Ketamine-Assisted Therapy –

A New Option for Treatment-Resistant Chronic Depression

Ketamine is a medication known for over fifty years and safely used in medical practice, originally as an anesthetic. In recent years, scientific evidence has shown that ketamine-assisted therapy, when applied under controlled medical conditions, offers an evidence-based option for patients whose depression has not responded to conventional antidepressant treatments(1,10). The therapeutic response may vary between individuals; however, studies and clinical experience indicate that improvement can often be observed after just a few sessions. When combined with psychological support—known as ketamine-assisted therapy (KAT)—it may help sustain positive effects and improve long-term outcomes6.

Ketamine-Assisted Therapy and Reduction of Suicidal Thoughts

Treatment-resistant depression is often associated with increased suicidal ideation, which requires rapid and effective intervention. Research suggests that ketamine can significantly reduce suicidal thoughts within 24 hours, even when previous treatments have been ineffective14.

The rapid symptom relief may create a “sensitive window,” during which patients are more receptive to therapy, allowing integration sessions to support longer-term stability5.

Safety Considerations

  • Ketamine does not replace acute crisis intervention
  • Only patients with ensured continuous psychiatric monitoring can be treated
  • Current evidence suggests that KAT may be a promising adjunctive option for patients with depression and suicidal ideation who have not responded to other therapies

Who May Be Suitable for Ketamine-Assisted Therapy?

The treatment may be recommended for patients who:

  • have not achieved sustained improvement with at least two different antidepressant medication13.
  • suffer from severe, long-standing depression unresponsive to other treatments8.
  • in some cases, it may also be used as an adjunct in substance use disorders, as it may reduce cravings and support behavioral change(7,9).

How Does Ketamine Work?

Ketamine affects communication between brain cells (synapses), promotes the formation of new connections, and plays a role in mood regulation(10,11).

Research shows that:

  • symptoms may improve within hours
  • it promotes the rebuilding of neural connections
  • its effects may last for days or weeks and can be prolonged with repeated treatments3

The Therapeutic Process at Our Clinic

1. Medical Consultation and Evaluation

The first step is a detailed medical assessment, including:

  • ECG and laboratory testing
  • anesthesiology pre-screening
  • full patient information about the procedure, protocol, and involved specialists

Initiation of therapy is the responsibility of a psychiatrist, who also determines patient eligibility.

2. Psychiatric Consultation

A psychiatric evaluation is required to confirm treatment-resistant depression.

The psychiatrist:

  • performs a detailed assessment
  • determines eligibility
  • coordinates psychological and pharmacological treatment

3. Preparatory Psychological Sessions

Two preparatory psychological sessions precede the first ketamine-assisted treatment. Their goal is to prepare the patient mentally, enhance a sense of safety, and clarify therapeutic goals. Standard questionnaires support the assessment process.

4. Ketamine-Assisted Therapy Treatment Series

The therapy consists of multiple ketamine infusions administered intravenously under medical supervision. Treatments are individualized and continuously monitored, tailored to the patient’s condition.

5. Integration Sessions

Each infusion is followed by a short integration discussion, and later by structured therapeutic sessions to help process experiences and reinforce changes.

6. Follow-up

The process concludes with regular psychiatric and psychological follow-ups to monitor long-term outcomes. The program typically lasts 14–18 weeks, based on internationally accepted KAT models6.

Safety and Side Effects

Treatments are performed under strict medical supervision by trained professionals.

After treatment:

  • patients remain under observation
  • they must leave with an escort
  • driving, operating machinery, and alcohol consumption are not allowed for 24 hours

Possible temporary side effects include:

  • increased blood pressure and heart rate
  • dizziness, nausea, vomiting
  • mild dream-like or altered consciousness experiences(10,11)
  • transient “out-of-body” sensations during infusion

What Makes This Approach Unique?

  • Rapid effect: symptom improvement may occur within 24 hours
  • New option: may be effective when other treatments have failed
  • Integrated approach: the “sensitive window” created by ketamine enhances the effectiveness of psychological work and long-term stability6
  • Also studied as an adjunct in addiction treatment7

Important Information

  • Ketamine use in psychiatry is currently off-label
  • Detailed medical information and written consent are required
  • Treatment can only be performed in a medical setting following strict protocols
  • Safety is ensured by a multidisciplinary team: psychiatrist, anesthesiologist, psychologist, and MSc-level nursing staff

Source:

  1. Sanacora, Gerard, Mark A. Frye, William McDonald, és mtsai. „A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders”. JAMA Psychiatry74, sz. 4 (2017): 399. https://doi.org/10.1001/jamapsychiatry.2017.0080.
  2. Bahji, Anees, Gustavo H. Vazquez, és Carlos A. Zarate. „Comparative Efficacy of Racemic Ketamine and Esketamine for Depression: A Systematic Review and Meta-Analysis”. Journal of Affective Disorders278 (2021. január): 542–55. https://doi.org/10.1016/j.jad.2020.09.071.
  3. Fava, Maurizio, Marlene P. Freeman, Martina Flynn, és mtsai. „Double-Blind, Placebo-Controlled, Dose-Ranging Trial of Intravenous Ketamine as Adjunctive Therapy in Treatment-Resistant Depression (TRD)”. Molecular Psychiatry25, sz. 7 (2020): 1592–603. https://doi.org/10.1038/s41380-018-0256-5.
  4. Morvai Szabolcs, Nagy Attila István, Bálint-Szöllősi Adrienn, Móré E. Csaba, Berecz Roland, és Frecska Ede. „Ketamin alkalmazása súlyos, terápiarezisztens depressziós beteg esetében”. Ideggyógyászati Szemle69, sz. 11–12 (2016). https://doi.org/10.18071/isz.69.0421.
  5. Reinstatler, Lael, és Nagy A. Youssef. „Ketamine as a Potential Treatment for Suicidal Ideation: A Systematic Review of the Literature”. Drugs in R&D15, sz. 1 (2015): 37–43. https://doi.org/10.1007/s40268-015-0081-0.
  6. Dore, Jennifer, Brent Turnipseed, Shannon Dwyer, és mtsai. „Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy”. Journal of Psychoactive Drugs51, sz. 2 (2019): 189–98. https://doi.org/10.1080/02791072.2019.1587556.
  7. Das, Ravi K., Grace Gale, Katie Walsh, és mtsai. „Ketamine Can Reduce Harmful Drinking by Pharmacologically Rewriting Drinking Memories”. Nature Communications10, sz. 1 (2019): 5187. https://doi.org/10.1038/s41467-019-13162-w.
  8. Andrade, Chittaranjan. „Ketamine for Depression, 4: In What Dose, at What Rate, by What Route, for How Long, and at What Frequency?”: The Journal of Clinical Psychiatry78, sz. 7 (2017): e852–57. https://doi.org/10.4088/JCP.17f11738.
  9. Kolp, Eli, Harris L. Friedman, University of Florida, és mtsai. „Ketamine Psychedelic Psychotherapy: Focus on Its Pharmacology, Phenomenology, and Clinical Applications”. International Journal of Transpersonal Studies33, sz. 2 (2014): 84–140. https://doi.org/10.24972/ijts.2014.33.2.84.
  10. Yavi, Mani, Holim Lee, Ioline D. Henter, Lawrence T. Park, és Carlos A. Zarate. „Ketamine Treatment for Depression: A Review”. Discover Mental Health2, sz. 1 (2022): 9. https://doi.org/10.1007/s44192-022-00012-3.
  11. Underwood, Emily. „Listening to Ketamine”. Knowable Magazine, advance online publication, 2019. március 29. https://doi.org/10.1146/knowable-032819-1.
  12. Taraku, Brandon, Joana R. Loureiro, Ashish K. Sahib, és mtsai. „Modulation of Habenular and Nucleus Accumbens Functional Connectivity by Ketamine in Major Depression”. Brain and Behavior14, sz. 6 (2024): e3511. https://doi.org/10.1002/brb3.3511.
  13. Yeung, Albert, Guy Sapirstein, Laura D. Crain, Margaret A. Cramer, és Fernando Espi Forcen. „Pharmacotherapy and Ketamine Assisted Psychotherapy for Treatment-Resistant Depression: A Patient With Lifelong Self-Doubt and Self-Criticism”. The Journal of Clinical Psychiatry84, sz. 3 (2023). https://doi.org/10.4088/JCP.23ct14798.
  14. Wilkinson, Samuel T., Elizabeth D. Ballard, Michael H. Bloch, és mtsai. „The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis”. American Journal of Psychiatry175, sz. 2 (2018): 150–58. https://doi.org/10.1176/appi.ajp.2017.17040472.