Who Is Not a Good Candidate for Ketamine Therapy: A Personal Story

Who is not a good candidate for ketamine therapy ? I still remember the day I first heard about ketamine therapy. I was in my therapist’s office, well into my third month of traditional treatments for anxiety and treatment-resistant depression. The meds weren’t doing much—and, truth be told, I was starting to lose hope.

That’s when Dr. Stevens leaned in and said: “Have you considered ketamine infusion therapy?” Half my mind shouted, That’s what club kids used, right? What if it messes me up? But I also remember thinking, Could this be the breakthrough I’ve been chasing?

Fast-forward six months. I’ve undergone eight infusions, and while many sessions brought relief, they also brought realizations—specifically, about who thrives under ketamine and who doesn’t. And in my own journey, I discovered that not everyone—myself included—was a perfect fit.

2. Setting the Scene: What Is Ketamine Therapy?

Before we dive deeper, let me lay the groundwork:

• What it is: In a medical setting, ketamine is administered via infusion or nasal spray, in doses far lower than what you might hear about in recreational use.
• What it treats: FDA approves it (via esketamine) for treatment-resistant depression. Off‑label, clinics also use it for PTSD, anxiety, OCD, chronic pain, and substance use.
• How it feels: Many describe a sense of detachment, altered perception, or even euphoria. It often ‘shakes loose’ rigid thought patterns, offering a new psychological perspective.

That said, it’s not a miracle cure. The effects can be temporary, and it’s not without its costs or risks.

3. Chapter One: Why I Almost Said No

A. Mental Health Conditions That Require Caution

When I first walked into the clinic, I listed all my diagnoses: generalized anxiety disorder, major depressive disorder, and a history of bipolar II spectrum. The intake team paused at bipolar—particularly mania or hypomania. Broken manic episodes in my past made this a real red flag.

⚠️ Danger sign: Ketamine can, in rare cases, trigger manic or psychotic episodes. If you or someone in your family has bipolar I—or any history of psychosis—it’s a major caution.

B. Cardiac Conditions: Not Just About the Mind

I learned my blood pressure spiked mid-infusion—a side effect for some. That sent me to cardiology. If you have uncontrolled hypertension, heart disease, or aneurysms, that’s a red flag, too. The heart races, blood pressure rises, and that’s a no-go in clinical settings without strict precautions.

C. Substance Use Disorders or Addiction

Ironically, while ketamine can help overcome addiction, it can also be habit-forming. My therapist and I reviewed my past. I used alcohol to self-medicate—and nervous laughter meant a nightly glass of wine. My therapist said: “If you have active substance issues, we tread carefully. Ketamine isn’t an escape; we’re trying to heal.”

4. Chapter Two: My First Infusion and the Tough Truth

A. The Day That Changed Everything

On infusion day, I was nervous. The clinic room was softly lit and quiet. I sat in a comfy recliner as the nurse inserted an IV. They hooked me up to monitors, and the steady drip began.

Within minutes, I felt warm and out of focus—distant from my body. My chest felt tight, but not with panic—more like I was floating inside a muted bubble. The nurse checked my vitals frequently. My blood pressure? Elevated. My pulse? Racing.

After about 20 minutes, I snapped back. The infusion was over. I left the clinic feeling oddly calm, but later that night, my thoughts spiraled. Guilt over my past alcohol habits. I sobbed—not out of depression, but out of feeling exposed. Not everyone has that reaction, but I did.

B. The Aftermath: My Brain on Replay

In the following days, I felt tender, raw. Therapy sessions felt deeper—I wasn’t deflecting. But something crept in: anxiety about my mental stability. “What if it destabilizes me?” I worried. I shared that with my psychiatrist. He reminded me: Ketamine isn’t a therapy, it’s a catalyst—but with catalysts come change, and change can be messy.

5. Who Might Not Be a Good Candidate

From my own journey—and what I’ve learned—those who might reconsider ketamine therapy include:

1. People with uncontrolled hypertension or serious heart conditions
   • Blood pressure typically spikes during infusion. If your heart is already on edge, this becomes a medical risk.
2. Those with active psychosis, schizophrenia, or bipolar I
   • The dissociative effect could deepen psychotic symptoms or trigger mania.
   • In my case, bipolar II was borderline, but even that required careful monitoring.
3. Those in the middle of substance use or addiction struggles
   • My therapist’s warning was clear: avoid infusions if you’re using ketamine recreationally, alcohol is out of control, or there’s ongoing misuse of any mood-altering substance.
4. Anyone unprepared for the emotional aftershocks
   • My post-infusion days were emotionally volatile. If you’re not in therapy or lack emotional support, that could be destabilizing.
5. People expecting a quick fix
   • After my first infusion I felt hopeful. After infusion four, hope faded without consistent improvement. If you expect instant, lasting relief—be prepared for potential disappointment.
6. Individuals with poor support systems or no therapy
   • Ketamine is most effective alongside therapy. Without structured support, psychedelic insights can turn into unprocessed confusion.

6. Pulling Back the Curtain: The Ripple Effects

A. Physical Side Effects

• Blood pressure increase
• Nausea, dizziness, or headaches post-infusion
  • I remember the worst headache I’d had in years right after a session.

B. Emotional and Psychological Turbulence

Every infusion was like stirring a dark pond. Eventually, sediments of guilt, shame, or trauma floated to the surface. This vulnerability can be therapeutic—but only if you’re ready.

When I wasn’t—when I tried infusions during a rough patch without trauma therapy—we hit a wall. I felt unanchored, like a ship without a rudder. That’s when my doctor said: “Let’s pause.”

7. Personal Reflection: The Infusion That Made Me Hit “Pause”

Infusion six was tough. I cried halfway through—more than usual—and walked out feeling defeated. That night, I lay awake, questioning everything: Am I making this worse? Maybe I’m not cut out for this.

In therapy, I said: “I’m freaked out that this is harming me more than helping.” And that vulnerability was real. Not everyone voices that—but it matters.

I took a two-week break. Used therapy to re-center. My blood pressure returned to normal. My spirit steadied. We resumed—but on a new plan: lower dosage, shorter infusion time.

That reset taught me: if ketamine therapy destabilizes your life, it might not be the right time—or right path—for you.

8. Alternatives Worth Exploring

If any of the risk factors apply to you, don’t worry—there are other evidence-backed treatments.

1. Traditional antidepressants and mood stabilizers
   • SSRIs, SNRIs, lithium, lamotrigine—especially for bipolar patients.
2. Psychotherapy: CBT, DBT, acceptance & commitment therapy
   • Integrative talk therapy can often build solid habits and coping tools.
3. Transcranial Magnetic Stimulation (TMS)
   • Non-invasive brain stimulation with fewer systemic risks.
4. Lifestyle interventions
   • Mindfulness, exercise, sleep hygiene, nutritional support—all can shift root patterns.
5. Support groups and peer-led recovery work
   • Sometimes community bonds bring the most healing.

9. Guided Questions: Am I a Good Candidate?

Ask yourself:

• ✔️ Do I have stable physical health—no uncontrolled blood pressure or heart issues?
• ✔️ Am I free from active psychosis, mania, or schizophrenia?
• ✔️ Am I not in the middle of addiction recovery or using substances that could interfere?
• ✔️ Do I have trauma or emotional wounds I’m ready to face in therapy?
• ✔️ Do I have a therapist or clinician ready to support me before, during, and after infusions?
• ✔️ Am I prepared for the possibility that progress isn’t linear?

If you hesitated on any of those—especially medical or mental health red flags—it’s worth pressing pause or trying other avenues.

10. My New Normal: What Worked for Me

• Combined infusions with weekly talk therapy, including somatic and trauma-informed work.
• Blood pressure tracking before and after infusion—stayed in steady shape with daily exercise.
• Lifestyle overhaul—I cleaned up my diet, limited alcohol, upped mindfulness.
• Fixed a support network—trusted friends, regular check-ins with practitioners.
• Kept a journal during treatment, tracking how each session felt physically and emotionally.

Six months later? My depression is manageable. Anxiety still visits, but it’s no longer the storm. I still rely on therapy, movement, community—and yes, ketamine—though with more restraint and awareness than I started with.

11. Final Takeaways: Who Is NOT a Good Candidate?

🔴 Ketamine therapy is powerful—but not a universal solution. You’re likely not a good candidate if:

• You have unstable heart conditions or uncontrolled hypertension
• There’s any active psychosis, schizophrenia, or bipolar I in your history
• You are in active substance misuse or addiction
• You lack a therapy framework or emotional support system
• You expect it to be a quick, permanent cure for deep-seated trauma

Even for people like me—who might fit many criteria—timing, medical cautions, therapy availability, and emotional readiness all matter. And it’s okay to pause or rethink.

12. Parting Words: My Story Isn’t Yours—but Our Paths Can Cross

I share this story not to discourage, but to illuminate. Ketamine therapy has helped me—but only when I approached it with caution, structure, and awareness of the risks. It’s powerful, yes—but not for everyone.

If you’re showing signs of being not a good candidate, that doesn’t mean ketamine is never for you. It might mean you need to do the groundwork:

• Build physical health stability
• Do trauma-informed therapy first
• Establish recovery from substance use
• Get strong medical clearance
• Cultivate a robust support system

Every step I took—every red flag I respected—helped me make a more informed decision. If you’re considering ketamine therapy, go in asking tough questions. Share your history openly. Treat it like the medical and emotional intervention it is.

And above all—your wellness journey deserves respect, patience, care, and self-compassion.

🔸 Want to talk more?

I’d love to hear from you. Have you considered ketamine therapy? What hurdles are you facing—medical, emotional, systemic? Let’s open the conversation.

This post explores who is not a good candidate for ketamine therapy, including bipolar/psychosis history, heart risks, substance use, lack of therapy support, and misaligned expectations.

You’ll find:

• An engaging 12-chapter personal narrative
• Real-world therapy insights and red flags
• Actionable alternatives if ketamine isn’t right now
• Reflective questions to assess your own readiness

If this resonates, share it with someone navigating mental health options. If you’d like more resources—medical guides, therapy directories, or clinician lists—just leave a comment or drop me a message.