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Who is Not a Good Candidate for Ketamine Therapy?

Ketamine therapy has emerged as a beneficial treatment for various mental health conditions. However, it is not suitable for everyone. This article will explore which types of people may be ill-suited to receive ketamine treatments, and consider alternative options. 

Key Takeaways

  • Ketamine therapy is not suitable for everyone.
  • Individuals with cardiovascular issues, a history of psychosis, active substance abuse, or in pregnancy/breastfeeding stages may not be good candidates for ketamine therapy.
  • It is important to consult with mental health professionals and explore alternative treatment options when ketamine therapy is not recommended.

The Benefits of Ketamine Therapy

Ketamine therapy has gained recognition for its remarkable ability to alleviate symptoms of depression and other mental health conditions.

Unlike conventional antidepressants, which may take weeks or even months to show their effects, ketamine is rapid-acting, offering much-needed relief to individuals in distress. The therapeutic effects of ketamine tend also to be longer-lasting than conventional medication, with a single dose lasting up to two weeks. 

To date, clinical trials have highlighted the effectiveness of ketamine in the treatment of depression, suicidal ideation, substance abuse disorder, anxiety, and post-traumatic stress disorder (PTSD).

Scientists think ketamine’s therapeutic effects may be explained by its ability to increase neuroplasticity – the ability of the brain to reorganize itself by forming new neural connections. This effect may help ketamine therapy patients overcome negative thoughts and behavior patterns. 

Despite these benefits, ketamine’s risk profile means the therapy could cause more harm than good in certain types of people.  Ketamine increases cardiac output, the volume of blood pumped out per minute, as well as heart rate. 

Cardiovascular Issues and Ketamine Therapy

Individuals with cardiovascular issues such as uncontrolled hypertension or recent heart attacks are not considered good candidates for ketamine therapy.

Ketamine has the potential to increase blood pressure and heart rate, which can pose risks for those with compromised cardiovascular health. This includes those with hypertension, tachycardia, arrhythmias and previous or family history of ischemia and cardiac arrest. 

In a study on rabbits, long-term ketamine use caused increased death of heart cells, build-up of scar tissue on the heart, and abnormal heart rhythms. The dosing and frequency of ketamine use in the study don’t reflect that of real-life ketamine therapy.

However, ketamine therapy could increase the risk of substance abuse (see below) and heart problems that may arise from chronic use.

History of Psychosis and Ketamine Therapy

Risks of Ketamine Therapy for Individuals with a History of Psychosis

Individuals with a personal or family history of psychotic disorders, such as schizophrenia or bipolar disorder with psychosis, are not recommended for ketamine therapy.

This is because ketamine temporarily induces psychotic-like symptoms, such as dissociation and hallucinations, which could potentially exacerbate psychosis or trigger a psychotic episode.

Increasing evidence highlights this may be a low risk.

One meta-analysis of nine ketamine studies encompassing 41 patients with depression and a history of psychosis, the results found ketamine didn’t exacerbate psychotic symptoms in this patient population. Some researchers have also begun considering whether ketamine could be helpful in the treatment of schizophrenia.

However, while the evidence remains limited it’s advised those with psychosis risk avoid ketamine. 

Substance Abuse and Ketamine Therapy

Active substance abuse poses a significant risk when considering ketamine therapy. As a powerful anesthetic with psychoactive properties, ketamine has the potential for misuse and addiction, particularly in individuals with a history of substance abuse.

This risk appears to be more prevalent in at-home ketamine telehealth users, where the administration isn’t supported or limited to controlled settings. 

Ketamine substance abuse is associated with a host of different physical and mental health problems. This includes:

To ensure the safety and efficacy of ketamine therapy, individuals must be in a stable recovery phase before considering treatment if they have previously had substance abuse issues.

Pregnancy and Breastfeeding Considerations for Ketamine Therapy

Because there’s limited evidence to show how ketamine may affect pregnancy and breastfeeding, it is recommended to avoid ketamine in either of these conditions. Moreover, experimental animal studies have shown that ongoing exposure to or high doses of ketamine could affect the brain and liver in a developing fetus.

Other Factors to Consider for Ketamine Therapy

When considering ketamine therapy, it is crucial to thoroughly assess the individual’s medical history to identify any pre-existing conditions that may affect the safety or efficacy of ketamine treatment. Medical conditions such as cardiovascular disease, liver or kidney dysfunction, or respiratory disorders may require careful monitoring or adjustment of doses in the treatment plan.

Furthermore, the medications the individual is currently taking must be evaluated for potential interactions with ketamine. Some medications may have interactions that could impact the response to ketamine therapy.

For instance, benzodiazepines and lamotrigine are thought to decrease ketamine’s effectiveness. Other medications may potentially interact in ways that increase ketamine’s side effect profile. For instance, mixing ketamine and MAOIs is thought to increase blood pressure. 

 It is vital to consult with a healthcare professional to ensure optimal treatment outcomes and avoid adverse effects.

Seeking Professional Guidance

Making decisions about mental health treatment can be complex, and it is crucial to seek guidance from qualified mental health professionals. They have the expertise and experience to provide individualized assessments, taking into account each individual’s specific needs and circumstances.

Through a thorough individual assessment, mental health professionals can make appropriate treatment recommendations based on their professional knowledge.

Conclusion

In conclusion, ketamine therapy presents a promising option for individuals struggling with certain mental health conditions. However, it is crucial to understand that not everyone is a good candidate for this treatment.

Consulting with mental health professionals is essential in making informed decisions about treatment options. They can provide expert guidance, individualized assessments, and alternative treatment recommendations when ketamine therapy is not recommended.

Exploring all available mental health treatment options is crucial to find the most suitable approach for each individual’s needs.

FAQs

Who Is Not a Good Candidate for Ketamine Therapy?

Individuals with cardiovascular issues, a history of psychosis, active substance abuse, or who are pregnant or breastfeeding are not considered good candidates for ketamine therapy.

What Are the Risks of Ketamine Therapy for Individuals With Cardiovascular Issues?

Ketamine can potentially increase blood pressure and heart rate, posing risks for individuals with cardiovascular issues such as uncontrolled hypertension or recent heart attacks.

Why Are Individuals With a History of Psychosis Not Recommended for Ketamine Therapy?

Ketamine can worsen psychotic symptoms and lead to an exacerbation of psychosis, making it unsuitable for individuals with conditions such as schizophrenia or bipolar disorder with psychosis.

Why Is Active Substance Abuse a Contraindication for Ketamine Therapy?

Ketamine has the potential for misuse and addiction, especially in individuals with a history of substance abuse. Stable recovery is necessary before considering ketamine therapy.

Why Is Ketamine Therapy Not Recommended During Pregnancy and Breastfeeding?

Limited research on the safety of ketamine therapy during pregnancy and breastfeeding makes it generally not recommended due to potential risks to the fetus or infant. Alternative treatment options should be explored.

Besides the Mentioned Factors, Are There Any Other Considerations for Ketamine Therapy?

Yes, each individual should undergo a thorough assessment, considering their medical history, current medications, and any potential interactions or contraindications.

What Are the Alternative Treatment Options for Individuals Who Are Not Good Candidates for Ketamine Therapy?

Alternative treatment options may include different forms of psychotherapy, medication management with other antidepressants, or alternative approaches such as holistic therapies or lifestyle changes.

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