Ketamine has emerged as a promising treatment for depression, anxiety, PTSD, and other mental health conditions. It can rapidly improve symptoms, even when traditional therapies and medications haven’t worked.
However, while many people can safely benefit from ketamine, it’s not suitable for everyone. In this article, we’ll explore instances where ketamine may have extra risks and therefore wouldn’t be advised.
Medical Conditions That May Make Ketamine Therapy Unsafe
Ketamine therapy is delivered in a carefully controlled setting. At Emerge Wellness, we administer ketamine through intravenous (IV) infusions, which allow the medication to quickly reach the brain and begin relieving symptoms. As ketamine moves through the bloodstream, it interacts with different organs in the body. For most patients, the effects are mild and short-lived. However, for people with certain health conditions, these effects can pose greater risks and require special consideration.
Heart Conditions
Ketamine can temporarily raise heart rate and blood pressure, which is usually well-tolerated. However, for individuals with certain cardiovascular complications—such as uncontrolled hypertension, arrhythmias, or a history of heart failure—ketamine imposes more significant cardiovascular risks. Ketamine can also be dangerous for people with hyperthyroidism, where heart rate is already increased.
Before starting therapy, we’ll review your heart health and may advise EKGs or other cardiovascular assessments if we suspect you’re at risk.
Liver or Kidney Disease
The liver metabolizes ketamine, and the kidneys excrete it. Patients with moderate to severe liver or kidney impairment may experience higher levels of the drug in their system, which can increase the risk of side effects.
Bladder Concerns
Chronic ketamine use—particularly recreational abuse—has been linked to ketamine-induced cystitis, a painful bladder condition. While medical ketamine therapy uses much lower doses, patients with pre-existing bladder issues should discuss their history with their clinician.
In some cases, we may adjust the dose, delay, or avoid treatment to protect your bladder health.
Ketamine and the Risk of Psychosis
Ketamine has dissociative effects, which can resemble psychotic symptoms, such as hallucinations or altered thinking. For most people, these effects are temporary and manageable.
However, individuals with schizophrenia, schizoaffective disorder, or other psychotic disorders may experience worsening of symptoms. Although current research does not suggest that ketamine causes psychosis, it could exacerbate pre-existing conditions.
We’ll carefully review your psychiatric history and may recommend alternative treatments if there is a concern about psychosis risk.
Ketamine and Substance Use Disorders
Ketamine is a drug with potential for misuse, and individuals with a history of ketamine abuse are not suitable candidates for ketamine therapy. However, it’s important to note that clinical ketamine therapy differs greatly from recreational use. Doses are carefully controlled, sessions are supervised by medical professionals, and patients are monitored before, during, and after treatment.
When used in controlled settings, ketamine can actually help people overcome substance abuse disorders. We’ve treated numerous patients struggling with addiction at Emerge, seeing positive outcomes in reduced drug-craving and abstinence following ketamine use. However, we still assess each potential patient on a case-by-case basis to help prevent the risk of ketamine abuse.
Previous Negative Reactions to Ketamine
Although rare, some patients may have allergic reactions or unexpected adverse responses to ketamine. This could include rashes, difficulty breathing, or unusual cardiovascular responses.
At Emerge, our medical team closely monitors you throughout treatment, ensuring that these events are controlled and you remain safe. However, if you’ve experienced negative reactions to ketamine or related anesthetics in the past, it’s crucial to disclose this history during your evaluation.
Medications Which Interact With Ketamine
Certain medications can interact with ketamine and potentially exacerbate its side effects. Examples include:
- Benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
These medications calm the nervous system and are commonly prescribed for anxiety or insomnia. When combined with ketamine, they may reduce ketamine’s therapeutic effects or increase sedation, making patients excessively drowsy.
- Medications for sleep (hypnotics)
Drugs that help you fall asleep can also intensify sedation when taken with ketamine. This may cause difficulty staying alert after treatment or increase the risk of breathing problems.
- Muscle relaxants
Since these medications reduce muscle tone, they can increase drowsiness and decrease reflexes when combined with ketamine.
- Opioids (for pain or cough relief)
Both opioids and ketamine affect the brain’s pain pathways. When combined, they can cause excessive drowsiness, slowed breathing, or confusion.
- Certain antidepressants (e.g., amitriptyline, trazodone)
Certain antidepressants affect brain chemicals in ways that can interact with ketamine’s mechanism of action. This may increase the risk of side effects.
At Emerge, we carefully review your medical history and the medications you’re currently taking to ensure ketamine therapy is safe for you. In some cases, we may recommend pausing or adjusting certain medications during treatment if they could interact with ketamine. Whenever possible, we’ll help advise you on safe alternatives, which should be verified with your primary healthcare provider.
Who Isn’t a Candidate for Spravato (Esketamine Nasal Spray)?
Spravato (esketamine) is an FDA-approved nasal spray version of ketamine used primarily for treatment-resistant depression. Unlike ketamine, it is FDA-approved for depression and has official exclusion criteria guidelines. Spravato has specific exclusion criteria outlined by the FDA, including:
- History of intracerebral hemorrhage
- History of seizures
- Aneurysmal vascular disease or arteriovenous malformation
- Uncontrolled hypertension
- Current or recent delirium
- Co-morbid psychotic disorder
- History of non-response to ketamine, esketamine, or electroconvulsive therapy (ECT)
Patients considering Spravato must undergo a comprehensive evaluation, similar to IV ketamine therapy, to ensure the treatment is appropriate.
Is Ketamine Therapy Right for Me?
Determining whether ketamine therapy is right for you requires careful consideration of medical history, psychiatric conditions, and previous reactions.
You may not be a candidate if you:
- Have uncontrolled heart, liver, or kidney disease
- Have significant bladder issues
- Have a history of psychosis or schizophrenia
- Have a history of ketamine or severe substance abuse
- Have had prior severe reactions to ketamine
- Meet specific exclusion criteria for Spravato
Many patients, however, are candidates after a thorough medical and psychiatric evaluation. Even those with some health concerns may still benefit from ketamine under careful monitoring and dose adjustments.
At Emerge Wellness in Boston, our team of medical professionals conducts comprehensive evaluations to determine eligibility and design a personalized treatment plan based on your needs. During your consultation, we review your health history, discuss potential risks, and answer all your questions about the treatment process.
If you’re considering ketamine therapy in Boston, the first step is to schedule a consultation. Our team is here to help determine whether ketamine therapy is right for your unique situation.