Who Is Not a Good Candidate for Ketamine Therapy?

Ketamine Therapy At Monima Wellness

Ketamine therapy has gained attention as a breakthrough treatment for individuals struggling with mental health conditions like treatment-resistant depression [1], PTSD, and anxiety disorders. With its ability to provide rapid symptom relief, ketamine offers hope to those who have not responded to traditional antidepressant medications or psychotherapy.

At Monima Wellness, the leading women’s mental health and trauma treatment center in San Diego, our clients have the opportunity to participate in ketamine therapy through our partial hospitalization (PHP) and intensive outpatient (IOP) programs. 

However, ketamine therapy is not suitable for everyone. While it has shown promise for many individuals, specific medical, psychological, and personal factors may make ketamine therapy a less ideal option for others. Monima Wellness takes a personalized, holistic approach to determine the best therapeutic modalities for each client based on their unique needs and circumstances.

Young woman wearing casual clothing, using a nasal spray, Spravato

Understanding Ketamine Therapy

Unlike standard antidepressants that primarily affect serotonin and dopamine levels, ketamine targets the glutamate system, which plays a crucial role in neuroplasticity and brain function. This mechanism helps stimulate the formation of new neural connections, allowing the brain to heal and rewire itself in ways that promote emotional resilience and symptom relief.

Unlike standard antidepressants that primarily affect serotonin and dopamine levels, ketamine targets the glutamate system, which plays a crucial role in neuroplasticity and brain function. This mechanism helps stimulate the formation of new neural connections, allowing the brain to heal and rewire itself in ways that promote emotional resilience and symptom relief.

There are two primary forms of ketamine therapy used in mental health treatment:

1. Intravenous (IV) Ketamine Infusions

  • How it works: Low-dose ketamine is administered intravenously in a controlled clinical setting, typically over a 40-minute session under medical supervision.
  • Who it’s for: IV ketamine is commonly used for treatment-resistant depression, PTSD, anxiety disorders, and chronic pain.
  • Benefits: Research suggests IV ketamine provides rapid symptom relief, with many patients experiencing improvements within 24-48 hours.
  • Considerations: IV infusions require multiple sessions (typically six initial treatments over 2-3 weeks, followed by maintenance treatments if needed).

2. Esketamine (Spravato®) Nasal Spray

  • How it works: Esketamine, an FDA-approved form of ketamine, is administered as a nasal spray in a doctor’s office or clinic. Patients remain under medical supervision for two hours after treatment due to potential side effects.
  • Who it’s for: Approved for adults with treatment-resistant depression or major depressive disorder with chronic suicidal thoughts.
  • Benefits: More accessible for some patients and covered by some insurance providers.
  • Considerations: The effects may take longer to become noticeable compared to IV ketamine, and doses are typically spread out over several weeks.

While both options have shown promising results, ketamine therapy is not a one-size-fits-all solution. A comprehensive psychological evaluation is necessary to determine whether ketamine therapy is the right fit for an individual’s unique health and mental wellness needs.

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Who Is Not a Good Candidate for Ketamine Therapy?

Ketamine therapy has been a game-changer for individuals struggling with conditions that don’t respond to traditional treatments. However, because ketamine affects brain chemistry, cardiovascular function, and perception, it isn’t the right fit for everyone.

Before beginning treatment, it’s essential to understand the potential risks and who may need additional screening or alternative options. Here’s what you should know about eligibility for ketamine therapy and when it may not be the safest or most effective choice.

1. Individuals with Uncontrolled High Blood Pressure or Heart Disease

Ketamine can cause temporary spikes in blood pressure and heart rate, making it potentially dangerous for individuals with:

  • Uncontrolled hypertension
  • Coronary artery disease
  • Congestive heart failure
  • Serious arrhythmias

Patients with controlled cardiovascular conditions may still be eligible for ketamine therapy but should be closely monitored by a medical professional during treatment.

2. Individuals with a History of Psychosis or Schizophrenia

Leaving treatment is a big transition. Without support, it’s easy to feel overwhelmed or unsure how to maintain your progress. Research shows that ongoing care significantly improves long-term recovery success[1]—we see this firsthand in our alumni community.

Aftercare is about having a solid foundation when life gets tough. It helps you:

  • Stay emotionally resilient under challenging moments
  • Keep up with healthy habits and coping strategies
  • Maintain connections with people who genuinely understand
  • Continue growing in confidence, independence, and self-awareness

Think of it like training for a marathon. You don’t stop running just because you made it past the first few miles—you keep training, pushing forward, and building endurance for the road ahead.

3. Pregnant or Breastfeeding Women

The safety of ketamine therapy during pregnancy and breastfeeding is not well studied. While research on ketamine’s effects in these cases is limited, there is concern that it could impact fetal development or pass into breast milk, potentially affecting the baby’s health.

Women who are:

  • Pregnant
  • Trying to conceive
  • Breastfeeding

should carefully consider the risks and consult with a medical professional before starting ketamine therapy. In some cases, alternative treatments may be recommended to ensure the well-being of both mother and child.

4. Individuals with a History of Substance Use Disorders

Because ketamine has some potential for misuse and dependency, individuals with a history of substance use may require additional screening before starting treatment. This includes those who have:

  • A history of ketamine addiction
  • A history of substance use disorder (SUD), including alcohol or opioids
  • Current drug or alcohol use

That said, ketamine-assisted therapy has also been studied as a treatment for addiction. If you have a history of substance use but are in recovery, consult with a healthcare professional about whether ketamine therapy is safe for you.

However, ketamine-assisted therapy has also been explored as a promising treatment for addiction. Studies suggest that ketamine is effective at reducing cravings, increasing motivation for sobriety, and improving abstinence rates in individuals with substance use disorders. [2] For some individuals in recovery, ketamine therapy can be beneficial in controlled clinical settings where risks can be carefully managed. 

At Monima Wellness, we take a personalized approach to mental health treatment. If you have a history of substance use but are in recovery, our team will work with you to determine whether ketamine therapy is a safe and supportive option.

5. Individuals with Severe Liver or Kidney Disease

Because ketamine is metabolized in the liver and excreted through the kidneys, individuals with severe liver disease or kidney dysfunction may not be good candidates for treatment. Conditions of concern include:

  • Cirrhosis or severe liver failure
  • Chronic kidney disease (CKD)
  • History of kidney stones or bladder conditions (ketamine can cause cystitis in long-term users)

A medical evaluation is essential for individuals with compromised organ function before considering ketamine therapy. 

6. Individuals Taking Certain Medications

Some medications can interact with ketamine, potentially reducing its effectiveness or leading to complications. If you’re considering ketamine therapy, it’s crucial to review your medications with your provider to ensure safe and optimal treatment outcomes.

Medications that may impact ketamine therapy include:

  • Benzodiazepines (e.g., Xanax®, Valium®, Ativan®) – May reduce ketamine’s antidepressant effects.
  • Lamotrigine (Lamictal®) – Can decrease ketamine’s efficacy.
  • Certain antipsychotic medications – May blunt ketamine’s therapeutic benefits.
  • Opioids and sedatives – Can increase the risk of over-sedation and respiratory depression.

At Monima, we prioritize informed, holistic treatment strategies, helping our clients navigate these considerations while receiving the highest level of support in our PHP and IOP programs.

7. Older Adults with Cognitive Impairment

Older adults, especially those with neurodegenerative disorders such as Alzheimer’s or dementia, may not be suitable candidates for ketamine therapy due to:

A medical evaluation is essential for individuals with compromised organ function before considering ketamine therapy. 

8. Individuals with Severe Anxiety About Dissociation

Ketamine therapy can induce temporary dissociative effects, which some people describe as feeling “disconnected” from reality or experiencing an “out-of-body” sensation.

For individuals with severe health anxiety, PTSD flashbacks, or fear of losing control, these effects may be distressing rather than therapeutic.

At Monima Wellness, we use trauma-informed approaches to ensure patients feel safe and supported throughout their treatment experience.

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Alternative Treatment Options for Those Who Are Not Good Candidates

If ketamine therapy is not the right fit, Monima Wellness offers a diverse range of alternative treatments designed to support healing and recovery. Our approach integrates evidence-based therapies with holistic modalities, ensuring individuals receive personalized care that aligns with their needs.

1. Holistic Therapies

At Monima Wellness, we embrace a mind-body approach to healing, offering integrative therapies that support emotional balance, trauma recovery, and overall well-being. Our services include, but are not limited to:

  • Trauma-Informed Yoga & Breathwork – Helps regulate the nervous system, reduce stress, and release stored trauma, fostering emotional resilience and mind-body connection.
  • Acupuncture & Traditional Chinese Medicine – Rooted in time-tested healing practices, these therapies promote emotional balance, stress relief, and overall vitality through energy alignment and natural remedies.
  • Sound Healing & Reiki – Encourages deep relaxation, nervous system regulation, and energetic alignment to support emotional and physical healing.
  • Mindfulness & Transcendental Meditation – Cultivates inner awareness, emotional resilience, and self-regulation, allowing individuals to reconnect with themselves in a grounded, peaceful way.

Whether used as a stand-alone practice or alongside traditional therapy, our holistic modalities help clients restore balance, reduce distress, and reconnect with their inner strength.

2. Evidence-Based Therapies

At Monima Wellness, we utilize proven clinical therapies to help individuals develop coping strategies, process trauma, and navigate mental health challenges effectively. Our services include, but are not limited to:

  • Cognitive Behavioral Therapy (CBT) & Dialectical Behavior Therapy (DBT) – Provide practical tools for managing emotions, reshaping thought patterns, and improving distress tolerance in daily life.
  • Eye Movement Desensitization and Reprocessing (EMDR) & Cognitive Processing Therapy (CPT) – Evidence-based approaches that help process traumatic memories, reduce distressing symptoms, and promote emotional healing.
  • Acceptance and Commitment Therapy (ACT) – Encourages emotional flexibility, mindfulness, and values-driven decision-making, supporting individuals in embracing change and moving forward with purpose.
  • Attachment Theory & Co-Dependency Therapy – Helps individuals explore relational patterns, build healthier attachments, and develop greater self-awareness in their relationships.

By integrating evidence-based modalities with holistic care, Monima Wellness provides a comprehensive, personalized approach that meets each individual where they are on their healing journey.

3. Medication & Integrative Support

Monima Wellness offers comprehensive, individualized treatment plans for those who benefit from medical interventions that integrate traditional and holistic approaches to support mental health and emotional well-being. Our services include, but are not limited to:

  • Psychiatric Medication Management – Thoughtfully tailored treatment plans that may include antidepressants, mood stabilizers, or hormonal support for mood disorders, ensuring medication is aligned with your unique needs.
  • Neuropsychological Evaluation – A thorough assessment that provides valuable insight into cognitive and emotional functioning, helping to inform treatment strategies for trauma, depression, anxiety, and other mental health conditions.
  • Integrative Healing Modalities – Complementary therapies such as acupuncture, breathwork, and mindfulness work alongside medication management to promote overall well-being and balance.

4. Community & Personal Growth

At Monima Wellness, we believe healing is not just an individual journey—it thrives within supportive relationships and personal development. Our services include, but are not limited to:

  • Healthy Relationships & Communication Skills Therapy – Designed to enhance self-awareness, set healthy boundaries, and foster deeper, more meaningful connections in personal and professional life.
  • Conscious Recovery & Restorative Justice Practices – A self-discovery and healing process that helps individuals understand and recover from past wounds while fostering accountability and personal transformation.
  • Family Program & Case Management Services – We provide structured guidance, education, and family involvement to promote lasting recovery and support holistic healing within family dynamics.
  • Identity-Affirming Care – Our inclusive approach ensures that women and female-identifying individuals receive care that acknowledges their unique experiences, challenges, and strengths.

Our comprehensive treatment model ensures that each person receives the care, tools, and community support they need to heal, whether through traditional psychotherapy, holistic wellness practices, or structured support systems.

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Is Ketamine Therapy Right for You?

Ketamine therapy is an exciting and promising treatment for both trauma and mental health challenges, but it may not be suitable for everyone. If you are considering ketamine therapy in San Diego, the best first step is to consult with a trusted mental health provider. At Monima Wellness, we offer comprehensive neuropsychological testing to assess cognitive and emotional functioning, helping to guide personalized treatment decisions.

As an outpatient center dedicated to supporting women and female-identifying individuals, we provide compassionate, evidence-based care for those navigating depression, trauma, and other mental health concerns. Whether through ketamine therapy or our wide range of holistic and clinical treatment options, we prioritize your safety, well-being, and long-term healing.

If you’re interested in exploring ketamine therapy or alternative treatments, reach out to us today to schedule a consultation.

Begin Your Healing Journey

If you’ve been struggling with treatment-resistant depression and haven’t found relief through traditional methods, you don’t have to face it alone. 

Monima Wellness is a safe haven for those needing more support than typical weekly therapy sessions. Our specialized programs combine evidence-based therapies, holistic healing practices, and compassionate clinical support to help you break through barriers to recovery. 

Take the next step toward healing—contact us today to explore your options and find the care you deserve.

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[1] McIntyre, R. S., Alsuwaidan, M., Baune, B. T., Berk, M., Demyttenaere, K., Goldberg, J. F., Gorwood, P., Ho, R., Kasper, S., Kennedy, S. H., Ly-Uson, J., Mansur, R. B., McAllister-Williams, R. H., Murrough, J. W., Nemeroff, C. B., Nierenberg, A. A., Rosenblat, J. D., Sanacora, G., Schatzberg, A. F., Shelton, R., … Maj, M. (2023). Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World psychiatry : official journal of the World Psychiatric Association (WPA), 22(3), 394–412. https://doi.org/10.1002/wps.21120

[2] Jones, J. L., Mateus, C. F., Malcolm, R. J., Brady, K. T., & Back, S. E. (2018). Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Frontiers in psychiatry, 9, 277. https://doi.org/10.3389/fpsyt.2018.00277