In this video, Dr Wells discusses medications and substances that may interfere with or decrease the efficacy of ketamine treatment.
Watch the video and see the summary below.
Can I still take my medications?
Ketamine is a very unusual medication in that it “plays well” with almost every other medication. If you’re on an SSRI, an SNRI, an MAOI, a mood stabilizer or almost any other prescription drug, you’re unlikely to have any interactions or other concerns about adding ketamine infusions. Ketamine doesn’t interfere with most medications and, in general, these medications don’t interfere with ketamine treatment.
There are some notable exceptions:
Benzodiazepines
Benzodiazepines, such as Xanax, Valium, Ativan, Klonopin and others, appear to slow down benefits seen with ketamine. For example, anything that a patient might notice after their first infusion might take a patient on large or consistent amounts of benzodiazepines until their second or third infusion to notice.
Benzodiazepines may also decrease the duration of benefit between ketamine infusions. For example, a patient might get 3 to 5 weeks of benefit from ketamine after their initial series while a patient on large or consistent amounts of benzodiazepines may only see 2 weeks of benefit before needing another maintenance treatment.
We think of benzodiazepines as mitigators – meaning they slow down or decrease the effect of ketamine but don’t prevent the effects.
Do I need to stop taking benzodiazepines before treatment?
No. We do not ask patients to stop or decrease medications before treatment.
It is very difficult to wean down or come off of benzodiazepines. This should be done carefully, over a long period of time, with the prescriber’s help, and with a lot of support.
There are still good reasons to pursue ketamine treatment, even while on benzodiazepines. When you’re feeling a little bit better after ketamine treatments and you’ve got your feet under you, it will likely then be easier to come off of benzodiazepines.
On the day of a ketamine treatment we often advise patients to hold their benzodiazepines until after their infusion, or to simply take them as normal. We will make adjustments to your treatment schedule such as adding extra infusion to the end of your initial series and spacing infusions closer together between maintenance treatments to work towards compensating for the benzodiazepines.
Gabapentinoids
Gabapentinoids, such as Ambien, Gabapentin, Lyrica and others, may also slow down positive changes seen with ketamine, but this effect can be a lot more variable between patients.
We ask you to take your gabapentinoids as you normally would around a ketamine treatment.
Lamictal or Lamotrigine
Lamictal or Lamotrigine is a mood stabilizer medication that is sometimes used for augmenting depression medications or often for bipolar disorder. This medication is unusual in that, for some patients, it doesn’t effect ketamine treatment at all. For other patients, it dramatically increases the amount of ketamine needed to have the typical, floaty, ketamine experience.
Needing a higher dose to have a typical ketamine experience does not necessarily mean a patient needs a higher dose to have ketamine’s beneficial effect on mood. However, we usually raise the dose in this scenario because a more typical ketamine experience may, possibly, be more beneficial.
Whether or not a patient chooses to take their Lamictal or Lamotrigine before an infusion, we ask that they be consistent between treatments. Inconsistency in taking medication creates a lot of variability in a patient’s ketamine experience and in the dose required for the experience.
Other Substances that May interfere with ketamine
Alcohol
Alcohol appears to dramatically decrease the effects of ketamine. Alcohol, like benzodiazepines, is a GABA agonist. It also decreases motivation and the desire to make lifestyle changes that are beneficial for treating anxiety and depression.
THC & Cannabis products
THC and cannabis products, similar to alcohol, decrease motivation and the desire to make lifestyle changes that are beneficial for treating mental health conditions – and probably cause some depression and anxiety as well.
Do I need to stop using these substances?
We never want patients to stop cold turkey. We typically suggest a slow, gradual reduction of these substances. – often with a provider’s assistance.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
