Combining Ketamine Treatment With Other Psychiatric Medications: What to Know

Ketamine treatment may be a welcomed option for patients who’ve struggled with finding effective relief for various mental health conditions.

For those choosing ketamine treatment while also using other psychiatric medicines, a common question arises: Is it safe to combine ketamine treatment with anxiety or depression medications, amongst others?

There are a number of things to consider when it comes to concurrent use of ketamine therapy and other pharmaceutical medications. Dr. Leonard Vando, a New York-based board certified psychiatrist and the Medical Director at Mindbloom, helps break it down.

Ketamine and SSRIs

Selective serotonin reuptake inhibitors (SSRI) are a common class of drugs that are typically used as antidepressants to treat conditions like major depressive disorder and anxiety disorders. Some brands of SSRIs include: Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), Citalopram (Celexa), and Paroxetine (Paxil, Pexeva).

When it comes to combining SSRIs and ketamine treatment, the good news is that it’s considered to be safe.

“Ketamine works with the NMDA receptors, the glutamate receptor,” says Dr. Vando. “You can use it in addition to most SSRIs, and almost every antidepressant on the market. As a blanket statement, that’s the truth.”

Ketamine and SNRIs

Serotonin–norepinephrine reuptake inhibitors  (SNRIs) are a category of antidepressant drugs used to treat a host of conditions like: major depressive disorder, anxiety disorders, obsessive compulsive disorder, social phobia, attention-deficit hyperactivity disorder, chronic neuropathic pain, fibromyalgia syndrome, and menopausal symptoms.

Brands of SNRIs include: Venlafaxine (Effexor XR), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), and Levomilnacipran (Fetzima). For the most part, SNRIs are safe to take during ketamine treatment.

However, some SNRIs tend to increase blood pressure in some patients, though it’s usually minimal and self limiting. Blood pressure and heart rate increases for many during ketamine treatment. Dr. Vando notes that’s why blood pressure is monitored before and after each session.

“If the blood pressure is too high, treatment won’t be administered,” he says.

Ketamine and MAOIs

Monoamine oxidase inhibitors (MAOI) are a class of antidepressants first introduced in the 1950s, which are also used to treat panic disorder and social phobia.

MAOIs are less commonly used compared to other classes of antidepressants, as they have a host of side effects. Patients on MAOIs often have a team of professionals to help administer the treatment, as well as a special diet they must follow. MAOI are often prescribed as a last resort, as they are shown to be highly effective.

Some brands of MAOI include: isocarboxazid (Marplan), tranylcypromine (Parnate), rasagiline (Azilect), phenelzine (Nardil), and selegiline (Eldepryl, Zelapar).

Dr. Vando says he has not heard of any adverse effects from ketamine treatment and patients who are on MAOI. However, they should proceed carefully with the treatment.

“Anyone using ketamine therapy while on MAOIs has to do it with caution, and only if the benefits clearly outweigh the risk,” he says.

Ketamine and Wellbutrin or ADHD medications

Wellbutrin is the brand name for Bupropion, which is an antidepressant mostly used to treat major depressive disorder (MDD), seasonal affective disorder (SAD), and to support smoking cessation. It’s also used as an off-label treatment for Attention Deficit Hyperactivity Disorder (ADHD).

Medications used to treat ADHD directly include: Adderall (amphetamine), Ritalin (methylphenidate), Concerta (methylphenidate), Dexedrine (amphetamine), Evekeo (amphetamine), Focalin XR (dexmethylphenidate), Quillivant XR (methylphenidate), and Strattera (atomoxetine hydrochloride).

Dr. Vando says this category of medication should be closely monitored while ketamine therapy is being administered.

“Blood pressure may be mildly elevated upon initiation of treatment, and while monitoring it is not routinely done for patients receiving these medications, it is worth noting that ketamine also may mildly increase blood pressure,” he explains. “This does not necessarily mean an added burden, as blood pressure monitoring is routinely done when receiving ketamine. So it really confers no additional risk.”

Medications and Other Psychedelic Therapies

Many patients who resort to ketamine therapy do so because traditional psychiatric medication doesn’t seem to be enough.

While ketamine can be used in combination with almost every antidepressant on the market, that’s not the case for all forms of psychedelic therapy.

That’s because other psychedelics work on similar pathways as antidepressants medications - like serotonin. Dr. Vando explains that if a patient decides to try ayahuasca, psilocybin, or DMT, it shouldn’t be mixed with their medication and they should consider getting off with the help of a professional.

Doing so without professional guidance may not be a good idea, and in some cases may cause more harm and risk in the long run.

“While alternative therapeutic treatment is known to help with depression and anxiety, most people who deal with depression and anxiety are on some type of antidepressant, so that’s an obstacle.”

Other Important Considerations

Be honest about legal and illegal drug use

It’s crucial to be upfront with your care team about your history of prescribed medications, as well as any illegal drug use, as it helps the care team make an informed decision for your overall health and safety.

“It’s good to reveal what you’re on to the person you’re working with,” says Dr. Vando.

Consider timing if combining with other drugs

Some medications that are prescribed, like Xanax, can be sedating —a physical effect which isn’t optimal when taken along with ketamine. So, for example, if you take sedating medication at night, it’s best to schedule the ketamine treatment in the morning so the two medications don’t overlap.

Listen to your body and mind, report anything awry

If something doesn’t feel right, speak up. Listen to your body and don’t dismiss anything that feels off, no matter how minor it might be. This treatment is for you, and your comfort and wellbeing is of the utmost importance.

Trust your clinical provider to determine how to approach treatment with multiple medications

Your provider will know the best course to take when it comes to ketamine treatment. Be upfront and honest about all other medications you are using, including the dosage and time of day taken.