Who is and is not a Good Candidate for Ketamine Treatment?

It is important to consult with a qualified medical professional to determine if Ketamine treatment is appropriate for an individual’s treatment of depression, anxiety, or PTSD. At Heading we conduct an intervention treatment Q&A with a care coordinator as well as a 60 minute psychiatric consultation session to establish a personalized care plan and also to determine candidacy prior to a patient receiving treatment.

It’s important to note that candidacy works hand in hand with outcomes and patient goals. Both of these should be monitored continually through the process, and the process is not ‘one-and-done’. Prior to every in-center ketamine or Spravato® appointment several factors are monitored before treatment. Keeping optimal outcomes, and safety in mind patients have access to their care-team during treatment sessions, immediately after treatment sessions, and throughout the course of a treatment protocol. 

Ketamine is becoming more well known as an interventional treatment for depression and anxiety that have not responded well to other treatments. Ketamine offers rapid relief for many people, especially when other medications have not worked.

That said, the results for any depression treatment method are not the same across the board, because every patient’s individual needs are different. That’s why it is important that a mental health care-team always consider the best course of treatment for an individual.

As a patient considers ketamine treatment there are factors to keep in mind.

Ketamine may not be the right choice for someone if:

1. They have uncontrolled high blood pressure or heart disease. Ketamine can cause an increase in blood pressure and heart rate, which is why it is important for prescribers and care teams to be aware of a patient’s cardiovascular health history prior to receiving treatment.

2. A patient has a history of schizophrenia or schizoaffective disorders. Ketamine may have adverse side effects and worsen symptoms of these conditions.

3. A patient has a history of substance abuse or addiction. Ketamine has the potential for abuse and care teams are careful to ensure that treatment will not trigger relapse. 

4. They are pregnant or breastfeeding. There is limited research on the safety of ketamine use during pregnancy and breastfeeding, and it is not recommended.

5. They have certain medical conditions, such as liver or kidney disease.

6. They are unable to participate in the requirements for the protocol such as payments or co-pays, the time-investment is not suitable for that moment in life, or making arrangements for care such as getting a ride to a center if they are receiving treatment at a medical office or making time for the length of treatment is not feasible with their schedule. 

It’s also important to note that this is not an exhaustive list, and a thorough consultation under the direct care of a psychiatric medical professional is crucial.  Since the goal of ketamine therapy is to experience relief from long-standing and hard-to-treat mental health disorders, if the protocol isn’t working for a patient – that’s ok! There are always changes that can be made, and other treatments.  Personalized approaches including combination therapies, and a team of mental health care providers working together can make all the difference – as mental health care is not one-side-fits-all. 

The two most important goals of determining candidacy are:

1) patient safety, and 

2) the best possible outcome for feeling better and healing.

Methods of receiving ketamine vary, and patient preference, insurance coverage, and access plays a large part into whether or not they seek treatment in a center, or through another means.  However, in-center treatments, under a doctor and medical team’s supervision, have added benefits to meet high standards for safety and outcomes.

“Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. These are also the same medical professionals you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience,” shared Dr. Arif Noorbaksh M.D. a leading psychiatrist at Heading who practices out of Dallas, Texas and offers virtual psychiatric services and medication management to patients statewide.

In addition to having medical professionals immediately available to monitor physical metrics before a treatment such as blood pressure and weight, some patients receiving Ketamine also feel more comfortable receiving treatment knowing that they are in a safe medical center with nurses and doctor’s just a few steps away as the medication takes effect.  Ketamine can induce a dissociative state, sometimes this is referred to as a ‘trip’, and the patient may feel out of body, like they are flying, or experiencing a range of sensations outside of their normal state of being.  In-center treatment options provide a patient with immediate options for assistance, and a team of medical professionals determining when a patient is ready and able to leave treatment. At Heading a ride to and from an appointment is required as it is not advised to drive or operate machinery until a patient has had a good night sleep after treatment.