Introduction
Preparing for a first ketamine therapy session can be accompanied by uncertainty and apprehension. Ketamine is different from conventional psychiatric medications in nearly every respect: it is administered in a clinical setting under direct medical supervision, it produces noticeable acute effects during the session including altered perception, and its therapeutic benefits can emerge within hours rather than weeks. Understanding what preparation involves, what will happen during the session, and how to plan for the period afterward helps patients approach treatment with realistic expectations and positions them for the best possible outcome.
This guide walks through the preparation process from the initial evaluation through the day of treatment and immediate follow-up, providing practical guidance based on standard clinical protocols.
Before the First Session
Medical Evaluation
Every ketamine treatment program begins with a comprehensive medical evaluation, which may be conducted in person or via telehealth depending on the program. This evaluation serves two purposes: confirming that ketamine is an appropriate treatment option for your condition, and identifying any medical factors that require special monitoring or preclude treatment.
The evaluation typically includes a detailed psychiatric history (current symptoms, prior diagnoses, previous medication trials and their outcomes), a medical history with particular attention to cardiovascular health, liver function, and kidney function, a review of all current medications and supplements, blood pressure measurement (in-person evaluations), screening for substance use history, and assessment for conditions that may be contraindications to ketamine, such as uncontrolled hypertension, active psychosis, or certain cardiovascular conditions.
Info: The most common reason for deferring a first ketamine session is elevated blood pressure at baseline. If your blood pressure is above the acceptable range at evaluation, your clinician may ask you to work with your primary care provider to optimize blood pressure control before proceeding with ketamine treatment.
Medication Review
Certain medications can interact with ketamine or influence the treatment response. Your clinician will review your medication list and may provide specific instructions, which could include temporarily holding benzodiazepines (such as lorazepam, clonazepam, or alprazolam) on the day of treatment, as these can attenuate ketamine's therapeutic effects in some clinical models. However, this decision is individualized, and patients should never discontinue medications without explicit instruction from their prescriber.
Lamotrigine, memantine, and certain other glutamate-modulating medications have theoretical interactions with ketamine, and your clinician will advise whether any adjustments are needed. Opioid medications are generally continued, though your clinician will factor them into the monitoring plan.
Important: Continue all other prescribed medications as usual unless your ketamine provider gives you specific instructions to the contrary. This includes blood pressure medications, antidepressants, and any other chronic medications.
Practical Logistics
The practical aspects of planning for a ketamine session are straightforward but important:
Transportation: You will not be able to drive for 24 hours following ketamine treatment. Arrange for someone to drive you home from the appointment. Ride-sharing services are an alternative if a personal driver is not available, though having a companion is preferable.
Time commitment: Plan for the total appointment to last 2 to 3 hours. The infusion itself (for intravenous ketamine) is typically 40 minutes, but pre-treatment vital sign checks, the recovery/observation period (60 to 90 minutes), and final assessment before discharge add to the total time. Sublingual protocols may have slightly different timelines.
Work and responsibilities: Schedule the session on a day when you do not have significant obligations afterward. Many patients prefer late-morning or early-afternoon appointments that allow them to return home and rest for the remainder of the day.
Clothing and comfort: Wear comfortable clothing with loose-fitting sleeves if intravenous access will be placed. Some patients bring an eye mask, headphones, or a meaningful personal item to enhance comfort during the session.
The Day of Treatment
What to Eat and Drink
Most clinics recommend a light meal two to four hours before the appointment. Avoid eating a heavy meal immediately before treatment, as nausea is one of the more common side effects and a full stomach increases this risk. An empty stomach is not necessary or advisable -- moderate food intake provides stable blood sugar without excessive gastric content.
Stay normally hydrated. Avoid alcohol for at least 24 hours before treatment. Limit caffeine on the treatment day, as it can independently raise blood pressure and increase anxiety.
Arriving at the Clinic
Upon arrival, you will typically check in, complete any remaining paperwork or consent forms, and have your vital signs measured (blood pressure, heart rate, oxygen saturation). If your blood pressure is above the acceptable range, the clinical team may have you rest quietly for 10 to 15 minutes and remeasure; significant anxiety upon arrival commonly elevates readings that normalize with brief relaxation.
An intravenous catheter (IV) will be placed if you are receiving an infusion. Once you are settled in a comfortable position (typically reclined in a chair or on a bed), monitoring equipment will be attached, and the clinician will review what to expect before beginning the infusion.
During the Treatment
Clinical: The acute effects of ketamine -- which may include feeling "floaty," dreamy, or disconnected from your surroundings -- are temporary and expected. They are not dangerous and typically resolve within 60 to 90 minutes after the infusion ends. Many patients find the experience neutral or even pleasant when they are prepared for it.
During a standard 40-minute intravenous infusion at 0.5 mg/kg, you may begin to notice effects within 5 to 10 minutes. Common experiences include a feeling of lightness or floating, changes in perception of time, mild visual changes (colors may appear more vivid, objects may seem to shift), emotional sensitivity or introspection, a sense of detachment from your body or surroundings, and a dreamy or meditative state.
These effects typically peak during the last 10 to 15 minutes of the infusion and gradually resolve over the following 30 to 60 minutes. Some patients experience mild nausea, which can usually be managed with anti-nausea medication. The clinical team will check your blood pressure regularly throughout.
Throughout the session, the clinical team is present and monitoring you. You can communicate with them at any time if you feel uncomfortable. If the experience becomes distressing, the infusion rate can be slowed or the infusion paused.
What You Will Not Experience
It is worth noting what ketamine at therapeutic doses does not do. You will not lose consciousness. You will not be unable to communicate (though you may prefer not to speak). You will not experience general anesthesia. The treatment occurs at doses far below those used for surgical anesthesia, specifically calibrated to produce therapeutic effects while maintaining consciousness and safety.
After the Treatment
Immediate Post-Session Period
After the infusion is complete, you will remain in the clinic for 60 to 90 minutes while the clinical team monitors your vital signs and assesses your recovery. During this time, the dissociative effects gradually resolve, and you will progressively feel more "normal." The clinical team will assess your alertness, orientation, and stability before clearing you for discharge.
Most patients describe the post-treatment period as feeling calm, relaxed, and perhaps mildly fatigued. Some patients notice mood improvement within hours of their first session, while for others the antidepressant effect develops more gradually over subsequent treatments. Both patterns are normal.
The First 24 Hours
For the remainder of the treatment day, plan to rest at home. Do not drive, operate heavy machinery, make major decisions, sign legal documents, or consume alcohol for 24 hours. Some patients feel tired and prefer to sleep; others feel energized and alert. Both responses are within the normal range.
Light activities such as reading, listening to music, gentle walking, or spending time with supportive people are appropriate. Many clinicians recommend journaling about your experience and any thoughts or insights that arose during the session, as this supports the integration process.
Follow-Up and Ongoing Treatment
Your clinician will schedule a follow-up contact (in person, phone, or video) within 24 to 72 hours of your first session to assess your response, address any concerns, and plan subsequent treatments. For most treatment protocols, ketamine is administered in a series of sessions (typically two to three per week for two to three weeks) rather than as a single treatment, followed by maintenance sessions at individually determined intervals.
Info: Mood improvement after ketamine often follows one of several patterns: some patients notice improvement within hours of the first session, others respond after two to three sessions, and some require a full initial series before experiencing significant benefit. Not responding immediately to the first session does not mean the treatment will not work.
Optimizing Your Experience
Setting Intentions
Before your session, consider reflecting on what you hope to gain from treatment. While ketamine works through pharmacological mechanisms regardless of your psychological state, many clinicians and patients find that approaching treatment with a clear therapeutic intention -- such as "I want to feel hope again" or "I want to break the cycle of negative thinking" -- enhances the subjective experience and supports the integration of treatment benefits into daily life.
Managing Anxiety
Pre-treatment anxiety is extremely common and does not indicate that you are a poor candidate for ketamine therapy. Strategies for managing anticipatory anxiety include asking your clinician to walk you through the entire procedure in advance (uncertainty drives anxiety more than the experience itself), practicing deep breathing or mindfulness exercises in the waiting area, bringing a trusted person to the appointment who can stay in the waiting room, and reminding yourself that the effects are temporary, the clinical team is monitoring you, and the experience is safe.
Building a Support System
Ketamine therapy is most effective when embedded in a comprehensive treatment plan that includes ongoing psychotherapy, healthy lifestyle practices, and social support. Consider informing a trusted friend or family member about your treatment so they can provide encouragement and practical assistance (such as transportation) throughout your treatment course.
References
- PubMed: Patient Perspectives on Ketamine Treatment for Depression — Qualitative study examining patient experiences and preferences regarding ketamine treatment preparation and delivery
- PubMed: Consensus Statement on the Use of Ketamine for Treatment of Mood Disorders — APA consensus guidelines addressing patient preparation, monitoring, and follow-up standards for ketamine therapy
- NIMH: Depression Treatment — National Institute of Mental Health resource on depression treatment options including novel pharmacological approaches
- MedlinePlus: Ketamine Injection Drug Information — National Library of Medicine patient medication information for ketamine
- Mayo Clinic: Treatment-Resistant Depression — Patient-oriented resource on treatment options for depression that has not responded to standard medications
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