The most common thing I hear from patients before a first consultation is some version of: “I am not sure I am a bad enough case for this.”
Let me address that directly, because it reflects the single biggest misconception I encounter. People assume ketamine and Spravato are reserved for the most extreme presentations — suicidal crisis, inpatient stays, absolute last resort. The reality is more straightforward than that. These are evidence-based treatments for people who have tried the standard path and not gotten there. That is the threshold.
The other thing I hear often is an assumption that these treatments are still experimental — something on the frontier of psychiatry that serious clinicians are skeptical of. That is no longer true. The evidence base includes dozens of randomized controlled trials, multiple systematic reviews and meta-analyses, and FDA approval for esketamine. This is mainstream clinical psychiatry now. The question is not whether it works. The question is whether it is right for you specifically.
What a Good Candidate Actually Looks Like
The typical patient who is a strong candidate for ketamine or Spravato at Parker Neuroscience is someone who has been doing everything right for years and is still not well. They are not someone who gave up on treatment — they are someone who stayed with it, tried multiple medications, engaged with therapy, and kept showing up. The system just did not deliver.
Clinically, the primary indication is treatment-resistant depression — a major depressive episode that has not adequately responded to at least two antidepressants at adequate dose and duration. Spravato carries FDA approval for that specifically, and also for major depressive disorder with active suicidal ideation. Beyond depression, the evidence supports consideration of ketamine for chronic PTSD, treatment-resistant anxiety disorders including OCD, and carefully evaluated cases of bipolar depression.
The common thread is not severity — it is that the standard approach has run its course without sufficient result.
Factors That May Limit or Complicate Candidacy
I am going to be straightforward here because I think patients deserve that. The following conditions are either contraindications or require careful evaluation before we proceed:
- ●Active or past psychosis or schizophrenia — ketamine’s dissociative effects can worsen psychotic symptoms
- ●Uncontrolled hypertension or glaucoma — ketamine raises blood pressure during infusion; we need cardiovascular stability first
- ●Active substance use disorder, including alcohol and kratom — not a permanent exclusion in most cases, but sobriety and stability are required before we start
- ●Pregnancy or breastfeeding
- ●Active mania — mood needs to be stabilized before interventional treatment begins
- ●Severe cardiovascular disease — requires thorough cardiac evaluation and clear risk-benefit conversation
Having one of these factors does not automatically end the conversation. It means we need more information. I have had patients come in with complicated histories where the right answer was not no — it was not yet, or we need to address X first. That is what a real clinical evaluation is for.
How I Approach the Consultation Differently
The first thing I do in a consultation that I believe sets Parker Neuroscience apart is tell you upfront what I can and cannot offer before we go any further. Not a pitch. Not a protocol walkthrough. A direct statement of what this practice does, what it does not do, and what my honest clinical read is on whether you are in the right place.
That means if I do not think you are a candidate, I will tell you — and I will try to help you understand what the right next step actually is. It also means if I think you are a strong candidate and have been waiting longer than you needed to, I will tell you that too.
What I do not do is run every inquiry through the same intake funnel and assume treatment is the answer before we have actually talked. Twenty years in emergency medicine taught me that the most important clinical skill is reading a patient accurately before doing anything at all.
The Bottom Line
If you have been doing everything right — following the treatment plan, taking the medications, showing up to therapy — and you are still not where you need to be, you are probably the person this practice was built for. Not because I am promising results. Because you deserve a real clinical evaluation from someone who will be straight with you, and because the evidence supporting these treatments is strong enough that not exploring them is a genuine clinical oversight.
The consultation is where it starts. I am in Omaha, Nebraska. And I will tell you the truth about what I think.
References
1. Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med. 2023;388(25):2315–2325.
2. Janik A, Qiu X, Lane R, et al. Esketamine monotherapy in adults with treatment-resistant depression. JAMA Psychiatry. 2025;82(9):877–887.
3. Feder A, Costi S, Rutter SB, et al. A randomized controlled trial of repeated ketamine administration for chronic PTSD. Am J Psychiatry. 2021;178(2):193–202.
4. Parikh SV, Lopez O, Maixner DF, et al. Developing an IV ketamine clinic for treatment-resistant depression: a primer. Psychopharmacol Bull. 2021;51(3):109–124.