Who is Not a Good Candidate for Ketamine Therapy?

Ketamine therapy has become a popular mental health treatment in recent years. Administered as an IV infusion, shot, nasal spray, or oral lozenge, it offers immediate antidepressant properties and may also reduce anxiety. It has shown to be effective in treatment-resistant depression where conventional treatments have failed.

However, ketamine treatments are not for everyone. They may not be recommended for people with certain physical and psychological symptoms, and those using medications. This article will review who ketamine therapy may not be for, helping you form opinions to guide your treatment.

What is Ketamine Therapy?

Ketamine was approved as an anaesthetic in the 1970s, but it has since been recognized for its potential to treat depression and chronic pain. Various studies have proven its effectiveness, including one published in the Harvard Gazette, which found it lowered depression scores by 49% and outperformed esketamine nasal spray.

Benefits

Medical use of ketamine therapy reveals the following advantages.

• Rapid antidepressant effects- ketamine can reduce depressive symptoms within hours
• A reduction in suicidal ideation, potentially helping high-risk patients
• Potential benefits in anxiety and mood disorders, including bipolar disorder and PTSD
• Adjunct to psychotherapy- Research reveals that ketamine can enhance the benefits of psychotherapy, assisting with emotional regulation
• Chronic Pain: Ketamine may relieve some neuropathic pain

About the Sessions

During the session, patients will experience a detached sense of disassociation and will be advised not to drive or operate machinery. Effects wear off gradually, but depression and other mental disorders can be controlled for up to a week, with regular sessions for mood maintenance purposes. It provides more lasting effects with ongoing use.

Sessions typically take place in a medical setting, with monitoring of blood pressure, heart rate, and mental status. Ketamine may be administered via IV infusion, intramuscular injection, intranasal spray, or oral lozenge. Doses are calculated based on body weight, health status, and response.

Treatments usually last 4-12 weeks, though some patients require sessions for months or longer.

Who Should Not Use Ketamine Therapy?

While ketamine is generally safe, it is not recommended for people with certain medical conditions, as follows:

People with Heart Conditions

Ketamine can raise blood pressure and heart rate. Therefore, it is not recommended for individuals with high blood pressure, those with a history of or at high risk for heart attacks, strokes, heart failure, extreme angina, or arrhythmia.

Individuals with Unstable Mental Health Conditions

While ketamine infusion therapy can reduce depressive symptoms, it is not recommended for all mental health disorders, including the following:

• Active Psychosis or Untreated Schizophrenia: Ketamine is dissociative and can amplify hallucinations and delusions.
• Severe, Unmanaged Bipolar Disorder: The therapy can increase the risk of mania or rapid cycling, especially in people not taking a mood stabilizer.
• Acute Suicidal Ideation: While ketamine therapy can treat severe suicidality in hospital settings, it can cause instability in low-support outpatient clinics.

Those With Substance Use Disorder

While ketamine can treat major depressive disorder (MDD) and post traumatic stress disorder (PTSD), which can contribute to drug use, it also has addictive properties and bladder toxicity potential. It should not be taken by anyone who has an active and untreated substance use disorder or by individuals with a history of ketamine abuse.

People with Certain Medical Conditions

Ketamine therapy services may also pose a health risk to people with certain medical conditions, including the following:

• Uncontrolled Thyroid Disease: Certain thyroid conditions can affect blood pressure, leading to unhealthy ketamine reactions.
• Severe Respiratory Disease: Ketamine produces sedative effects that may affect respiration, making it unsafe for people with asthma and COPD.
• Pregnancy and Breastfeeding: There is limited research on ketamine’s safety for people who are pregnant or breastfeeding. Therefore, they are often advised to hold off on treatment until they are at a point where it won’t harm their baby.
• Kidney or Liver Disease: Ketamine is metabolized in the liver and excreted by the kidneys. Advanced organ damage can impact drug levels and side effect risks.

Individuals on Certain Medications

Some medications can interact with ketamine. For example:

• Benzodiazepines and high-dose sedatives can diminish ketamine’s effects or increase associated respiratory risks
• Monoamine oxidase inhibitors and other anti-anxiety medications may interact with ketamine or cause blood pressure issues. Talk to a medical professional before combining these two drugs.

What Does a Ketamine Screening Involve?

Given the possible risks associated with ketamine therapy, a comprehensive screening process typically takes place before treatment is approved. Here’s what the assessment involves:

• Eligibility: Ketamine infusion clinics will first want to confirm that you are a good candidate for therapy. Typically, those who qualify are suffering from psychiatric disorders or chronic pain. They may have taken medications in the past without results.
• Medical History: Next, ketamine clinics will want to know about your medical history including past medical issues and surgeries and any medications you are currently taking.
• Mental Health Assessment: A mental health provider will assess your emotional state to determine if your diagnosis aligns with ketamine therapy. They will also ask about medications you use to treat depression and other condtions to minimize the risk of interactions.
• Physical Exam: The assessment will also include a physical exam. Health care professionals will want to make sure you don’t have any conditions that could be exacerbated by ketamine treatments.

BNI Treatment Centers Ensures a Safe Process

BNI offers mental health care with a focus on teen wellness. Our specialized approach for young adults ensures high success rates. We offer academic support, ensuring clients don’t fall behind in their studies while receiving care team assistance.

Contact us to learn more about our comprehensive services.

Dr. Aram Keshishyan, PsyD.

Aram Keshishyan, PsyD. is a bilingual, Armenian-speaking, licensed clinical-forensic psychologist who has been practicing since 2013. Dr. Keshishyan emigrated to the United States at the age of 1 and grew up in the highly diverse Los Angeles County area. He obtained a Bachelor of Arts degree in Psychology from the University of California, Los Angeles, and Master of Arts and Doctorate of Psychology degrees in Clinical-Forensic Psychology from Alliant International University, Alhambra.

Arastou Aminzadeh, MD

Dr. Aminzadeh co-founded BNI to provide patients with exceptional and complete care that goes beyond the regular standards. Each individual is unique and based on each person's genetic makeup, some have a more painful response to challenges that arise on their journey and need assistance to get back on track.