When ketamine is not a treatment of choice for depression?

Ketamine is a wonderful, relatively safe and rapid acting psychedelic category 3 controlled drug

that have shown tremendous potential in improving treatment resistant mental health illnesses such as major depression, bipolar disorder type 2 with depression,  generalized anxiety, OCD, PTSD, chronic refractory pain and alcohol use disorder. However as with any other medication, ketamine is not for everyone. Patients can consider not to use ketamine because of the following reasons.

1. No randomized double-blinded placebo-controlled studies have been conducted so far to receive

FDA approval for iv ketamine use in mental health illnesses or chronic refractory pain.

2. Although short-term ketamine use is known to be safe, but safety of its long-term use (use over 5

years or 10 years or 20 years) has not been well established. In our practice, many patient have been receiving ketamine treatments for last 6 years without any complications.

3. Ketamine has high efficacy rate close to 70-80% but still it is not 100% effective in all patients. There is a

possibility that you might not respond to it. Gene testing might help in such patients.

4. Ketamine is not a cure for mental health illnesses and most patients require once or

twice a month booster ketamine infusions.

5. Ketamine use in mental health illnesses is off label and not FDA approved.

6. Outpatient ketamine therapy is expensive. Most insurances don’t cover ketamine

infusions although recently more and more of our patients have started receiving partial

reimbursement from their insurances with our super-bill.

7. In the past, daily high dose ketamine use as a street drug has reported to cause liver,

bladder and kidney problems in some people. Supervised use of intravenous ketamine

infusions has not shown to cause any of these side effects.

8. Possible addictive potential with unsupervised use but not when administered in small, recommended

doses and under physician supervision.

9. Ketamine is sympathomimetic. It means it can raise your heart rate and blood pressure.

If you have any history of uncontrolled hypertension or arrhythmias, ketamine can be

avoided or must be given with continuous vital signs monitoring using automated machines.

10. Ketamine can cause acute psychosis and mania in some patients especially if they have

underlying undiagnosed bipolar disorder type 1.

11. Most patients feel enlightening out of body daydreaming experience, but some can

have frightening experience. So, if this is a risk that you don’t want to take, you should

reconsider receiving ketamine treatment.

As with any other medication, ketamine does have its limitations and benefits.

Patients must do their diligent research and discussion with the ketamine specialist to see if

ketamine is a right choice for them. If You have any questions for yourself or loved ones,

feel free to contact us at (516) 280-3842 or email us at contact@ketamine-wellness.com.