Ketamine infusion therapy has emerged as a promising treatment modality for individuals struggling with conditions such as treatment-resistant depression, chronic pain, and severe anxiety. This innovative approach offers rapid symptom relief by targeting neurotransmitter systems in the brain, particularly the NMDA receptor. To maximize the therapeutic benefit, careful preparation is required. Understanding the necessary medical, logistical, and psychological steps beforehand is a fundamental part of the overall treatment plan.
Medical and Medication Adjustments
Strict fasting guidelines are the most immediate preparatory measure, mitigating the risk of aspiration, a serious complication if a patient vomits while sedated. Patients are typically instructed to avoid all solid foods and non-clear liquids for at least four to eight hours before the scheduled infusion time. This period ensures the stomach is empty, significantly reducing the likelihood of complications if nausea, a common side effect of ketamine, should occur. Clear liquids, such as water or apple juice, are often permitted up to two hours before the appointment, but this timeline must be confirmed with the treating clinic.
A comprehensive review of all current prescription medications must be completed with the prescribing physician. Certain classes of psychoactive drugs can interfere with ketamine’s mechanism of action or heighten adverse effects. Specifically, medications like benzodiazepines, which are often used for anxiety, may need to be temporarily paused or have their dosage adjusted, as they can dull the therapeutic effects.
Other medications, including stimulants, opioids, or certain antidepressants, require discussion with the medical team, as they may affect the patient’s blood pressure or heart rate. Unlike benzodiazepines, most selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants do not typically need to be stopped. However, the exact protocol for every medication must be determined by the ketamine provider to ensure a safe procedure and optimal therapeutic outcome.
Logistical Planning for the Day of Infusion
Proper logistical arrangements are mandatory for the day of the infusion, focusing on post-treatment safety and comfort. Because ketamine can cause grogginess, disorientation, and impaired coordination, operating a vehicle is strictly prohibited. Patients must arrange for a trusted friend or family member to drive them home, or utilize a rideshare service, as driving is unsafe for several hours, sometimes up to 24 hours.
Selecting comfortable attire is advisable, as the patient will be seated or reclining for the 90-minute infusion. Loose-fitting clothing allows for easy placement of the intravenous line and monitoring equipment, and bringing layers is recommended since the clinical environment may feel cool. Patients should confirm the expected arrival time and total duration of their stay to accommodate the full timeframe, including recovery.
Enhancing the Treatment Environment
Bringing items that enhance the “setting” of the experience can contribute to a more positive treatment environment. This often includes an eye mask to block out light and high-quality headphones to listen to a pre-selected playlist of calming, instrumental music, which can help guide the experience. While hydration is encouraged the day before, a water bottle can be brought to use immediately after the infusion is complete, as patients may feel thirsty upon recovery.
Mental Preparation and Setting Expectations
The psychological approach to the infusion, referred to as “set and setting,” significantly influences therapeutic efficacy. Patients should work to establish a positive mindset (“set”) by practicing relaxation techniques like mindfulness or deep-breathing exercises in the days leading up to the appointment. This helps to reduce pre-treatment anxiety and promotes a state of openness before the medicine is administered.
A core component of mental preparation involves setting a clear intention—an objective or goal for the session, such as seeking emotional relief or clarity. This intention acts as a mental anchor during the dissociative phase of the experience, providing a focus for the mind. Focusing on this goal can help ground the patient and guide the therapeutic insights that may arise during the altered state of consciousness.
The dissociative sensation is an expected pharmacological effect of ketamine, not a cause for alarm. This temporary separation from typical reality often facilitates new neural connections and perspectives. Patients are encouraged to relinquish the need to control the experience, trusting the process and allowing the internal journey to unfold naturally, which maximizes the treatment’s potential for lasting change.