KETAMINE SESSION AS A "DEMO VERSION OF LIFE": INTERVIEW WITH A KAT THERAPIST

Ketamine-assisted therapy is a fairly innovative method in our region, which, unfortunately, we can currently use only for the diagnosis of “pharmacoresistant depression.” In this regard, we lag behind the other six countries that use ketamine. This creates many obstacles to applying this therapy to other diagnoses relevant to us: PTSD, complex PTSD, and comorbid disorders. At this point, we can already see that the substance helps achieve an antidepressant effect in a very short time (one session), and years of therapy are not required to achieve results. Consequently, financial resources can be saved, and patients can quickly reach a qualitatively new level of quality of life.

During one of our therapy sessions, we realized that undergoing psychotherapy requires a certain resource, but the patient actually seeks psychotherapy in order to obtain that resource. So it turns out that we need a magician who can break this cycle. We believe that ketamine isn’t a magic potion, per se. Ketamine simply provides this resource and facilitates recovery.

As a rule, upon closer examination of the patient - including psychiatric screening and an initial interview with a psychotherapist - we find that PTSD is accompanied by depression. A review of previous treatment and medications allows us to determine which therapies and approaches have already been used to treat the depressive component, and if necessary, we prescribe KAT for this patient.

We always begin by having patients undergo a psychiatric screening. This is especially true when a person with a history of addiction — for example, to opioids — comes to us. If we have doubts about the appropriateness of ketamine therapy, we give the patient the opportunity to decline on their own, or we ask additional questions that may lead them to decline.

That said, we’ve had patients with a history of addiction who’ve come to realize that it’s actually possible to work very productively on this issue therapeutically using ketamine. Essentially, anything that could potentially give you a high confronts you with a complex experience, and you begin to distinguish between what is recreation and what is therapy; you start to monitor your reactions, goals, and intentions. In classical psychotherapy, a person is, let’s say, less likely to overcome addiction.

As for psychiatric diagnoses, ketamine-assisted therapy is contraindicated in cases of psychotic states, for example. The same applies to hypomania and certain phases of bipolar disorder. Therefore, this is a matter for a psychiatrist to evaluate. We have a guiding principle: if the risks outweigh the potential benefits, we do not proceed. Each case is highly individual. During treatment, we also monitor the patient’s progress to see if there is improvement or, for example, if further evaluation is needed.

We always take an individualized approach. For example, the use of antidepressants may be limited in order to restore receptor sensitivity. Typically, a psychiatrist reduces the doses of certain antipsychotics that may diminish the dissociative effect of ketamine, which is therapeutically important. We should also not overlook the fact that for a patient accustomed to taking medication, an abrupt discontinuation can be psychologically traumatic. However, the key point is that ketamine acts on the body’s glutamate system, whereas antidepressants affect serotonin pathways in the brain. This interaction is completely safe.

Unfortunately, we have limited time for the preparatory process. Of course, we conduct a psychiatric screening, and we advise patients to abstain from alcohol for at least 3 days — preferably a week, and ideally 2 weeks. We ask that patients avoid heavy meals on the day before the session itself. In addition, we have a clinical manual that we provide to patients. We know that the psyche is a very rigid structure; it needs more time to process changes. And the more time the psyche has, the more meaningful and conscious these changes can become. Because we understand that the experience itself is an intention. A sense of readiness, trust, and safety may not fully develop after just one psychotherapy session — which we conduct before the ketamine infusion — but we strive to make the most of this limited time in a way that’s as natural as possible.

I immediately wanted to say something paradoxical: precisely where there should be rules — because this is a new experience — there are no rules. Usually, the patients we deal with are people who are used to certain restrictions, rules, and control. They want this “option” turned off within them. Turn it off without actually turning it off. Because while it’s theoretically possible to adjust your mindset to let go of control, this sounds very provocative to the inner controller. That’s why, before the first session, we prepare the patient for the fact that this kind of therapy involves maximum contact, starting with the smallest therapeutic dose.

We foster a mindset of openness to curiosity. After all, depression is precisely characterized by the fact that we lose access to our inner child; there are no more dreams, everything is already known — so why go through what we already know all over again? Depression isn’t about “I don’t want things to be difficult.” Depression is about losing interest in everything. That’s what ketamine therapy addresses.

In the clinical practice of ketamine-assisted therapy, we prefer the term “complex psychoemotional experience” over the stigmatizing and clinically inaccurate concept of a “bad trip.” Intense emotional reactions, anxiety, dysphoria, or other subjectively challenging experiences do not necessarily indicate a negative therapeutic outcome. At the same time, such states require proper clinical assessment, professional support, and differentiation from adverse drug reactions. A safe, controlled therapeutic environment creates the conditions for processing and subsequent psychological integration of this experience.

Given our protocol, we are very careful about the doses we prescribe and may deviate from the protocol only under certain circumstances: if a person has been taking an antidepressant or antipsychotic for a long time, or has a history of recreational drug use. In such cases, we may increase the dose, but generally we start with a therapeutic dose and observe the person’s reaction — how they experience this state — because even a minimal dose can be a very vivid experience and lead us to the therapeutic goal we are striving for.

When this is not the first session, we discuss with the patient to what extent something experienced during the session might relate to the “shadow” category (in the subconscious), and, in general, what the person thinks about it, what it means to them, and whether they feel it makes sense to delve deeper into this topic. If you choose to suffer less, you need to accept this duality (note: the shadow and the manifest sides). Ketamine therapy is precisely about the subconscious processes that lead to a profound re-examination of oneself and the world.

People do ask that question a lot, but I guess for those who work with ketamine, it doesn't really make sense. I'm starting to feel like it's a bit pointless.

By the way, drinking alcohol "to your health" — that's actually toxic to all of the body's systems, including the brain.

So, I’ll give a purely rational answer. If we’re talking about a racemate — that is, the two isomers in ketamine — it would need to be used every day for a month, or perhaps even longer, for tolerance and dependence to develop. But we have to take the individual situation into account. When did the person start taking ketamine? For example, did they already have an addiction to, say, marijuana, or perhaps to opioids or alcohol? So if a patient is already asking this question, we can ask why it’s coming up: did they just hear something somewhere, or do they know they’re prone to becoming addicted to a certain substance? So, we cannot deny that there are people with certain medical histories who have a predisposition to developing addictions.

I would like to note that a 2025 review of peer-reviewed articles — which covered 16 studies and more than 2,000 patients with depression — reported signs of tolerance to the antidepressant effect or dependence in only four individuals. This confirms the low risk of ketamine abuse under proper clinical supervision (Scientific basis: Ingrosso et al., Journal of Psychopharmacology, 2025; Vasudeva et al., Journal of Psychopharmacology, 2026).

I often hear patients who are already halfway through their therapy and undergoing integration sessions say: “You know, it’s only now that it’s really starting to sink in for me—how to properly revisit the images I saw and the feelings I experienced during ketamine-assisted therapy, and the realization that I can reflect on them longer and gain a deeper understanding of them.” A touch of healthy provocation from the therapist can’t hurt—it helps the patient realize a little faster that what’s happening in the therapy room isn’t an escape from real life, but rather a way to make that life possible. We simply use certain techniques that allow you to relax more, to feel more assured that you won’t die, that you won’t be publicly humiliated, and so on, depending on the fears the person has. And so, very often, when a patient says they don’t really want to return to this difficult world, we place special emphasis on the need to realize what they’re running away from. Also, for example, when a person encounters a difficult situation during therapy, we use that situation to engage with the nervous system and, in essence, rewrite the memory of the experience itself. A rewriting of the experience takes place. This is very difficult to achieve without a therapist.

First of all, I want to say that it’s still very often the case that, as a therapist, you find yourself surprised. To one degree or another, experience brings a certain level of insight, and it happens that after the first session, you can predict what the outcome will be and how quickly it will happen. But it’s important to remain open-minded, because hidden within every person’s psyche are the possibilities for quantum leaps toward the best possible outcomes.

I’d also like to point out that depression in and of itself contributes to a decline in creativity and access to the imagination. Einstein said that our resource lies in the realm of the imagination. Essentially, this is the space where we recharge. But we very often fail to tap into it—again, because of the rationalization and control we’ve conditioned ourselves to follow since childhood. People with a vivid imagination can achieve results more quickly. Or when a person can connect with their inner child more quickly—that also speeds up the process. Imagination is all about your potential. Because all those projects you want to bring to life start as internal processes.

I think this is the right time. The patient comes to understand the potential and the dynamics more quickly. The person essentially begins to string themselves together like beads on a bracelet: resources emerge, along with hope—from the word “action”—and the realization that all is not yet lost.

We also have faster access to addressing the specific issue. If we approach it through emotion, we aren’t specifically working with the image of a father or mother. We delve into the experience through the emotion, which leads to a chain of events. For example, there might be a key event that has a huge impact on one’s life, but which you don’t recall. KAT allows us to see this and resolve it.

When it comes to veterans, the potential of this therapy lies in the fact that we have the opportunity to gently negotiate with all the internal prohibitions and traumas that exist in the psyche, and to untangle these issues.

A person considering ketamine therapy most likely already has some kind of diagnosis. In that case, my question is simply this: how much longer does a person have to suffer before they decide to choose a different path? Depression, in general, brings to mind existential themes: life and death. After all, depression is, to some extent, a symbolic death. It’s when you’ve strayed as far as possible from something within yourself, from your own path. So, I suppose it really comes down to a choice: to give yourself a chance at a different life, or to accept that you’re choosing suffering. It’s important to be honest with yourself.

With regard to people who are currently working under the extremely stressful conditions of wartime and are not suffering from severe depression, we are raising the issue of access to preventive care and “resetting.”

For combatants and active-duty service members who have been through combat—the possibility of “decompression”—but this is a very individual matter.

I was reminded of a comment (a metaphor, because this is precisely why we work with complex experiences) made by a soldier in integrative psychotherapy with another soldier: “I was a wolf who has now learned to sleep; I don’t just know this—I’ve felt it.”

Finally, I want to say that we often ask ourselves why we suffer, even though we’re good people—or at least always try to be. In reality, it’s all so that you can continue on your path. And it’s not a question of what makes a good person, but a question of your own path and how to find it. People often say that after depression, you become like a phoenix: renewed, different from before, and strong. And I have a sincere desire to help people on their path to recovery, to rise from their own ashes.