Ketamine can be a powerful tool for mental health clinicians because of its remarkable safety profile across medical and therapeutic modalities.
In fact, the World Health Organization (WHO) lists it as an essential medicine and advocates for its widespread availability globally. However, like any medication, patients should be well-informed about ketamine's contraindications and potential side effects, along with alternative treatments available, to determine if ketamine therapy is right for them.
Is Ketamine a Safe Drug?
Ketamine is considered safe when used in a clinical setting under the supervision of medical professionals. We strongly advise against recreational use of ketamine since the strength and quality are uncertain and widely variable (it can be cut with a handful of substances). Further, long-term damage to the body is sometimes seen among recreational users who consume at higher doses or higher frequencies than would be advised in a clinical setting.
Why Ketamine is Considered Safe
Ketamine was first approved by the Food and Drug Administration (FDA) for use as an anesthetic in the 1970’s. It has been widely used by anesthesiologists during surgeries with young children to aging seniors since. It is used in many socio-economic environments, and continues to be used because it is generally safe, well-tolerated, and effective in what it does.
A factor indicating the safety profile of ketamine as a medicine is that it is used in a variety of medical settings to treat a broad (and growing) number of symptoms and conditions.
Some of these applications include:
- Anesthesia for surgery
- Analgesia for a wide variety of painful conditions, traumas, or procedures
- Combating major depression and anxiety symptoms
Ketamine’s use in a variety of medical and therapeutic indications, with relatively positive safety outcomes, supports its safety profile in many age groups
An important note: Anesthetic dose ranges —those used in surgical procedures— are much higher than those that are used for treating mental health conditions, such as treating depression, anxiety, OCD, and other conditions. When thinking about the safety profile of ketamine at an anesthetic dose, which can be 4-8x and higher a dose used in mental health, it helps us understand how safe ketamine can be in a treatment model like Mindbloom’s.
Is Ketamine Safe for Depression and Anxiety?
With the emergence of science that has validated other therapeutic indications for ketamine treatments (depression, anxiety, OCD, PTSD) more and more clinicians have begun to follow the science and treat conditions with ketamine, off-label.
This, along with a paradigm shift in emerging mental health treatments, has helped drive ketamine from the hospital into outpatient clinics. Outpatient clinic models vary greatly and you can receive treatment from anesthesiologists, licensed clinicians, and in some settings a psychotherapist paired up with a prescriber.
Results of emerging science continue to be promising. We continue to learn about how ketamine works in the body to treat mental health conditions, and its safety profile in this context. This learning has lead to continued evolution of treatment models that aim to increase access to care (such as in-home treatments) and enhance its therapeutic potential (such as coupling up with therapy).
A true testament to the safety of ketamine is that with professional guidance, it can be taken by clients in their homes. This ensures it’s dosed properly and with proper education around developing a safe environment and mindset. Throughout these sessions, there are few, if any, adverse events that arise —demonstrating the tolerability of ketamine as a therapeutic medicine as well.
Ketamine’s Risk Profile & Contraindications
No medicine available is without risks and contraindications —symptoms or conditions that an individual may be experiencing that indicate treatment may not be suitable. This is why ketamine is a regulated medicine, used in structured procedures and administered by medical professionals.
Ketamine does not require the use of supplementary tools or procedures such as external oxygen sources, electricity supplies, or large clinical teams — further simplifies the procedures, and this reduction in complexity serves to reduce the potential for adverse effects or events.
Some of the contraindications include:
- Uncontrolled high/low blood pressure, heart problems, glaucoma or intracranial pressure.
- Active and unstable substance use disorder
- Psychotic disorders
- Active mania
There is also potential for adverse events through the dissociative effects of ketamine, such as grogginess, drowsiness, or disorientation leading to an accident or confusion during/after use.
This is why using ketamine as prescribed, in a medical or therapeutic context with trained practitioners, is important. If done in this manner, as has been proven over the past decades, ketamine is a safe and effective medical and psychedelic therapy treatment.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety