Patient Decision Guide
Who Is a Candidate for
Ketamine Therapy?
A clear clinical guide to understanding whether ketamine-assisted psychotherapy may be worth exploring for your situation — and what the evaluation process involves.
Ketamine therapy is not appropriate for everyone — and it is not presented as such. It is a specialized treatment used in specific clinical situations, typically when standard approaches have not produced adequate results or when there is a clinical reason to prioritize rapid response.
The following clinical indicators reflect patterns seen in patients who are often considered for ketamine-assisted psychotherapy. This is not a self-diagnostic checklist — suitability is determined through a formal psychiatric evaluation. What it can do is give you a clearer sense of whether a consultation is worth pursuing.
Situations Where Ketamine Therapy Is Often Considered
Treatment-Resistant Depression
The most common clinical indication. This generally refers to depression that has not responded adequately to at least two antidepressant medications tried at appropriate doses and durations. Ketamine works through a different biological mechanism than SSRIs and SNRIs — acting on the glutamate system rather than monoamine pathways — which is why it may be effective when standard medications have not been.
Persistent Depressive Disorder (Dysthymia)
Patients who have experienced chronic low-grade depression over many years — often since adolescence or early adulthood — and for whom standard treatment has provided incomplete or no relief. The neuroplasticity-promoting effects of ketamine are particularly relevant here, as chronic depression is associated with measurable changes in synaptic architecture.
Major Depression with Significant Functional Impairment
When depression is causing serious impairment in daily functioning — work, relationships, basic self-care — and existing treatments are not working quickly enough, ketamine's rapid onset (often within hours to days) may be clinically meaningful. This is distinct from the 4–8 week onset of standard antidepressants.
PTSD and Trauma-Related Conditions
Emerging research and clinical experience suggest ketamine may be beneficial for PTSD, particularly when paired with psychotherapy. The drug appears to facilitate a window of increased neuroplasticity that may support trauma processing in subsequent integration sessions. Ketamine-assisted psychotherapy is specifically designed to take advantage of this effect.
Difficulty Tolerating Standard Antidepressants
Some patients are unable to tolerate the side effects of conventional antidepressants — including sexual dysfunction, weight changes, emotional blunting, or gastrointestinal effects — and have discontinued medications before they could work. Ketamine is used as a short-course treatment and does not carry the same long-term side effect profile.
Depression with Prominent Suicidal Ideation
Clinical studies have shown ketamine produces rapid reduction in suicidal ideation — often within 24 hours. For patients experiencing significant passive suicidal ideation who are otherwise appropriate candidates, this property may be clinically important. Active suicidal crisis with a specific plan is managed through different channels.
Interest in a Therapy-Integrated Model
Patients who are already engaged in psychotherapy and are interested in a treatment that combines pharmacology with a psychotherapeutic framework. KAP is specifically designed as a collaborative process — not a medication alone. Patients who are psychologically minded and open to exploration of their inner experience tend to engage with it well.
Situations Requiring Careful Evaluation
The following do not automatically disqualify someone from treatment, but they require thorough clinical assessment and in some cases coordination with other providers or specialists before proceeding:
Bipolar disorder
Requires careful evaluation of phase, history of mania, and current mood state. Not a universal contraindication, but requires significant clinical judgment.
Complex trauma with severe dissociation
The dissociative effect of ketamine can be challenging for patients who already struggle with dissociation. Preparation and careful dosing are particularly important.
History of substance use
A thorough substance use history is essential. Remote history of substance use does not automatically preclude treatment. Current active use disorders are typically a contraindication.
Significant personality pathology
The ketamine experience can be psychologically intense. Stability of the therapeutic relationship and psychological preparedness are important factors.
Cardiovascular or medical conditions
Ketamine raises blood pressure transiently. Patients with uncontrolled hypertension, coronary artery disease, or other cardiovascular conditions require medical clearance prior to treatment.
Active psychosis or recent psychotic episode
Psychosis is generally considered a contraindication to ketamine treatment. A careful history is taken to assess for any past psychotic symptoms.
Pregnancy or breastfeeding
Ketamine is not appropriate during pregnancy. Patients who are planning a pregnancy should discuss timing with their physician.
What the Initial Evaluation Involves
Before any treatment begins, an initial psychiatric consultation is required. This is not a formality — it is the clinical foundation on which appropriate treatment decisions are made. The evaluation includes:
Full psychiatric history
Previous diagnoses, treatments tried and their outcomes, hospitalizations, family psychiatric history.
Medical history review
Current and past medical conditions, medications, allergies, cardiovascular health, any conditions that may affect safety.
Substance use history
Current and historical substance use, including alcohol, cannabis, prescription medications, and any history of misuse.
Current symptom assessment
Standardized rating scales for depression, anxiety, PTSD, and other relevant domains. Severity and functional impact.
Treatment goals discussion
What the patient is hoping to achieve, realistic expectations, integration with existing or future psychotherapy.
Informed consent
A thorough review of what the treatment involves, realistic outcomes, risks, and what to expect — before any commitment to proceed.
Common Questions
The Next Step Is a Conversation
If you read this page and recognized your own situation in it, the appropriate next step is a free 15-minute screening call. This is not a commitment to treatment — it is an opportunity to ask questions.
The initial evaluation is where clinical decisions are made. The screening call is simply where the conversation begins.
No obligation · 15 minutes · English and Hebrew available