Overview
Despite the marvelous benefits of ketamine therapy, no one seems to ask who is not a good candidate for ketamine therapy.
This drug is not a one-size-fits-all solution for all mental health problems. With the complexity of human physiology and psychology, it is critical to understand that this novel therapy has its caveats.
In this article, we will discuss who is not a good candidate for ketamine therapy. But before we do that, let us briefly cover what ketamine therapy is and some common uses.
What is ketamine?
Ketamine is an anesthetic drug that was introduced in the 1960s to treat injured soldiers during the Vietnam War.
As a Schedule III drug, ketamine is a prescription-only drug that gets used in veterinary medicine. Note that the Schedule III classification means that the drug has medical benefits but is subject to abuse.
Experts also classify ketamine as a hallucinogen. However, this categorization is loosely defined since other potent medications, such as lysergic acid diethylamide (LSD), peyote, phencyclidine (PCP), and psilocybin (mushrooms), also belong to this category.
As for its medical uses, ketamine can help with a variety of physical/mental disorders, including post-traumatic stress disorder (PTSD), depression that resists conventional therapy, anxiety, and chronic pain.
How does ketamine work?
Researchers are still uncertain about ketamine’s mechanism of action.
However, the antidepressant properties of this medication may help individuals who failed to respond to conventional treatment.
According to one study, ketamine targets NMDA receptors in the brain, which increases the amount of glutamate. The latter activates another receptor known as AMPA.
This combined action promotes interneuronal communication, which is thought to improve your mood, critical thinking, and cognition.
Researchers also believe that ketamine may dampen inflammation – another mechanism that explains its antidepressant properties.
All in all, the scientific community agrees that ketamine affects the brain in several ways, eventually improving the symptoms of depression and other psychiatric disorders.
Ketamine therapy for major depressive disorder
Depression is a mental condition that belongs to the mood disorder category. It affects millions of people every year and presents with debilitating symptoms.
Unfortunately, many patients do not seek help due to socioeconomic factors and continue suffering in silence.
According to reports released by the National Institute of Mental Health, around 17.3 million adults in the United States went through at least one episode of major depressive disorder (MDD) in their lifetime.
Internationally speaking, the World Health Organization (WHO) reports that approximately 800,000 MDD-related deaths occur every year.
Unfortunately, some patients do not respond to conventional treatments for depression, which leads to a poor prognosis and increases the risk of suicide. The good news is that ketamine therapy seems to help this set of patients after other methods have failed.
In the spring of 2019, the Food and Drug Administration (FDA) approved Ketamine (i.e., Spravato) as a treatment for resistant forms of depression.
The reason behind this approval boils down to ketamine’s mechanism of action. Unlike other antidepressants, such as fluoxetine (Prozac), venlafaxine (Effexor), and sertraline (Zoloft), which interfere with the concentrations of serotonin in the brain, ketamine acts on the NMDA receptors.
With that said, researchers are still investigating the reason that explains why some people respond to ketamine therapy while others do not.
Before receiving FDA approval, healthcare professionals used to administer ketamine intravenously. However, since its approval, giving patients ketamine via a nasal spray under medical supervision seems to be the preferred route of administration.
The side effects of ketamine therapy
Learning about the common side effects of ketamine therapy will provide you with a solid idea of who is not a good candidate for ketamine therapy.
Here are a few side effects triggered by ketamine therapy:
- Tachycardia (i.e., rapid heartbeat)
- High blood pressure
- Muscle tremors
- Increased muscle tone
- Vocal tics
- Confusion
- Hallucination
- Drowsiness
- Memory loss
Who is not a good candidate for ketamine therapy?
While the benefits of ketamine therapy are diverse, some people are better off without it. For example, patients with medical conditions, such as uncontrolled high blood pressure, aortic dissection, myocardial infarction, and aneurysms, should not receive this treatment.
Another category that’s not a good candidate for ketamine therapy includes people who took drug and developed symptoms of hypersensitivity (e.g., hives, swollen lips).
Finally, psychiatric patients with schizophrenia are not good candidates for ketamine therapy since it may worsen their symptoms.
Ketamine and trying to get pregnant
While we still don’t have any concrete evidence about the side effects of ketamine therapy during pregnancy, healthcare professionals do not recommend taking the drug for pregnant or breastfeeding women.
General information about ketamine therapy
- To treat depression, your doctor will administer a much lower dose of ketamine compared to anesthesia.
- Ketamine has some addictive properties. Therefore, make sure to balance the benefits and the risks to come up with a tailored decision that fits your needs. For people with a history of substance abuse, speaking with the doctor about this side effect is crucial.
- The intravenous administration of ketamine to treat depression usually produces a clinical response within 1–3 infusions. If you do not develop a reaction after 3 infusions, continuing the treatment is unlikely to help.
- Conversely, patients who experience symptomatic improvement after 1–3 infusions of ketamine are likely to benefit from extending the treatment.
Things to keep in mind before undergoing ketamine therapy
While there are no official guidelines for the use of ketamine, the American Psychology Association (APA) released a statement in JAMA Psychiatry to guide physicians on the use of this drug.
All doctors should follow these instructions before starting the treatment:
- Perform a comprehensive assessment of the depressive symptoms and their evolution over time.
- Check for a history of substance abuse, psychiatric disorders, and whether there are suicidal thoughts.
- Make sure that conventional treatments of depression failed to produce symptom improvement despite appropriate dosage and administration.
- Evaluate the individual’s overall well-being.
- Assess the susceptibility to adverse effects after administering the drug.
Since many clinics that offer ketamine therapy do not follow proper protocols, your role as a patient is to look for the following guidelines before getting the treatment:
- Evaluation – the credentials of the person who is performing the initial evaluation
- Experience – whether the physician who is giving you the treatment has experience with this therapeutic modality
- Administration and monitoring
- Cost
Takeaway message
Ketamine therapy can be a great way to help patients with resistant forms of depression and anxiety. However, learning about who is not a good candidate for ketamine therapy is just as important. The recent FDA approval will aid in mainstreaming this therapeutic modality to reach more patients.
We hope that this article managed to introduce the complex topic of ketamine therapy and its role in treating mental disorders.
If you have any questions, concerns, or a personal story about ketamine therapy, please do not hesitate to share your thoughts in the comment section below or contact us by clicking on this link.