How to Determine Whether You Are a Good Candidate for Ketamine Therapy
As a psychologist, I am often asked about the suitability of ketamine therapy for mental health concerns. While ketamine has shown promise for several mental health conditions, it is still considered a novel treatment approach and is not appropriate for everyone. Understanding who may be more or less likely to benefit from ketamine therapy, as well as those who might be more at risk for negative outcomes, can help you make a more informed decision about your care.
What Is Ketamine Therapy?
Ketamine was originally developed as an anesthetic and has been used in medical settings, such as emergency and operating rooms, for decades. More recently, ketamine has emerged as a rapid-acting intervention for certain mental health disorders, particularly when other treatments have failed. Ketamine can involve various routes of administration depending on an individual’s preferences and goals, including intravenously, intranasally (i.e. nasal spray), or orally (i.e. lozenges). When provided by a licensed physician, ketamine is relatively safe, however as with any medication it can pose significant risks if used inappropriately. It is therefore important to find a doctor who is trained and experienced in ketamine therapy and to pair it with psychotherapy for post-treatment integration.
Who May Be a Good Candidate for Ketamine Therapy?
It is important to speak with your doctor or care team about whether or not you are an appropriate candidate for ketamine therapy. Some things to consider as you make your decision are the severity and level of impairment caused by your symptoms; whether you have had success with other treatments for these symptoms; your level of comfort with and tolerance for dissociative/anesthetic medications; and financial cost, since most ketamine therapy is not covered by insurance. In terms of symptoms or conditions that ketamine therapy can be effective for, the strongest research is in support of the following:
Major Depressive Disorder (MDD): The most robust evidence for ketamine therapy exists for adults with treatment-resistant depression who have not responded to standard antidepressant medications or psychotherapy. These individuals often experience rapid and significant symptom relief that lasts weeks or months after finishing treatment.
Suicidal Ideation: A common symptom of major depressive disorder is suicidal ideation, and this often dissipates as depressive symptoms improve from the ketamine therapy.
Generalized Anxiety Disorder (GAD): Some studies suggest that ketamine may help those with severe and intractable anxiety. A smaller body of research also points to the benefits of ketamine for other anxiety disorders such as panic disorder, as well as anxiety-related disorders, such as obsessive compulsive disorder (OCD).
Post-Traumatic Stress Disorder (PTSD): Emerging research supports ketamine’s use in alleviating symptoms of PTSD, particularly in cases where other therapies have not provided sufficient relief.
Bipolar Depression: Some research suggests that ketamine may help those with bipolar depression, especially when conventional mood stabilizers and antidepressants have failed. However, careful monitoring is required due to the risk of mood destabilization.
Chronic Pain: While not as well-established, ketamine therapy has shown promise for chronic pain management, especially when used in conjunction with the stellate ganglion block procedure.
Who May Not Be a Good Candidate for Ketamine Therapy?
Ketamine therapy is not considered a first-line treatment and is generally reserved for individuals who have not found relief through standard interventions. Although considered very safe when administered carefully by a trained provider, it is essential to undergo a thorough medical and psychiatric intake before starting ketamine therapy and to be aware of the potential risks associated with ketamine use. Some individuals may be more prone to these risks, including:
Individuals with a history of psychosis or schizophrenia, as ketamine may exacerbate symptoms associated with these conditions.
Those with uncontrolled hypertension or certain cardiovascular conditions due to ketamine’s tendency to increase blood pressure.
People with an active or previous substance use disorder, given ketamine’s potential for misuse. An exception is if someone is receiving treatment for this and will be under close monitoring, in which case ketamine could still be an appropriate treatment option if the care team agrees.
Pregnant or breastfeeding individuals, as safety data on this population is limited.
While this is not an exhaustive list, these are some of the main criteria that might lead to higher risk or more adverse outcomes from ketamine use. With any treatment, however, suitability should be determined on an individual basis and it is important to discuss whether ketamine is the right treatment option for you with your doctor.
Conclusion
Ketamine therapy offers hope for individuals struggling with a variety of mental health conditions, many of whom have been unable to find relief or improvement with traditional treatment options. That said, it is not a universal solution and should be considered only after careful evaluation by a qualified mental health professional and in collaboration with a multidisciplinary care team. If you are considering ketamine therapy, consult with your provider to determine whether this innovative treatment is right for your specific needs.