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Who is Not a Good Candidate for Ketamine Therapy?

Published On: January 29, 2025Last Updated: January 29, 2025

Is Ketamine Therapy Right for You?

Ketamine has been available medically since the 1960s. Long known as an anesthetic, it is now used in psychiatry as a tool for treatment-resistant depression, suicidal ideation and PTSD. Ketamine therapy can be a powerful resource for our Nevada Mental Health clients. We believe in its efficacy, especially when administered using an evidence-based approach to promote the safest and best results. However, it’s important to consider who is not a good candidate for ketamine therapy when deciding what treatment is best for you.

Angela Rupp, a board-certified Psychiatric Mental Health Nurse Practitioner at Nevada Mental Health, oversees our ketamine therapy program. She has significant experience with ketamine in both outpatient and inpatient settings, and has safely helped hundreds of patients. She recently shared a few insights to educate the public on the benefits and challenges with ketamine therapy in psychiatry.

a psychiatrist discussing who is not a good candidate for ketamine therapy with a patient

A Great Tool, but Not a Fix-All

Before we discuss who is not a good candidate for ketamine therapy, let’s see how it works. One of the greatest benefits ketamine brings is its ability to activate glutamate, an excitatory neuron, in the brain. This glutamate surge leads to increases in neuronal growth factors, such as brain-derived neurotrophic factor (BDNF), which can enhance neuroplasticity. A BDNF boost can help to reverse old neuroplasticity deficits, commonly found in major depression and trauma.

A small therapeutic dose of ketamine, far smaller than the amount needed for anesthesia, can temporarily wipe your mind clean of depressive symptoms so you can reconsider old perspectives that may have been limiting you or increasing your emotional pain. Follow-up counseling sessions, learning new behavior management strategies and medications are also keys to successful outcomes. There’s currently a lot of excitement around ketamine therapy, but Rupp cautions that it is a “tool in the toolbox” and not a singular fix for your mental health concerns. It’s important to consider who is not a good candidate for ketamine therapy, as it can end up not helping in the way we want it to.

“Ketamine works well for a short time, so you should work with a provider team to implement strategies to enhance and prolong its effects,” she says. “The therapy (counseling) integration piece is really what works on the brain’s neuroplasticity to prolong ketamine’s potential benefits.”

What Evidence-Based Strategies Look Like

Nevada Mental Health establishes a comprehensive individualized treatment plan for each patient. The plan is driven by evidence-based strategies that have been tested and known to work for others with treatment-resistant depression, suicidal ideation or PTSD symptoms. When ketamine therapy is done in conjunction with, for example, counseling (cognitive behavior therapy), mindfulness practices, reflection and journaling and medication, you maximizes the potential for long-term benefits, Rupp emphasizes.

Additionally, there are two other important factors for success: the trust you build with the therapist and the environment where your ketamine therapy session takes place.

“That therapist relationship and the therapeutic environment promote feelings of safety. These two pieces work together to enhance the effects of ketamine therapy,” Rupp adds.

To ensure your comfort and safety, evidence-based best practices suggest ketamine therapy rooms should be dark or dimly lit and quiet, with comfortable seating such as couches or recliners. Some patients like to wear a mask over their eyes to block out light. You can enjoy calming music and there’s a white noise machine outside the room to assure privacy. You’re also encouraged to bring a personal blanket, and use it during the session.