Beginning Treatment
Ketamine BasicsWhat is Ketamine?Is Ketamine Safe?What are the Different Types of Ketamine?What is the Connection Between Ketamine and Therapy?
Eligibility, Insurance, and MoreWho is Eligible for Ketamine?Ketamine Eligibility QuestionnaireInsurance and Cost InfoWhere Can I Get Ketamine Treatment?
Beginning Ketamine TreatmentPreparing for TreatmentWhat to Expect at TreatmentIntention SettingHow Will I Feel After Treatment
In Ketamine TreatmentIntegrationJournalingArtistic ReflectionMeditation & Reflection

Beginning Ketamine Treatment

Many people find the build-up to their first appointment to be the most anxiety inducing. We're here to help you ease that worry with some tips about what you can do leading up to your appointment and set expectations for your treatment.
Preparing for my first treatment
What to expect at my first treatment
experience by ketamine type
how i will feel after my first treatment
Preparing For
My First TreatmentWhat To Expect
At My First TreatmentExperiences
By TypesIntention SettingHow Will I Feel After My First Session
Table of Contents
Preparing For
My First TreatmentWhat To Expect
At My First TreatmentExperiences
By TypesHow Will I Feel After My First Session

Physical

Mental

fyi

Your provider may have their own list of recommended practices before, during, and after the session. Always listen to their recommendations first before considering these recommendations.

What is an intention? Is it different from a goal?

Many providers will suggest that you set an intention before your sessions and that this is different from a goal. A goal is outcome oriented, something you would achieve, while an intention is a mindset or thoughts with which you’d like to frame your sessions.
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A goal might be “Stop being angry” whereas an intention could be “explore where my anger is coming from.” Or a goal would be “change my response to an event” whereas an intention could be “patience and curiosity.”
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As you can see, intentions are more focused on the process and observations as you move through your treatments. They can help to direct your mind where you’d like to go and what you want to happen during your session.

How do I set an intention?

Finding your intention can be difficult, especially if you don’t know where to start! Start simply with reflecting inward and identify possible reasons you are seeking ketamine therapy. The good news - There’s no one “right” intention. You are the best source for the answers to your questions. Need a little help finding those questions? Here are a couple to help guide your discovery:
  • What is the reason you are seeking this treatment?
  • What aspects of your life do you find are holding you back or causing you to get stuck?
  • What would you like to change about your approach or outlook to your personal life, work, friends, family?
While it’s easy to start identifying areas of your life you’d like to focus on, don’t take on too much! We’ve found that focusing on 1-2 intentions allows you to explore these areas more deeply - even just a single word could work. Perhaps thinking of healing, gratitude, patience, awareness, or inspiration could help you find a your intention.

It is important to spend time with these reflections in order to get the most out of your treatment. While there is no one perfect way to set your intentions, we recommend you try journaling through these questions, talking about them with friends or family that you trust, or simply discussing them with your therapist or psychiatrist.

To assist with intention setting, it may be helpful to treat your treatment and integration as big events on your calendar. Allow them to occupy your mind as it can help you reflect on what you want to focus on during and after your treatment as well as during your integration. More on integration in the In Treatment section of our resources.

Clinic Space

Most clinics have either private or semi-private spaces where you'll sit for your treatment and therapy. These rooms often have a reclining chair or lounger in them and should be equipped with the appropriate medical supplies.

On the day of your session, your provider or a member of the team will bring you to the treatment space, discuss logistics, and administer the drug. Of course, the administration process will vary depending on the type of ketamine you are receiving.

Setting Elements

With ketamine treatment, the addition of eye masks, music, and other "add-ons" can have a strong influence on your experience. Two elements patient often use during sessions are eye masks and music.

Eye masks can impact the therapeutic nature of your session, directing your thoughts internally or externally. When your eyes are covered, so your thoughts and the images you see are free to wander. Without a eye mask, you engage more with the external world, the people and objects in the room where you're sitting, and this can shape the experience in a different way. Some providers may make a recommendation but you're entitled to choose what's most comfortable for you.

Music can play an important role in your ketamine treatment. The beat, instruments, and pace of the music can influence the rate and intensity of your visualizations and thoughts. Patients often enjoy listening to music during their session to go deeper into the experience and others prefer no music at all. It’s completely up to you!

Some providers use playlists that they’ve curated to accompany your session and they may offer headphones or play the music out loud. There are companies, like Wavepaths, that have a broad selection of music that you can curate to your therapeutic experience. Below, we share some playlists from MAPS and Johns Hopkins for you to check out as well as links to other services that are often used during ketamine sessions.

Time in Clinic

For the ketamine treatment itself, the treatment can last anywhere from 90 minutes to ~2.5 hours. Compliance requirements for Spravato™️ mandate that a patient remains in the clinic for a 2 hour observation period.
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With Ketamine-Assisted Psychotherapy (KAP), many providers will have you in the clinic for ~1 - 2 hours surrounding your treatment to conduct a medical exam as well as for preparation and integration therapy sessions. Different providers do this differently, but if you're doing KAP, you can expect to have a longer session than ketamine treatment alone.

Full Drug Effects

Remembering that ketamine is a dissociative drug, it's completely normal to feel some things once the drug takes full effect that might be uncomfortable.

Some of the side effects include nausea, headache, dizziness, drowsiness, blurry vision, mood changes, sensitivity to light and sound, and temporary elevation of heart rate and blood pressure. Most side effects are fully resolved 30 minutes to 1 hour. This will vary depending on the form of ketamine you're receiving.

ketamine types

Intravenousintramuscularoral/sublingualesketamineIntramuscularSublingual/OralEsketamine/Spravato™️Intravenous

words to know

the legal stuff

The information and statistics provided below are generalized for the purpose of approachability. Each patient, their experience, and the medical professional they work with may have different experiences or recommendations. Please speak with a licensed medical provider to understand how ketamine therapy might work for you. We are not suggesting or recommending any course of care for readers. We are providing this information for educational purposes only.

Intravenous  when a needle or catheter with a solution of ketamine is injected into the patient’s veins

Setting

Clinical Setting

Bioavailability

High

Onset

Within Seconds

Duration

1 - 2 Hours

Frequency

6 infusions over 2 - 3 weeks

Cost

$400 - $1,000 per infusion

what to expect during the session

The provider will start a small IV in the patient’s hand or arm, and place them on a monitor. As the infusion starts, the patient is instructed to recline, relax, and close their eyes. Throughout the infusion, the provider will intermittently monitor vital signs. It is possible that during the first 15-20 minutes no noticeable effects arise.

Halfway through, most patients begin to experience feelings described as: euphoria, floating, heightened perceptions, feeling disconnected, or in a dream. However, the patient is awake during the infusion, fully aware of their presence and able to communicate with the staff. During the infusion, patients usually have a slight increase in their rate of breathing. The heart rate and blood pressure will also moderately increase. These feelings usually last about 10-15 minutes after the completion of the infusion. The session lasts approximately 90 minutes from entering the clinic to leaving.

Although less common, some patients may experience some anxiety, sweating, or a headache and medication can be administered if those symptoms persist.After the infusion, mood effects are typically noticeable 4 to 24 hours post-infusion. The patient might feel less sad, more hopeful, with decreased thoughts of suicide and/ or increased calmness

Intramuscular  when the ketamine solution is injected into the muscles of either the patient's leg or arm

Setting

Clinical Setting

Bioavailability

High

Onset

2 - 4 Minutes

Duration

1 - 2 Hours

Frequency

6 infusions over 2 - 3 weeks

Cost

$250 - $750 per injection

what to expect during the session

A nurse or doctor injects the medication directly into the patients’ arm. Some patients report minor pain typical of an injection.

As the ketamine enters the bloodstream, some patients experience a tingling sensation, others begin to feel “heavier”, and others feel somewhat detached from their body. Patients also report feeling extremely calm and relaxed. If wanting to move, the patient should ask for assistance, as their balance may be temporarily impaired. Less commonly, some patients experience side effects, including nausea, faintness or headaches.

It is recommended that the patient stay for a 1-hour period of observation after the treatment. Many patients return quickly to a regular state, although it is normal to feel groggy immediately after and for about 3 hours post-treatment. Coordination may be temporarily impaired as well. Because IM causes an immediate upstroke in blood levels, IM has a much sharper onset, plateau, and comedown than IV.

Oral/Sublingual  when a lozenge or oral solution is held in the mouth for approximately 10 to 15 minutes as it is slowly absorbed into the bloodstream

Setting

Clinical or Home Setting

Bioavailability

Low

Onset

5 - 10 Minutes

Duration

2 - 4 Hours

Frequency

6 treatments over 4 - 6 weeks

Cost

$150 - $200 per treatment

what to expect during the session

An average patient probably won’t feel anything for the first 15 minutes while holding the medicine in their mouth. During the next 15 minutes, they may feel unreal, or as though they are floating. If standing, the patient is likely to feel unsteady and dizzy. The patient may even have uncommon effects such as seeing double. These symptoms should last shortly.

In the third 15 minutes, the patient might feel sleepy and sleeping is encouraged. By the fourth 15 minutes, the patient will probably wake up on their own feeling fresh. Patient should be fully recovered 60-75 minutes after having begun to sip the ketamine.

Some patients experience rapid heartbeat, can feel anxious and may even cry. The medicine can produce nausea and vomiting, especially if the patient is fasting. Similarly, dissociative and other AEs can be stronger if the patient is fasting.

Esketamine  a ketamine derivative nasal spray, also known under the brand name Spravato™️, is delivered as one spray in each nostril, at 15 minute intervals

Setting

Clinical Setting

Bioavailability

Medium

Onset

~ 10 Minutes

Duration

2 - 4 Hours

Frequency

12 treatments over 8 weeks

Cost

$0 - $900 per treatment,
insurance dependent

what to expect during the session

An average patient probably won’t feel anything for the first 15 minutes while holding the medicine in their mouth. During the next 15 minutes, they may feel unreal, or as though they are floating. If standing, the patient is likely to feel unsteady and dizzy. The patient may even have uncommon effects such as seeing double. These symptoms should last shortly.

In the third 15 minutes, the patient might feel sleepy and sleeping is encouraged. By the fourth 15 minutes, the patient will probably wake up on their own feeling fresh. Patient should be fully recovered 60-75 minutes after having begun to sip the ketamine.

Some patients experience rapid heartbeat, can feel anxious and may even cry. The medicine can produce nausea and vomiting, especially if the patient is fasting. Similarly, dissociative and other AEs can be stronger if the patient is fasting.

Intravenous  when a needle or catheter with a solution of ketamine is injected into the patient’s veins

Setting

Bioavailability

Onset

Clinical Setting

High

Within Seconds

Duration

Frequency

Cost

1 - 2 Hours

6 infusions over 2 - 3 weeks

$400 - $1,000 per infusion

what to expect during the session

The provider will insert a small IV in the patient’s hand or arm, and place them on a monitor. As the infusion starts, the patient is instructed to recline, relax, and close their eyes. Throughout the infusion, the provider will intermittently monitor vital signs. It is possible that during the first 15-20 minutes no noticeable effects arise.

Halfway through, most patients begin to experience feelings described as: euphoria, floating, heightened perceptions, feeling disconnected, or dreamlike. However, the patient is awake during the infusion, fully aware of their presence and able to communicate with the staff. During the infusion, patients usually have a slight increase in their rate of breathing. The heart rate and blood pressure will also moderately increase. These feelings usually last about 10-15 minutes after the completion of the infusion. The session lasts approximately 90 minutes from entering the clinic to leaving.

Although less common, some patients may experience some anxiety, sweating, or a headache. However, medication can be administered if those symptoms persist. After the infusion, mood effects are typically noticeable 4 to 24 hours post-infusion. The patient might feel less sad, more hopeful, with decreased thoughts of suicide and/ or increased calmness

Intramuscular  when the ketamine solution is injected into the muscles of either the patient's leg or arm

Setting

Bioavailability

Onset

Clinical Setting

High

2 - 4 Minutes

Duration

Frequency

Cost

1 - 2 Hours

6 infusions over 2 - 3 weeks

$250 - $750 per injection

what to expect during the session

A nurse or doctor injects the medication directly into the patients’ arm. Some patients report minor pain typical of an injection.

As the ketamine enters the bloodstream, some patients experience a tingling sensation, feel “heavier”, and feel somewhat detached from their body. Patients also report feeling extremely calm and relaxed. The patient should ask for assistance to move as their balance may be temporarily impaired. Less commonly, some patients experience side effects, including nausea, faintness or headaches.

It is recommended that the patient stay for at least a 1-hour period of observation after the treatment. Many patients return quickly to a regular state, although it is normal to feel groggy immediately after and for about 3 hours post-treatment. Coordination may be temporarily impaired as well. Because IM causes an immediate upstroke in blood levels, IM has a much sharper onset, plateau, and comedown than IV.

Oral/Sublingual  when a lozenge or oral solution is held in the mouth for approximately 10 to 15 minutes as it is slowly absorbed into the bloodstream

Setting

Bioavailability

Onset

Clinical or Home Setting

Low

5 - 10 Minutes

Duration

Frequency

Cost

2 - 4 Hours

6 treatments over 4 - 6 weeks

$150 - $200 per treatment

what to expect during the session

On average, you likely won’t feel anything for the first 15 minutes. During the next 15 minutes, you may feel as though you are floating. If standing, you will likely feel unsteady and dizzy. The patient may even have uncommon effects such as seeing double. These symptoms should last shortly.

In the third 15 minutes, the patient might feel sleepy and sleeping is encouraged. By the fourth 15 minutes, the patient will probably wake up on their own feeling fresh. Patient should be fully recovered 60-75 minutes after sipping the ketamine.

Some patients may feel anxious or a flood of emotions, experience rapid heartbeats, or nausea, though this typically subsides over the treatment. If the patient has been fasting, the dissociative experience can be stronger.

Esketamine  a ketamine derivative nasal spray, also known under the brand name Spravato™️, is delivered as one spray in each nostril at 15 minute intervals

Setting

Bioavailability

Onset

Clinical Setting

Medium

~ 10 Minutes

Duration

Frequency

Cost

2 - 4 Hours

12 treatments over 8 weeks

$0 - $900 per treatment,
insurance dependent

what to expect during the session

At the doctor’s office, the patient is given a nasal spray bottle containing the Spravato™️. During the Spravato™️ delivery, the patient should sit with their head reclined 45 degrees. The patient will have to insert the spray into one nostril while closing the other nostril to avoid losing the medication through exhalation, then press down on the plunger to deliver half the dose. The same process will be repeated with the opposite nostril. Spravato™️ enters the bloodstream through blood vessels located in the sinuses. The patient should remain with their head back for 2 to 5 minutes until the medication has been absorbed.

The patient can administer the Spravato™️ nasal spray themselves under the supervision of a healthcare provider. The provider will take the patient’s blood pressure before and after the nasal spray. The patient must remain under observation after each session for at least two hours to monitor sensations and any side effects. The Spravato dosage does not lead to sedation for most patients.

Common feelings patients taking Spravato™️ experience include:
  • Dissociation: the sense of what is real and what is not may become distorted and many patients report having out-of-body experiences
  • Exhaustion: feeling exhausted during the 2 hour observation period is the most common sensation, which is normal given that ketamine is sedative
  • Disorientation: feeling some dizziness, visual distortions, and being "out of it" are also common

Physical

Mental

It's easy to just pop back to your daily routines, but if you can make the time for it you will see the benefits of integrating your session into your life. You might feel overwhelmed or overstimulated after your session, so consider the items listed below to ease yourself out of your experience.
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