What to expect from ketamine treatment

Any legitimate program starts with a real medical and psychiatric evaluation, and it takes longer than filling out a form. Expect a review of your diagnosis and treatment history (what you've tried, for how long, at what doses), your current medications, cardiovascular health, and any history of psychosis or substance use. Blood pressure is checked because ketamine raises it temporarily.

Spravato® is FDA-approved for treatment-resistant depression (generally, depression that hasn't responded to at least two adequate antidepressant trials) and, together with an oral antidepressant, for depressive symptoms in adults with major depression and acute suicidal thoughts or behavior. The FDA approves those indications; the clinic and your insurer are the ones who decide whether you meet them. Good infusion clinics apply similar standards even though they legally don't have to.

You'll be told not to eat for a few hours beforehand (nausea is a common side effect), and to arrange a ride home. You won't be able to drive afterward; the driving rules are in the section for the person driving you.

Most clinics ask you to continue your regular psychiatric medications. Observational studies suggest benzodiazepines may blunt ketamine's antidepressant effect, so some programs adjust the timing of a dose on session days. That is your prescriber's call. Never skip or stop a dose on your own. Tell the clinic about stimulants and MAO inhibitors too: Spravato®'s label says both can add to the blood-pressure rise, and benzodiazepines, opioids, and alcohol can add to sedation.

Wear comfortable clothes. Many people bring headphones; calm music is standard in well-run clinics.

An IV infusion for depression typically lasts about 40 minutes, with the standard research dose at 0.5 mg/kg. Spravato® is self-administered as a nasal spray under supervision, followed by a required observation period of at least two hours in the clinic. In both cases your blood pressure is checked before and after dosing and your breathing and oxygen levels are monitored; for Spravato® that monitoring continues throughout the observation period.

What it feels like: most people experience dissociation, a dream-like, floating, or detached feeling. Colors and sounds may seem different; time can feel distorted. Some find it pleasant or meaningful, others find it strange or briefly unsettling. It peaks during the session and largely resolves within an hour or two afterward. Nausea, dizziness, and a temporary rise in blood pressure are the other common effects.

You'll rest at the clinic until cleared to leave, then go home with your ride. Some people feel tired the rest of the day. Either way, hold off on major decisions until the next day. Some people notice mood improvement within hours; for others it builds over the first few sessions.

Ketamine is almost never a single treatment. A typical IV induction series is six infusions over two to three weeks. For treatment-resistant depression, Spravato® starts twice weekly for a month, then steps down to weekly and then every one to two weeks. Response is usually assessed with standardized depression scales. If a clinic isn't measuring anything, that's a flag.

For typical schedules and how long results last, see How Many Ketamine Treatments Do You Need?

Benefits often fade over weeks without maintenance. Plans vary from monthly boosters to as-needed sessions when symptoms return. This is where cost planning matters. An induction series is a defined expense, but maintenance is open-ended. It's also where staying connected to your psychiatrist or therapist matters most, because ketamine works best as one part of a broader treatment plan.