When Ketamine Is Not Appropriate: Medical and Psychiatric Contraindications

Ketamine can be powerful for depression, PTSD, anxiety, and chronic pain—but it's not appropriate for everyone.

Key Contraindications

1. Psychosis or Schizophrenia History – Can cause worsening symptoms
2. Bipolar Without Mood Stabilizer – May trigger mania
3. Acute Suicidality – Hospital-based care may be safer first
4. Uncontrolled Hypertension – Ketamine raises blood pressure
5. Moderate/Severe Liver Dysfunction – Metabolism issues
6. Active Substance Use Disorder – May reinforce addictive patterns
7. Seeking Only "The Experience" – Requires medical indication
8. Pregnancy or Breastfeeding – Avoided unless urgent
9. No Peer Supervisor – Must not be alone during treatment
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10. Medication Conflicts – Some require evaluation
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11. No Psychological Support – Need support to process experiences
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12. Ketamine Allergy – Absolute contraindication

Conclusion

Safe care means recognizing when ketamine helps and when stabilization should come first.