Should I stop my SSRI before ketamine?

No. Do not start, change, or discontinue any medication without your prescribing provider. Most SSRIs are considered compatible with ketamine therapy, and many patients continue them throughout treatment. Your clinician will review your full medication list during the consultation and coordinate with your prescriber as needed.

Will my benzodiazepine block the effect of ketamine?

Possibly attenuate it. Research published in the Journal of Clinical Psychiatry suggests benzodiazepines may blunt ketamine's antidepressant response. Many clinics ask patients to discuss dose-day timing with their prescriber. We never instruct patients to skip or change a benzodiazepine independently - that decision belongs to the prescribing clinician.

Is lamotrigine a problem for ketamine therapy?

Some research suggests lamotrigine may blunt ketamine's psychoactive and possibly its antidepressant effects because it modulates glutamate release. The clinical decision is patient-specific. Your prescriber and our clinical team will review whether any adjustments make sense, and any change to your lamotrigine must be directed by your prescribing physician.

Can I do ketamine therapy if I take stimulants like Adderall?

Often yes, with careful blood pressure and heart rate monitoring. Ketamine and stimulants can both elevate cardiovascular parameters, so dose-day timing is often discussed with the prescriber. Marla Peterson, CRNA, provides anesthesia-level monitoring during every session and adjusts the plan in real time as needed.

What about MAOIs and ketamine?

MAOIs require careful coordination with the prescriber primarily because of blood pressure considerations. Ketamine can transiently raise blood pressure, and MAOIs add a layer of cardiovascular complexity. We work directly with your prescribing clinician to make sure any plan is safe. Never adjust an MAOI on your own.

Ketamine and Your Other Medications: What to Know

Why this conversation matters before your first session

Most people who come to us are already taking something. An SSRI for depression. A benzodiazepine for sleep or anxiety. A stimulant for ADHD. A mood stabilizer for bipolar disorder. Sometimes all of the above. The first thing we want patients to hear is the most important sentence in this article: do not start, change, or discontinue any medication on your own. Every adjustment belongs in a conversation with the clinician who prescribes it.

That said, ketamine does interact with several common medication classes, and the research on those interactions has matured enough to give patients and prescribers a meaningful starting point. Some medications may attenuate ketamine's effect. Others raise safety considerations around blood pressure or heart rate. A few are genuinely compatible with no special handling. The goal of this article is to give you a working map of those categories so you can have an informed conversation with your prescriber and our clinical team.

Ketamine is FDA-approved as an anesthetic. Spravato (esketamine) is FDA-approved for treatment-resistant depression and major depressive disorder with acute suicidal ideation. Most other psychiatric and pain uses of ketamine are off-label. The FDA-approved Spravato Prescribing Information (2023) provides the most detailed regulatory guidance available on cardiovascular monitoring, post-dose observation, and concomitant CNS depressants and stimulants, and many clinics, including ours, use it as a reference point for IV ketamine safety practices.

Lamotrigine and ketamine

Lamotrigine is a mood stabilizer commonly prescribed for bipolar disorder and, sometimes, treatment-resistant depression. It works in part by reducing presynaptic glutamate release. Because ketamine's antidepressant effect is thought to involve a glutamate surge that drives downstream neuroplasticity, there has been long-standing interest in whether lamotrigine might blunt that surge.

The clinical picture is mixed. A clinical review by Andrade C in the Journal of Clinical Psychiatry (2017) examined pharmacologic factors that may attenuate ketamine's antidepressant response, with lamotrigine cited as one of the agents that could theoretically dampen the effect. Some controlled studies in healthy volunteers have shown that lamotrigine reduces ketamine's psychoactive and dissociative effects. Other clinical reports suggest that patients on lamotrigine still respond to ketamine, just possibly to a different degree.

The practical takeaway: lamotrigine is not a hard contraindication, but it is a factor your prescriber and our clinical team should know about. We do not ask anyone to alter their lamotrigine. If a change is appropriate, your prescribing physician makes that call. Our safety overview walks through how we coordinate this kind of medication review.

Benzodiazepines: the morning-of question

Benzodiazepines such as alprazolam, lorazepam, clonazepam, and diazepam are GABA-enhancing medications that calm nervous-system excitability. Several published reports, including the Andrade review (2017) and subsequent secondary analyses, suggest that chronic benzodiazepine use may attenuate ketamine's antidepressant response. The proposed mechanism is straightforward: ketamine works in part by transiently increasing glutamate signaling, and benzodiazepines push the system in the opposite direction.

This is the area where dose-day timing comes up most often. Some prescribers and ketamine clinics ask patients to consider whether the morning dose can be deferred until after the infusion, or whether overall benzodiazepine use can be tapered before treatment. Both decisions belong to the prescribing clinician. We never instruct patients to skip a benzodiazepine on their own. Abrupt discontinuation of a benzodiazepine carries its own real risks, including rebound anxiety and seizures, and is genuinely dangerous without medical supervision.

If you take a benzodiazepine and are considering ketamine therapy, the right next step is a conversation with your prescriber about whether and how the medication fits into the plan. Our team can talk with your prescriber directly if that is useful.

Stimulants and blood pressure

Stimulants such as amphetamine salts (Adderall), methylphenidate (Ritalin, Concerta), and lisdexamfetamine (Vyvanse) raise heart rate and blood pressure as part of their normal action. Ketamine also produces a transient increase in blood pressure and heart rate during infusion. The combination is not automatically problematic, but it is something we plan for.

The Sanacora et al. consensus statement in JAMA Psychiatry (2017), issued under the auspices of the American Psychiatric Association, lays out pre-treatment medication review and cardiovascular monitoring as core safety expectations for ketamine in mood disorders. The Spravato label (FDA, 2023) also describes specific blood pressure monitoring requirements during and after dosing. Both documents inform how we approach stimulant-using patients.

In practice, that means anesthesia-level monitoring throughout the infusion, with continuous tracking of blood pressure, heart rate, and oxygen saturation. Marla Peterson, CRNA, oversees every infusion and adjusts in real time as needed. Many patients on stable stimulant doses do well. Some prescribers prefer dose-day timing adjustments. As with everything else in this article, that decision belongs to the clinician who prescribes the stimulant.

SSRIs, SNRIs, and other antidepressants

SSRIs (sertraline, escitalopram, fluoxetine, paroxetine, citalopram) and SNRIs (venlafaxine, duloxetine, desvenlafaxine) are the most common medications among patients we see. The good news is that this category is generally considered compatible with ketamine therapy. There is no clinically significant pharmacokinetic interaction, and most patients continue their existing antidepressant throughout a course of ketamine infusions.

Research suggests that ketamine and SSRIs may even work synergistically, with ketamine producing rapid relief in the first hours to days and the SSRI supporting longer-term mood stability. The Sanacora et al. consensus statement (JAMA Psychiatry, 2017) explicitly accommodates concurrent antidepressant use as part of standard practice.

That said, please talk to your prescriber before changing anything. People sometimes assume that if a new treatment is working they should stop their old one. That assumption is not safe. Antidepressants have discontinuation syndromes that need clinical management, and the decision to taper or maintain belongs to your prescribing physician, not to a ketamine clinic and not to you alone.

MAOIs and ketamine

Monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine, and selegiline are older antidepressants that are still prescribed for treatment-resistant cases. They are uncommon but not rare. The main interaction concern with ketamine is cardiovascular: MAOIs sensitize the body to sympathomimetic effects, and ketamine produces a transient sympathetic surge during infusion. The combination raises the theoretical risk of significant blood pressure elevation.

Published case reports describe MAOI patients receiving ketamine without incident under careful monitoring, but the literature is small and the picture is not fully settled. The Spravato Prescribing Information (FDA, 2023) flags concomitant CNS-active medications as part of its safety framework, and most clinics treat MAOI use as a flag for direct prescriber coordination rather than a hard contraindication.

If you take an MAOI and are interested in ketamine therapy, the only correct path is a conversation with your prescriber and our team together. Do not adjust the MAOI on your own. The washout periods required for safe MAOI changes are long and very specific, and they must be handled by a physician.

Opioids, alcohol, and recreational substances

A few quick notes on substances outside the prescription antidepressant lane. Chronic opioid use can interact with ketamine therapy in complex ways. Some research suggests opioid receptor activity may be involved in ketamine's antidepressant effect, while other findings suggest opioids may complicate the picture. As with all of these decisions, opioid management belongs to the prescribing clinician.

Alcohol should be avoided in the 24 hours before and after each session. Recreational substances, including cannabis, MDMA, and psychedelics, should be disclosed honestly during your consultation so the clinical team has a complete picture. Disclosure does not create judgment. It creates safety.

Never change a medication without your prescriber

If there is one sentence we want every reader to take away, it is this: never start, stop, or change a medication without the clinician who prescribes it. Not because of a policy. Because withdrawal syndromes, rebound effects, and interaction risks are real, and they can hurt people. We have seen patients arrive convinced they should taper themselves off something before treatment. We always send them back to their prescriber first.

What we will do is review your full medication list during the consultation, flag anything that warrants a conversation, and coordinate directly with your prescribing clinician when that helps. Our approach to FDA-approved and off-label use is to treat the prescribing physician as a partner, not a competitor. The full intake process is built around that principle.

Ketamine therapy works best when it is integrated with the rest of your care. We are not here to replace your antidepressant, your mood stabilizer, your stimulant, or your benzodiazepine. We are here to add a different mechanism that the research suggests may help where conventional medications have not been enough. The off-label nature of psychiatric ketamine use is real, and so is the responsibility that comes with it. The right team coordinates. The wrong team improvises.

If you want to talk through your medication list, send it to us. Or bring it to your consultation. We will go through every line with you and your prescriber, with no pressure to change anything.