Here’s the good news: There are more options than ever when it comes to tackling depression. In the United States, market data shows a clear upward trend for ketamine clinics. Ten years ago, they were a niche rarity, regarded more as a recreational pastime than a serious intervention.
Today? Different story. Ketamine is marching at the frontier of mental healthcare for a reason. Where most medications need weeks to begin taking effect, research shows that ketamine therapies produce “rapid antidepressant effects,” and may even accelerate the mental healing process as a whole if used alongside other drugs.
Which begs the question; is it safe to mix ketamine and antidepressants? Before you book an appointment at a ketamine clinic - or try something more holistic - you need to know how ketamine interacts with different drugs.
When it comes to mixing ketamine and antidepressants, the short answer is yes, you can - but with some caveats. Both produce substantial neurochemical changes in your brain, and anyone who has ever worked in a lab will tell you to be careful about what you mix together.
Monotherapy refers to trying one medical or pharmaceutical intervention at a time. But doctors or mental health professionals will often take a multi-pronged approach to tackling mental health issues like depression or anxiety, called adjunctive therapy.
Ketamine is often utilized as adjunctive therapy with pharmaceutical antidepressants. For example, FDA rules require patients taking esketamine - you’d know it as the Spravato nasal spray - to also use an oral antidepressant.
Pairing a pharmaceutical with intravenous ketamine isn’t mandatory, but is quite common as well. Why are they so often paired?
Doctors and therapists will typically use ketamine as adjunctive therapy with an antidepressant because the two drugs behave differently in the brain.
This two-pronged chemical approach is the basis for using ketamine as adjunctive therapy in treating mental health issues. And don’t worry, adjunctive therapies aren’t unique to mental health - doctors use multiple concurrent treatments all the time to tackle complex issues.
When it comes to ketamine and antidepressants, most common medications are safe for combined therapies. But remember - your doctor or healthcare provider will have the most informed perspective on how to modify your mental health treatments. They should be your primary resource if you’re thinking about trying ketamine.
SSRIs, or selective serotonin reuptake inhibitors, are generally safe to use in conjunction with ketamine therapies, though existing research emphasizes the importance of doing so under supervision.
Common SSRIs include:
Selective norepinephrine reuptake inhibitors, or SNRIs, are similarly eligible - think Cymbalta or Effexor. What’s more, some data has shown that esketamine can produce better long-term outcomes when combined with an SNRI.
If you’re treating depression with a lower-grade antidepressant, such as Wellbutrin, you’re in the clear, too. There are limited clinical data directly examining how drugs like bupropion (the active ingredient in Wellbutrin) interact with ketamine, but institutions broadly regard it as safe.
Not all medications are safe to combine with ketamine therapies. Some drugs may cause deleterious health effects or worsen your state of mind rather than bettering it. These drug categories don’t necessarily prohibit ketamine, but may require more direct oversight or strict medical supervision.
“Benzos” may blunt the efficacy of ketamine or esketamine treatments. Common benzodiazepines have been shown to “reduce ketamine’s treatment outcome.” If you’re currently taking one of these medications, your doctor may want to adjust your regimen before incorporating ketamine.
If you’re taking a medication which may have negative effects if combined with ketamine, you should absolutely not quit cold turkey. This goes for SSRIs and benzos alike - medications that take weeks to accumulate to the therapeutic level are likely to cause issues if you don’t gradually wean off.
All drugs have side effects. Many are dose-dependent, and any reputable clinic or physician will know how to properly prescribe or administer therapies to minimize harm. That said, there’s always some level of risk.
Serotonin syndrome is a rare, but potentially dangerous, condition caused by erratic neuropathic behavior in the brain, typically as a result of introducing too many psychoactive compounds at once.
You may also be at risk of developing high blood pressure from mixing ketamine and antidepressants, particularly if you’re taking a MAOI, according to case study data. Ketamine clinics and retreats will conduct extensive medical history checks prior to beginning any treatment and advise you on what to do if you’re on a blood pressure medication.
MAOIs, or monoamine oxidase inhibitors, have also been thought to increase risk of serotonin syndrome, but contemporary scientific works haven’t corroborated that assumption.