supervision. Each treatment is personalized, monitored continuously, and adjusted to the patient’s condition.

5. Integration Sessions

Every infusion is followed by a brief integration discussion, and a full therapeutic integration session is scheduled shortly after to help process the experience and reinforce changes.

6. Follow-Up

The entire program includes regular psychiatric and psychological follow-up to track the durability of therapeutic effects. The typical duration is 14–18 weeks, aligned with internationally accepted KAP models (Dore, 2019).

Safety and Side Effects

All treatments at our clinic are provided under medical supervision, led by a specialist with MSc-level training and supported by an experienced nursing team. After treatment, patients remain under observation and may leave only with an escort. Driving, operating machinery, and alcohol consumption are prohibited for 24 hours.

Possible temporary, mild side effects include:

  • Increased blood pressure and heart rate,
  • Dizziness, nausea, vomiting,
  • Mild “dreamlike” or altered consciousness experiences (Sanacora, 2017; Underwood, 2019),
  • Transient “out of body” sensations during infusion.

Why Is This Approach Unique?

  • Rapid effect: symptom relief may appear within 24 hours.
  • New option: may be effective when other medications have failed.
  • Integrated approach: the ketamine-induced “sensitive window” enhances psychotherapy and contributes to long-term stability (Dore, 2019).
  • Substance use disorders: studied as an adjunctive method (Das, 2019).

Important Information

  • The psychiatric use of ketamine is currently off-label.
  • Detailed medical information and written consent are required.
  • Treatment can only be administered in an institutional setting, following strict professional protocols.
  • Safety is ensured through the coordinated work of psychiatrists, anesthesiologists, psychologists, and MSc-trained nurses.

References