• Uncontrolled or untreated hypertension (above 150/90)
• Some hepatic disorders (reviewed case by case)
• Some kidney disorders (reviewed case by case)
• Some vascular disorders (reviewed case by case)
• Presence of active psychotic symptoms
• Dementia
• Delirium
• Inability to tolerate group work
• Extreme emotional instability
• Ketamine allergy
• Pregnancy
• Medications that reduce the effectiveness of Ketamine:
  • Benzodiazepines
  • Lamotrigine
  • Buprenorphine

• Treatment in clinical trial where psilocybin would exclude patient from continuing to recieve treatment.
• Pregnancy or lactation
• Poorly controlled insulin-dependent diabetes
• Currently taking on a daily basis: investigational agents, or  MAO inhibitors. 
  • Patients taking MAO-A inhibitors (especially the irreversible inhibitors) will require a minimum 2-week washout period. The possible concern over serotonin syndrome with these agents is not well documented in the literature, however the long interval before MAO is replenished may warrant a cautious approach based on the patient’s risk factors and warrants oversight from the MRP (Most Responsible Physician)
  • Patients taking MAO-B inhibitors should be assessed on a case by case basis as there is a potential for a heightened response and warrants oversight from the MRP.
• Active uncontrolled epilepsy. 
• Cancer has central nervous system involvement. 
• Paraneoplastic syndrome or a tumor with ectopic hormone production which may place the patient at risk for hypercalcemia, Cushing’s syndrome, or SIADH secretion. 
• Uncontrolled cardiovascular conditions: uncontrolled hypertension, uncontrolled angina, a clinically significant ECG abnormality (e.g. QT prolongation). 
• Uncontrolled vascular disease (such as TIA in the last 3-6 months, stroke with loss in mental status, peripheral or pulmonary vascular disease with active claudication). 
• Severity of depression or anxiety symptoms warranting immediate emergent treatment with antidepressant or daily anxiolytic medication (e.g., due to suicidal ideation) as these patients would require immediate referral to community psychiatry.
• Current or past history of meeting DSM-5 criteria for (the following diagnoses must have been confirmed by a qualified psychiatrist or psychologist):
  • Schizophrenia; 
  • Psychotic Disorder (unless substance-induced or due to a medical condition); 
  • Borderline Personality Disorder; 
  • Bipolar I Disorder; 
  • Bipolar II Disorder; 
  • Other psychiatric conditions judged to be incompatible with establishment of rapport or safe exposure to psilocybin. 
  • Borderline Personality Disorder, Bipolar I Disorder and Bipolar II Disorder may be considered after a psychiatric consult.
  • Bipolar I would require more in-depth investigation in relation to the history of manic episodes.
• Meet DSM-5 criteria for Dissociative Disorder 
• Concurrent use of illicit drugs causing ongoing intoxication 
• Unstable housing conditions (homelessness)

Conditions requiring special psychiatric consideration:

• First degree relatives meet DSM-5 criteria for Bipolar Disorder or Schizophrenia.