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Who is not a good candidate for ketamine therapy? What you should know




You’ve likely heard of the drug Ketamine.

First synthesized in 1962, It’s used in hospitals for surgeries and procedures of all kinds.

In the 80s and 90’s, it became a popular party drug, but today it is being used as a treatment for severe depression, anxiety, PTSD, chronic pain, and more.

Although the drug has not been widely approved by the US Food and Drug Administration for the treatment of mood disorders, physicians may prescribe it “off-label” at their discretion.

Esketamine, a ketamine derivative, was approved in nasal spray form for the treatment of major depression and suicidal ideation in 2019.

Yale University psychiatrists and researchers have called it a “miracle” drug and a “game changer,” noting that in one study, 70% of patients who were given the nasal spray but were otherwise resistant to treatment improved.

Who is not a good candidate for ketamine therapy?

According to the National Institutes of Health, Ketamine is not recommended for patients who have underlying conditions that would increase the risk of complications, such as aortic dissection, uncontrolled hypertension, myocardial infarction, or aneurysms.


  • It is not recommended for people who have previously demonstrated hypersensitivity to the drug.
  • It is not advised to use this medication during obstetrics, pregnancy, or breastfeeding because it is unknown whether it passes into breast milk.
  • Due to additive sedation, patients who are intoxicated with ethanol must be treated with caution.
  • It is not recommended for patients with schizophrenia due to the risk of exacerbating the underlying condition.

Also, Ketamine is controversial in patients with cerebrospinal fluid (CSF) elevations due to questionable intracranial pressure elevations caused by ketamine.

According to some studies, the risk of CSF elevation with ketamine is exaggerated. Kropf et al. discovered comparable hemodynamic properties to etomidate. According to newer research, ketamine may improve cerebral perfusion pressure and may even have neuroprotective properties.

Ketamine side Effects

According to The National Center for Biotechnology Information advances science and Health, “The most common side effects associated with ketamine are nausea, vomiting, dizziness, diplopia, drowsiness, dysphoria, and confusion. There are reports of the emergence phenomenon for approximately 6% to 12% of patients. Rarely patients experience hallucinations.”

A list of side effects follows:

  • Allergic: anaphylaxis, breathing difficulties, facial, lip, throat, and tongue swelling, hives
  • Cardiovascular: arrhythmias, blood pressure frequently elevated, bradycardia, hypotension, left ventricular dysfunction in patients with heart failure, respiratory and cardiac arrest
  • Gastrointestinal: anorexia, nausea, and vomiting
  • Muscular: muscle stiffness and spasms/tonic-clonic movements resembling seizures, enhanced skeletal muscle tone
  • Neurologic: confusion, seizures
  • Ophthalmologic: diplopia, increased intraocular pressure, nystagmus
  • Psychiatric: amnesia, anxiety, confusion, depression, disorientation, dysphoria, dissociative state (patients may not be able to speak or respond purposefully to verbal commands), emergence phenomena/delirium (6% to 12% in different studies and can last for up to 3 hours) including hallucinations, flashbacks, unusual thoughts, extreme fear, excitement, and irrational behavior, insomnia, physical and psychological dependence, addiction when used recreationally. (Drug dependence and tolerance may develop after prolonged use. Withdrawal symptoms may occur if stopping ketamine suddenly.)
  • Respiratory: apnea, increased laryngeal, and tracheal secretions, laryngospasm, airway obstruction in infants (may not be drug-related), respiratory depression 
  • Skin: (infrequently) at the site of injection, local pain, erythema, morbilliform rash

DISCLAIMER: We provide information for educational purposes only. This information is not specific medical advice and does not replace information you receive from your healthcare provider. You must talk with your healthcare provider for complete information about your health and treatment options.

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