Ketamine therapy: Procedure and complementary therapies

Individual adaptation of ketamine therapy

At the Las Almas Institute, ketamine therapy is individually tailored to the specific needs of each patient. The selection of complementary therapies used in combination with ketamine therapy depends on the patient's specific clinical picture and current health status. This tailored approach ensures optimal treatment effectiveness.

Definition and use of ketamine

Ketamine has been an established anesthetic for decades, traditionally used for short-term anesthesia during minor surgical procedures and in emergency medicine. More recently, ketamine has proven extremely effective in the treatment of a wide range of psychosomatic illnesses. The Almas Institute specializes in a globally unique combination of ketamine therapy with other therapeutic modalities to achieve rapid and sustained treatment success.

Indications for ketamine therapy

  • Treatment of depression
  • Treatment-resistant depression
  • Postpartum depression
  • Post-traumatic stress disorder (PTSD) / trauma
  • Obsessive-compulsive disorder (OCD)
  • Anxiety disorders
  • Addictions
  • Chronic pain
  • Eating disorders
  • Alzheimer's / Dementia

In addition, treatment with ketamine infusions can also be beneficial for other conditions such as migraines or burnout. The Almas Institute offers comprehensive consultations to determine the best possible treatment option for each patient. Contact us for further information.

How ketamine works

Ketamine has been shown to promote brain neuroplasticity, a mechanism essential for the adaptability and learning of neural networks. By inducing synaptic changes, ketamine supports the formation of new neuronal connections and contributes to the reorganization of existing networks. This neuroplastic effect differs fundamentally from the mode of action of conventional antidepressants, which typically only show clinically relevant effects after several weeks of use. In contrast, the antidepressant effect of ketamine often occurs after the first infusion and reaches its maximum within a few hours or the following day (Zarate et al., 2006; Murrough et al., 2013).

Duration of effect and therapeutic approach:

The duration of the antidepressant effect varies greatly from individual to individual and can range from a few days to several weeks. In rare cases, patients even report sustained effects lasting for months (Wan et al., 2015). To achieve long-term symptom reduction, sequential administration is usually required. The therapeutic benefit can be significantly increased by combining it with complementary approaches such as cognitive behavioral therapy (CBT), hypnotherapy, or repetitive transcranial magnetic stimulation (rTMS) (Wilkinson et al., 2018). Ketamine shows particularly promising results in patients with treatment-resistant depression who do not respond to conventional antidepressants. Of particular importance is the rapid reduction of suicidal ideation – an effect that has not yet been achieved with this intensity by any other pharmacological agent (Grunebaum et al., 2018).

Mechanism of action:

The precise pharmacological mechanism of action of ketamine in depression and suicidal ideation is currently the subject of intensive research. Ketamine primarily acts as a non-competitive antagonist at the N-methyl-D-aspartate (NMDA) receptor, a subtype of glutamate receptor that plays a key role in synaptic plasticity and neuronal communication (Duman et al., 2019). Interestingly, the therapeutic effect outlasts the pharmacological presence of ketamine in the organism. Although ketamine is largely metabolized and excreted after just a few hours, the antidepressant effects persist for days to weeks. This phenomenon is referred to as the "hit-and-go" effect and implies that ketamine triggers long-term neuroplastic changes through short-term receptor modulation (Berman et al., 2000).

Process of ketamine therapy at the Almas Institute

Therapy at the Las Almas Institute always begins with a detailed initial consultation to gain a comprehensive understanding of the patient's personal situation. This includes taking into account the results of previous treatment attempts, medication use, and any existing or previously treated illnesses.

Patients are asked to bring any previous medical reports with them to avoid duplicate examinations.

Therapy planning at the Almas Institute

Unlike many other clinics, the Almas Institute always offers ketamine infusions in combination with complementary procedures. Which additional procedures are used in the individual treatment depends on the clinical picture and current findings. Our goal is to ensure long-term therapeutic success. Typically, three infusions are sufficient during the two-week treatment period. In some cases, a fourth session is added.

Performing a ketamine infusion

A ketamine infusion is typically administered over a period of approximately 40 minutes while the patient rests in a relaxed position on a couch. Ketamine is administered continuously at a low dose as an infusion solution via a venous access (venous cannula). The entire treatment is carried out under close supervision by trained therapeutic and medical professionals to ensure maximum safety and the best possible well-being during the infusion.

Possible experiences during the infusion:
Subjective sensations during a ketamine infusion vary greatly from individual to individual. Some patients report a mild, pleasant state of intoxication, comparable to the feeling after moderate alcohol consumption. Others experience vivid memories of previously repressed events or describe the state as a kind of "dream journey" accompanied by intense internal images. Occasionally, mild, reversible changes in perception, including mild hallucinatory experiences, can occur.

Should any unpleasant sensations arise during the infusion, the infusion rate can be adjusted at any time, or the treatment can be interrupted immediately if necessary. Continuous monitoring ensures that any side effects are quickly identified and promptly treated appropriately, so that the entire procedure can always be as comfortable and safe as possible for the patient.

For some patients, a single ketamine infusion is sufficient to achieve a lasting effect. However, we typically administer three to a maximum of four infusions, each spaced between two and four days apart.

Please also check out our "Studies" page. There you will find evidence-based studies and publications on our individual procedures: https://www.lasalmasgroup.com/studien/