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Who is Not a Good Candidate for Ketamine Therapy?

older adult consulting with a ketamine therapy practitioner

Written by Dr. Ladan Eshkevari, PhD, CRNA, LAc, FAAN

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Ketamine therapy holds the power to revolutionize chronic pain and mental health management. Relatively low doses of this dissociative anesthetic can provide profound relief where traditional treatments are failing. Infusions can rapidly alleviate treatment-resistant depression, anxiety, and pain symptoms in hours. Research-based protocols can even provide long-term relief when paired with integration therapy. 

Still, ketamine is not a one-size-fits-all remedy, and some patients may not be ideal candidates.

This article investigates who is not a good candidate for ketamine therapy based on underlying conditions, medications, and age while offering hope to all patients. 

Who Benefits From Ketamine Therapy?

Most people struggling with mental health issues or chronic pain who have not responded to traditional pharmaceuticals could benefit from ketamine therapy. 

Ketamine infusions selectively target brain receptors called N-methyl-D-aspartate (NMDA) found within the glutamatergic system. NMDA receptors regulate various functions, including learning, memory, and pain perception. By targeting them, ketamine can increase transmission of the neurotransmitter glutamate,  producing diverse therapeutic effects.

Researchers believe this glutamate modulation helps ease symptoms in patients with treatment-resistant conditions:

Who is Not a Good Fit for Ketamine Therapy?

Ketamine has helped countless patients resolve deeply rooted mental and physical conditions. However, this powerful dissociative anesthetic isn’t practical for everyone. Patients who fall into the categories below should speak with a ketamine practitioner to see if this therapy can help.

who is not an ideal ketamine therapy candidate

High Blood Pressure or Heart Disease

Research shows that ketamine infusion therapy can elevate blood pressure and heart rate, posing a risk for people with uncontrolled conditions. 

High blood pressure (BP), arrhythmias, coronary artery disease, congestive heart failure, and congenital defects (CV diseases) don’t automatically disqualify patients. But ketamine makes the heart work harder, and that is a risky prospect for people with unstable or untreated conditions. 

Reputable ketamine practitioners screen patients for heart disease before initiating an infusion protocol to determine whether the patient can safely receive the medicine. With appropriate monitoring, and low infusion doses, patients with controlled BP and managed CV disease should be able to tolerate ketamine therapy with minimal side effects.

Ketamine Allergies or Intolerances

Ketamine can spark allergic or adverse reactions, like any medication. 

A  ketamine allergy can manifest as hives, itching, or swelling. Severe reactions can also cause heart rate or blood pressure changes, difficulty breathing, and confusion. 

Fortunately, these responses are rare, and ketamine practitioners at Avesta closely monitor patients during infusions to mitigate reactions should they occur. 

Patients with ketamine allergies or those who have experienced previous adverse reactions should speak with an expert to determine if they’re viable candidates.


people on thyroid replacement medication may not be ideal ketamine candidates

Case reports indicate that ketamine’s heart and pulse impacts might be more severe in patients taking thyroid replacement medication. Why?

Thyroid disorders like hyperthyroidism can lead to an elevated heart rate due to sympathetic overactivity. Ketamine use in such cases may exacerbate this condition. The concern primarily revolves around people with poorly controlled hyperthyroidism experiencing high blood pressure and an unstable cardiac state. 

Inadequate management of thyroid issues could further raise blood pressure and place additional strain on the heart. 

Ketamine practitioners screen patients with hyperthyroidism to maintain safe blood pressure levels and heart function during infusions.

IV Ketamine infusions for depression anxiety ptsd chronic pain fibromyalgia CRPS Bethesda MD McLean VA Washington DC

Substance Use Disorders

substance use disorders may not be ideal at-home ketamine therapy patients

People with substance use disorders may not be ideal candidates for at-home ketamine therapy for several reasons. 

Ketamine is a powerful dissociative with the potential for recreational abuse and addiction. This attribute makes ketamine risky for those already struggling with substance use disorders. Additionally, people with a history of addiction may have a heightened risk of relapse when taking ketamine at home, as it can trigger cravings or reinforce unhealthy behaviors. Finally, the patient’s emotional vulnerabilities may impact the therapeutic process and outcomes. 

Patients should talk to medical experts to assess and address substance use issues before considering ketamine therapy. 

Having said that, IV ketamine therapy can actually mitigate alcohol use disorder and opioid addiction. At Avesta, we collaborate with patients and their mental and addiction specialists to formulate a safe and effective treatment plan.

Older Adults

older adults may not be ideal ketamine therapy candidates

Older adults with an extensive medical history may not be ideal candidates for ketamine therapy due to several factors. 

Oftentimes, seniors have complex co-existing conditions such as cardiovascular disease or neurodegenerative disorders. These factors can complicate ketamine therapy as the compound could exacerbate heart conditions or negatively interact with medications. 

Also, older adults may be more susceptible to adverse reactions from ketamine’s dissociative and hallucinogenic effects. Heightened sensitivity to ketamine necessitates lower initial doses and close monitoring. 

Finally, older adults may not get the same benefits as younger people because their brains are less neuroplastic. Reduced neuroplasticity hinders the brain’s capacity to adapt and form new neural pathways, essential for mental health treatments like ketamine therapy. In older patients, this limitation can reduce ketamine’s ability to reshape thought patterns and emotional responses. 

Still, older patients experiencing treatment-resistant depression or chronic pain have hope. A review of two randomized controlled trials indicates ketamine therapy can be safe and effective for depressed patients over 60

  • One study showed clinically significant outcomes for depression using repeated subcutaneous ketamine injections. 
  • The second study didn’t reach clinical significance but showed that esketamine nasal spray helped improve depression symptoms. 

Seniors considering ketamine treatment should seek a consultation with clinical experts to determine if they’re a good fit. At Avesta, we have successfully treated older patients with carefully monitored IV ketamine infusions.

Bipolar Disorder & Psychosis

bipolar disorder may make ketamine therapy risky

People with bipolar disorder or psychosis may benefit from ketamine therapy as it can rapidly alleviate depressive symptoms associated with these conditions. But ketamine could also exacerbate bipolar manic states, characterized by abnormally elevated mood, energy, and impulsivity.  

People with bipolar disorder or psychosis may be at greater risk of ketamine-induced mania. Patients with these conditions considering ketamine therapy should engage in open and thorough discussions with their healthcare providers, including doctors and therapists. 

Professionals can carefully evaluate patients’ mental health history, current state, and specific treatment needs to determine whether ketamine therapy is an appropriate modality.

Medication Interactions

medications that could negatively interact with ketamine

Research shows ketamine can negatively interact with certain medications. 

One study on ketamine and psychiatric medications showed the following considerations:

  • Lamotrigine might diminish ketamine’s effects. 
  • Benzodiazepines consistently reduce the duration of ketamine’s beneficial impact on depression. 
  • Antipsychotic medications, including haloperidol, risperidone, and clozapine, may interact with ketamine, but the quality of this evidence remains uncertain. 
  • Ketamine can cause increased sedation when taken with other sedatives such as opioids, certain migraine medications, and antiseizure drugs.

Professionals can carefully evaluate patients’ medical history, and current medication regimen, to determine interactions with ketamine therapy and devise a safe treatment plan for patients.

Hope for All Patients

Depressed and chronic pain patients with pre-existing conditions such as heart disease, hyperthyroidism, and bipolar disorder, as well as older adults, should not lose hope. 

Reputable ketamine providers like Avesta employ a collaborative care model to help as many people as possible. In Avesta’s collective care approach, the treatment team closely communicates with patients’ doctors and psychotherapists to review their history, medications, and eligibility for ketamine therapy immediately or in the near term. 

Avesta then crafts an effective personalized plan for patients who can safely undergo treatment. 

Frequently Asked Questions

What should I consider before deciding on ketamine therapy?

Before starting ketamine therapy, patients should carefully evaluate their medical history, including pre-existing conditions, chronic illnesses, and mental health issues. It is vital to assess current medications for any potential interactions with ketamine, as well as discuss allergies or previous adverse reactions. 

Patients may have different goals for ketamine therapy, such as seeking relief from treatment-resistant PTSD, depression, and anxiety or managing chronic pain. Patients must discuss their goals and medical history with a ketamine specialist to determine if this treatment can be safe and effective. 

What are the possible ketamine therapy side effects?

Ketamine therapy is extraordinarily safe, effective, and well-tolerated. However, this dissociative anesthetic causes several temporary side effects. For example, nausea, vomiting, increased blood pressure, raised heart rate, and disorientation are common. 

Ketamine can also cause out-of-body experiences and other changes in perception.  Fortunately, these effects are temporary and do not interfere with healing. 

What pre-existing medical conditions might make someone a bad candidate for ketamine therapy?

Ketamine therapy can be a suitable option for people of all backgrounds. However, those with pre-existing conditions like uncontrolled hypertension, heart conditions, hyperthyroidism, and active addictions should discuss ketamine therapy with their physicians and obtain a consultation from a ketamine expert before proceeding. Additionally, seniors and people with bipolar disorder or psychosis may not benefit from this treatment.

Only a ketamine practitioner with extensive experience can determine if an individual is a good prospect after a thorough evaluation. 

Schedule a free consultation with Avesta’s ketamine clinic care team to assess your eligibility and craft a personalized plan for healing. 

Ketamine Infusions in Bethesda, MD, McLean, VA and Washington, DC

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