Navigating the Boundaries: Understanding Contraindications for Ketamine-Assisted Psychotherapy

Exploring the potential of ketamine-assisted psychotherapy (KAP) is an exciting journey into transformation, growth, and healing. At Kalea Wellness, we believe in helping each person chart a path that is not only powerful but also safe. KAP offers real hope for conditions like depression, PTSD, anxiety, and addiction - but like any treatment, it is important to know when it may not be the right fit, at least not right away. The good news? Most of these concerns are just detours - not dead ends - and with the right support, many clients still find their way to healing.

Let us start with substance use disorders. If you are in active use, especially with alcohol, KAP is not recommended right away. Ketamine’s healing potential depends on a clear, receptive mind, and mixing it with substances like alcohol can cloud that process and even increase risks. But here is the silver lining: this does not mean you cannot start your journey with us. We can usually begin an initial Comprehensive Assessment right away, even if you are in early sobriety. We will talk through your goals and needs, and help you map out the right next steps. Many clients with alcohol use disorder benefit from detox and rehab before beginning ketamine-assisted therapy - and we are here to walk that journey with you, step by step. Once several weeks of sobriety have been achieved, KAP becomes a possibility.

For those living with bipolar disorder, timing is everything. We do not begin KAP during a manic or hypomanic episode, and we ask that a few months have passed since the last episode before we get started. This ensures the brain is in a stable and receptive state to safely process the deep therapeutic work ketamine can help unlock. The silver lining? Stability brings power. During the Comprehensive Assessment, we explore where you are in your mood cycle and plan for the most effective timing. It is not a “no,” it is just a “not yet” - and that small pause can set the stage for deeper healing.

When it comes to cardiovascular health, those who have recently experienced a heart attack, stroke, or other serious event may need more time before safely pursuing KAP. Because ketamine can temporarily raise blood pressure and heart rate, we want to make sure your heart and body are fully ready. But the silver lining here is that KAP is not going anywhere. Healing is still possible, and with medical clearance and careful planning, many patients find that this therapy becomes a future option once recovery is further along.

Severe liver disease is another condition we approach with caution. Ketamine is metabolized by the liver, and impaired liver function could result in prolonged or intensified effects. But again, this does not close the door entirely - it just means we need to understand your liver health before proceeding. The bright side? If your liver condition is stable or mild, treatment might still be possible with appropriate modifications.

Now let us talk about active psychosis - such as delusions or hallucinations. Because ketamine itself can alter perception, it can potentially worsen these symptoms if they are already present. But here is the hopeful part: with the right psychiatric care and stabilization, many individuals with a history of psychosis go on to explore ketamine safely down the road. Healing is a layered process, and we are always here to revisit this option when the time is right.

Pregnancy and breastfeeding come with unique considerations, and because the effects of ketamine on developing babies and infants are not fully known, we avoid KAP during this time. The good news? Parenthood often brings motivation and clarity, and many clients return after this chapter to begin their journey toward mental wellness with even greater resolve.

A supportive, safe environment is another key to successful KAP. The insights and emotions that emerge during treatment can be powerful, so having a stable home life and emotional support system is essential. If that is not your current reality, do not worry. The silver lining here is that we can still begin the conversation. During your Comprehensive Assessment, we will help you explore what resources might be needed and how to build the support network that will help you thrive in therapy.

Finally, for those who have had a recent suicide attempt, outpatient KAP is not recommended right away. The intensity of suicidal crises requires closer monitoring than the outpatient setting allows. But this is not a permanent barrier - it is a pause. We prioritize safety and healing first, and once stability has returned, KAP can become a future tool in your recovery toolkit.

At Kalea Wellness, we believe in meeting you exactly where you are. Whether you are ready to begin treatment now or need a little time to prepare, we are here to help guide your journey in the safest and most effective way possible. Our initial Comprehensive Assessment is the perfect place to start. It gives us the chance to understand your health, your goals, and your story—including any potential contraindications for ketamine-assisted psychotherapy. From there, we will work together to build the path that fits you best.

If you are curious about KAP or wondering whether it is the right step, reach out. Healing might take time, but you do not have to wait to start feeling hopeful again. We are ready when you are—and rooting for you every step of the way.