Ketamine is a synthetic drug (more recently found naturally in certain mushrooms) that has been used for many years as an anesthetic before various medical procedures. Since its approval by the FDA in 1970, ketamine has been widely used worldwide for surgical procedures and pain relief. Because of its exceptional safety, it is often chosen as the first choice anaesthetic for children and the elderly, or for patients with serious health problems. Ketamine is listed as an essential medicine by the World Health Organisation (WHO, 2019).

It is known as a "dissociating anesthetic" because of its unique property of temporarily inducing a state of expanded (abnormal) consciousness - a feeling of mind-body dissociation (dissociation) - which is due to neuroplasticity.

Ketamine is an NMDA (N-methyl-D-aspartate) antagonist that acts on many brain receptors. It acts primarily on NMDA receptor-inhibiting GABAergic interneurons, causing a rapid downstream increase in neurotransmitter glutamate, stimulating AMPA receptors, which increases BDNF (brain-derived neurotrophic factor), and modulating the monoamine systems (dopamine, serotonin, norepinephrine), among others.

At very high doses it acts as an anaesthetic (complete sleep), but at lower doses (such as we use) it induces an altered state of consciousness, which, together with psychotherapeutic support, allows for effective and safe psychotherapy. The nervous system enters a state of relaxation, calm, and neuroplasticity, where brain healing occurs - the growth of new neurons (neurogenesis) and the formation of new neural connections (synaptogenesis). Ketamine allows for brief but intense mystical (altered state of consciousness) experiences, which are associated with improvements in depression and other psychological conditions.

More recently, ketamine has also been found to have rapid antidepressant and neuroplastic effects at much lower doses and is now increasingly used as an off-label drug for a wide range of chronic conditions, treatment-resistant mental illnesses such as depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, psychoactive substance abuse and dependence and other psychiatric diagnoses.

Ketamine's unique characteristic is its rapid onset of activity, which is something that many other prescription antidepressants do not have, with effects that take only a few weeks to take effect (and with more side symptoms).

As of 2019, one form of ketamine, S-ketamine (esketamine, Spravato), is approved for the treatment of treatment-resistant depression in combination with antidepressants.

We use intramuscular injections of ketamine (in the upper arm, similar to vaccinations) to treat it. The doses are selected individually during the preparation consultation. Low, medium and high dose ranges are used, which are significantly lower than those used in anaesthesiology.

Treatment with ketamine can be given in conjunction with or as an alternative to antidepressants (off-label prescribing for scientifically justified indications).

To enhance the positive effects of ketamine-induced neuroplasticity, we use ketamine treatment in combination with psychotherapy (preparation and integration).

Ketamine is a very safe medicine (when taken under medical supervision). It is used daily in emergency departments around the world as a safe and effective anesthetic for minor surgical procedures. For more than 50 years, ketamine has been used to induce general anesthesia in healthy adults and children.

For the treatment of mental illness, ketamine has been used in lower (subanaesthetic) doses since the early 2000s. The doses of ketamine used in the treatment of mental illness are 5-10 times lower than those used in anaesthesiology and therefore very safe.

Before treatment with ketamine, our team of doctors and psychotherapists will carry out a thorough screening, medical examination, and psychological preparation. Blood pressure and oxygenation (saturation) are monitored during the treatment session. All patients are thoroughly screened and fully monitored at all times. Your safety is our top priority.

KAP consists of three phases:

(1) preparation of the selected patient,(2) a medical ketamine session (treatment and "opening up") under the supervision of one or two therapists, and (3) the psychotherapeutic integration of the experience ("growth and healing"). One KAP session with ketamine lasts about 3 hours (2 hours plus 1 hour initial integration) and blood pressure is measured and monitored before each session. Special questionnaires are used for psychological assessment before and after the KAP sessions, and the sessions are carried out with the patient's informed consent. Further information about the KAP process will be provided during the NOOS INTRO introductory consultation and screening.

The session takes place in a safe and comfortable environment, under the supervision of one or two experienced therapists (a man and a woman), in a semi-reclining position, with the eyes covered (blindfolds (sleep-masks) are used to promote introspection) and with specially selected music.

The NOOS clinic follows a holistic biopsychosocial model, with simultaneous medical treatment, psychological support and psychotherapeutic interventions.

During the introductory and preparatory KAP consultations, experienced therapists will discuss the whole treatment process in detail and answer your questions - you can choose the times of your NOOS INTRO consultations.

Ketamine, administered in small (sub-anesthetic) therapeutic doses, induces temporary and intense changes in consciousness that help brain neurons to reconnect with lost connections so that people are able to see unhelpful patterns of behavior from a new perspective and more easily modify them, gaining new insights and reconnecting with their bodies, emotions, and environment. Ketamine-induced neuroplasticity expands awareness and inhibits the neural networks responsible for intrusive and disruptive thoughts in the brain. During a ketamine session, patients report gaining insights, untapped emotions, and new perspectives on thinking. Unlike antidepressants, which help to manage symptoms, ketamine-assisted psychotherapy helps to get to the root of the problem and promotes healing so that you can get better.

The state of expanded consciousness induced by ketamine is often referred to as 'dissociative', i.e. a dissociation from the normal self is experienced.

Some clients describe it as a dream, "floating" or deep meditation. Sometimes it is also referred to as an "out-of-body" experience or a psychedelic ("mind-opening") experience. Such experiences allow you to experience your mind and body as if from the outside. Sometimes clients also describe the experiences as "euphoric", "soothing" and "mystical". Most people experience a change in energy - they feel calmer or more energized, and their heart rate may temporarily increase. Sometimes experiences can be difficult and challenging, but even negative experiences provide important insights. Most often, clear consciousness and memory are maintained. All ketamine sessions are conducted under the supervision of a doctor and therapist.

Experiences can be grouped into autobiographical (real memories), perinatal (pre-birth memories), or transpersonal (beyond the self, space, and time) categories. These experiences, combined with targeted psychotherapy, can help the client to see their psychological problems in a new light. With the help of the therapist, all these experiences are integrated to help create a life worth living.

It is important to note that the experiences in each KAP session are unique, individual, and unpredictable. This is further discussed in the preparation and integration sessions.

Research shows that KAP can be appropriate and effective in the following cases:

• Depression (especially treatment-resistant depression)

• Anxiety disorders

• Suicidal ideation

• Obsessive-compulsive disorder (OCD)

• Post-traumatic stress disorder (PTSD)

• Eating disorders

• Fear of death and anxiety in cancer or other diseases

• Addictions and abuse of alcohol or psychoactive substances

Although ketamine treatment is an effective treatment for mental illness, we would like to stress that it is not a cure-all and is not suitable and/or effective for everyone. Therefore, each client must go through a careful assessment and screening process before starting ketamine treatment. It is most important to us that the treatment we provide is always safe and meaningful for the client.

Although ketamine augmentation therapy is safe for most people, some medical conditions may limit your eligibility for KAP. For this reason, we carry out a thorough medical and psychological assessment to find out if KAP is suitable and safe for you.

Contraindications to KAP:

• Age under 18 years.

• Pregnancy and breastfeeding

• Uncontrolled hypertension (high blood pressure), certain cardiovascular conditions

• Uncontrolled hyperthyroidism (thyroid hyperfunction)

• Recent history of brain injury, high cerebral blood pressure

• Past/present psychosis or schizophrenia

• Active mania/hypomania

• Severe obstructive sleep apnoea

• Active psychoactive substance abuse;

After KAP, the following changes are possible, focused on personal growth:

• A new approach to everyday thinking and reality (including established patterns of thought, behaviour and perception).

• A more positive attitude towards difficult situations and life challenges; greater openness

• Increased psychological flexibility and psychological resilience

• Increased motivation to achieve desired lifestyle changes.

• Reduced frequency/intensity of negative or intrusive thoughts and negative inner comments ('inner critic', rumination).

• Increased ability to deal with difficult situations.

• Significant changes in self-esteem, interpersonal relationships, and one's place in the world.

• Increased self-confidence, self-efficacy

• Increased compassion for self and others

• Relief of existential anxiety

Many patients (about 60%) experience positive effects after the first session of ketamine. The improvement in cognitive function may start within a few hours of a single ketamine session, peak after 1-3 days, and persist for at least a week or more.

If the screening process shows that KAP is not suitable for you, or if you change your mind during the KAP process, we will be able to offer you standard, non-augmented ketamine psychotherapy sessions. We would discuss this in the introductory part of the NOOS INTRO after the psychiatric screening. We would also consider other ways to achieve a state of expanded consciousness without medication, such as the Holotropic Breathing Method (according to Stanislav Grof).

You will receive detailed instructions on how to prepare yourself physically and psychologically for the KAP sessions during the preparatory consultation after the selection.

For safety reasons, you will not be able to drive or operate machinery for 12 hours after ketamine therapy.

Ketamine increases the brain's neuroplasticity and opens a "window of opportunity" for new learning. Because it is easier for people to see their problems in a different light, to see and gain new perspectives, it makes psychotherapy easier. For this reason, ketamine augmented psychotherapy (KAP) can help people to break free from difficulties by facilitating the adoption of new and more flexible ways of thinking and behaving.

• Safe and legal therapy: Ketamine is a legal and safe drug with a long history of medical use. Our therapists are highly trained to work with ketamine. Potential side effects are minor and easily managed.

• Scientifically proven therapy: Clinical trials show 70-80% effectiveness of KAP in the treatment of conditions resistant to standard treatment (depression, anxiety disorders, post-traumatic stress disorder, addictions, etc).

• Rapid onset of action and long-lasting results: Ketamine's antidepressant effects are evident in as little as 12-24 hours, so unlike antidepressant treatments, there is no need to wait 4-8 weeks for the effects to take effect (and to decide on their suitability). Our clients experience a lasting reduction in symptoms of depression and anxiety after our treatment. Many of our clients report a greater sense of meaning and fullness of life and experience personal growth after completing our therapy program.

• Individual and supportive approach: we believe in your inner healing capacity and value you as a whole, multifaceted person. That's why we personalize our science-based protocol to create a program that best suits your unique needs and desired outcomes. You have what you need, and together we will find it.

• Medical and mental health experts: our therapists are experts in their fields, continually expanding their knowledge and practice internationally and locally, with personal experience of expanded states of consciousness. We work as a team to support you throughout your treatment, focusing on individual support and care.

In order to maintain the benefits of treatment, it is important to put into practice the new knowledge and insights gained during therapy in your everyday life. Your therapist will help you to do this during the integration sessions. Additionally, strengthening new neurological pathways is possible with psychotherapy.

For maximum effect of ketamine and psychotherapy, we recommend the 4-week NOOS MOON programme - this will permanently rebuild new nerve cells, which can lead to lasting symptom improvement. After such a month-long treatment programme, most patients repeat the one-off KAP sessions (NOOS BOOST) periodically (1-2 times every 6-12 months), or do not require further ketamine treatment. Repeated doses of ketamine maintain increased synaptic plasticity. Sometimes one initial session (NOOS ONE) is enough to have a positive lasting effect.

There is increased neuroplasticity after ketamine therapy, making it easier to engage in psychotherapy sessions. We therefore recommend that psychotherapeutic (non-augmented) sessions continue in order to better consolidate new patterns of thinking, perception and behavior and to achieve ultimate recovery.

The total duration of treatment depends on each individual's unique characteristics, symptomatology, response to treatment, and capacity, and therefore KAP treatment will be planned on a case-by-case basis.

During the initial consultation and assessment of response to treatment, we will discuss the most appropriate plan for you.

Ketamine treatment itself is not currently reimbursed, but KAP psychotherapy sessions may be reimbursed by private health insurance - we will discuss the best KAP reimbursement options for you on an individual basis.

KAP is unique in that to fully exploit the therapeutic effects of ketamine, it is necessary to combine different therapeutic approaches in different phases of therapy.

• In the preparation and integration phases, we use modern evidence-based psychotherapeutic methodologies and models: mindfulness-based therapy, classical and process-oriented Cognitive Behavioural Therapy (CBT), Acceptance & Commitment Therapy (ACT), Brief Solution Focused Therapy (SBT), Dialectical Behavioural Therapy (DBT), Motivational Interviewing (MIT), body-oriented therapies, and others.

• In the "opening" phase of ketamine therapy, we adopt a transpersonal, holotropic (S.Grof) and non-directive client-centred therapeutic stance (C.Rogers). We are also open to elements of ancient traditional practices, the ideas of anthropologist J.Campbell and K.G.Jung.

We combine intensive ketamine sessions with modern mindfulness, compassion and personalised integrative psychotherapy sessions to create a holistic healing approach that heals on multiple levels.

KAP integration is about integrating unusual experiences and insights into life, making sense of those experiences, and promoting positive change (growth). It is like bringing the different parts together into a whole, achieving wholeness.

Psychotherapeutic integration is essential to get the most out of ketamine-augmented therapy; each ketamine session is followed by an integration session, which is complemented by subsequent sessions. Integration sessions are the most effective use of neuroplasticity. Integration also significantly prolongs the therapeutic effect of ketamine, which would otherwise be short.

Our specialists have received international training in psychotherapeutic KAP integration and will ensure the best possible outcome.

Like any medicine, ketamine can cause potential adverse events that are temporary and usually go away after the drug has worn off. In the treatment of mental illness, ketamine is used in much smaller (subanaesthetic) doses than in anaesthesiology, so side effects are less pronounced:

• Temporary impairment of balance and coordination

• Feeling drowsy, mental confusion, slurred speech, numbness of body parts

• Altered visual, auditory, and tactile perception

• Feeling of detachment or dissociation from the usual sense of self ('I')

• Increased anxiety, fright, nausea, or vomiting.

• Temporary increase in blood pressure

• Temporary change in heart rate (increase/decrease)

Sometimes (especially during the first session) you may feel anxious at first, but this will pass later and the therapist on hand will always help you to cope with this. You will be closely monitored during the KAP session and you will only be able to leave the clinic after the KAP session once you have fully recovered from the effects of the drug (you will need to be picked up by an escort or a taxi will be required; you will not be able to drive or operate machinery for 12 hours after the ketamine).

Ketamine is a controlled psychoactive substance subject to Schedule III regulations under the Controlled Substances Act 1970 and is not available in pharmacies.

The recreational use of ketamine, like most controlled drugs commonly used in medicine (self-administration, unsupervised, unsupervised, high doses, rapid and frequent use), may increase the risk of dependence and addiction.

The addictive potential of ketamine is significantly lower than that of caffeine, alcohol, nicotine, or benzodiazepines.

At lower, controlled, infrequently administered clinical doses, the risk of dependence (tolerance and physical withdrawal symptoms) is very low. In clinical practice, given the limited availability, psychoeducation on responsible use, and close monitoring, problems of ketamine abuse and use are not common.

Ketamine used at low therapeutic doses, in a therapeutic setting, combined with treatment intent, psychotherapeutic preparation, and experiential integration, is generally not addictive. The drug is only a temporary tool to help awaken one's inner healing power ("Noos") during intensive KAP sessions and is no longer needed.

During KAP treatment, we carefully monitor any risks associated with unlikely addiction.

It is therefore essential that ketamine treatment is carried out by professionals knowledgeable about this method of treatment, qualified as a doctor and psychotherapist.