Ketamine therapy is a groundbreaking treatment for mental health disorders and chronic pain management, particularly for individuals who have not found relief through conventional therapies. As a family physician with nearly a decade of experience in applying ketamine in clinical settings, I have seen many patients undergo ketamine therapy. However, it is crucial to understand that ketamine therapy is not suitable for everyone. In this guide backed with expert insights from Field Trip Health clinics I will cover the reasons why we disqualify some patients from ketamine therapy.
Medical Conditions That May Disqualify You from Ketamine Therapy
Research into how ketamine interacts with various bodily systems has concluded that specific medical conditions can disqualify individuals from ketamine therapy. In my practice I can confirm how important these disqualifying factors are as they significantly impact treatment safety and efficacy.
Cardiovascular Issues and Ketamine Treatment
In high doses, as an anaesthetic, ketamine is preferred due to its safety profile. Compared to other anaesthetic agents, ketamine does not change breathing (respiration) or hemodynamics (heart rate and blood pressure). For some patients, a rise in blood pressure may occur. As a result, for those whom a rise in blood pressure may be unsafe, they would be disqualified from treatment. It should be noted that even in cardiac procedures, ketamine is a preferred anaesthetic due to its hemodynamic safety. However, out of an abundance of caution, if a patient has uncontrolled high blood pressure – systolic 160/ 100 diastolic and higher generally, we would prefer their blood pressure be more controlled prior to treatment.
Cardiovascular related conditions that may exclude patients from treatment include:
- Uncontrolled hypertension: Ketamine can induce increases in blood pressure for some patients, potentially exacerbating cardiac issues.
- Severe cardiovascular conditions: Advanced heart disease (uncontrolled/ unstable coronary artery disease/ angina) and congestive heart failure may preclude patients from ketamine therapy.
- Poorly managed arrhythmias: Due to the potential for increased sympathetic nervous system activity, patients with poorly managed arrhythmias may be excluded
Thyroid Disorders and Ketamine Therapy Contraindications
Thyroid disorders, particularly hyperthyroidism, can significantly impact ketamine treatment and may disqualify patients from ketamine therapy. Research has shown that an overactive thyroid gland can amplify ketamine’s effects on the cardiovascular system, potentially leading to dangerous spikes in heart rate and blood pressure. As noted, the sympathomimetic effects of ketamine can lead to a rise in heart rate and blood pressure for some patients. For patients already at risk due to their thyroid status, it warrants caution for the patient.
The complex interaction between thyroid hormones and ketamine’s physiological effects may increase risks in individuals with thyroid disorders. At our clinics, we recommend patients achieve proper thyroid control before considering ketamine therapy.
Severe Liver Dysfunction and Ketamine Therapy
Severe liver dysfunction can be a significant disqualifying factor for ketamine therapy. In clinical terms this can someone with acute liver injury, acute hepatitis or cirrhosis. The liver plays a crucial role in metabolizing ketamine, and impaired liver function can lead to unpredictable drug levels and potential toxicity.
Patients with severe liver disease may experience prolonged effects from ketamine due to the liver’s reduced ability to break down and eliminate ketamine. This can increase the risk of side effects and complications.
In patients with severe liver disease, it may be difficult for the liver to metabolize some medicines which can potentially exacerbate existing liver conditions. For these reasons, individuals with severe liver dysfunction are not considered suitable candidates in our clinics for ketamine therapy.
Interstitial Cystitis and Ketamine Therapy
Ketamine-induced cystitis is a well-documented complication of long-term, high-dose ketamine use, particularly in recreational settings. While the therapeutic doses we use in ketamine therapy are significantly lower, it is still important to have caution for this condition.
Despite ketamine cystitis being very rare and not reported in clinical trials of ketamine for mental health conditions, it is still an entity we watch out for. For patients with a history of interstitial cystitis, chronic bladder conditions or active urinary tract infections, we may ask that they manage these conditions before undergoing ketamine therapy, if it is felt that the risk of exacerbating existing bladder issues outweighs the potential benefits of ketamine therapy in these cases.
In cases of mild, well-managed bladder conditions, we may consider ketamine therapy on a case-by-case basis.
Psychiatric Conditions That May Affect Ketamine Eligibility
At Field Trip Health clinics we qualify patients for ketamine therapy for psychiatric conditions based on their individual mental health profile. For instance, those with active psychosis or a history of psychotic disorders, such as schizophrenia, are generally not considered suitable candidates due to a potential risk of ketamine’s dissociative effects exacerbating their condition. Active mania is a contraindication to ketamine therapy as well.
Additionally, individuals with severe personality disorders, particularly those with dissociative features, may not be ideal candidates for ketamine therapy. For patients whom the altered state of consciousness induced by ketamine could potentially be destabilizing, alternative treatments to ketamine therapy would be recommended.
Medications That May Affect Ketamine Therapy
One good thing about ketamine therapy is that no medication will truly disqualify patients from the treatment. Patients can continue their other medications without issue. However, some medications may reduce the efficacy of ketamine treatment. One such medication is naltrexone, an opioid receptor antagonist that some evidence suggests may reduce efficacy of ketamine therapy on depressive symptoms. In patients with alcohol use disorder, some evidence suggests there may not be such reduced effect, and so clinicians may weigh factors affecting each patient and naltrexone differently.
Lamotrigine is another medicine that may reduce ketamine therapy efficacy by its effects on the glutamate neurotransmitter system. While so far no clinical studies have shown a reduced efficacy in patients taking lamotrigine, lamotrigine can reduce ketamine’s dissociative effects. Lamotrigine is commonly used as an anti seizure medicine and in bipolar depression, as well as off label for mood stabilization effects in other mental health conditions. Generally if a patient is being referred for or seeking ketamine therapy, the lamotrigine may not be helping them for their mental health to the extent desired. If alternative therapy to lamotrigine can be considered for seizure or mental health management, it may be preferred for patients who want to maximize the potential of ketamine therapy.
The final medication that may reduce efficacy of ketamine therapy are benzodiazepines, particularly in higher doses. One study found that at least at first, higher doses of benzodiazepines may reduce efficacy of ketamine therapy treatment. Another study similarly showed the potential for reduction in efficacy with higher doses of benzodiazepines. If it is safely possible for patients to taper their benzodiazepine dosing prior to treatment, it may help improve the response to treatment.
Patients should always consult their prescribing clinician and mental health care provider prior to making any medication changes.
Lifestyle Factors That Could Impact Ketamine Therapy Eligibility
Certain lifestyle factors can significantly reduce an individual’s eligibility for ketamine therapy. From my years of experience in clinical settings, lifestyle factors can never be overlooked when determining the safety and efficacy of ketamine treatments for a patient.
Substance Use and Its Effect on Ketamine Treatment
Active substance use can interfere with ketamine therapy, potentially disqualifying individuals from treatment. During consultations at Field Trip Health clinics, we promote a trustworthy environment to encourage patients to be transparent about their substance use history. Patients should not be actively using substances at the same time as ketamine therapy. Substances like alcohol, opioids, stimulants and benzodiazepines at the same time as ketamine therapy can compromise the safety and efficacy of ketamine treatment.
Pregnancy and Breastfeeding Considerations
Pregnant patients unfortunately are generally not eligible for ketamine treatment, although there is evidence for efficacy of ketamine therapy for mental health symptoms in the intra and postpartum period. Ketamine in breast milk drops to safe levels in the hours after treatment, and some providers may consider breastfeeding appropriate 24 hours after treatment.
The Screening Process for Ketamine Therapy
At Field Trip Health clinics, our Intake consists of 3 steps:
Step 1: Discovery call
The journey begins with a discovery call, where we engage in an initial conversation to understand your needs and expectations. During this call, we provide an overview of ketamine therapy, discuss your medical history, and address any immediate concerns or questions you may have. This step helps us determine if ketamine therapy might be a suitable option for you and allows you to make an informed decision about proceeding with the screening process.
Step 2: Questionnaire
Following the discovery call, we ask you to complete a comprehensive questionnaire. This detailed form covers your medical history, current medications, lifestyle factors, and mental health status. The questionnaire is designed to identify any potential contraindications or risk factors that might affect your eligibility for ketamine therapy. It’s crucial to be thorough and honest when filling out this form, as it forms the basis for your personalized treatment plan.
Step 3: Medical consultation
The final step in our screening process is a thorough medical consultation with one of our qualified healthcare professionals. During this consultation, we review your questionnaire responses in detail, take a detailed history, discuss any concerns or potential risks, and perform any necessary physical examinations or tests. This step allows us to make a final determination on your eligibility for ketamine therapy and, if appropriate, develop a tailored treatment plan that addresses your specific needs and ensures your safety throughout the therapy process.
Alternative Options When Disqualified from Ketamine Therapy
When ketamine therapy isn’t an option, you can explore alternative treatments for mental health conditions at our Field Trip Health clinics. We keep up to date with all advancements in mental health research and developed our own range of therapies that do not use ketamine. We provide options for those who may not be eligible for ketamine therapy or are looking for different approaches to address their mental health concerns.
Other Psychedelic Therapies
Our other therapies are based on the latest research into other psychedelic compounds for mental health treatments. MDMA, psilocybin, and LSD are showing promising results in clinical trials for various conditions, including treatment-resistant depression, anxiety, PTSD, and substance abuse disorders.
Our clinics offer MDMA-Assisted Psychotherapy that is very effective at treating patients with severe PTSD (Post-Traumatic Stress Disorder).
Additionally, patients with treatment-resistant depression, anxiety, and substance use disorders may be eligible for Psilocybin-Assisted Psychotherapy.
Conventional Treatment Options for Mental Health
For those who can’t access ketamine therapy, conventional treatments remain viable options. Our clinics offer psychotherapy & counselling that leverages multiple therapy techniques and wellness tools to help patients with treatment-resistant depression, anxiety, PTSD, and substance abuse disorders.
Field Trip Health also specializes in non-invasive treatment options like Repetitive Transcranial Magnetic Stimulation (rTMS). This revolutionary neurostimulation tool is designed to break through the barriers of treatment-resistant mental health conditions. It works by making your brain more adaptable in important areas that control your mood.
Addressing Disqualifying Factors: Steps Towards Eligibility
If you’re interested in ketamine therapy but have been disqualified due to certain factors, don’t lose hope. For some conditions there are steps you can take with a qualified health care provider to potentially become eligible for ketamine therapy.
Managing Medical Conditions to Qualify for Ketamine Treatment
Many medical conditions that initially disqualify you from ketamine therapy can be managed effectively, opening the door for treatment. For example, If you have high blood pressure, work closely with your doctor to bring it under control. This might involve medication adjustments, dietary changes, or increased physical activity.
For those with thyroid issues, particularly hyperthyroidism, follow the direction of your physician or prescribing health care provider. Regular check-ups and medication adherence can help stabilize your condition, making you a better candidate for ketamine therapy. Remember, it’s not just about qualifying for treatment; it’s about ensuring your overall health and safety during the therapy process.
Lifestyle Changes That May Improve Eligibility
Making lifestyle improvements can significantly increase your eligibility for ketamine therapy. If substance use is a concern, consider seeking help to address this issue as our clinics require a period of sobriety before beginning treatment.
Improving your overall health can also enhance your eligibility. Regular exercise, a balanced diet, and stress management techniques can all contribute to better physical and mental health. These changes not only make you a better candidate for ketamine therapy but can also improve your response to treatment if you do qualify.
Ready to Explore Your Ketamine Therapy Options?
If you’re considering ketamine therapy for your mental health journey, don’t let potential disqualifying factors discourage you. At Field Trip Health, we’re committed to finding the right treatment path for every individual. Whether you’re eligible for ketamine therapy or need to explore alternative options, our expert team is here to guide you. Take the first step towards healing by scheduling a discovery call with us today. Together, we’ll navigate your unique situation and work towards a brighter, healthier future.
FAQs
Uncontrolled high blood pressure, severe heart disease, unstable arrhythmias, hyperthyroidism and severe liver dysfunction can disqualify you from ketamine therapy. A thorough medical evaluation is necessary to determine eligibility. Some conditions may not disqualify you but require a modified treatment plan.
Ketamine therapy, when properly supervised, has a good safety profile for long-term use with mild and short-lived side effects. Regular check-ups are crucial to monitor your response and adjust treatment as needed. Each patient’s experience is unique, so we tailor the therapy to your specific needs and medical history.
Generally, you can continue your current medications while undergoing ketamine therapy, but some may interact with ketamine. Providing a complete list of your medications during screening is essential. We’ll review everything carefully and may suggest adjustments to ensure safety and maximize the therapy’s benefits.
Active substance use can impact your ketamine therapy eligibility. Clinics generally require sobriety before starting treatment, as substances like alcohol, opioids, or benzodiazepines can dangerously interact with ketamine. Healthcare providers can guide you on the necessary steps to become eligible for ketamine therapy.
Studies show that ketamine therapy has a success rate of 60-70% for treatment-resistant depression. Many patients experience rapid improvement in symptoms, within hours or days of treatment. Ketamine is used when other treatments have failed, making these success rates very promising for difficult-to-treat cases.
Ketamine therapy is generally not covered by public health insurance plans like OHIP (ON) or MSP (BC) in Canada. However, some private insurance plans cover the psychotherapy or ketamine portion of treatment, or both. Patients should consult their insurance companies for details as coverage varies by provider and plan.
No, you should not drive after receiving ketamine therapy. The effects of ketamine can impair your reaction time and judgement for several hours after treatment. It’s recommended to have someone drive you home and avoid operating heavy machinery or making important decisions for at least 24 hours following treatment.
Most patients can return to work the day after ketamine therapy. It’s recommended to take the rest of the day off after each treatment session. Some people may feel tired for 24-48 hours post-treatment. If your job involves operating heavy machinery or making critical decisions, you may need to take more time off.
About the Author
Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.
Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in Toronto, Montreal, Vancouver, Ottawa, Hamilton, Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.
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