Analysis of psychiatric contraindications to the use of ketamine as an adjunct in psychotherapy
Viacheslav Zaika, Yan Tytarenko
Psychosomatic Medicine and General Practice September 30, 2026 DOI: 10.26766/pmgp.v11i3.741 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine-assisted psychotherapy |
| Topics | Esketamine Ketamine |
| Key findings | Proposes a three-tier classification of psychiatric contraindications to ketamine-assisted psychotherapy: high-risk conditions such as schizophrenia, bipolar I disorder, mania, and psychotic symptoms should remain contraindications; ASD, OCD, and untreated sleep apnea may warrant removal; and evidence for Cluster B personality disorders is insufficient. The authors argue this system may improve patient selection and safety. |
Abstract
Background and aims. Depression is highly prevalent, and 30%–60% of patients do not respond adequately to standard therapy. Ketamine-assisted psychotherapy (KAP) is a promising approach, but psychiatric contraindications remain unstandardized. This study aimed to systematize mental health-related contraindications to ketamine-assisted therapy. Material and methods. We reviewed 74 publications, selected 15 key guidelines and reviews to compile a unified list of psychiatric contraindications, and then analyzed 126 targeted studies to assess the risks of each condition. Each contraindication was classified as retained, removed, or supported by insufficient evidence. Results. The conditions were divided into three groups. Schizophrenia, schizoaffective disorder, depression with psychotic symptoms, psychotic symptoms, delirium, mania, bipolar I disorder, cognitive impairments, and eating disorders with somatic decompensation should remain contraindications. ASD, OCD, and untreated sleep apnea may warrant removal, while evidence for Cluster B personality disorders remains insufficient. This structured system may improve patient selection and therapy safety. Conclusions. This study proposes a three-tier classification of psychiatric contraindications for KAP based on clinical risk. While high-risk disorders should remain restricted, some conditions may be reconsidered for exclusion. Further large-scale studies are needed to refine risk stratification and standardize safety protocols. Keywords: ketamine, ketamine-assisted psychotherapy, treatment-resistant depression, mental disorders, contraindications, treatment safety.
Comparable studies
Other narrative reviews on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms | 2018 | Review | |
| Mechanisms of Ketamine Action as an Antidepressant | 2018 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) | 2013 | Review | |
| A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | 2017 | Review and consensus statement |