Are You a Candidate for Ketamine Therapy?
What’s the Criteria? What Makes You Ineligible?
Because therapy with ketamine is a medical procedure rather than a pill you take at home, some of the eligibility criteria may be surprising. In order to qualify you need to:
- Have a diagnosed form of depression
2. Meet the medical guidelines for ketamine therapy
3. Be able to take time off from work
4. Have someone you trust to drive you to and from each session
5. Be able to afford treatment (it’s expensive)
1. You Must Have A Diagnosed Form Of Depression
As you can see from this table, not all forms of ketamine therapy treat every type of depression:
| Form of Ketamine Therapy | What Form of Depression It Treats |
|---|---|
| Spravato | * Treatment-resistant depression ONLY |
| IV Ketamine Infusions & Injections |
* Treatment-Resistant Depression * Major Depressive Disorder (also known as "clinical depression") * Persistent Depressive Disorder * Bipolar Depression * Seasonal Affective Disorder (SAD) |
Major Depressive Disorder (MDD): Also known as clinical or unipolar depression, this is the most common form of depression.
Persistent Depressive Disorder (PDD): Formerly known as dysthymia, this is a chronic, low-grade depression lasting for two years or more. Symptoms are less severe than major depression but can be just as debilitating.
Bipolar Depression: Part of bipolar disorder, this involves depressive episodes similar to major depression but is distinguished by periods of mania or hypomania.
Seasonal Affective Disorder (SAD): A type of depression that occurs at specific times of the year, typically during winter months, and resolves in the spring.
The Esketamine Nasal Spray Spravato
1. It’s Only Available for the Most Severe Cases of Depression
Spravato, the esketamine nasal spray, is only available if you’re diagnosed with TRD, treatment-resistant depression. That’s an FDA mandate.
TRD means you have tried and failed to get adequate relief from at least two different antidepressant treatments. These could include:
- SSRIs (like Prozac, Zoloft, or Lexapro)
- SNRIs (like Effexor or Cymbalta)
- Other antidepressants (like Wellbutrin or tricyclics)
- Other forms of depression treatment (like TMS or ECT)
2. Treatment Is Only Allowed In Spravato-Certified Treatment Clinics
Many IV and injection ketamine clinics are not REMS-certified, which means they cannot legally administer Spravato. Therefore, if you want Spravato you may be limited to fewer locations, forcing you to travel long distances. In some rural areas, there may not be a REMS-certified clinic available at all, making access even more challenging.
Ketamine Infusion Therapy (and injections)
1. You Can Be Diagnosed With Almost Any Form of Depression to Qualify
Because IV ketamine infusion therapy and injections are used off-label, they aren’t bound by the strict FDA regulations that apply to approved drugs like Spravato. That means they can be used to treat nearly all depression sufferers, whereas Spravato, the nasal esketamine spray, is limited to only the 30% of depression sufferers diagnosed with treatment-resistant depression.
“Off-Label” isn’t some shady medical workaround. It’s a cornerstone of modern medicine, backed by research, used by top doctors, and responsible for some of the most effective treatments we have today.
Off-label just means a drug is being prescribed in a way not specifically outlined by the FDA, even though research and clinical experience support its safety and effectiveness.
The FDA approved ketamine as a surgical anesthetic—but not as a depression treatment. Not because it doesn’t work, but because no pharmaceutical company can make a fortune off it. Ketamine is a cheap, decades-old generic, which means no one can slap a patent on it and justify spending tens of millions on FDA approval.
2. Ketamine Infusion and Injections Have Fewer Restrictions Than Spravato
- No need to prove multiple antidepressants have failed you.
- No requirement for a treatment-resistant depression diagnosis.
- No need to go to a REMS-certified clinic with strict federal oversight.
2. Must Meet Medical Guidelines
There’s a long list of medical conditions that could disqualify you (for any form of therapy with ketamine)—but for most people, it’s not an issue. The goal isn’t to keep you out, it’s to make sure treatment is safe and effective for you.
Even if you see a condition that applies to you, don’t panic. Many just mean your doctor will take a closer look, maybe order a few tests, or monitor you more carefully during treatment.
COMPLETE STOP SIGNS
These are deal-breakers because they create immediate life-threatening risks:
- Brain aneurysm or arteriovenous malformation
- History of brain bleeding
- Known allergy to ketamine
- Severe cardiovascular disease
- Pregnancy/breastfeeding
- Active psychosis or schizophrenia
- Actively suicidal with a plan
HIGH CONCERN
These conditions need careful evaluation and might be manageable with proper medical oversight and extra precautions:
- Uncontrolled high blood pressure
- Recent stroke or TIA
- Increased pressure in the brain
- Severe liver disease
- Uncontrolled seizures
- Severe breathing problems requiring CPAP
- Current substance abuse or alcohol abuse
CONDITIONAL
These conditions need attention but might not rule out treatment if well-controlled:
- Controlled high blood pressure
- Stable heart rhythm issues
- Controlled seizure disorders
- Mild to moderate asthma
- Treated thyroid problems
- Managed eating disorders
- Anxiety (unless severe)
- Glaucoma (needs eye doctor clearance)
- Bladder problems (with urologist clearance)
Important Notes:
Some conditions won’t automatically disqualify you from treatment but might require a closer look from your doctor. In some cases, they may order additional tests or consult with a specialist to ensure it’s safe to proceed.
Certain conditions might mean you’ll need to be monitored more frequently during treatment to manage any potential risks. Even mild conditions, when combined, can add up and create a level of risk that needs careful evaluation. It’s about tailoring the approach to your unique situation, not ruling you out entirely.
3. Must Be Able To Take Time Off From Work
Taking ketamine for the treatment of depression means blocking out a significant chunk of your schedule. This isn’t like a quick doctor’s visit where you can return to work afterward – you’ll need to set aside most of your day for each treatment.
Let’s break it down: you’ll probably need 20-30 minutes to get to the clinic, about 2 hours for the actual treatment, and another 20-30 minutes to get home. That’s a solid three hours.
Here’s something you have to take into account: for several hours after treatment, you’ll likely feel pretty out of it. We’re talking drowsiness, fatigue, feeling lightheaded, and having trouble with balance.
Trying to work, concentrate, or focus on anything important during this time? Pretty much impossible. When you add it all up – the travel time, the treatment itself, and the recovery period – you’re looking at losing most of your day.
With anywhere from 10-14 treatment sessions or more (depending on the best ketamine therapy for you), that’s a lot of time off work. Some clinics offer evening appointments, which can help if you work regular daytime hours.
It’s important to have an upfront conversation with your employer about taking these days off. Many people use sick days or medical leave, just like they would for any other medical treatment. If you’re concerned about privacy, remember you don’t have to share the specific details – you can simply say you’re having a medical procedure that requires recovery time.
Bottom line: Before starting low dose ketamine for depression, make sure you can realistically manage this time commitment. Your healing process needs to come first, and there’s just no way to rush through this or multitask on treatment days.
4. You’ll Need a Trusted Driver for Every Session
You must have someone drive you to and from your ketamine treatment – this isn’t optional or a “just to be extra safe” kind of rule. Here’s why: Ketamine’s effects don’t just switch off when your session ends. The drug continues to affect your brain and body for several hours afterward.
Think about it this way – ketamine is actually used as an anesthetic in operating rooms. While the dose for depression treatment is much lower, it still seriously impacts your ability to function.
After treatment, you’ll likely feel dizzy and disoriented. Your reaction time will be slower, your coordination will be off, and your judgment will be impaired.
You might feel like you’re in a bit of a fog or dream-like state. Some people describe it as feeling “wobbly” or like they’ve had a few drinks. Your depth perception and ability to judge distances – crucial skills for driving – won’t be working properly.
This isn’t like taking a regular antidepressant where you can pop a pill and drive home. Operating any kind of vehicle in this state would be as dangerous as driving under the influence of alcohol – it puts both you and others at serious risk.
In fact, it’s not just dangerous – it’s illegal to drive while under the influence of ketamine, even if it was legally administered in a medical setting.
Your driver needs to be a responsible adult – not a taxi, rideshare, or public transportation. This person should be someone you trust, as they’ll need to make sure you get home safely and get settled.
Planning your transportation might feel like a hassle, but it’s a non-negotiable part of ketamine therapy. If you can’t arrange reliable transportation to and from every session, you’ll need to wait until you can before starting treatment.
Pro Tip: Ask your clinic if rideshares like Uber or Lyft are allowed. Many understand that not everyone has a friend or family member available for every session. Most clinics just require that you have a ride home, not who provides it.
5. You Must Be Able To Afford Treatment
Ketamine therapy isn’t cheap. IV infusions and injections? Not covered by insurance. That means you’re paying 100% out-of-pocket, and a full course can easily hit $6,000—or more.
Spravato, the FDA-approved nasal spray, is covered by insurance—but only partially. Even with coverage, you’re looking at over $8,000 in out-of-pocket costs for a full course of treatment.
But here’s the twist: if you qualify for the manufacturer’s subsidy, your cost could drop to almost nothing. The catch? It depends on your insurance.
Want the full breakdown? Read my complete guide to ketamine therapy costs and insurance coverage so you know exactly what you’re up against.
