Is Addiction a Contraindication for Ketamine Therapy?

By Ashley Barnes, M.S.

Reviewed by: Mark Hrymoc, MD

Addiction/SUD

Addiction is often used synonymously with substance use disorders (SUD), describing “a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine” (Mayo Clinic, 2022). As ketamine is a relatively new development in the history of medicine, many people have questions about whether addiction or substance use disorders pose a contraindication (a condition or circumstance that suggests or indicates that a particular technique or drug should not be used in the case in question) to ketamine therapy.

Experts in medicine have asked this question too.

Ketamine and Depression

Ketamine Therapy has been researched to have a high response rate in treatment-resistant depression with 70% of patients reporting improvement in contrast with only 15% for another oral antidepressant (Trivedi et al., 2006). A wealth of more recent studies back ketamine as being a highly effective treatment option for treatment-resistant depression. Treatment-Resistant Depression describes “depression that doesn’t respond to antidepressants,” also known as treatment-refractory depression (Healthline, 2022). Someone with TRD may try two or more antidepressant medications such as Selective serotonin reuptake inhibitors (SSRIs) and feel no effect.

Depression and Addiction/SUD

Dr. Mark Hrymoc, founder of Ketamine Therapy Center and Board-Certified Addiction Psychiatrist explains that “substance abuse is often a co-occuring disorder alongside depression. Those who live with depressive disorders experience emotional pain in the form of suicidal ideation and depressed mood; some use substances as a way to temporarily numb emotional symptoms. However, the co-occurring disorders feed off each other in a way that worsens both the substance abuse and depression over time.”

There is a strong connection between substance use and mood disorders, including major depressive disorder. In a nationwide study of 43,093 adults 18 years old and over, researchers found that for those suffering from a current alcohol addiction, there was evidence that over 20% of them also met the criteria for that of a comorbid major depressive disorder (Pettinati & Dundon, 2011). Further, substance use is a risk factor for suicide. Due to the relationship between depression and addiction as well as the groundbreaking research indicating ketamine therapy as being a highly effective treatment option for depression, experts have become curious about ketamine therapy’s effects on addiction/SUD.

Research on Ketamine and Addiction/SUD

According to research examining ketamine’s impact in substance use disorders, researchers have argued that ketamine may block reconsolidation of drug-related memories (Das et al., 2013, Zhai et al., 2008). Studies have also found ketamine to provoke “peak or mystical-type experiences that enhance psychotherapeutic process and lead to profound perspective shifts” (Krupitsky et al., 2002, Krupitsky et al., 2007, Morgan et al., 2017).

Ketamine has been studied to offer antidepressive effects, which is likely beneficial given the high comorbidity of depression and substance use disorders (Ivan Ezquerra-Romano et al., 2018; McIntyre et al., 2021). Research has indicated that ketamine facilitates neurogenesis/neuroplasticity, thus promoting learning (Dakwar et al., 2019, Li et al., 2010, Zanardini et al., 2011). “Enhanced learning is proposed to reverse drug-related neural adaptations, accelerate the benefits of psychotherapy, and generally facilitate the acquisition of new adaptive behaviors” (Garel et al., 2022).

Speaking from direct experience, Dr. Mark Hrymoc notes that history of addiction is “not a contraindication for ketamine treatment. We've treated a number of folks who are in stable long term recovery from addiction but still having problematic depression or anxiety…however, patient safety always comes first, and if a patient is actively struggling with dangerous alcohol or drug use, we may explore other, more immediate treatment options before starting ketamine therapy.”

Ketamine Therapy Center

Ketamine Therapy Center is a treatment branch from the Mental Health Center that specializes in ketamine infusion therapy. We plan to offer even more types of psychedelic treatments and assisted therapies when it is permissible to do so, as we believe in evidence-based treatment approaches that have the power to transform one’s life.

Our doctors offer Ketamine Therapy Evaluations to thoroughly assess patients for ketamine therapy candidacy; from here, they collaborate with patients to develop treatment plans. Our office in the Cedars- Sinai Medical Office towers houses rooms specially designed for patient comfort. Our highly experienced and talented nurses are well-versed in ketamine infusion therapy and help patients feel comfortable as they move through the treatment process. Our therapists are trained in Ketamine Assisted Psychotherapy and offer therapeutic guidance to enhance the psychological benefit of the treatment while simultaneously creating a grounded and safe space.

For more information, please do not hesitate to explore our website or contact our office!

References

Dakwar, E. et al., (2019). A single ketamine infusion combined with mindfulness-based behavioral modification to treat cocaine dependence: a randomized clinical trial. Am. J. Psychiatry, 176 (11) (2019), pp. 923-930.

Das, R. K. et al., (2013). The effects of N-methyl D-aspartate and B-adrenergic receptor antagonists on the reconsolidation of reward memory: a meta-analysis. Neurosci. Biobehav Rev., 37 (3) (2013), pp. 240-255.

Ezquerra-Romano, I. et al., (2018). Ketamine for the treatment of addiction: Evidence and potential mechanisms. Neuropharmacology, 142 (2018), pp. 72-82.

Garel, N. et al., (2022). Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug and Alcohol Dependence, 239 (2022).

Healthline Media. (2020). How to manage treatment-resistant depression. Healthline. Retrieved November 30, 2022, from https://www.healthline.com/health/treatment-resistant-depression

Krupitsky, E. et al., (2002). Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. J. Subst. Abus. Treat., 23 (4) (2002), pp. 273-283.

Krupitsky et al., (2007). Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence. J. Psychoact. Drugs, 39 (1) (2007), pp. 13-19.

Li, N. et al., (2010). mTOR-dependent synapse formation underlies the rapid antidepressant effects of NMDA antagonists. Science, 329 (5994) (2010), pp. 959-964.

McIntyre, R.S. et al., (2021). Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am. J. Psychiatry, 178 (5) (2021), pp. 383-399.

Morgan, C. et al., (2010). Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1–year longitudinal study. Addiction (2010).

Pettinati, H.M., & Dundon, W.D. (2011). Comorbid depression and alcohol dependence. Psychiatric Times, 28(6).

Trivedi, M.H., Rush, A.J., Wisniewski, S.R., et al. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry, 163(1): 28–40. doi: 10.1176/appi.ajp.163.1.28.

Zanardini, R. et al., (2011). Alterations of brain-derived neurotrophic factor serum levels in patients with alcohol dependence. Alcohol Clin. Exp. Res, 35 (8) (2011), pp. 1529-1533.

Zhai, H. et al. (2008). Effects of scopolamine and ketamine on reconsolidation of morphine conditioned place preference in rats. Behav. Pharm., 19 (3) (2008), pp. 211-216.