Daniel Santarsieri, MD
Ketamine is a novel and effective off-label treatment for mental health conditions like refractory depression, anxiety, PTSD and chronic pain. A potent modulator of the neurotransmitter glutamate, ketamine exerts rapid antidepressant effects on its own, even at low doses, and sets off a cascade of beneficial changes in the brain that promote neuroplasticity: the survival, growth, and differentiation of neurons. At higher doses, ketamine can also produce dissociative and even psychedelic effects, which may play a role in the overall therapeutic experience. To get the most out of this therapy, we recommend following a holistic approach that emphasizes psychological preparation, mindful integration, and appropriate follow-up. Here are some steps you can take before, during, and after your ketamine infusion to ensure an optimal experience.
Before the Ketamine Infusion:
- Set Intentions: While ketamine is not hallucinogenic, it can induce altered states of consciousness during the infusion. Setting clear goals or intentions for what you wish to achieve with the treatment—such as emotional healing, gaining insight into depressive thought patterns, or even achieving a state of calm—can help positively guide your experience. You might ask yourself (and write down answers to) the following questions:
“What has led me to embark on this treatment? Why am I here?”
“What would I like to shift/change in my life? Where do I feel stuck?”
“What does my “best self” need and want?
- Understand the Mechanism: Ketamine works differently than traditional antidepressants. It is a NMDA receptor antagonist, modulating the neurotransmitter glutamate and stimulating the natural process of brain plasticity, with growth of new branches and connections between brain cells. This facilitates decreased cognitive rigidity and increased flexibility in thoughts, feelings, and behavior. Understanding this mechanism can help you appreciate the potential of ketamine beyond symptom relief, highlighting its role in creating new neural pathways that support healing. It may also help reduce anxiety and increase trust in the process.
- Align with Your Provider: Having an open discussion with your psychiatrist or therapist about your expectations, fears, or possible concerns before the infusion can provide essential emotional scaffolding. This therapeutic relationship can also help integrate the experience afterward, as it’s common for people to have novel insights during their ketamine session that require unpacking.
- Optimize Your Physical and Emotional State: In the days leading up to the infusion, focus on self-care. Get adequate sleep, stay hydrated, and nourish your body with proper nutrition. Avoid alcohol or recreational drugs, as these can interfere with the effects of ketamine and may disrupt your mental clarity. On the day of your infusion, avoid overloading your schedule. Give yourself space to rest and process your feelings afterward. Infusions can sometimes leave patients feeling fatigued or emotionally drained, and it’s best to have a quiet environment to return to post-treatment.
During the Ketamine Infusion:
- Ensure a comfortable setting: Your physical surroundings during the ketamine infusion can play a significant role in shaping your experience. The clinic will provide a comfortable, private space with warm lighting, relaxing music, as well as a blanket and eye shades. You may also wish to bring any personal items that help you feel grounded, such as a favorite photo, a journal, a sentimental token or charm, or essential oils. You should also wear loose comfortable clothing that feels good against your skin and can provide a sense of calm and familiarity.
- Embrace the Experience: Ketamine’s dissociative effects can sometimes feel unusual or disorienting. Rather than resisting the experience or trying to control it, allow yourself to “surrender” to the sensations. Trust the process and remind yourself that it’s temporary. Rather than trying to “make sense” of everything as it happens, let your mind flow naturally and follow the experience where it takes you. Many people report that ketamine allows them to confront buried emotions or traumas. While this can be challenging, it can also open the door to deeper healing.
- Practice Mindfulness: Mindfulness practices, such as focusing on your breath or body sensations, can help you stay present and engaged with your inner experience. If you find yourself becoming overwhelmed, focusing on your breath can serve as a calming anchor. Some individuals also find value in visualizing themselves in a safe or serene place. Whether it’s a beach, a forest, or a quiet room, having a mental “safe space” can provide a comforting retreat if the infusion brings up difficult emotions.
- Communicate with the Clinician: You will have a medical professional present during your infusion, monitoring your vitals and ensuring your safety. Feel free to communicate with them if you experience discomfort or anxiety, as they can make adjustments to improve your experience.
After Your Ketamine Infusion:
- Post-Infusion Reflection: Many people experience a sense of clarity, emotional release, or perspective shifts immediately after the infusion. Taking time to reflect on the experience via journaling can be an excellent way to capture any insights or realizations that came up during the session. Writing down emotions, memories, or images that arose for you can help with integration, even if they seem disjointed or fragmented.
- Integration Therapy: Ketamine infusions are most effective when paired with therapeutic support. Schedule follow-up sessions with your therapist to process the insights and emotions that came up during your infusion. If you don’t have a therapist, Principium offers integration sessions with a trained therapist to help you address emotional material that may have been previously pushed away or buried.
- Practice Self-Compassion: After the infusion, you might feel more vulnerable or emotionally raw. This is natural, as ketamine loosens mental defenses temporarily. Be gentle with yourself and allow time for self-care. Avoid overly stimulating environments and give yourself permission to rest and contemplate the experience without rushing to “feel normal” again.
- Long-Term Follow-Up: Most individuals benefit from multiple ketamine infusions as part of a broader therapeutic plan. Ask your clinician about what the appropriate treatment schedule is for you. Keep in mind that while ketamine can provide rapid relief, the effects may require ongoing maintenance or integration with other therapies such as CBT, DBT, or mindfulness practices.
Ketamine infusions offer a promising path for those struggling with depression, anxiety, and other conditions. To get the most out of the experience, preparation, mindfulness during the session, and post-infusion integration are essential. By setting intentions, creating a calming environment, reflecting on the experience, and seeking ongoing therapeutic support, you can maximize the benefits of ketamine therapy and work toward long-lasting mental well-being.
Principium Psychiatry offers ketamine infusion services at multiple locations:
– Midtown Manhattan: 110 E 42nd St, Suite 815, New York, NY 10017.
– Wall Street: 26 Broadway, Suite 1103, New York, NY 10004.
– Greenwich, Connecticut: 4 Dearfield Dr, Unit 203, Greenwich, CT 06831.
– Santa Monica, California: 2222 Santa Monica Blvd #105, Santa Monica, CA 90404.
Each location provides a comfortable and professional environment to support your treatment journey.
