Key Issues in Ketamine: Benjamin Brody, MD, Highlights Patient Considerations at ASCP Annual Meeting

During a presentation on ketamine safety at the 2026 American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, Benjamin Brody, MD, associate professor of clinical psychiatry at Weill Cornell Medical College, and colleagues discussed on the practical safety considerations psychiatrists should evaluate before initiating treatment.

The discussion addressed a fundamental question facing clinicians: Which patients are most appropriate for ketamine therapy, and what safeguards should be in place to ensure treatment is delivered safely?

Patient Selection Begins With Careful Diagnostic Assessment

According to Brody, determining candidacy for ketamine starts with a thorough evaluation of the patient’s psychiatric presentation. Although ketamine has generated significant interest across a range of psychiatric conditions, Brody told Psychiatric Times that clinicians should remain focused on identifying patients whose diagnoses and symptom profiles align with the evidence base supporting treatment.

The presence of treatment-resistant mood disorders or acute suicidal ideation associated with mood disorders may help guide decision-making regarding whether ketamine represents an appropriate intervention, he added.

By emphasizing diagnostic appropriateness as the first step in evaluation, Brody underscored that ketamine should not be viewed as a universal treatment option but rather as a targeted intervention that requires careful clinical judgment.

Medical Stability Remains a Critical Safety Consideration

Beyond psychiatric diagnosis, Brody emphasized the importance of assessing medical stability before treatment begins.

“Other factors that should be considered are medical stability,” he said. “If patients have uncontrolled hypertension, that would be a concern.”

The comment reflects the broader need for psychiatrists to conduct medical screening before initiating ketamine therapy. Although ketamine has become more widely available in psychiatric settings, Brody suggested that clinicians should remain attentive to medical conditions that may increase risk during treatment administration.

Evaluating cardiovascular status and identifying potentially destabilizing medical conditions are among the factors that can help inform whether ketamine treatment can proceed safely.

Substance Use Disorders Present a Complex Clinical Challenge

One of the more nuanced areas discussed by Brody involves patients with active substance use disorders.

Although emerging research suggests ketamine may hold promise for certain individuals with substance use concerns, Brody cautioned that the decision-making process is far from straightforward.

“If patients are actively abusing substances, that's a very tricky area,” he told Psychiatric Times. “There is some research that suggests that ketamine might be particularly effective in that [patient] population, but there's also risks associated with exposing patients with substance use disorders to new compounds that are potentially substances of misuse.”

The challenge, he explained, lies in balancing potential therapeutic benefits against concerns related to misuse and abuse liability. As ketamine treatment expands into broader clinical settings, psychiatrists may increasingly encounter patients whose substance use histories complicate treatment planning.

“That's a tricky area as well,” Brody added, emphasizing the need for individualized risk-benefit assessments rather than one-size-fits-all decision-making.

Why In-Person Monitoring Matters

The setting in which ketamine is administered also plays a significant role in patient safety, Brody told Psychiatric Times.

Brody identified in-person monitoring as a key component of responsible ketamine treatment.

“The setting of ketamine administration is critical,” he said.

The emphasis on monitoring reflects growing recognition that ketamine treatment involves more than medication delivery alone. Medical oversight during administration may allow providers to identify adverse reactions, respond to distressing experiences, and support patients throughout treatment sessions.

Preparing Patients for Dissociative Experiences

Another important aspect of ketamine safety involves preparing patients for the dissociative effects that frequently accompany treatment, he said.

According to Brody, patients' responses to these experiences can vary considerably. Although individuals often describe dissociation as unusual but manageable, others experience it very differently.

“Many patients find them odd, but not especially troubling,” Brody said. “There's a group of patients that find them pleasant and pleasantly intoxicating.”

At the same time, he noted that positive experiences may contribute to ketamine's potential for misuse in some individuals.

More concerning, however, are patients who experience dissociation as intensely distressing.

“Through some of my work, I've also identified some patients who find the dissociative experience to be frightening and potentially terrifying,” Brody said, “and some who have even expressed suicidal ideation in the context of ketamine administration.”

Those observations underscore the importance of setting expectations before treatment begins, he said. Educating patients about possible perceptual and psychological effects may help reduce anxiety and improve preparedness should dissociative symptoms occur during administration.

“It's important, I think, for patients to know about the potential experiences they may have during the dissociative experience so that they can go into it informed,” Brody said.

Practical Takeaways for Those Considering Ketamine Therapy

For psychiatrists evaluating patients for ketamine treatment, Brody's message is ultimately one of careful preparation and clinical vigilance. Appropriate patient selection, assessment of medical stability, consideration of substance use history, structured monitoring, and proactive patient education all play important roles in promoting safe treatment.

“Those are some of the major things that I think clinicians should be aware of and should be thinking about when they're evaluating patients for possible ketamine therapies,” he told Psychiatric Times.

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