Am I a Candidate for Ketamine Therapy for Depression?

Ketamine therapy is only right for you if you meet five non-negotiable criteria: you must have a diagnosed form of depression, meet strict medical guidelines, be able to take time off work, have someone to drive you to and from treatment, and be able to afford it.

Certain conditions automatically disqualify you. These include brain aneurysms, a history of brain bleeding, severe heart disease, pregnancy or breastfeeding, active psychosis or schizophrenia, or being actively suicidal with a plan.

Other conditions might or might not disqualify you depending on how well they’re controlled, like high blood pressure, liver disease, seizures, asthma, or past substance abuse.

Each treatment session runs about two hours, and recovery can take another four to six. You’ll likely feel foggy, lightheaded, or physically off-balance—making it unsafe to work or drive.

If you can’t meet all five criteria, ketamine therapy is not an option until those barriers are resolved.

The answer depends on which form of ketamine therapy you’re considering. Spravato, the esketamine nasal spray, is only approved for treatment-resistant depression—meaning you must have tried at least two different antidepressants without relief.

IV infusions, injections, and oral ketamine are used off-label and can treat a much wider range of depression types, including major depressive disorder, persistent depressive disorder, bipolar depression, and seasonal affective disorder.

This matters because Spravato requires strict proof of diagnosis and failed treatments, while other forms don’t.

If your depression doesn’t meet the treatment-resistant standard, you won’t qualify for Spravato—but you will likely qualify for IV, injection, or oral ketamine as long as you’ve been diagnosed with one of the accepted depression types.

Clinic discretion exists but is limited. While no federal guidelines enforce diagnosis requirements for off-label treatment, most clinics still follow their own institutional standards and will not treat undiagnosed patients.

Eligibility depends on which form of ketamine therapy you’re pursuing. Spravato, the esketamine nasal spray, is only available to people diagnosed with treatment-resistant depression who have tried and failed at least two antidepressants. IV infusions, injections, and oral ketamine don’t require this—they can be used to treat a broader range of depression diagnoses without proving past treatment failure.

Even if you meet those criteria, certain medical conditions will disqualify you. These include brain aneurysms, prior brain bleeding, severe cardiovascular disease, pregnancy or breastfeeding, active psychosis or schizophrenia, or being actively suicidal with a plan.

Other conditions may not disqualify you outright but still require medical clearance. These include high blood pressure, liver disease, seizure disorders, respiratory issues, or recent stroke. Clinics may require extra screening, monitoring, or specialist consultation before proceeding.

You can do ketamine therapy for depression if you also have anxiety, but only if the anxiety isn’t severe. Anxiety is considered a conditional concern—not a complete stop sign—which means treatment might still be possible depending on how well the condition is managed.

This matters because ketamine’s dissociative effects can intensify certain symptoms during treatment, and unmanaged anxiety can make the experience more destabilizing. Clinics will want to understand how your anxiety presents and whether it interferes with safety during or after the session.

Patients with mild or treated anxiety are often cleared for therapy without issue. But if your anxiety is severe, especially if it overlaps with panic attacks or intrusive thoughts, you may need further evaluation before starting.

It’s not about ruling you out—it’s about making sure the treatment environment won’t worsen existing symptoms or create additional risk. The decision will come down to how your clinic interprets your overall stability.

Heavy alcohol or cannabis use doesn’t automatically disqualify you from ketamine therapy, but it raises red flags that clinics take seriously. Both substances act on the same brain systems ketamine affects, including glutamate signaling and neuroplasticity. That overlap can make the treatment less effective—or harder to predict.

Most clinics won’t demand full sobriety, but they will ask about frequency and intent. If you’re drinking daily, using weed heavily, or relying on either to manage symptoms, they may delay treatment or bring in medical oversight. Patients are often asked to avoid alcohol for at least 24 hours before and 48 hours after each session to protect the “plasticity window,” when the brain is most open to change.

That said, ketamine has shown early promise in reducing cravings for alcohol—and there’s emerging research suggesting similar effects for cannabis. Some patients report that ketamine helped interrupt their urge to drink or use. But those benefits don’t cancel out the risks.

If your use feels more like self-medication than recreation, it won’t necessarily disqualify you—but it won’t be ignored either.