Preparing for ketamine-assisted therapy involves medical screening, medication adjustments, physical preparation the day before and day of, and mental groundwork that can meaningfully shape your experience. Most clinics will walk you through their specific protocols, but knowing what to expect ahead of time helps you arrive ready and get more from each session.
Medical Screening and Medication Review
Before your first session, your provider will evaluate your medical history and current medications. Ketamine temporarily raises blood pressure, sometimes significantly. A retrospective study at Yale Psychiatry Hospital found that severe hypertension occurred in about 12.5% of patients during infusions, with the highest risk during the first three sessions. If you have uncontrolled high blood pressure or cardiovascular concerns, your provider needs to know. During each session, blood pressure is typically checked every 10 minutes.
Medication interactions matter more than many people realize. Benzodiazepines (drugs like lorazepam, clonazepam, or diazepam) have been repeatedly shown to reduce how long ketamine’s antidepressant effects last. In one case, a patient’s antidepressant response jumped from 2 to 3 days up to 10 to 14 days after lorazepam was withdrawn. Higher doses of benzodiazepines also predicted nonresponse during follow-up. Lamotrigine, a mood stabilizer commonly prescribed for bipolar disorder, may also blunt ketamine’s effects, though the evidence is less consistent. Don’t stop any medication on your own. Instead, bring a full medication list to your screening appointment so your provider can plan any tapering or timing adjustments well in advance.
Physical Preparation the Day Before and Day Of
Most clinics require you to fast from solid food for at least six hours before your session. Even at the lower doses used in psychiatric treatment (well below surgical anesthesia levels), fasting is standard because ketamine can cause nausea. Some providers allow clear liquids closer to the appointment, but confirm this with your clinic. Eating a light, balanced meal the evening before helps you avoid arriving both hungry and nauseous.
Plan your transportation before the day arrives. You cannot drive or operate heavy machinery for 24 hours after a ketamine session. The dissociative and sedative effects can linger well beyond the session itself, even if you feel relatively clear-headed. Arrange for someone to pick you up, or schedule a ride service. Most clinics will not begin treatment unless you have a confirmed ride home.
Wear comfortable, loose-fitting clothing. You’ll likely be reclined for 45 minutes to a few hours depending on the route of administration, and restrictive clothing can become a distraction. Skip caffeine the morning of your session, as it can increase anxiety and elevate your heart rate alongside ketamine’s own cardiovascular effects. Hydrate well the day before.
Setting an Intention
Intention setting is one of the most commonly recommended psychological preparation steps, and it’s different from traditional goal setting. A goal might be “I want to feel less depressed.” An intention is more exploratory and process-oriented: “I want to understand what’s underneath my sadness” or “I want to explore how my childhood experiences shape my current anxiety.”
Good intentions tend to fall into a few categories. Some focus on healing specific wounds: exploring the impact of past trauma, understanding how old relationships shaped your sense of trust, or integrating repressed emotions. Others center on emotional exploration: investigating the roots of chronic anxiety, processing shame, or understanding triggers behind anger. A third category involves self-discovery: clarifying personal values, recognizing recurring relationship patterns, or developing self-compassion.
Your intention doesn’t need to be poetic or perfectly worded. Something as simple as “I want to be open to whatever comes up about my grief” gives your mind a loose direction without rigidly controlling the experience. Many therapists recommend writing your intention down and revisiting it briefly right before the session begins. If nothing specific resonates, “I’m open to whatever I need to see” is a perfectly valid starting point.
Understanding Set and Setting
“Set and setting” is a concept borrowed from psychedelic research. “Set” refers to your mindset going in. “Setting” refers to your physical environment. Both influence the quality and emotional tone of the experience.
For mindset, the days leading up to your session matter. Try to reduce unnecessary stressors. Avoid heavy alcohol use, get adequate sleep, and give yourself permission to slow down. Some people find it helpful to journal or meditate in the days before treatment, not as a requirement but as a way of tuning into what’s already surfacing emotionally.
The physical setting in a clinical environment typically includes a reclined chair or couch, soft blankets, an eye mask to block visual input, and curated music. Most clinics use gentle instrumental or ambient soundscapes, which can guide emotional processing during the session. The room is usually dimly lit and quiet, designed to minimize distractions. A therapist or trained guide stays present throughout, providing emotional grounding if you need it. If you’re doing at-home ketamine treatment (which some providers offer with telehealth supervision), recreating these elements yourself becomes important: a quiet room, comfortable seating, an eye mask, headphones with calming music, and no interruptions.
What to Expect During the Session
Knowing what the experience feels like can reduce anxiety significantly. At therapeutic doses, ketamine produces a dissociative state that most people describe as a sense of floating, detachment from the body, or dreamlike imagery. Some sessions feel emotionally rich and full of insight. Others feel abstract or even uneventful. Neither type is “wrong,” and the therapeutic benefits don’t require a dramatic experience.
You may feel mild nausea, dizziness, or a sense of heaviness. Some people experience temporary anxiety as the effects begin, which usually passes within minutes. Your blood pressure and heart rate will be monitored periodically. The active phase of the experience typically lasts 40 to 60 minutes for infusions, though other routes of administration can vary. After the peak effects wear off, you’ll stay in the clinic for an observation period until your provider confirms you’re stable enough to leave with your designated driver.
Integration: The Hours and Days After
What you do after a session may be as important as the session itself. Ketamine triggers a burst of neural plasticity, essentially a window during which the brain is more receptive to forming new connections. Research in animal models has shown that this heightened plasticity potential peaks around 2 to 4 hours after administration and dissipates by about 12 hours. This is one reason integration work in the hours and days following treatment is so strongly emphasized.
Integration means actively processing what came up during your session. The most common approach is a follow-up therapy session, ideally within 24 to 48 hours, where you discuss any emotions, images, memories, or insights with your therapist. Many providers schedule these integration sessions as a standard part of the treatment protocol.
On your own, journaling immediately after the session (even brief, fragmented notes) helps capture material that can fade quickly, similar to how dreams slip away after waking. Some people find that creative expression like drawing, movement, or music helps process nonverbal aspects of the experience. Keep your evening after treatment low-key. Avoid screens, alcohol, and demanding social situations. Give yourself space to sit with whatever surfaced.
In the days between sessions, pay attention to shifts in your mood, thought patterns, and reactions to everyday situations. These subtle changes often carry more therapeutic weight than the dramatic moments during the session itself. Bringing these observations to your next integration session gives your therapist concrete material to work with and helps you build on each experience rather than treating sessions as isolated events.