Ketamine Therapy Session

Your First Ketamine Therapy Session: What to Expect

If you are old enough, you’ll probably remember ketamine as a street drug or veterinary medicine, but now people are going to start remembering their first ketamine therapy session, as it is becoming a legal but off-label treatment for depression.  While the anticipation of your first ketamine therapy session can seem overwhelming, you can prepare yourself by getting familiar with what Time Magazine called a “new hope for depression.”   In this article, Frshminds explains what ketamine infusions are, how much it costs, how you can go about getting them and what to expect during your first ketamine therapy session.

What is Ketamine Infusion?

How Does Ketamine Work?

Ketamine Therapy Session
Time Magazine highlighting the potential of ketamine for depression management.

Starting with a study at Yale in 2000, Ketamine’s antidepressant effects have been explored as a treatment for major depressive disorder. In contrast to SSRIs (selective serotonin reuptake inhibitors) like Prozac and multiple-receptor antidepressants, the most commonly prescribed drugs to treat depression, Ketamine is an NMDA (N-methyl-D-aspartate) receptor antagonist, meaning it targets glutamate absorption in the nerve cells while traditional antidepressants raise serotonin levels by blocking the reabsorption of the neurotransmitter.

Ketamine Infusion Therapy

Ketamine infusion therapy, also called intravenous or IV, ketamine is as its name suggests given as an infusion into the bloodstream; it uses racemic ketamine, a mixture of two mirror-image molecules, that was FDA-approved decades ago as an anesthetic by the FDA and is now used off-label to treat depression.

What IV Ketamine Infusion Feels Like

IV ketamine infusions are different for everyone, and individuals report different experiences with each use due to ketamine’s dissociative properties. Depending on the dose of ketamine and the length of the infusion, patients who have used IV ketamine report the following experiences:

  • A feeling begins with warm dissociation from my body.
  • Time seems to slow down, and my limbs feel like they’re floating away from me. I always feel relaxed and after a few minutes,
  • Start to “see” shapes, colors, and sometimes entire scenes in my mind.
  • Increased body awareness
  • Quieting of the mind, feelings of love and gratitude,
  • Death of your ego.
  • Reliving past experiences from a different perspective.

How Much Does Ketamine Infusion Therapy Cost

One of the most common questions after “What does ketamine therapy feel like?” is “How much does ketamine cost?”.  Ketamine infusion costs between $400 and $2000 per infusion, depending on the provider, location, ketamine dose per treatment, duration of infusion, and the condition being treated.  Most ketamine clinics are out of network, so you need to cover the costs with the clinic upfront and sort out the details with the insurance company after.

Ketamine Infusion Cost for Depression

Actual treatment costs depend on the ketamine infusion dosage. Conditions like depression require a lower concentration of ketamine and shorter infusion duration than pain conditions. Many ketamine providers require an upfront payment for a complete set of 4 to 6 infusions and can range from $1600 to $4800 for a full series of IV ketamine treatments for depression.

Getting Started: Your First Ketamine Therapy Session

How to Get a Ketamine Prescription

For those who don’t know how to get ketamine prescribed, you should know that you can’t just go to the pharmacy, purchase some ketamine and pop it in your mouth as you feel like it.   While any medical doctor can prescribe ketamine, it is only approved as an anesthetic in a medical procedure by the Food and Drug Administration (FDA), so you don’t buy it at a pharmacy and administer it yourself.   

Rather than being a first-line treatment, ketamine infusions are, as the term describes, administered by an IV infusion in the arm, and typically the effects last for anywhere from days to weeks. It’s administered in a tapering sequence in which patients receive three infusions the first week, two in the second week, once weekly for the next three weeks, and then moving to maintenance of, on average, once per month.

The doctor who prescribed ketamine to you will refer you to a specialty doctor or clinic. Once you have a referral, the specialist doctor or clinic will do their own assessment of you to ascertain whether ketamine really is the right treatment for you by performing a history.

How to Get Ketamine: Visiting a Clinic

Before going to your first ketamine therapy session, you may fear the process if you suffer from an anxiety disorder. It is important to remember that ketamine does not induce a fearful state of mind; you are much more likely to be fearful if you bring that emotion into the treatment process with you. Typically, your first appointment at a ketamine clinic will be a consultation with a supervising physician, where the doctor learns a little about you and your history. Typically this meeting covers:

  • Your current mental health situation,
  • Your mental health history,
  • Your physical health history and,
  • External factors such as family, personal relationships and professional activities

This meeting aims to build an individualized ketamine treatment plan for you. This treatment plan outlines the initial dose of ketamine and is based on your:

  • Individual medical history,
  • Weight,
  • Age, and
  • Prior treatment history, among other factors.

Based on your initial response to treatment, your ketamine dosage will be adjusted up or down.

What is a Ketamine Treatment Like?

Ketamine, once used on the battlefields of Vietnam, is making a comeback as of late as a fast-acting treatment for a range of difficult-to-manage psychiatric conditions like depression, anxiety and even post-traumatic stress disorder (PTSD). Due to how ketamine works in the brain, ketamine may help with many mental health conditions for which few effective and fast-acting medications exist. Ketamine which works via the neurotransmitter Glutamate, works almost instantly, with few side effects. 

Clinics are intentionally designed to provide patients with an enjoyable experience, and most patients report that the infusion experience is quite comfortable. If you suffer from a mood disorder, your ketamine infusion treatment sessions last for 45-60 minutes. During the treatment, the clinic will monitor your vitals with a fingertip pulse oximeter.

The clinics typically provide you with a private room and often allow for your relative or therapist to be in the room as well; it is recommended that your guests remain silent unless you start a conversation. To create a calming atmosphere, you are usually relaxed in a comfortable reclining chair; lights are generally dim and quiet music may play in the background. As ketamine is delivered by an IV drip, patients stay fully dressed during the entire process.

Ketamine treatments for mood disorders are at much lower doses than those that are used in general anesthesia, so you will maintain full consciousness during a ketamine treatment session. You may experience a slight amount of dissociation, often described as a “relaxing, warm, out of body experience mixed mild euphoric feeling.” Unlike many of the SSRI drugs you may have taken for managing your mental health, the effects of ketamine are immediate.

The Ketamine Infusion Process

Ketamine is delivered via an intravenous (IV) drip, so if you have received IV medications before, you know that you need to have a needle inserted in your arm. Ketamine clinics use IV pumps to deliver accurate amounts of ketamine evenly over the entire duration of your infusion treatment to balance the effects of the medication over your session. Initially, the medication may feel cold as it enters your bloodstream.

Side Effects of Ketamine Infusion

Given that most clinics use a very small dosage compared to typical anesthetic doses. While you will not be unconscious, you may experience some of the psychedelic/dissociative effects of ketamine, especially if you are looking to integrate psychotherapy with your ketamine experience.  Some patients with a history of experiencing dizziness and nausea with other medications may react like this to ketamine. Clinics can provide you with anti-nausea medication before or during ketamine treatment to limit this problem.
If it is not used under the care of health professionals in a medical setting, users of ketamine put themselves at risk in several ways:

  • Like all anesthetics, ketamine prevents users from feeling pain, so a person may not know if an injury occurs.
  • Difficulty standing up and being confused about their surroundings; injuries and fatalities are often the result of falls and other accidents.
    • Driving or operating machinery while under the influence of ketamine, or any drug, increases the risk of physical injury to the user and to others.
  • Increase the risk of stroke or heart attack as ketamine raises heart rate and blood pressure.
  • Frequent use of ketamine may cause bladder problems (e.g., increased need to urinate, passing blood in urine).
  • When mixed with other drugs, ketamine can have unpredictable and sometimes dangerous effects.

What Happens after a Ketamine Infusion

Most clinics have a recovery room where you can relax post-treatment. While you usually return to your pretreatment level of attentiveness, you may feel tired after an infusion, while others feel fine and ready to leave the office immediately.

Integrative Psychotherapy and Ketamine

Some clinics combine ketamine treatment with psychotherapy sessions for treatment-resistant depression, often called Ketamine Assisted Psychotherapy (KAP). While some professionals view the psychedelic effects of ketamine as unwanted, many believe exploring these effects can benefit patients when done properly. Integrative psychotherapy and ketamine leverages ketamine’s tendency to produce disconnection from your usual way of feeling and experiencing. Psychotherapy allows you to reflect on the expanded states of awareness, alternative views of your life concerns, and relief from the routines of your ordinary state of mind produced by ketamine.

Are Ketamine Infusions Addictive

Tolerance to the dissociative effects of the drug comes with regular use, so an ever-increasing amount is needed to achieve the same effect.  Like any drug, some people become addicted to ketamine and use it when they plan not to or despite its negative effects. Withdrawal symptoms occur because the ketamine has altered opioid receptors in the brain. Psychological withdrawal symptoms can be dangerous, with the most dangerous being intense depression, leading to increased suicide risk.  Withdrawal can last from 72 hours to several weeks, set in between 24 to 72 hours after the last dose of ketamine and is not generally life-threatening.

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About the Author

I've battled depression for most of my adult life, so I speak with the voice and experience of someone who understands the fight.

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