Ketamine therapy as a complement to rTMS therapy
Ketamine infusion as an additional option in selected, treatment-resistant cases
Ketamine therapy is a medically supervised ketamine treatment. It is discussed above all for its potentially rapid onset of effect in severe depressive illness. In our treatment concept we do not see it as a replacement but as a complementary option alongside rTMS therapy.
rTMS is the central, biophysical form of neuromodulation here. The ketamine infusion can be used, in carefully selected cases, as a pharmacological addition. It is carried out exclusively under medical responsibility and in close cooperation with anaesthesiological expertise.
Ketamine therapy – what it involves
Ketamine is a medicine long established in anaesthesia. At low doses it is also used in specialised medical settings as ketamine therapy for certain psychiatric conditions, and it is the subject of ongoing research.
Its mechanism of action differs from that of classic antidepressants. Among other things, ketamine acts on the glutamatergic system (NMDA receptor modulation). This is discussed as a possible mechanism behind rapid symptom relief.
One point matters here: a rapid effect does not automatically mean lasting stabilisation. In practice, ketamine therapy is therefore usually embedded in a wider treatment concept, for example in combination with rTMS.
Who might ketamine treatment be suitable for?
The best current scientific evidence is for severe depressive episodes, particularly in treatment-resistant depression (TRD). In clinical practice, TRD is assumed when at least two courses of medication at adequate dose and duration have not produced a sufficient response.
Possible contexts of use, always after medical assessment:
- treatment-resistant depression and severe depressive courses
- a high symptom burden, where a rapid therapeutic impulse may make sense (decided case by case)
- long or post-COVID with depressive symptoms: the evidence here is limited. This is not a standard therapy but a possible case-by-case consideration based on medical judgement.
Ketamine infusion – how the treatment runs and how it is monitored
Administered as an intravenous ketamine infusion
In our setting the ketamine infusion is given intravenously. Other routes such as nasal sprays are not used. The infusion usually takes around 40 minutes and is medically monitored throughout.
Medical screening before starting
Before ketamine therapy begins, a thorough medical assessment takes place, covering among other things:
- diagnosis, course of illness and previous treatment attempts
- current medication
- possible contraindications and risk factors, for example blood pressure, history of substance use, the overall psychiatric picture
- realistic goals, for example symptom relief, stabilisation, monitoring over time
After the treatment
Because temporary drowsiness or altered perception can occur, the following applies for safety reasons:
no driving and no operating machinery on the day of treatment.
Possible side effects and safety
In our medically supervised setting, side effects are rarely observed overall and, where they do occur, are usually mild and temporary.
Possible effects include:
- temporary dissociative experiences or a feeling of being detached
- nausea or vomiting
- headache, dizziness or drowsiness
- a rise in blood pressure
For transparency:
For esketamine (nasal spray), the approved product information notes a potential for misuse and dependence, among other things. Its use is therefore tied to direct medical supervision.
Why combine ketamine therapy and rTMS?
Two approaches, one goal: a rapid impulse and stabilisation
The combination follows a clear principle: ketamine can set a short-term therapeutic impulse, while rTMS acts on neural networks over repeated sessions and can contribute to stabilisation.
What does the research say about combining TMS and ketamine?
Published work on combining rTMS and ketamine exists, mostly retrospective analyses, case reports or smaller studies. One frequently cited approach is “CTK” (Combination TMS with Ketamine).
A 2024 review rates the combination as promising, but points to the variety of protocols used and the need for larger, methodologically robust studies.
Important for context:
For long and post-COVID in particular, this combination is not an established standard treatment. A clear distinction between the evidence in TRD and the limited evidence in post-COVID is essential here.
Ketamine infusion or nasal spray (esketamine) – why intravenous?
Intravenous ketamine infusion
The intravenous ketamine infusion is widely used because it offers high bioavailability and precise dose control. The literature also describes a rapid onset of effect. Claims of superiority should nevertheless always be made carefully and in context.
Esketamine (nasal spray) – a regulated framework
Esketamine is approved in the EU, but subject to clearly defined safety and usage requirements. It is administered exclusively under medical supervision.
Ketamine therapy FAQ
How quickly does ketamine therapy work?
Studies frequently describe a rapid onset of effect. The effect of a single dose can be limited in time, which is why embedding it in an overall concept is decisive.
Is ketamine therapy a standard treatment?
Established protocols exist for treatment-resistant depression in specialised settings. The combination with rTMS, by contrast, is not yet uniformly standardised.
Is ketamine also used for long or post-COVID?
There are first case reports and ongoing studies, but no general standard recommendation. Where it is used at all, this happens in the context of depressive symptoms and after careful medical consideration.
Next step: ketamine therapy at the Neuro-Spa Group
If you are interested in ketamine treatment, we first clarify in a medical consultation whether ketamine therapy – where appropriate as a ketamine infusion carried out in cooperation with anaesthesiological expertise – makes sense and is safe within your individual rTMS treatment plan.
Arrange an initial consultation
The initial consultation is a free phone call, Monday to Thursday between 17:00 and 19:00. We go through your situation and the question of whether rTMS is a sensible next step for you. If you would rather not call, you can book an appointment directly instead.
Treatment takes place at our main practice in Zurich or at a partner practice of the Neuro-Spa Group: in Germany, among others in Munich and Schwäbisch Hall, with further practices internationally. If you would rather go to a partner practice, please contact it directly – all addresses and phone numbers are listed in the location overview.