Ketamine clinics have expanded quickly, and the standard of screening between them varies considerably.
Some assess carefully. Others take a card number and book you in.
Whether you are a ketamine therapy candidate depends on your diagnosis, your medical history, your other medications, and factors that in particular rule treatment out. This guide covers all four, plus what a responsible screening looks like so you can tell the difference.
Who Is a Ketamine Therapy Candidate?
Ketamine therapy is usually considered for adults with depression, anxiety, PTSD, or certain chronic pain conditions that have not responded adequately to standard treatment. Candidacy depends on diagnosis, medical history, current medications, blood pressure, and any history of psychosis or substance use. It is not a first-line treatment, and it is not suitable for everyone. Screening happens at a clinical assessment rather than through an online form.
The phrase that matters is “not responded adequately to standard treatment”.
Ketamine sits after standard approaches have been tried properly, not instead of them. Someone who has never tried an antidepressant is usually not the right candidate yet.
Conditions Ketamine Is Used For
At this practice, ketamine is offered for depression, anxiety, PTSD, chronic pain including fibromyalgia and migraine, and substance use and addiction.
Two points about that list.
Only Spravato is FDA approved, and only for treatment-resistant depression. Ketamine given intramuscularly or intravenously for any of these conditions is off-label prescribing, which is legal and common but worth understanding clearly.
The evidence base differs by condition. Depression has the largest body of research behind it. PTSD and chronic pain have meaningful but smaller evidence bases. Anxiety and substance use have less again.
A provider should tell you where your condition sits on that spectrum rather than presenting all uses as equally supported.
Suitability depends on severity and on what has already been tried. Mild symptoms that have never been treated are not usually a starting point for ketamine.
What Rules People Out
Some factors make ketamine inappropriate or require careful management first.
Uncontrolled high blood pressure. Ketamine raises blood pressure during treatment, so this needs addressing beforehand.
A history of psychosis, including schizophrenia or psychotic features, since ketamine can worsen psychotic symptoms.
Active substance use disorder involving ketamine, or an unstable substance use situation.
Pregnancy or breastfeeding.
Certain cardiovascular conditions, including recent heart attack or unstable angina.
Increased intracranial pressure or specific neurological conditions.
Severe liver disease, since ketamine is metabolized by the liver.
Bipolar disorder is not an automatic exclusion, and it does require careful assessment and monitoring, since any treatment affecting mood carries a risk of destabilization.
Age matters too. Ketamine therapy is usually provided to adults, and use in adolescents is a specialist consideration outside routine practice.
Medications and Conditions to Disclose
Bring a complete list. These in particular affect the decision.
Disclose
Why it matters
Blood pressure medication
Ketamine raises blood pressure during treatment
Benzodiazepines
May reduce ketamine’s antidepressant effect
Other psychiatric medication
Interactions and combined effects
Any history of psychosis
A significant contraindication
Substance use history, including alcohol
Affects suitability and monitoring
Liver or kidney conditions
Affects metabolism and clearance
Pregnancy, or possibility of pregnancy
Rules treatment out
Thyroid conditions
Can affect blood pressure and symptoms
Benzodiazepines are the item most people do not think to mention. Some research suggests they may blunt ketamine’s antidepressant effect, and your prescriber may want to discuss timing.
Do not stop any medication before an appointment on your own. Bring the list and let the prescriber decide.
What a Proper Screening Involves
A responsible assessment covers five areas before treatment is offered.
Psychiatric history. Diagnosis, previous treatments, what worked, what did not, and how long each was tried.
Medical history. Cardiovascular status, liver and kidney function, neurological conditions, and blood pressure measured at the visit.
Medication review. Everything you take, including over the counter and supplements.
Substance use. Asked directly and without judgment, since it affects both suitability and safety.
Risk assessment. Including suicidal thoughts, which changes urgency and monitoring rather than disqualifying you.
You should leave the screening knowing whether you are suitable, what the proposed course involves, what it costs in total, and what the plan is if it does not work.
The National Institute of Mental Health publishes background on ketamine and esketamine that is worth reading before any consultation.
Warning Signs of a Clinic to Avoid
Six things should give you pause.
Booking treatment before any clinical assessment
No physician involvement in screening or supervision
No questions about your medications or medical history
Large pre-paid packages required before assessment
Claims of guaranteed results or specific success rates
No plan for what happens if treatment does not help
The last one is the most telling. Ketamine does not work for everyone, and a clinic with no answer for non-response has not thought past the sale.
Good practice looks like the opposite. Assessment first, blood pressure checked, medications reviewed, honest discussion of the evidence, and ongoing psychiatric care rather than treatment in isolation.
FAQs About Being a Ketamine Therapy Candidate
Do I have to fail other treatments first? Usually yes. Ketamine is usually considered after standard treatments have been tried at adequate doses for adequate durations without sufficient response. It is not a first-line treatment. Your prescriber assesses whether previous trials were genuinely adequate, since many were stopped early or never fully dosed.
Does high blood pressure disqualify me? Not automatically, though uncontrolled high blood pressure needs addressing first. Ketamine raises blood pressure during treatment, so it must be controlled and monitored. Bring your readings and your medication list to the assessment.
Can I have ketamine if I take antidepressants? Often yes. Many people continue their existing antidepressant during ketamine treatment. Benzodiazepines are the class most likely to need discussion, since some research suggests they may reduce ketamine’s effect. Never adjust medication yourself before an appointment.
Does a history of drug use rule me out? Not necessarily, and it must be disclosed. Ketamine is a controlled substance with recognized misuse potential, so a substance use history affects suitability, monitoring, and how treatment is structured. Active ketamine misuse is a contraindication. Honesty here protects you.
What if ketamine does not work for me? It does not work for everyone, and a good provider discusses this before you start. Other options for treatment-resistant depression include augmentation, switching medication class, combined psychotherapy, and neuromodulation such as TMS. Non-response is information, not the end of the pathway.
Get Screened Properly
An assessment tells you whether ketamine suits your history and what the realistic alternatives are if it does not. Both answers are worth the appointment.
Atlanta Ketamine Clinic provides ketamine therapy at 5755 North Point Parkway Suite 256, Alpharetta, GA 30022.
Book My Screening or call (770) 817-9200.
Reviewed by Angelo Sambunaris, M.D., with more than 20 years of clinical experience and over 30 years in clinical research.If you are having thoughts of suicide or self-harm, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day.This article is general information, not medical advice. Never stop or change medication without speaking to your prescriber.
