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  • Writer's pictureMegan Begley, LCSW

Is Ketamine-Assisted Psychotherapy Safe for any Mental Health Disorder?




Although professional opinions may vary, the following is a practice-informed perspective that errs on the side of caution for your well-being.


Ketamine treatment can be useful for most mental health disorders, but it is not recommended if you have schizophrenia or another primary psychotic disorder. It is also not recommended for unstabilized bipolar disorder. However, note that people with developmental trauma history (C-PTSD) are often misdiagnosed with bipolar disorder due to vacillation from depression to anxiety or anger rather than depression to mania, which has very specific features. 

If suicidal ideation or a passive death wish is a newer symptom in your life or one that you are unlikely to act upon, ketamine may bring significant relief from that in as little as one session. However, for someone who has struggled with a pattern of suicide attempts or threats, ketamine may only create more vulnerability. Because of the psychedelic effect on the brain and nervous system described above, it's important to consider that suicidal ideation, as frightening as it may be, is a coping mechanism suppressing more painful feelings. A thorough psychological assessment is important. 

 

If you've been diagnosed with borderline personality disorder, or struggle with symptoms such as repeated suicide attempts or threats, self-injurious or reckless behavior, extreme instability of relationships or intense fear of abandonment, this form of KAP is likely to feel too disruptive, and is not recommended. If you identify with these symptoms currently, Dialectical Behavioral Therapy is the recommended initial treatment approach. After stabilization with DBT, a cognitive approach to KAP could then be considered.

 

If you have an active substance use disorder, it's important to seek formal comprehensive treatment and develop a recovery lifestyle first, as ketamine is not a magic bullet. Although ketamine's neurotransmitter benefits can be useful for mood or cravings in recovery, and ketamine-assisted psychotherapy can help you address trauma or emotional wounds masked or created by addiction, many psychological patterns are rewired best by new behaviors, routines, and positive connections with others.  Ketamine does facilitate ego maturation that chronic substance abuse arrests, but it's unlikely to substitute the lifestyle efforts that build maturity naturally. 

For obsessive-compulsive disorders, which imply extra rigidity to repetitive neural networks in the Default Mode Network, ketamine may not alleviate OCD symptoms as quickly as other types. More treatment than average may be necessary to make headway. Ketamine and other psychedelics are likely the best treatment available for the issue, but extended preparation therapy targeting the underlying root issue seems to be extra important in this case. For example, non-response would be highly likely without thorough preparation.



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