Who is Not A Good Candidate For Ketamine Therapy

Last Updated on September 5, 2024

Ketamine therapy has gained significant attention due to its potential benefits in various medical conditions. Ketamine therapy, also known as Ketamine-assisted therapy, is a treatment approach that involves using low doses of ketamine, which is a dissociative anesthetic medication. 

Ketamine therapy was synthesized in 1962 by Professor Calvin L. Stevens, who sought a safer alternative to phencyclidine (PCP). Initially tested on animals, ketamine’s favorable results led to its use on human prisoners in 1964, including its use as a battlefield anesthetic during the Vietnam War.

Its effectiveness has piqued the interest of both the medical community and patients alike, leading to a surge in research and clinical use. This treatment method has been used to address a variety of mental health conditions, including treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD). 

Mechanism of Action of Ketamine Therapy

Ketamine therapy works in these ways;

#1. Regulating Glutamate Transmission

Unlike most antidepressants that affect serotonin levels, ketamine targets the N-methyl-D-aspartate (NMDA) receptor, a critical component in how neurons communicate with each other through the neurotransmitter glutamate. This influence on the NMDA receptor modulates glutamate transmission, which plays a vital role in mood regulation and thought processes.

#2. Establishing New Neural Connections

Ketamine treatments lead to neurogenesis (new neuron growth) and neuroplasticity (brain rewiring) for approximately 72 hours. This effect is particularly intriguing because it suggests that ketamine can help the brain ‘rewire’ itself, potentially offering new perspectives and approaches to patients who have been stuck in detrimental patterns of thought.

#3. Anti-inflammatory Functionalities

The anti-inflammatory properties of ketamine also contribute to its therapeutic effects. Inflammation has been linked to a variety of mental health issues, and by reducing inflammation, ketamine may alleviate some of the symptoms associated with these conditions.

Does Ketamine Therapy Get You High?

The therapeutic use of ketamine is distinct from recreational use, where the term “high” is commonly associated with the pursuit of euphoria or altered states of consciousness.

How Fast Does Ketamine Work for Anxiety?

What sets ketamine apart from traditional anti-anxiety medications is its rapid onset of action. Ketamine works by quickly increasing the activity of glutamate, a neurotransmitter that plays a significant role in mood regulation and neuroplasticity, providing relief from anxiety symptoms. 

While selective serotonin reuptake inhibitors SSRIs may take 2 to 6 weeks to start reducing anxiety symptoms, ketamine therapy has been reported to alleviate anxiety in less than 2 hours. Some reports indicate relief from anxiety symptoms within an hour. This fast-acting nature of ketamine is beneficial for patients with treatment-resistant anxiety who do not respond to conventional medications. 

What Does Ketamine Therapy Feel Like?

Patients have reported a range of experiences during ketamine therapy. Common sensations include;

• Feeling relaxed or sleepy (a deep sense of calm or lightness)

• Clarity of Thought (enhanced clarity of thoughts or gaining new insights)

• Temporary Confusion (a feeling of disorientation, particularly as the ketamine is wearing off)

• Nausea  (some individuals feel dizzy during or after the session)

• Emotional Release (feelings of relief or catharsis)

• Reduced Physical Sensation (a decrease in the perception of pain or physical sensations)

• Euphoria (feelings of heightened well-being or happiness)

• Altered Perception of Time (time may seem to pass more slowly or quickly)

• Visual and Auditory Changes (some people experience changes in how they see or hear things, including vivid imagery or distorted sounds)

How Much Does Ketamine Therapy Cost?

The cost of ketamine therapy can vary widely depending on several factors, including the type of treatment, the provider, geographic location, and the specific condition being treated. Generally, prices for ketamine therapy sessions can range from a few hundred to several thousand dollars.

• For mental health conditions such as depression, PTSD, and anxiety, ketamine treatments typically cost between $400 and $2000 per session. 

• When it comes to chronic pain, ketamine treatments can cost anywhere from $700 to $2000 per treatment. The higher price is due to longer infusion times and larger doses of ketamine required.

• Some ketamine clinics offer at-home treatments, which can start as low as $89 for basic ketamine treatments or run up to $750 per session. These treatments combine sublingual ketamine with telehealth services, providing more affordable options for patients.

It’s also worth mentioning that Esketamine, a nasal spray derived from ketamine and marketed as Spravato, is FDA-approved for major depressive disorder with suicidality and is covered by most insurance plans, including Medicare and Medicaid. It could be a more accessible option for those with insurance coverage.

How Does Ketamine-assisted Psychotherapy Work?

Ketamine-assisted psychotherapy (KAP) combines the use of the medication ketamine with psychotherapy to create a unique treatment modality for mental health issues. The process of KAP involves administering a controlled dose of ketamine to the patient, which induces a trance-like state. This altered state of consciousness catalyzes the psychotherapeutic process.

During the ketamine-induced experience, trained therapists guide patients through the exploration of their thoughts and emotions. It can facilitate a deeper engagement with the therapeutic process and allow individuals to confront and process painful memories and emotions more easily.

Here’s a step-by-step overview of how it typically works:

• Initial Assessment: Patients undergo a thorough evaluation to determine their suitability for KAP, including medical history, mental health status, and treatment plans.

• Pre-therapy Sessions: Patients usually have one or more preparatory sessions with their therapist to build rapport, set intentions for the therapy, and discuss what to expect during KAP sessions.

• Ketamine Administration: The dosage of ketamine is carefully determined based on individual needs and medical guidelines. The therapist remains present or on-call to provide support, guidance, and reassurance, which can facilitate deep psychological exploration.

• Post-therapy Session: After the ketamine session, patients have one or more integration sessions with their therapist to process the experiences gained during the session.

• Follow-up: The patient’s progress is regularly evaluated, and adjustments to the treatment plan are made as needed.

Who is Not A Good Candidate for Ketamine Therapy?

Ketamine therapy has emerged as a promising treatment for conditions, particularly those related to mental health. However, it’s crucial to understand that ketamine therapy is not suitable for everyone. 

There are specific contraindications that healthcare providers consider before recommending this treatment to ensure patient safety and treatment efficacy.

1- Patients with Hypertension

One of the primary contraindications for ketamine therapy is the presence of uncontrolled cardiovascular diseases, such as hypertension. Patients with a history of cardiovascular issues, uncontrolled high blood pressure, heart conditions, or certain respiratory issues need careful assessment due to ketamine’s potential to increase blood pressure and heart rate during administration. 

2- People with certain Mental Health Conditions

Another significant contraindication is a history of psychosis, multiple personality disorder, or bipolar I disorder. Ketamine can induce dissociative effects, which might exacerbate symptoms in individuals with these conditions. 

3- Individuals with Substance Abuse Concerns

Since ketamine itself can be abused and has an addictive impact, those with a history of substance abuse might be at higher risk. Such patients may not be ideal candidates due to the risk of misuse and the potential for ketamine to be habit-forming in recreational settings. 

4- Patients with certain Neurological Conditions

Patients with neurological specifications, such as brain tumors, aneurysms, or seizure disorders, are also not suitable candidates for ketamine therapy. The drug’s impact on the central nervous system could pose risks for individuals with these underlying issues.

5- Patients with Hypersensitivity 

Allergies or hypersensitivity to ketamine itself are clear contraindications. Patients need to disclose any known drug allergies to their healthcare provider to avoid adverse reactions.

6- Patients with Hepatic Disorders

Since the liver metabolizes ketamine, individuals with significant liver impairment may not be good candidates. Liver function is a fundamental consideration; those with hepatic insufficiency may not be able to metabolize ketamine effectively, leading to an increased risk of toxicity. 

7- Pregnant or Breastfeeding Women

Additionally, ketamine is contraindicated during pregnancy and breastfeeding due to the lack of sufficient research on its safety in these populations. Since the safety of ketamine during pregnancy or breastfeeding has not been established, so it’s recommended to avoid it.

How Long Does Ketamine Therapy Last?

Ketamine therapy has varying durations of effect depending on the method of administration and individual patient factors. 

Intravenous (IV) Route

Intravenous (IV) ketamine, used off-label for depression, can provide rapid relief that may last from days to weeks. Typically, a series of sessions are scheduled, starting with two doses a week for 2 to 3 weeks, then once weekly, and eventually tapering to once monthly. 

Nasal Spray

Esketamine offers a rapid onset of relief, with standard dosing involving twice-a-week administration for about four weeks, followed by once a week for another four weeks, and then a gradual reduction over time. 

Also Read: What is Field Control Therapy? Everything You Need to Know

FAQs

Conclusion

While ketamine therapy offers new hope for many, it’s essential to approach it with caution and awareness of its contraindications. It’s vital for anyone considering ketamine therapy to consult with medical professionals and thoroughly understand the potential benefits and risks. By doing so, healthcare providers can ensure the safety and well-being of their patients, and individuals can make informed decisions about their treatment options.