Selecting the right patient is key to success with ketamine! One expert psychiatrist who has given several thousand ketamine administrations will decline the medicine to perhaps half the patients seeking it. In the medical literature the success rate is around 70%; his is in the upper 90s, because he is so careful who he gives it to.

There are several issues in screening:

• Safety. Are there medical or psychiatric reasons this drug should not be used?

• Condition being treated: Ketamine is really effective for PTSD and other trauma-related conditions, and for helping to loosen the locked-in emotions. On the other hand it’s pretty limited in OCD, and while it can help in treating addictions, it is not effective on its own. It’s good for bipolar depression but mustn’t be used during mania. Part of the screening is making sure what we’re treating.

• Is your particular depression really a psychiatric condition, or is it a symptom of other things going on? Some really common causes of symptoms of depression include low thyroid and other hormones, sleep apnea, anemia, alcohol and cannabis use, certain nutritional deficiencies, and medications. If depression is caused by one of these it is really unlikely to improve with ketamine and you’re best off treating the underlying condition.

• Medications. There are some medications that will interfere with ketamine’s effectiveness, and you may be better off waiting for ketamine until you have reduced or eliminated these medications. And getting off of them may be all you need to treat depression.

• Patient readiness. Are you doing the work, are you working with a therapist who can help you move forward? Are your expectations and intentions appropriate? Is there space in your life to experience ketamine and to process the experience? Are you willing to make the changes in your lifestyle (and, possibly, medication regimen) to make the most of this?

The screening process starts with first contact. I will have a short conversation with you, via phone or text, about your condition and intention. If there is a clear reason not to move forward I will let you know that.

The next step is to download the screening form. It’s long and comprehensive, and will take an hour or more to fill out. There are several reasons for this length: it helps me know you and to use our intake time effectively; it digs for how ketamine might be helpful, or not; and it makes you do a big review of your health. Ideally I would like to see it in advance, but otherwise you can bring it to the intake session. Please use this form as an opportunity for some serious reflection.

I will meet with you for a 2-hour block for intake. That sounds like a long time but it goes quickly. There may be things you don’t want to talk about, and I will respect that, but there are also things I need to know for safety. Part of the intake is to go over the process and what to expect, and to answer questions. And we will go over informed consent.

I may recommend meeting one or more times between the intake and the journey if I feel it’s important.