Ketamine Therapy · Preparing for Treatment · Reviewed by Samuel Caruthers, MD
Most people booking a first infusion have two worries they do not say out loud. One is whether it will work. The other, usually the louder one, is what it will feel like to be given a medication best known to the public as an anesthetic, and whether they will feel out of control.
That second worry deserves a proper answer, because uncertainty about it stops people booking. Here is what the appointment actually involves, start to finish, including the parts that are strange and the parts that are simply administrative.
Before the appointment
Arrange your ride first. Not later, not on the day. You cannot drive yourself home, you cannot take a rideshare alone, and you will need an adult who can be with you afterward. Sort this before you book, because it is the single most common reason appointments get cancelled at short notice.
You will receive specific instructions about eating and drinking. There is generally a period before the infusion when you should not eat, and often a shorter window for clear liquids. Follow the instructions you are given precisely; if you have not followed them, say so when you arrive rather than proceeding, because it is a safety issue and nobody will be annoyed with you.
Take your usual medications unless told otherwise. Your medication list will have been reviewed at your evaluation and you will be told if anything needs holding. Do not make that decision yourself.
Wear comfortable clothes with sleeves that move easily, since an IV goes in your arm and you will be sitting for a while. Bring anything that helps you settle, such as headphones, an eye mask, or a playlist. Many patients find music makes the experience considerably more pleasant.
Clear the rest of your day. Do not schedule work, errands, or anything requiring judgment afterward. Plan to go home and rest.
Arriving
You will check in, your vital signs will be taken, and a member of the clinical team will confirm your history, your medications, and that you have followed the preparation instructions and have a ride home.
An IV line is placed, usually in the arm or hand. Monitoring equipment is attached, typically a blood pressure cuff, a pulse oximeter on your finger, and heart rate monitoring. These stay on throughout.
You will be settled somewhere comfortable, usually a reclining chair in a quiet room with the lights lowered. You can ask questions at any point. Nothing starts until you are ready.
During the infusion
The medication is given slowly through the IV at a low dose calculated for you, and the rate can be adjusted during treatment. Pain protocols are given over an extended period, typically considerably longer than the brief infusions used in mood treatment, and your physician will tell you the expected duration for your protocol.
Effects usually begin within the first several minutes. What patients describe varies, and the most common experiences are these.
A sense of floating or lightness. Many people describe feeling physically buoyant, or as though the boundary between the body and the chair has softened.
Altered perception of time. Time often feels stretched or compressed. Patients frequently guess wrong about how long they have been sitting there.
Visual changes with the eyes closed. Patterns, colours, or drifting imagery are common. With eyes open, the room may look slightly unfamiliar.
A feeling of distance from your own thoughts. This is dissociation, and it is the effect people find hardest to anticipate. Thoughts and sensations, including your pain, can feel like they are happening slightly further away. For most patients this is neutral or pleasant. For some it is disorienting.
The important thing to know is that you remain conscious, you can speak, and you can tell the team at any point that you want the rate reduced.
You are not asleep, you are not unconscious, and someone is with you. If the experience becomes uncomfortable, that is not something you have to endure quietly. The dose can be adjusted, and medication can be given to ease anxiety or nausea if needed.
What helps, from patients who have done it
- Headphones with familiar, calm music. Unfamiliar music can feel more intense.
- An eye mask, which most people find makes the experience gentler rather than stranger.
- Deciding in advance to let it happen rather than fighting it. Resistance tends to make it less comfortable.
- Telling the team beforehand if you are anxious. It changes how they support you.
Afterward
When the infusion ends, the effects fade over the following stretch of time rather than stopping abruptly. You will stay for a recovery period with monitoring continuing until you are steady.
Expect to feel groggy, slightly unsteady on your feet, and possibly a bit spacey for the rest of the day. Some patients feel mildly nauseated, though this is often managed with medication given beforehand. Blood pressure and heart rate may run slightly high during the infusion and settle afterward, which is why monitoring continues.
Your driver takes you home. Rest. Do not drive, do not make significant decisions, do not sign anything, and do not drink alcohol. Most people feel normal the next morning.
What to notice over the following days
Pain relief, when it happens, does not necessarily arrive during the infusion. Some patients notice change within hours, others over the following days, and some not until further into a series.
It is worth keeping a simple record. A pain score once or twice a day, how you slept, and what you were able to do. Memory is unreliable about pain, and a written record gives you and your physician something real to assess rather than an impression.
One infusion is not a trial of the treatment
Chronic pain is rarely addressed by a single infusion. Treatment typically begins with a series over a compressed period, with maintenance at longer intervals afterward if the series helps. Judging the whole approach on one appointment usually produces a misleading answer. If cost or logistics mean a full series is not realistic for you, say so at your evaluation so the plan can account for it.
| Stage | Roughly how long | What happens |
|---|---|---|
| Check-in and setup | 15 to 30 minutes | Vitals, history confirmation, IV placement, monitoring attached |
| The infusion | Varies by protocol, longer for pain than for mood | Medication given slowly, rate adjustable, staff present throughout |
| Recovery | Until you are steady | Monitoring continues, effects fade, discharged to your driver |
| Rest of the day | The remainder | No driving, no work, no decisions, no alcohol |
For the person bringing you
Whoever drives you is doing more than providing transport, and it helps if they know what to expect.
They should plan to be available for the whole appointment, including the recovery period, since discharge time is not precisely predictable. They do not need to sit in the treatment room, and some patients prefer they do not.
At pickup, you may be groggy, slower than usual, and a bit unsteady. That is expected. You may also be unusually talkative, or quiet, or emotional. Their job for the rest of the day is simple: get you home, keep an eye on you, and take on anything that requires judgment.
Some patients find it useful to have the same person each time, because that person notices patterns across appointments that are easy to miss from the inside.
Between infusions
In a series, the days between appointments matter more than people expect.
Keep the record going. A pain score, sleep quality, and one line about what you managed to do. Patterns across a series are far more informative than how you felt on any single day.
Try to use any window you get. If pain drops for a period, that is the moment for physical therapy, walking, or activity you have been avoiding. Part of what treatment is meant to buy is the ability to do the other work, and the benefit tends to hold better in people who use it.
Do not judge too early. Response varies across a series, and a disappointing first infusion is not a reliable predictor of the outcome.
Say what is happening. Report side effects, changes in mood, or anything unexpected between appointments rather than saving it up. Protocols are adjusted in response to how you actually do.
Common side effects
Most are short-lived and resolve as the medication wears off. The ones patients most often encounter are nausea, dizziness, a transient rise in blood pressure and heart rate, blurred or double vision during the infusion, vivid dreams or unusual thoughts, and grogginess afterward.
Serious reactions are uncommon, which is precisely why monitoring is continuous and why treatment happens in a medical setting rather than at home. Tell the team about anything you are experiencing. There is no symptom too minor to mention.
We see patients at our Parsippany, Clifton, Hackettstown, and Hamburg offices. If you have not yet had an evaluation, the candidacy questions are covered here.
Why this happens in a medical office
Ketamine offered for home use has become more visible in recent years, generally as lozenges or sprays sent by mail after a video consultation. It is worth understanding why infusion therapy for chronic pain is not delivered that way.
Ketamine transiently raises blood pressure and heart rate, which is why monitoring runs continuously and why an evaluation screens cardiac history beforehand. Intravenous dosing allows the rate to be adjusted while treatment is happening, in response to how you are actually doing, which is not possible with a fixed dose taken at home. And the dissociative effects are considerably easier to manage with trained staff present than alone in a living room.
None of that makes the appointment intimidating. It is a quiet room, a comfortable chair, and people whose job is to watch the numbers so that you do not have to think about them.
Frequently asked questions
Will I be unconscious?
No. The doses used for pain infusions are far below anesthetic doses. You remain awake and able to speak throughout, and staff are present the entire time.
Can I really not drive myself home?
Correct, and there are no exceptions, including for maintenance appointments later in a course. Ketamine affects perception and coordination for a period afterward.
Will it hurt?
The IV placement feels like any other IV. The infusion itself is not painful.
What if I panic during it?
Tell the team. The rate can be reduced, medication can be given to ease anxiety, and you will not be left to manage it alone. Telling them beforehand that you are nervous is genuinely useful.
How soon will I know if it is working?
Some patients notice change within a day, others later in a series, and some not at all. Your physician will discuss a sensible point at which to assess whether continuing makes sense.
Can I eat before my appointment?
You will be given specific instructions, and they generally include a period without food beforehand. Follow them exactly and tell staff if you have not, since it affects whether it is safe to proceed.
Knowing what happens makes it far easier to decide.
If you have questions this article did not answer, a consultation is the place for them. No commitment to treatment.
Medical disclaimer. This article is for general educational purposes and is not medical advice, nor does it create a physician-patient relationship. Protocols, timings, and preparation instructions vary by patient and by condition; follow the specific instructions given to you by your treating physician rather than anything described here. Ketamine infusion therapy for chronic pain is an off-label use and is not FDA approved for this indication. Individual results vary and no outcome is guaranteed. Do not start, stop, or change any medication based on this article. If you are experiencing a medical emergency, call 911.