Ketamine-Assisted Therapy for Treatment-Resistant Depression (TRD)

At Paracelsus Recovery, we can include ketamine-infusion therapy in our TRD programme. When applicable, you will be provided with daily or weekly infusion sessions to help ease your symptoms.

During your TRD programme, we will tailor-make your plan to make sure it addresses all of your underlying issues in a complete 360-degree analysis of your health. We only ever work with one client at any time, which means you will work exclusively with a multidisciplinary team of 15+ doctors. You can learn more about our TRD programme here.

One Client at a Time

Unparalleled staff to patient ratio of 15:1

Ketamine-Assisted Therapy at Paracelsus Recovery

In Switzerland, ketamine is legal for psychiatric use when combined with psychotherapy. As a result, we can provide ketamine-infusion therapy (racemic ketamine) at our Zurich-based treatment centre. However, we can only include it in our treatment-resistant depression programme and even then, we do so hesitantly and as a last resort.

The duration and frequency of your sessions will depend on the severity of your symptoms. In general, infusions typically last 45 – 60 minutes and take place in the comfort of your private penthouse residence. You will not lose consciousness during the treatment, but you may experience a mild euphoria or ‘out of body sensation (known as dissociation).

Your mind will also become very engaged during the treatment. Clients often report that infusions feel like a therapy session in and of themselves. Your psychotherapist will be there with you during these sessions to discuss any emotions, traumas, ideas, fantasies, or memories that are coming up for you.

 

The process is usually a very peaceful one. However, if you would rather avoid infusions, we can also provide a ketamine nasal spray, known as esketamine. There are specific molecular differences between these forms of treatment that alter their effects. For example, the nasal spray tends to be much more fast-acting. Some experts (2020) also argue that racemic is more effective than esketamine for dual diagnoses. Our doctors will always run tests and take your preferences into account.

Paracelsus logo

Why is Ketamine-Assisted Therapy Only Available for Treatment-Resistant Depression?

Ketamine has been approved as a treatment modality for TRD because numerous studies (2021, 2019, 2016, 2015, 2015) show that it is rapid-acting and highly effective. However, ketamine therapy can produce side effects, and we are not yet as confident in ketamine’s ability to aid your recovery from other mental health issues. As such, it is presently only available for treatment-resistant depression.

What Does the Science Say?

Although most well-known as a horse tranquiliser turned party drug, ketamine has fascinated scientists for nearly 20 years. Known as a dissociative anaesthetic, it was first synthesised in Belgium in the 1960s. The FDA approved ketamine in 1970 as a general anaesthetic, and it has been subsequently used as an anaesthetic ever since. Its use was prevalent during the Vietnam War.

However, since 1994, countless clinical studies have found that ketamine is useful in relieving short-term pain and an effective treatment method for chronic pain syndromes and psychological issues, such as TRD.

For example, in one recent study (2022), ketamine induction led to a 30% remission rate amongst patients suffering from major depression. In another study (2012), 70 – 85% of patients with severe depression who tried ketamine said that it was effective. The results have been so astounding that in 2012, researchers called ketamine “the biggest breakthrough in depression research in a half-century.”

 

I. Ketamine Strengthens Neuroplasticity

Thanks to ground-breaking neuroscientific advancements; we know now that our brains are ever-evolving. Known as neuroplasticity, our brains are malleable and can change in response to our environment and experiences.

However, we also now know that when someone struggles with depression, the number and strength of these interconnections begin to decrease. As a result, the person suffering will struggle to retain information. That means that they will feel detached from the world and those around them. This, in turn, makes them feel numb, empty, and tired. What often then happens is that they turn to alcohol or substance abuse to cope with these difficult feelings, which then weakens their brain’s ability to self-regulate. They then start to feel angry, sad, and the inner critic begins running the show.

When a person undergoes ketamine infusion therapy, studies (2018) show that we can see regrowth in the number of connections and synapses. In other words, ketamine is a highly effective antidepressant because it helps the brain regrow these neuro-cell synapses and connections.

Ii. Acts on Different Neurotransmitters Than Normal Antidepressants (SSRIs)

Elaborating on that, ketamine effectively minimises treatment-resistant depression because it works differently from antidepressants. For example, a person is diagnosed with TRD when they have not responded to at least two antidepressant trials of adequate dose and duration.

However, instead of impacting one of our monoamine neurotransmitters (e.g., dopamine, norepinephrine, or serotonin) like classic SSRIs do, it acts on glutamate. This is one of the most common chemical messengers in our brain, and it also plays a vital role in mood regulation.

Researchers at the Karolinska Institute of Sweden found that “elevated glutamate has been linked to stress, depression and other mood disorders.” Ketamine works against these effects by stimulating AMPA receptors which can indirectly inhibit the presynaptic release of glutamate and thereby ease depressive symptoms.

Iii. Decreases Severity of Symptoms (E.g., Suicidality)

Perhaps most poignantly, ketamine therapy has been shown to decrease the severity of symptoms, especially suicidal ideation, in clients suffering from treatment-resistant depression. For example, studies (2021) show that oral ketamine treatment can decrease chronic suicidality by 50%.

In some respects, this could also be because, as ketamine therapy has been shown to decrease symptoms after only a few sessions (compared to the months-long journey people must go through to find the right antidepressant), it introduces hope into that person’s life, which can help ease symptoms even more.

Side-Effects and Drawbacks

Although ketamine-assisted therapy has been proven to be safe and effective, it is not without side effects such as:

 

  • Out-of-body experiences
  • Dependency
  • Bladder problems.
  • Effects can be short lived (a typical 6 week course often wears off within a few weeks to months. However, that is also why it is so important to undergo ketamine infusion therapy in conjunction with psychotherapy. The latter can help you integrate the thoughts, emotions and sensations pulled forth in those immediate sessions.
  • Scientists still remain largely in the dark when it comes to the neurobiological underpinnings of depressive states, remission, relapse and even why ketamine seems to be so successful in treating it.

 

Finally, it cannot be overstated that ketamine therapy will only work for you in a controlled setting and administered by professionals. Prolonged ketamine abuse can lead to chemical changes in the brain that make it very difficult to quit. Signs of ketamine addiction are similar to most other substance abuse dependencies, characterised by needing more and more of the drug to feel pleasure, feeling preoccupied with the substance to the detriment of one’s relationships, career and well-being as well as experiencing withdrawal symptoms. You can learn more about how we treat ketamine addiction here.

Nonetheless, we are honoured to provide our clients with ketamine-assisted psychotherapy, whether via infusions or nasal spray.

As the WHO reminds us, depression is one of the leading causes of disability, and over 30% of people will go on to develop TRD. However, ketamine-assisted psychotherapy is changing that. Thanks to ground-breaking discoveries in psychiatry, treatment-resistant depression may, in fact, be treatable.