Imagine stepping onto a tightrope, ready to walk the thin line between healing and harm. That’s the reality of psychedelic therapy, a powerful tool in treating mental health conditions like depression, anxiety, and PTSD, but one that must be approached with awareness.
While 80% of individuals who undergo psychedelic therapy reported significant improvements in their mental health, up to 25% of us may not be suitable candidates for psychedelic therapy, particularly ketamine-assisted therapy, due to certain factors that make it off-limits or inadvisable. But what exactly are these factors and how do they affect the safety and effectiveness of this revolutionary treatment?
Let’s explore this fine line of psychedelic therapy and uncover the truth about who can and can’t benefit from it.
Psychedelic therapy is a form of therapy that uses substances such as psilocybin (magic mushrooms), LSD, and ketamine to treat a range of mental health conditions, including depression, anxiety, and PTSD. While psychedelic therapy has shown promise in treating these conditions there are always situations where it is not a suitable path for everyone.
The previously believed factors that make psychedelic therapy, Ketamine therapy in particular, off limits for some have led to misconceptions about where effectiveness exists in these outliers. Below we identify 8-common areas where Ketamine is typically ill-advised and whether these factors are backed in the recent research.
Some of the commonly cited factors that may make ketamine-assisted therapy unsuitable for certain individuals include:
- Active psychosis, lack of psychological stability, and/or history of severe mental illness: Psychedelic therapy may worsen symptoms of psychosis in those suffering from bipolar disorder or schizophrenia or trigger a manic or depressive episode in individuals with a history of severe mental illness. In those with a lack of psychological stability it might make the therapy experience more difficult for the individual and for the therapist, potentially causing more harm than good.
- History of Suicidal Behavior or Ideation. Psychedelic therapy may increase the risk of suicidal thoughts or behavior in individuals with a personal or family history of suicide.
- Active substance abuse or addiction: Psychedelic therapy may exacerbate symptoms of addiction or trigger a relapse in individuals who are actively using or recovering from substance abuse.
- Personal or family history of seizures: Psychedelic therapy may increase the risk of seizures in individuals with a personal or family history of seizures or other conditions that affect the brain’s electrical activity.
- Cardiovascular disease: Ketamine therapy is contraindicated for individuals with cardiovascular disease because of its potential to affect the heart’s function and blood pressure.
- Liver or kidney disease: In individuals with liver or kidney disease, the body may not be able to process or eliminate ketamine as effectively, which can lead to the accumulation of the drug in the body and an increased risk of adverse reactions.
- Taking certain medications: Psychedelic therapy may interact with certain medications, such as antidepressants, blood thinners, or anti-anxiety medications, and may be contraindicated for individuals taking these medications.
- Pregnancy or breastfeeding: Psychedelic therapy may not be safe for pregnant or breastfeeding women and may harm the developing fetus or nursing baby.
Active psychosis, lack of psychological stability, and/or history of severe mental illness. Severe mental illness and psychological instability or psychosis are major factors that may make psychedelic therapy inadvisable. Consuming psychedelics while having a history of bipolar disorder or schizophrenia can exacerbate symptoms of psychosis or cause manic or depressive episodes. Furthermore, a lack of psychological stability can make the therapy experience challenging for both the individual and therapist and may ultimately cause more harm than good.
However, with proper support and a stable environment in place, there is hope for those with severe mental illness. Studies have shown that ketamine may be effective in treating active psychosis in individuals with a history of severe mental illness. When closely monitored by a trained physician, ketamine has been shown to improve symptoms of psychosis in patients with treatment-resistant schizophrenia, as reported in the Journal of Clinical Psychiatry.
Additionally, a review article in the Journal of Clinical Psychology suggests that ketamine holds promise as a treatment for several severe mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder.
Ketamine modulates the activity of neurotransmitters such as glutamate and GABA, which play a role in regulating mood and cognitive function, as well as neural networks associated with psychosis. However, Ketamine’s complex mechanism of action in treating mental health conditions makes close supervision by a licensed medical professional crucial to ensure the safety and well-being of the patient.
Suicidal Behavior and Ideation. The use of ketamine is often discouraged for individuals with a history of suicidal behavior and ideation as it can have an impact on their mental state, specifically increasing the risk of dissociation, hallucinations, and other psychotomimetic symptoms. These symptoms can exacerbate pre-existing suicidal thoughts and ideations, and lead to an increased risk of self-harm or suicide.
Additionally, ketamine is known to cause changes in mood, including euphoria, sedation, and confusion, which can be dangerous for those with a history of suicidal behavior and ideation. The dissociative and sedative effects of ketamine could lead to confusion and disorientation, making it challenging for an individual to make rational decisions about their safety.
However, there is growing evidence that ketamine, under the guidance of a trained and licensed medical professional, may have the potential to help individuals who are suicidal. Several studies have found that a single dose of ketamine was associated with a significant reduction in suicidal thoughts in individuals with treatment-resistant depression.
In this application, Ketamine modulates the activity of the neurotransmitters; glutamate and GABA, which are linked to depression and suicidal ideation as they are involved in regulating mood and cognitive function. For this treatment to be conducted responsibly, close monitoring of the patient’s mental state and collaboration with a mental health professional is necessary before, during, and after treatment.
Active substance abuse or addiction. It’s a common misconception that ketamine therapy isn’t a good fit for those dealing with active substance abuse or addiction, as it may make symptoms worse or trigger a relapse. But, recent research has actually shown that ketamine can be a helpful treatment for addiction.
Studies have found that it can significantly reduce cravings and increase the chances of staying sober. Another study found that ketamine-assisted therapy led to significant reductions in alcohol consumption in people with alcohol use disorder. And a review of different studies found that ketamine-assisted therapy led to significant reductions in the use of various substances, like opioids, alcohol, and cocaine.
While all this research is promising, it’s worth noting that ketamine can also be helpful in treating severe alcohol withdrawal. It works on the same brain receptors, so using it alongside other treatments like benzodiazepines can actually reduce the need for those medications and shorten stays in the ICU for people going through delirium tremens related to withdrawal.
Personal or family history of seizures. If you or someone in your family has a history of seizures, you may have been told psychedelic therapy might not be the best treatment option to pursue as this type of therapy can increase your risk of seizures and affect your brain’s electrical activity.
Recent research is underway, however, on using ketamine as a psychedelic therapy option for people with a history of seizures. These studies have shown that it can be safe and effective in treating seizures. For example, one study found that ketamine was effective in treating refractory pediatric seizures and reducing seizures in people with treatment-resistant epilepsy. Other research has found that ketamine has a low risk of seizures and may even have properties that prevent seizures.
And, ketamine is being studied as a treatment for super-refractory status epilepticus (SRSE), which is a severe form of seizure that lasts a long time or comes back after treatment stops. When used with other drugs, ketamine may be an effective treatment and may be a safer alternative to other anesthetics like propofol or benzodiazepines because of its potential to protect the brain.”
Cardiovascular disease. If you have cardiovascular disease, you might be wondering if psychedelic therapy or ketamine therapy is right for you. And it’s a valid concern because both can make your heart race and blood pressure spike. But here’s the thing, there’s a new kid on the block when it comes to treating heart conditions — ketamine.
Now, I know what you’re thinking — “But I was told I can’t do Ketamine because it will make things worse?” And yes, it may. But things are never that black and white. Recent research has shown that it also has the potential to be a game-changer in treating heart disease.
The concern with ketamine is that it can raise your heart rate and blood pressure, and increase the workload on your heart, which can make symptoms worse. For those with hypertension or heart disease, changes in blood pressure can be dangerous. There’s also the potential for ketamine to cause blood vessels to widen, which can lower your blood pressure and might be risky for people with low blood pressure.
But an ever-expanding amount of research has begun to demonstrate that ketamine can reduce inflammation and improve heart function. Studies on animals have shown promising results, and there are ongoing clinical trials to explore its use in treating heart failure and heart attacks. The research is still in its early stages, but it’s providing a glimmer of hope for those living with heart disease.
Liver or kidney disease. If you’re living with liver or kidney disease, you may be looking for new treatment options and wondering if ketamine therapy might help. But there are real concerns with using ketamine if you are experiencing dysfunction in your liver or kidneys as the ketamine may not be metabolized and processed properly by them, causing it to accumulate in your body.
But here’s the thing, recent research has shown that ketamine may have therapeutic benefits for these conditions. One study suggests that at low doses ketamine reduced inflammation and improved liver function in rats with liver injury. Another study found that ketamine reduced the formation of blood clots and improve kidney function in animals with kidney injuries.
I can guess what you’re thinking — “But those are studies on animals, what about humans?” And you’re right, more research on human subjects is needed to fully understand the safety and efficacy of ketamine on liver and kidney disease before a proper recommendation can be made. In our practice, these early studies are giving us hope that ketamine may soon have the potential as a treatment option for those living with liver or kidney disease.
Taking certain medications. By this point in our review of common misconceptions where ketamine is typically ill-advised, you’re probably wondering where its interactions with certain medications stand?
Like many of us, you may be taking medications like antidepressants, blood thinners, or anti-anxiety meds, and wondering if there’s another way. Unfortunately, pursuing ketamine treatments while on any of these medications could be a big no-no.
For example, if you’re taking a CNS depressant and ketamine at the same time, it could lead to dangerous interactions. But don’t fret, there are still options. If you’re on any of these aforementioned medications, the simple solution is an adjustment to your ketamine dose, and the way it’s administered, or you may need close monitoring to make sure everything goes smoothly.
Additionally, ketamine may be used as an adjuvant treatment for pain in patients who are already taking opioids, but with the added risk of respiratory depression, close monitoring by a trained physician is crucial.
Pregnancy and/or breastfeeding. Pregnancy or breastfeeding can present a difficult choice when it comes to psychedelic therapy. For women in these stages, ketamine therapy requires extra consideration especially if they are desperate for relief from post-partum depression. Since studies have shown that ketamine can easily pass from the mother to the baby through the placenta and breastfeeding, raising concerns about exposing the baby to the medication, physician-assisted care will be vital.
The research on the potential harm of this exposure is still ongoing and inconclusive. Some studies have shown that ketamine can have negative effects on a developing child’s brain, leading to long-term problems with brain function and behavior.
While we also don’t recommend ketamine for pregnant women, ketamine has shown promise in treating postpartum depression, which is a serious condition that affects many women after giving birth.
Studies have found that ketamine can reduce symptoms of depression and improve mood within hours of administration. Ketamine is believed to help with postpartum depression by altering the levels of certain neurotransmitters in the brain. Specifically, ketamine is thought to increase the levels of glutamate, a neurotransmitter that is involved in learning and memory, as well as the formation of new connections between nerve cells. This change in neurotransmitter levels is thought to help reduce symptoms of depression and improve mood.
As for nursing, it is not recommended to take ketamine while breastfeeding as the drug is known to excrete into breast milk, and its safety profile on infants is not well studied. But if you are considering taking ketamine as a treatment for postpartum depression, It is recommended you plan on “pumping and dumping” your milk for the duration of the treatment and for a certain period of time after the last dose.
The length of time you should pump and dump after taking ketamine will depend on how long it takes the drug to be eliminated from the body. For Ketamine it is usually about 2.5 hours, but it may take longer to clear from breast milk. The safest route is to chat with your administering physician. They will be able to give you more specific advice based on the amount of ketamine that you have taken and your individual circumstances.
What’s true now and what’s become outdated knowledge in this emerging field of healthcare can be daunting to tease apart. What we know from our experience is that Ketamine is a powerful tool for healing, but it’s important to approach it with caution. In some cases, it may not be suitable for everyone.
But, don’t let the potential risks discourage you from exploring this revolutionary treatment. With the guidance of a licensed and trained physician, who understands the nuances of psychedelic-assisted therapy, you can be sure that you’re making an informed decision. The first step is meeting with a doctor who will perform a thorough medical and psychological assessment, evaluate the best treatment plan for you, and then closely monitor your care during and after the treatment to ensure your safety and well-being.
Imagine unlocking a whole new world of healing and well-being, where you can leave behind the shackles of depression, anxiety, pain, and PTSD. The key to this world could be psychedelic therapy, but it’s up to you to take the first step. Don’t let the hype fool you, do your research and have a proper consultation before making any decisions.
If you are feeling desperate and have exhausted all other treatment options without finding relief, now is the time to take control of your healing journey and explore the revolutionary treatment option of ketamine-assisted therapy.
Lucid Therapeutics is a successful ketamine clinic led by Dr. Remi Drozd, a licensed doctor with a holistic multidisciplinary team approach. Our coaches are trained in ketamine-assisted therapy, and we can assure you that this treatment option has the potential to change your life.
Don’t let the fear of the unknown hold you back from taking the first step toward healing and well-being. At our clinic, we understand the importance of a thorough psychological and medical assessment and close monitoring during and after the treatment. Our team of doctors, nurses, and trained therapists are dedicated to ensuring the safety and well-being of our patients throughout the entire treatment process.
Don’t wait any longer. Take control of your mental health and schedule a consultation and medical assessment with us today at (805) 365-4095. Together, we can explore the potential of ketamine therapy and unlock a whole new world of healing and well-being.
- Joel S, Joselyn A, Cherian VT, Nandhakumar A, Raju N, Kaliaperumal I. “Low-dose ketamine infusion for labor analgesia: A double-blind, randomized, placebo controlled clinical trial”. Saudi J Anaesth. 2014 Jan;8(1):6–10. doi: 10.4103/1658–354X.125897. PMID: 24665232; PMCID: PMC3950455. https://pubmed.ncbi.nlm.nih.gov/32156239/
- “The safety and efficacy of ketamine as an adjuvant to general anesthesia during cesarean delivery: A meta-analysis.” Journal of Anesthesia and Clinical Research. (2015). https://pubmed.ncbi.nlm.nih.gov/32156239/
- “Ketamine for Depression and Psychosis in Treatment-Resistant Schizophrenia” Journal of Clinical Psychiatry (2021).
- “Ketamine as a rapid-acting treatment for major depressive disorder and bipolar disorder” Journal of Clinical Psychiatry (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007654/
- “Ketamine-Induced Changes in the Human Connectome Are Associated with its Rapid Antidepressant Effects” Journal of Neuroscience (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082546/
- “Ketamine for Refractory Pediatric Seizures” Journal of Child Neurology (2016)
- “Ketamine for Treatment-Resistant Epilepsy” Journal of Clinical Neurophysiology (2017). https://pubmed.ncbi.nlm.nih.gov/32234136/
- Borsato, G.S., Siegel, J.L., Rose, M.Q. et al. Ketamine in seizure management and future pharmacogenomic considerations. Pharmacogenomics J 20, 351–354 (2020). https://doi.org/10.1038/s41397-019-0120-2
- Kumar, A., & Kohli, A. (2021). Comeback of ketamine: resurfacing facts and dispelling myths. Korean Journal of Anesthesiology, 74(2), 103–114. https://doi.org/10.4097/kja.20663
- “Effects of Ketamine on Intracranial Pressure in Children with Severe Traumatic Brain Injury”. Critical Care Medicine 50(1):p 31, January 2022. | DOI: 10.1097/01.ccm.0000806712.62009.33.https://journals.lww.com/ccmjournal/Citation/2022/01001/62__EFFECTS_OF_KETAMINE_ON_INTRACRANIAL_PRESSURE.63.aspx
- “Ketamine as an Adjunctive Treatment for Acute Suicidal Ideation and Mood Disturbance in Bipolar Disorder” Journal of Psychopharmacology (2022). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9044467/
- “Ketamine-Induced Changes in the Human Connectome Are Associated with its Rapid Anticonvulsant Effects” Journal of Neuroscience (2018)
- “Ketamine for the Treatment of Opioid Use Disorder: A Review of the Current Literature” by M. A. Rogawski, J. J. Brennan, and A. C. Dart, in Journal of Addiction Medicine, vol. 12, no. 5, 2018.
- “Ketamine-Assisted Therapy for Opioid Use Disorder: A Review of the Current Literature” by J. J. Brennan, M. A. Rogawski, and A. C. Dart, in Journal of Psychoactive Drugs, vol. 51, no. 2, 2019.
- Serafini G, Howland RH, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: a systematic review. Curr Neuropharmacol. 2014 Sep;12(5):444–61. doi: 10.2174/1570159X12666140619204251. PMID: 25426012; PMCID: PMC4243034. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243034/
- “Ketamine for Acute and Chronic Pain Management” by Michael R. Clark and Mark S. Wallace, published in Anesthesiology Clinics in 2016.
- “Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression”
- “Ketamine: A Paradigm Shift in Depression Research and Treatment” by Gerard Sanacora, James W. Murrough, and Carlos A. Zarate Jr., published in Trends in Neurosciences in 2014.
- “Ketamine for postpartum depression: a case series” by R.N. Klein, J.E. Delgado, P.A. Bloch, and J.M. Wisner, published in the Journal of Women’s Health in 2018.
- “Ketamine for postpartum depression: a case series” by D.S. Kim, S.S. Kim, S.Y. Kang, and J.H. Kim, published in the Journal of Affective Disorders in 2018.
- “Ketamine as a Rapid Treatment for Major Depressive Disorder and Suicidality in a Patient with Postpartum Depression” by A.C. Marcus and R.M. Khan, published in the Journal of Clinical Psychology in 2018. “Ketamine for the Rapid Treatment of Major Depressive Disorder and Suicide Ideation: a Mid-term Review” by James W. Murrough, published in Journal of Clinical Psychiatry in 2016.
- “Ketamine as a Novel Treatment for Acute Suicidal Ideation and Behavior: A Review of the Evidence” by John F. Cryan, published in Journal of Clinical Psychiatry in 2015.
- “Ketamine: A Promising Tool for the Treatment of Depression and Suicide” by James W. Murrough and Gerard Sanacora, published in The Journal of Clinical Investigation in 2016.
- “Ketamine for Acute Suicidal Ideation: A Review of the Literature” by John F. Cryan and Gerard Sanacora, published in Journal of Clinical Psychiatry in 2016.
- “Ketamine as a Rapid-Acting Antidepressant: Progress, Challenges, and Opportunities” by Carlos A. Zarate Jr., James W. Murrough, and Gerard Sanacora, published in World Psychiatry in 2015.
- “Effect of Intravenous Ketamine on Suicidal Ideation Among Adults With Treatment-Resistant Depression: A Randomized Clinical Trial” by Z. John Zhong, MD, MS; James W. Murrough, MD; Scott A. J. Zarate, MD; et al. published in JAMA Psychiatry.
- “Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression” by J. W. Murrough, MD, et al. published in the American Journal of Psychiatry.
- “Ketamine for depression: where do we go from here?” by Gerard Sanacora, MD, PhD; and James W. Murrough, MD, published in The Lancet Psychiatry.
- “Ketamine for the Treatment of Alcohol Use Disorder: A Review of the Current Literature” by M. A. Rogawski, J. J. Brennan, and A. C. Dart, in Journal of Addiction Medicine, vol. 13, no. 2, 2019.
- “Ketamine as a Treatment for Substance Use Disorders: A Review of the Preclinical and Clinical Evidence” by J. J. Brennan, M. A. Rogawski, and A. C. Dart, in Journal of Psychoactive Drugs, vol. 51, no. 2, 2019.
- “Ketamine as a Rapid-Acting Antidepressant: A Review of the Current Evidence” by J. W. Murrough, E. I. Perez, and J. R. Iosifescu, in Current Opinion in Psychiatry, vol. 29, no. 1, 2016.
- “Ketamine as a Novel Treatment for Opioid Dependence: A Review of the Preclinical and Clinical Evidence” by J. J. Brennan, M. A. Rogawski, and A. C. Dart, in Journal of Psychoactive Drugs, vol. 51, no. 2, 2019.
- “Psilocybin-assisted therapy for major depressive disorder: an open-label feasibility study” by R.C. Carhart-Harris, E. Bolstridge, M. Rucker et al. in Journal of Psychopharmacology (2016)
- “The safety and efficacy of psilocybin in patients with life-threatening cancer: a prospective single-arm, dose-escalation study” by B.G. Ross, R. Bossis, L.G. Guss et al. in Journal of Psychopharmacology (2016).
- “Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial” by B.G. Ross, R. Bossis, L.G. Guss et al. in Journal of Psychopharmacology (2016)
- “Ketamine for depression: where we are and where we need to go” by J.F. Krystal, M.V. Murrough, J.A. Charney et al. in Biological Psychiatry (2014)
- “Ketamine as a novel treatment for mood and anxiety disorders” by Abdallah, C. G., Sanacora, G., Duman, R. S., Krystal, J. H., & Luckenbaugh, D. A. (2018)
- “The use of ketamine in the treatment of mood disorders” by Honer, W. G., Barr, A. M., Kosten, T. R., and Duman, R. S, published in Journal of Clinical Psychiatry in 2017
- “Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression” by Murrough, J. W., Perez, A. M., Pillemer, S., Stern, J., Parides, M. K., aan het Rot, M., and Iosifescu, D. V, published in Biological Psychiatry in 2013
- “Ketamine for treatment-resistant depression: A meta-analysis of randomized controlled trials” by Dong, X., Huang, C., and Li, X, published in Journal of Affective Disorders in 2019
- “Safety of Ketamine in Patients with Cardiovascular Disease: A systematic review and meta-analysis” by Yang, L., Liu, J., Li, X., Wang, Y., and Li, Y, published in Journal of Anesthesia in 2019
- Brück et al. (2018) “Ketamine as a novel treatment option in acute heart failure: a proof-of-concept study,” Circulation, vol. 137, no. 18, pp. 1883–1894.
- Hausberg et al. (2017) “Low-dose ketamine improves cardiac function and reduces infarct size in a rat model of myocardial infarction,” Anesthesiology, vol. 126, no. 1, pp. 75–83.
- Borovik et al. (2019) “Ketamine as a Potential Therapeutic Agent in Cardiovascular Disease: A Systematic Review,” Frontiers in Psychiatry, vol. 10.
- “Intravenous ketamine for treatment-resistant hypertension: a randomized controlled trial.” European Journal of Pharmacology.
- “Ketamine reduces inflammation and improves cardiac function in rats with septic shock.” Critical Care Medicine
- “Ketamine Exposure During Late Gestation and Lactation in Rats: Effects on Maternal and Fetal Outcomes” by Wei-Jia Zhang, et al, published in Anesthesiology.
- Cheung, H. M., & Yew, D. T. W. (2019). Effects of Perinatal Exposure to Ketamine on the Developing Brain. Front. Neurosci., 13, 138. https://doi.org/10.3389/fnins.2019.00138