Ketamine-Assisted Therapy
Ketamine-assisted therapy proceeds in several steps, from the initial meeting through psychiatric and physical assessments and preparatory meetings to the actual ketamine experience and subsequent integration sessions. You can read what the individual steps entail in more detail on this subpage dedicated to the specifics of ketamine-assisted therapy.
The foundation of ketamine-assisted therapy is to combine the benefits of psychotherapy with the pharmacological effects of ketamine in order to capitalize on the potential of both modalities. Ketamine has a direct anxiolytic and antidepressant effect. At the same time, it induces a state of expanded consciousness – a state of altered perception, thought, and experience, where one often comes into contact with a whole range of emotions and memories that are less accessible in the normal state of consciousness. This experience is then integrated into everyday life.
To put this in simpler terms: taking ketamine alone can make you feel better for a few days; however, your issues are likely to return. If you go to psychotherapy, it is possible that, despite all your efforts, you will not be able to resolve some problems, typically those that are lodged very deep within. And this is something that can happen in a ketamine session. Thus, ketamine-assisted therapy combines ketamine and psychotherapy to achieve longer-term relief and even greater improvement in mental health.
The risks associated with ketamine therapy are very low. Its safety has been demonstrated over more than 50 years of clinical experience in anesthesiology. In addition, the doses used to induce altered states of consciousness are approximately 5–10 times lower. Each client can discuss all possible risks and benefits individually with our doctors. Like any drug, ketamine has its package information leaflet detailing all the information about the medication, including possible risks.
Ketamine does not cause addiction or dependence when administered as part of ketamine-assisted therapy. Our experience as well as that of other institutions shows that thanks to the therapeutic environment the clients do not need to abuse the substance on their own at all. To cause addiction and/or dependence, ketamine would have to be used regularly, practically on an everyday basis, over a very long period of time.
We currently have contracts with the following insurance companies:
- Všeobecná zdravotní pojišťovna (111)
- ZP Škoda (209)
- Vojenská zdravotní pojišťovna (201)
- Česká průmyslová zdravotní pojišťovna (205)
- Zdravotní pojišťovnou Ministerstva vnitra ČR (ZP MV ČR)
- Oborovou zdravotní pojišťovnou (OZP)
Clients of these insurance companies are fully covered for most of our psychiatric outpatient services and psychotherapy. Ketamine-assisted therapy is covered partially but to a significant degree. For detailed information on insurance coverage please see our price list. We are working hard to establish partnerships with more insurance companies. For information on newly acquired contracts, please follow our website or Facebook.
We also have a subsidy program which aims to make our services more accessible to people who cannot afford the standard prices. In this program, a client can apply for a subsidy or reimbursement of the treatment.
As with any treatment, the results of ketamine-assisted therapy are always an individual matter. Here are a few facts that can give you a general idea.
- Three-quarters of our clients feel a positive and beneficial change at the end of treatment. A large number of them feel immediate relief already on the day of administration. This direct pharmacological effect of ketamine may gradually wear off, which is why we do intensive work with the experience in follow-up psychotherapy sessions.
- For some people, the time after the ketamine session can actually be rather challenging due to the resurfacing of difficult mental content that needs to be further processed (e.g. repressed emotions, memories, etc.). This is a normal and natural part of the treatment. Our therapy team will help you work through these issues to improve your mental health.
- After the completion of treatment, however, both of these groups of clients share the belief that what they experienced in KAT has been meaningful for them.
- From the perspective of psychotherapy, ketamine-assisted therapy affects the clients positively also because it facilitates change – put simply, it sets things in motion. This allows the client to see problems from a new perspective, approach previously inaccessible personal topics, and generally move forward.
The decision on admission to ketamine-assisted therapy is always, without exceptions, made by a physician based on a comprehensive assessment.
This is individual for each client. Admission to our treatment is conditional on an initial meeting and then a comprehensive psychiatric and physical examination. Only after these examinations have been completed will a final decision be made as to whether ketamine-assisted therapy is appropriate and safe for the client, and a decision is also made as to the appropriate treatment approach.
In general:
- Indications for ketamine-assisted psychotherapy include depressive syndrome (including various diagnostic units), anxiety disorders (social phobia, generalized anxiety disorder, OCD), posttraumatic stress disorder (PTSD), and eating disorders.
- The main psychiatric contraindications include psychotic illness, family history of chronic psychotic illness, active addiction, acute risk of suicidality, and severe personality disorder(s).
- Other contraindications are serious somatic diseases (mainly cardiovascular and liver-related), pregnancy or breastfeeding, acute infection, allergies to ketamine, and the concomitant use of drugs that could negatively interact with it.
- Other conditions include a minimum age of 18 years, motivation to cooperate therapeutically, and at least one previous treatment attempt (i.e. an attempt to treat the issue such as psychotherapy, pharmacotherapy, etc.).
Put briefly, it is because the use of ketamine to treat certain mental health conditions under clinically controlled conditions is effective, safe, scientifically sound, and legal.
Ketamine has been commonly used in clinical medicine for decades. Its use in psychiatry is warranted mainly due to its direct anxiolytic and antidepressant effect. In our ketamine-assisted therapy, we also utilize the fact that ketamine induces a state of expanded consciousness, i.e. a state of altered perception, thought, and experience. In the follow-up integration sessions after ketamine treatment, we systematically work with the client’s experience.
In the field of mental health (including our ketamine-assisted therapy), ketamine is currently used off-label, i.e. outside of its primary indications. For this reason, ketamine treatment may only be indicated if the client has had at least one treatment attempt for the current episode of illness (e.g., psychotherapy or relevant alternative and/or pharmacotherapy) before signing up for KAT. Off-label use is legal and legitimate if the scientific evidence points to the safety and effectiveness of a medication in an indication for which it has not yet been officially approved. The aim is to allow doctors to help more patients who may benefit from the medication.
In our ketamine-assisted therapy, ketamine can be administered either by drinking it (in a liquid solution) or having it injected into the gluteal muscle. In medical terms, you can receive ketamine either orally (by drinking) or as an intramuscular (IM) injection. The most suitable route of administration is always agreed on between the doctor and the client individually.
In both cases, the medicinal product administered is Calypsol, approved by the State Institute of Mental Health (more about the drug on the Institute’s website). When given orally, the client receives 200–350 mg of the substance. When administered by IM injection, the dose is 0.2–1.5 mg/kg.
The medicinal product Calypsol (containing the active substance ketamine) is approved primarily as an anesthetic and analgesic; however, physicians worldwide commonly use it to treat depression and other ailments. In psychiatric indications, it is currently used off-label. This means that the drug may be used for indications other than its primary purpose (in the Czech Republic, this is only general anesthesia and analgesia in the case of ketamine). Such use is regulated by law and is permitted based on comprehensive scientific evidence for each individual indication.
The medicinal product Calypsol (containing the active substance ketamine) is approved primarily as an anesthetic and analgesic; however, physicians worldwide commonly use it to treat depression and other ailments. In psychiatric indications, it is currently used off-label. This means that the drug may be used for indications other than its primary purpose (in the Czech Republic, this is only general anesthesia and analgesia in the case of ketamine). Such use is regulated by law and is permitted based on comprehensive scientific evidence for each individual indication.
Your current medication must always be consulted with our physicians.
The experienced psychiatrists in our outpatient clinic can help you taper or discontinue your current medication, if necessary. Most antidepressants can be discontinued just one day before the ketamine session and you can continue taking them on the day after.
Ketamine-assisted therapy consists of several steps, all of which take place over several weeks. After you complete an initial online appointment, our psychiatrists will have to assess whether ketamine-assisted therapy is an appropriate treatment option for you. This is why you will be required to undergo a psychiatric evaluation and a physiological examination that includes blood sampling.
If the doctor agrees that you are suitable for KAT (i.e. no obvious factors that would preclude the treatment have been found), the treatment in itself takes approximately 2–5 weeks, including all therapy sessions as well as the ketamine experience. The exact duration always depends on the individual agreement between the client and the therapist.
The dates and times of all examinations, appointments, and sessions are scheduled in advance by mutual agreement between the client and our staff. Clients are advised to take a day off after the ketamine session, but throughout the rest of the process, they should be able to function as usual—no need to worry about being “out of commission” for several weeks.
Our subsidy program is intended for prospective clients who might benefit from the treatment but cannot afford it. This includes e.g. people whose mental illness prevents them from earning an adequate income, people with disability pensions, students, retirees, etc.
The program aims to significantly reduce the price in order to make our services as affordable as possible. It is our long-term goal to make our services available to all those in need.
If you are interested in applying for the subsidy program, please let us know during the initial online meeting.
The most common concerns of our clients
Don’t worry. The risk of developing a psychotic disorder after taking psychedelics in general is extremely low, unless there are contraindications to psychedelic therapy. Ketamine is no exception and is also considered safe in this regard. To ensure the highest level of safety, each patient must undergo a comprehensive evaluation process, including a risk assessment for the development of psychosis, before treatment can be indicated. Ketamine-assisted therapy is not suitable for individuals with a family history of psychotic disorders (e.g. schizophrenia). It is useful to bear in mind that the effect of ketamine has its own dynamic: It’s a return ticket – “there and back again” – and one always comes back to the “shared” reality.
You can never predict where the experience will go, so it cannot be completely controlled. What we can do, however, is build trust and create an environment where you feel safe and comfortable. And that is what the preparation sessions are for.
The strongest foundation is a sense of trust in the therapist. This is built up during the preparation phase, when the therapist and client get to know each other and the client gains experience interacting with the therapist. Together we create a safe space where everything is welcome and the client can relinquish at least some control over their behavior. Therapist and client also agree options and forms of support together in advance so that the client can venture into more challenging topics or feelings if the experience takes them there.
As part of the preparation, the therapist and client also discuss the external framework of the session, i.e. what we can control. This includes the proximity/distance of the therapist, the level of support and contact, etc. We make it clear that the therapist, who will be present throughout the session, and the physician, who will be available on site, will help keep the client safe at all times and ensure nothing happens to the client’s body, i.e. prevent falls and other injuries.
You may find the experience challenging. However, it is important to remember that while the experience may be challenging, it is not unmanageable. In fact, difficult psychedelic experiences are considered an important factor in the treatment of mental disorders. You can’t encounter anything you won’t be able to handle. In addition, you will have a therapist by your side to support you at all times. As part of the preparation, you will practice breathing techniques to help you manage anxiety and calm your mind.
Going through a challenging experience can sometimes help you move forward in therapy – this is also something to bear in mind. During integration, each experience is interpreted in the context of the client’s life and individual journey. The therapist helps the client process the experience in a way that allows the client to build on it and grow. Ketamine also has an anxiolytic (anxiety-relieving) effect, which makes it easier for the client to explore challenging feelings and touch on deeper issues and experiences without feeling overwhelmed.
Finally, it should be noted that difficult experiences among recreational users usually occur when they do not know what they are getting into, have no support, and are not in a safe environment. All of these aspects are addressed in the clinic.
The risk of addiction exists almost exclusively in people who use ketamine recreationally, very frequently, and in higher doses than in ketamine-assisted therapy.
Using ketamine in a therapeutic context is deep work that is subsequently integrated into one’s life. It is not a shortcut to pleasure, as is typically the case with recreational use. It is therefore not tempting to use it frequently.
Sometimes it takes only one ketamine experience for difficulties to subside or to diminish substantially. In other cases, however, the client, together with the therapist and the indicating psychiatrist, may come to the conclusion that a repetition of the treatment would be appropriate in order to reinforce, amplify or deepen the therapeutic effect. This option is of course available and is frequently used and recommended both in the Czech Republic and abroad (more about repeat therapy here).
We would like to emphasize that you should not make any demands on yourself in the sense that ketamine-assisted therapy is the only way to advance your therapeutic process. During therapy, we do everything we can to make one session of ketamine sufficient; however, if we come to the conclusion that a re-administration is advisable, it is neither the client’s fault nor a sign of ineffective treatment. Certain deep-rooted themes with origins in childhood often take more time to resolve. Sometimes, the journey is simply a little longer.