Preparing for ketamine therapy involves a combination of physical steps (fasting, hydration, clothing choices) and mental ones (setting intentions, arranging transportation, reviewing your current medications). Most clinics will walk you through their specific protocols, but knowing what to expect ahead of time helps you arrive calm, comfortable, and ready to get the most from your session.
Fasting and Hydration Timeline
Ketamine can cause nausea, and having food in your stomach increases that risk. The standard protocol at most clinics follows a straightforward timeline: no solid food for eight hours before treatment, no gum, candy, or smoking for six hours before, and water only up to four hours before your session. If your appointment is at 10 a.m., that means your last meal should be no later than 2 a.m. the night before, and your last glass of water by 6 a.m.
Staying well-hydrated in the days leading up to your appointment is worth the effort. Good hydration makes it easier for the clinical team to place an IV line if you’re receiving an infusion, and it helps your body process the medication more smoothly. Drink plenty of water the day before, and have a glass or two the morning of your session within that four-hour window.
Medications That Can Reduce Effectiveness
Two common medication classes deserve special attention before starting ketamine therapy: benzodiazepines and lamotrigine. Both can interfere with how well ketamine works, and your provider needs to know if you’re taking either one.
Benzodiazepines (drugs like lorazepam, diazepam, and clonazepam, as well as sleep aids in the same family) appear to blunt ketamine’s antidepressant effects in a dose-dependent way. A systematic review in the International Journal of Neuropsychopharmacology found that patients on higher doses of benzodiazepines took significantly longer to respond, reached remission more slowly, and relapsed sooner. In one case report, a patient’s response to ketamine jumped from lasting several days to lasting 10 to 14 days after their benzodiazepine was withdrawn. Patients on lower doses still responded, but higher doses predicted nonresponse during the week following an infusion. The takeaway: minimizing benzodiazepine use before and after ketamine sessions can meaningfully improve outcomes.
Lamotrigine, a mood stabilizer commonly prescribed for bipolar disorder, works by reducing the same type of brain signaling that ketamine ramps up. Multiple studies have found that lamotrigine pretreatment weakens ketamine’s effects on dissociation, brain activity, and psychiatric symptoms. If you’re on lamotrigine and don’t respond well to ketamine, the interaction is worth discussing with your prescriber.
Do not stop or adjust any medication on your own. Bring a full list of everything you take, including supplements and over-the-counter drugs, to your pre-treatment consultation so your provider can make a safe, informed plan.
Blood Pressure and Physical Screening
Ketamine temporarily raises blood pressure and heart rate, which is why clinics monitor your vitals throughout each session. If your blood pressure is uncontrolled, your session may be postponed. The Veterans Affairs system, for example, considers a systolic reading above 160 or a diastolic reading above 90 a contraindication for IV ketamine for depression.
If you have a history of high blood pressure, make sure it’s well-managed in the weeks leading up to treatment. Avoid caffeine on the morning of your session, as it can push readings higher. Your clinic will check your vitals before starting, and if your numbers are outside their acceptable range, they’ll ask you to reschedule rather than proceed.
What to Wear
Comfort matters more than you might expect. You’ll be sitting or reclining for 40 to 60 minutes during an infusion, and the medication can make you sensitive to physical sensations. Wear loose, soft clothing: think leggings or sweatpants, a comfortable shirt with sleeves you can easily push above your elbow. The clinical team needs access to your upper arm for a blood pressure cuff and potentially your forearm or hand for an IV line. Skip anything with excessive zippers, buttons, or tight collars that might feel restrictive once the medication takes effect.
Many clinics keep the room cool, so layering with a light sweater or bringing warm socks is a practical move. Blankets are typically provided, but your own comfort items can help you feel more at ease.
Setting an Intention
Unlike picking up a prescription, ketamine therapy, especially ketamine-assisted psychotherapy, benefits from mental preparation. Setting an intention before your session gives your experience a focal point. This doesn’t need to be elaborate or perfectly worded. It’s simply a question you want to sit with or an area of your life you want to explore while the medication opens a different perspective.
Intentions can be broad or specific. Some examples that clinicians commonly suggest:
- Exploring the roots of chronic anxiety or recurring emotional patterns
- Understanding how past relationships or childhood experiences shape your present behavior
- Developing greater self-compassion or self-acceptance
- Processing grief, trauma, or unresolved anger
- Cultivating a sense of grounding and stability during stressful periods
- Deepening awareness of the connection between your body and emotions
Write your intention down before you arrive. Some people journal about it the night before, others simply hold a phrase in mind during the session. The goal isn’t to force a particular outcome. It’s to give your mind a gentle direction so the experience feels purposeful rather than aimless.
The Room and Sensory Environment
Ketamine sessions typically take place in a carefully controlled setting designed to feel safe and calming. Expect dim, adjustable lighting, soft furnishings like blankets and extra pillows, and minimal visual clutter. Many clinics provide eye masks to help you turn your attention inward, and noise-canceling headphones through which a curated music playlist is played throughout the session.
The music isn’t background noise. It’s chosen deliberately to support emotional processing and act as an anchor during the experience. Some clinics share the playlist ahead of time so you can familiarize yourself with it, which can reduce anxiety on treatment day. If your clinic offers this, take advantage of it. Hearing familiar sounds during an unfamiliar experience makes a difference.
If you haven’t visited the clinic before, ask whether they can show you the treatment room in advance or send photos. Knowing what the space looks like removes one layer of uncertainty.
Transportation and the 24-Hour Rule
You will not be able to drive yourself home. The standard guideline is no driving or operating heavy machinery for 24 hours after a ketamine infusion. This isn’t a suggestion. Ketamine affects coordination, reaction time, and judgment, and these effects can linger well after you feel “normal” again.
Arrange a ride before your appointment. A trusted friend, family member, or rideshare service all work. Some people find it helpful to have someone they’re comfortable with pick them up, since you may feel emotionally open or disoriented in the first hour or two after treatment. Plan for a quiet evening at home. Keep your schedule clear for the rest of the day so you can rest, reflect, or simply decompress without obligations.
The Night Before and Morning Of
A good night’s sleep before your session helps your body and mind handle the experience more smoothly. Avoid alcohol the night before, as it can increase nausea and interact unpredictably with ketamine. Eat a light, balanced dinner that falls within the eight-hour fasting window.
On the morning of your session, keep things simple. Hydrate within the allowed window. Skip caffeine if your clinic advises it (or if you have any blood pressure concerns). Bring your ID, insurance information, a list of current medications, headphones if your clinic asks you to, and anything that helps you feel comfortable: a favorite blanket, warm socks, a journal for afterward. Leave your phone on silent or hand it to a companion so notifications don’t intrude during treatment.
If you feel anxious the morning of, that’s completely normal. A few minutes of slow breathing or reviewing your written intention can help settle your nerves before you walk through the door.