Who Is Not A Good Candidate For Ketamine Therapy?

Ketamine therapy is a recent development in treating resistant mental health conditions and symptoms, such as depression, suicidality and bipolar disorder. Ketamine increases excitability and neuroplasticity in the brain, which is beneficial in mental health recovery. However, the pharmacological effects of ketamine also come with specific risks, indicating some people are not good candidates for ketamine therapy. In this article, we will discuss the uses and risks of ketamine therapy in mental health conditions, specifying who is not a good candidate for ketamine therapy.
Klara Hatinova

Klara Hatinova

Klara is postgraduate researcher in experimental psychology at the
University of Oxford.

A blue image with text saying "Risks of Ketamine Therapy"

Uses of Ketamine Therapy

Ketamine therapy is the quickest treatment to alleviate suicidal thoughts [1, 2]. This is why ketamine therapy has many applications - it is used frequently used in severe depression , ketamine can be used for bipolar disorder, post-traumatic stress disorder. Some research suggests that ketamine for OCD may be effective in reducing the symptoms of OCD [2, 3]. Ketamine is administered intravenously under the close supervision of a medical professional [3].

It is essential to note that ketamine therapy is not FDA-approved, and any use of ketamine in mental health is off-label [4]. This means that there is preliminary evidence that ketamine is safe and alleviates mental health symptoms, but ketamine therapy will not be covered by health insurance.

Ketamine is a mixture of two forms of chemicals – S-ketamine or R-ketamine [3]. S-ketamine, also known as esketamine, is currently marketed as Spravato and administered as an intranasal spray, which makes administration easier [3]. Spravato was approved in 2019 by the FDA as a treatment for treatment-resistant depression alongside antidepressants [5].

How does Ketamine work?

Ketamine and esketamine work in similar ways. Ketamine binds to the NMDA glutamate receptor, achieving an intra-cellular cascade of responses that improve neuroinflammation in the brain, a common factor in mental health conditions [6].

Ketamine also acts at the phenomenological level. As it is a hallucinogenic, dissociative substance, it places the individual into a state of altered consciousness, which may also be necessary for facilitating mindset changes in ketamine therapy [6].

Ketamine is not an opioid.

Who is not a good candidate for Ketamine Therapy?

Ketamine therapy comes with risks. The hallucinations and dissociation are some of the effects of ketamine that can be damaging to specific populations. Moreover, the pharmacological activity of ketamine in the brain and body can, in specific populations, cause more harm than good. In these specific groups, it is important to weigh out the risk vs benefits of ketamine therapy:

  • Individuals at risk or with schizophrenia. Dissociation is a symptom of schizophrenia, and altering the neurotransmitter balance in the brain can trigger schizophrenia in at-risk individuals. Therefore, anyone with schizophrenia or with a family member suffering from schizophrenia is not a good candidate for ketamine therapy [7].
  • Pregnant women. Ketamine acts along a range of neurochemical systems in the brain and body, which can change the composition of the blood supplying the fetus. Critically, the impact of ketamine on the fetus cannot be ethically studied, and so there is no evidence to indicate safety nor harm. Therefore, pregnant women will be contraindicated for ketamine therapy, as it is unknown whether ketamine therapy can outweigh the unknown risks.
  • Allergic individuals. Individuals may have allergic reactions to ketamine, indicating they will not be good candidates for ketamine therapy. It is important to note that ketamine allergy is rare and has only been observed when ketamine has been used for analgesic purposes [8].
  • Individuals with high blood pressure. Individuals with high blood pressure should avoid taking ketamine, as it can increase the pressure in the fluid within the brain cavities. Ketamine also acts on the sympathetic nervous system, which can further exacerbate high blood pressure. Therefore, a careful risk analysis must be carried out when using ketamine in individuals with high blood pressure [4].
  • Drunk people or people drinking alcohol. Alcohol is a psychoactive substance that increases the GABA inhibitory neurotransmitter. It interacts with ketamine and can increase risk of overdose and side effects [9].

To summarize, ketamine therapy is not suitable for people at risk of schizophrenia, people with schizophrenia, pregnant women, individuals with high blood pressure, people with ketamine allergies or drunk people. Critically, ketamine is not a substance you should be taking without medical supervision.

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Klara Hatinova

Klara Hatinova

Klara is a postgraduate researcher in experimental psychology at the University of Oxford. She has worked across a spectrum of hot topics in neuroscience, including her current project measuring reinforcement learning strategies in Parkinson’s disease. Previously, she studied the efficacy of psilocybin as a therapy for critical mental health conditions and examined molecular circadian rhythms of migraine disorders. She completed her undergraduate degree in Neuroscience at the University of Glasgow and participated in a year abroad at the University of California, where she worked on a clinical trial for spinal cord injury.