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.
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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