Who Is Not A Good Candidate For Ketamine Therapy?

Ketamine therapy has emerged in recent years as a promising treatment option for many mental health conditions like depression, anxiety, OCD, PTSD, and chronic pain. However, while studies show excellent results for many patients receiving low-dose, supervised ketamine infusions, there are some patients for whom ketamine therapy carries higher risks or would be contraindicated. This article examines Who Is Not A Good Candidate For Ketamine Therapy and which types of patients may be suitable for ketamine therapy interventions.

Overview of Ketamine Therapy Suitability Factors

Ketamine, approved as an anesthetic but used off-label for therapeutic effects on mood and perceptions, does have abuse potential as a recreational street drug. Additionally, some pre-existing medical factors can heighten risks of adverse reactions. So medical professionals determine patient suitability for ketamine infusions carefully based on:

  • Age 
  • Substance abuse history
  • Cardiovascular health
  • Interactions with other medications  
  • Past reactions to anesthetics
  • Presence of certain mental health conditions

Evaluating these and other individual factors ensures only patients for whom benefits outweigh potential risks move forward with supervised ketamine therapy regimens.

Key Types of Patients Typically Excluded

Based on assessments using the above criteria, certain categories of patients often prove unsuitable for proceeding with therapeutic ketamine:

Patients Below 18 Years Old 

Ketamine has not undergone sufficient testing on safety and effects for patients under 18 years old. Brain development continues actively through the teens, so psychiatric medications require thorough studies with adolescent subjects before approval for use. With few exceptions, minors cannot obtain ketamine therapy.

Pregnant or Breastfeeding women

Well documented pregnancy safety data does not yet exist for ketamine treatments. The developing fetus may face higher risks from medications and interventions impacting the mother. To exercise extreme caution, therapists advise pregnant women and nursing mothers to forgo starting ketamine until after pregnancy/breastfeeding. Those already receiving infusions pre-pregnancy require individualized assessments by their doctors. 

Those with Significant Substance Abuse Histories 

Many clinics exclude prospective ketamine patients with current or extensive past substance addictions. Abusing alcohol, opioids and illegal street drugs often correlates with poorer impulse control plus elevates risks of misusing medications for percieved recreational effects. Moreover, chronic substance abuse may worsen certain psychiatric conditions that ketamine aims to alleviate in therapy. Given higher likelihood of patient compliance issues, most facilities demand at minimum one year free of substance use disorders before allowing ketamine.

Patients Taking Contraindicated Medications

Some drugs prescribed for conditions like high blood pressure can dangerously interact with ketamine by elevating blood pressure and heart rate to unsafe levels. Doctors must know a patient’s full medication regimen to check for problematic interactions. Individuals unable to safely transition off high-risk combinations would not qualify for ketamine therapy administrations until safer medication adjustments occur.

Those with Cardiovascular Conditions

Ketamine may trigger temporary jumps in blood pressure, breathing rate, or cause abnormal heart rhythms during infusions. Patients managing diagnosed cardiovascular illnesses like arrhythmias, coronary artery disease, or prior heart attacks undergo deeper assessment of risks versus benefits. Providers must confirm sufficient heart health stability before greenlighting co-administration of ketamine alongside heart medications.  

 People with Schizophrenia or Psychosis Histories

Therapists exercise extreme caution regarding ketamine therapy for schizophrenia patients, who may relapse into acute psychosis due to ketamine’s sensory-altering effects. Additionally, administering psychedelic-type drugs to people exhibiting current schizophrenic or psychotic symptoms remains contraindicated. For less severe cases or family histories of schizophrenia, psychiatric clearing may be required beforehand.

Those with Poor Dissociative Drug Tolerances  

Low doses of ketamine do induce mild dissociative states temporarily. In rare cases, some patients react with severely unpleasant, disorienting out-of-body type effects. If such reactions occurred previously receiving anesthetics like PCP or DXM, doctors may exclude ketamine therapy to prevent trauma-inducing experiences.  

Seeking Responsible Ketamine Therapy Providers

Patients with excluded conditions above should not pursue ketamine treatments independently. Responsible clinics conduct comprehensive health and psychiatric assessments before enrolling patients in ketamine therapy regimens, expressly to catch high-risk factors. However, some unethical providers exploit ketamine’s popularity and administer infusions negligently to unscreened, vulnerable patients seeking treatments.

To encourage accountability, the American Society of Ketamine Physicians, Psychotherapists & Practitioners Association for Psychedelic Practices and other groups now offer verified member listings of credentialed, ethical practitioners. Checking provider qualifications protects patients and promotes proper screening for ideal candidates to maximize benefits from ketamine’s immense therapy potential while minimizing avoidable risks.


Ketamine therapy stands out as a versatile treatment for previously refractory psychiatric illnesses like chronic depressions or PTSD when administered carefully to appropriate patients. However, health professionals determine suitability for supervised ketamine infusions based on considerations of age, medications, psychiatric history, and cardiovascular risk factors. Pregnant women, active substance abusers and minors cannot receive ketamine therapy. 

Schizophrenia patients warrant precautions, as do patients on contraindicated prescription combinations. While cardiological risks factors are manageable often, poor heart health may also dictate postponing ketamine. Ultimately, choosing legitimate medical officials at certified clinics ensures proper vetting for who qualifies to pursue ketamine’s benefits and who requires exclusion for personal safety.

1. Who Is Not A Good Candidate For Ketamine Therapy?  

Patients below 18, pregnant or breastfeeding women, those with significant substance abuse histories, and individuals taking contraindicated medications are generally excluded.

2. Can individuals with cardiovascular conditions undergo ketamine therapy?  

Patients with cardiovascular conditions undergo careful assessments. If heart health is stable, they may receive ketamine, but it depends on individual evaluations by healthcare professionals.

3. Are people with schizophrenia eligible for ketamine therapy?  

Extreme caution is exercised for schizophrenia patients. Those with current symptoms or acute psychosis should avoid ketamine therapy, while others may require psychiatric clearing before consideration.

4. What if someone has had adverse reactions to dissociative drugs in the past?  

Patients with poor dissociative drug tolerances, especially if they had severe reactions in the past, may be excluded from ketamine therapy to prevent trauma-inducing experiences.

5. How can one find a responsible ketamine therapy provider?  

Look for providers listed by reputable associations like the American Society of Ketamine Physicians, Psychotherapists & Practitioners. Check qualifications to ensure ethical and comprehensive screenings.

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