Before any ketamine therapy session there is always a psychiatric assessment consultation. In that consultation the psychiatrist confirms the diagnosis, reviews previous treatments, physical health and medication, and explains what is known and what is not yet known about this therapy. The decision to go ahead is made by the psychiatrist, together with the person. KETAMED is a medically assisted psychedelic therapy clinic, with assessments in Lisbon and sessions in Sintra, and this is how every pathway at the clinic begins.

Ketamine is an anaesthetic. Its use for treatment-resistant depression and other psychiatric conditions is off-label (outside the approved indications) and always requires a psychiatric assessment. In Portugal, using a medicine outside its approved indications is the responsibility of the prescribing doctor. INFARMED — off-label use of medicines.

Who it may be suitable for

Ketamine therapy is mainly considered for adults whose depression has not improved enough with at least two different antidepressants, at adequate doses and for an adequate time. This is what is called treatment-resistant depression, and it is where the evidence is strongest. Sanacora et al., JAMA Psychiatry, 2017.

The only medicine in this family with an approved indication in depression is esketamine nasal spray, authorised in the European Union for adults with treatment-resistant depression, together with an antidepressant. The decision to prescribe it rests with a psychiatrist. European Medicines Agency — product information.

Clinical guidance recommends that ketamine be considered after other treatments, not as a first option, and that people seeking it should already have been seen by a psychiatrist. Royal Australian and New Zealand College of Psychiatrists, 2025.

When it is not suitable

In some situations ketamine should not be used, because the temporary rise in blood pressure it can cause would be a serious risk. The European esketamine information lists, for example, aneurysmal disease of the blood vessels, a history of bleeding in the brain, and a heart attack or other cardiovascular event in the last six weeks. European Medicines Agency — section 4.3.

In other situations the decision needs careful weighing of benefits and risks: poorly controlled blood pressure, unstable heart or lung disease, a history of psychosis or bipolar disorder, problematic use of alcohol or other substances, severe liver disease, pregnancy and breastfeeding. European Medicines Agency — sections 4.4 and 4.6 · McIntyre et al., American Journal of Psychiatry, 2021.

None of this leaves the person without an answer. If ketamine is not the right option, the consultation is also a chance to discuss other treatment paths.

What clinical information and tests are requested

The assessment starts with a careful medical and psychiatric history: the current diagnosis, how severe the symptoms are, the antidepressants and psychotherapies already tried, physical illnesses, all medication, allergies and the use of alcohol and other substances. It helps to bring previous medical reports and a list of medication. Sanacora et al., JAMA Psychiatry, 2017.

Blood pressure is always measured and a physical examination is done. Other tests, such as an electrocardiogram, blood tests, a urine test or a pregnancy test, are requested according to each person’s situation: international consensus statements leave that choice to the clinical assessment of each case. Sanacora et al., JAMA Psychiatry, 2017 · McIntyre et al., American Journal of Psychiatry, 2021.

The roles of the psychiatrist, the anaesthesiologist and psychology

The psychiatrist carries out the assessment, decides whether the treatment is indicated and follows the whole process. Clinical guidance asks that treatment only start after assessment by a psychiatrist experienced in the use of ketamine. Royal Australian and New Zealand College of Psychiatrists, 2025.

Medical safety during sessions, such as blood pressure, breathing and physical well-being, requires trained professionals and suitable equipment. At KETAMED the team includes an anaesthesiologist who oversees the safe use of anaesthetics, and sessions take place under medical and nursing supervision.

Psychology supports the preparation and the integration of the experience, helping to make sense of what was lived in the sessions. Research on the best way to combine ketamine with psychotherapy is still ongoing. Royal Australian and New Zealand College of Psychiatrists, 2025.

What happens after the assessment

If the therapy is considered suitable, the decision is shared. What is known and what is not yet known, the alternatives, the expected effects and the follow-up plan are explained, and written informed consent is requested before starting. Sanacora et al., JAMA Psychiatry, 2017.

The most studied schedules range from two sessions a week to one session a week, for a few weeks. Loo et al., British Journal of Psychiatry, 2023 · European Medicines Agency — section 4.2. The appropriate schedule is decided case by case, after a psychiatric assessment.

At each session, blood pressure and general condition are monitored until the person is stable and ready to leave. On the day of the session, we recommend not driving and going home with a companion. European Medicines Agency — sections 4.2 and 4.7.

After a course of sessions it is important to have a follow-up plan, because symptoms can return. That plan is agreed from the start. Royal Australian and New Zealand College of Psychiatrists, 2025.

To learn more about the treatment, see the ketamine therapy page. To book the assessment consultation, use the contact page.