What Is Ketamine Therapy?
Ketamine therapy — specifically Ketamine-Assisted Psychotherapy (KAP) — combines the pharmacological effects of ketamine with structured psychotherapy. Unlike standalone ketamine infusions, KAP embeds the medicine within a full clinical framework: preparation before, a supervised dosing session, and integration therapy afterward.
Ketamine is a legal, Schedule III medication with over 50 years of safety data as an anesthetic. At sub-anesthetic psychiatric doses, it produces a brief altered state that promotes rapid antidepressant effects and neuroplasticity — the brain's ability to form new neural connections.
Why Psychiatrists Use Ketamine Therapy
Ketamine works differently from all conventional antidepressants. SSRIs and SNRIs modulate serotonin — a slow process taking weeks. Ketamine acts on the glutamate system, producing changes in mood and cognition within hours to days. For patients who have waited months or years for relief from depression or trauma, this speed is clinically significant.
The mechanism involves NMDA receptor blockade, which triggers release of BDNF (brain-derived neurotrophic factor) and promotes synaptogenesis — the formation of new synaptic connections. This opens a window of enhanced neuroplasticity that integration therapy can capitalize on.
Treatment-Resistant Depression
Approximately 30% of people with major depression do not achieve adequate remission with standard antidepressants. These patients have often tried multiple medications, experienced partial responses or intolerable side effects, and are left searching for alternatives. Ketamine offers a clinically validated path for this population, with response rates of 60–75% in treatment-resistant cases.
KAP in Tel Aviv is particularly relevant given the limited awareness of this treatment option in Israel. Many patients have never been told that effective alternatives to failed antidepressants exist.
Safety and Screening
Ketamine therapy is safe when properly administered. Dr. Rosenbach conducts a comprehensive psychiatric and medical evaluation before approving any patient. This includes review of cardiovascular health, current medications, psychiatric diagnosis, and substance use history. All sessions include continuous vital signs monitoring.
Common during-session effects — dissociation, perceptual changes, transient blood pressure elevation — are expected and manageable. Serious adverse events are rare in properly screened patients. Long-term risks associated with recreational ketamine use (bladder damage, cognitive effects) are not observed at clinical therapeutic doses.
IM vs IV vs Oral Ketamine
Intramuscular (IM) injection — the route used in this practice — delivers ketamine directly into muscle tissue with ~93% bioavailability. Effects begin in 5–10 minutes and last 45–90 minutes. IM does not require IV access, making in-home treatment feasible.
Intravenous (IV) infusion provides 100% bioavailability and precise dose control but requires a clinical facility. Both IV and IM produce comparable clinical outcomes in treatment-resistant depression.
Oral/sublingual lozenges have lower bioavailability (~25–30%) and produce a gentler experience. They are sometimes used as an adjunct between sessions.
Who Qualifies for Ketamine Therapy?
Good candidates typically include people with treatment-resistant depression, PTSD, complex trauma (C-PTSD), severe anxiety disorders, OCD, or existential distress — who have not found sufficient relief from conventional treatments.
KAP may not be appropriate for individuals with uncontrolled psychosis, active mania, uncontrolled hypertension, active substance use disorder, or certain medication combinations. Full candidacy is determined through a comprehensive evaluation.
The first step is a free 15-minute screening call with Dr. Rosenbach, available through the scheduling link on this website.
