What to Expect from Ketamine Therapy

Before You Start: Understanding the Timeline
Phase 1: Initial Psychiatric Evaluation
Phase 2: Pre-Treatment Preparation
Phase 3: Arrival & Setup
Phase 4: During the Infusion
Phase 5: What Is Dissociation? Managing the Experience
Phase 6: Post-Infusion Recovery & Monitoring
Phase 7: First Week & Ongoing Sessions
What to Bring & Wear
Common Patient Questions
Disclaimer
References

Key Takeaways

Full process: 2–3.5 hours per session (infusion + monitoring)
First session: Expect mild anxiety; dissociation is normal, expected, reversible
Initial evaluation: 60–90 minutes; determines candidacy; thorough medical review
Dissociation experience: Dreamlike, "floating," time distortion; not frightening; staff present
Recovery timeline: Back to baseline within 4–8 hours post-session
Cannot drive: Arrange transportation for 8–12 hours after session
Acute phase: 2x/week × 4 weeks typical; most feel relief by session 2–3
Supportive environment: Staff at bedside; pain-free IV; professional, caring approach

Before You Start: Understanding the Timeline

A note on FDA status: IV (racemic) ketamine for depression is used off-label and is not FDA-approved for psychiatric conditions; the FDA-approved form is esketamine (Spravato), indicated for treatment-resistant depression. Ketamine therapy is always clinician-supervised in a medical setting. The description below reflects a supervised in-office IV ketamine program.

Ketamine therapy is not a single treatment; it's a structured program with distinct phases:

Evaluation (Week 0): Psychiatrist determines if you're a candidate
Acute Phase (Weeks 1–4): Intensive infusions 2x/week; symptom breakthrough
Transition Phase (Weeks 5–12): Move to weekly infusions; consolidate gains
Maintenance Phase (Months 3–18): Biweekly or monthly sessions; sustain improvement
Long-term Plan: Discuss with Dr. Thangada; some patients continue indefinitely

Total timeline: 3–4 months minimum; often 6–18 months depending on response and goals.

Phase 1: Initial Psychiatric Evaluation

What Happens

Duration: 60–90 minutes

Location: KwikPsych office, 12335 Hymeadow Dr, Ste 450, Austin, TX 78750

Cost: $299 (self-pay); may be covered by insurance

The Evaluation Process

1. Check-In (10 min)

Provide insurance information, ID
Complete intake questionnaire: depression history, medications, past treatments
Staff explains what to expect; answer initial questions

2. Psychiatric Interview (45–60 min)

Dr. Monika Thangada will discuss:

Depression history: When did it start? How severe? Impact on daily life?
Treatment trials: Which antidepressants have you tried? At what doses? For how long?
Suicidal ideation: Do you have thoughts of harming yourself? Plans or intent?
Medical history: Hypertension? Heart problems? Liver/kidney disease? Seizures?
Medications: Full list of current drugs, supplements, herbal products
Substance use: Current or past alcohol/drug use? Any concerns?
Cardiac risk: Chest pain, shortness of breath, palpitations?
Family history: Depression, bipolar disorder, schizophrenia in family?

3. Vital Signs (10 min)

Blood pressure (baseline is critical)
Heart rate, temperature, respiratory rate
Height and weight (for dosage calculation)

4. Physical Exam (5 min)

Cardiac exam: Heart sounds, rhythm
Lungs: Breathing sounds
Neurologic exam: Basic mental status, coordination

5. Candidacy Discussion (15 min)

Does Dr. Thangada recommend ketamine therapy?
What are the risks for your specific situation?
What are the benefits and realistic timeline?
Alternatives discussed: TMS, ECT, continued antidepressants?

After Evaluation

If approved:

Schedule first infusion (typically within 1–2 weeks)
Insurance pre-authorization initiated (if insured; 1–3 weeks typical)
Receive pre-infusion instructions: fasting, medications, transportation

If not approved:

Dr. Thangada explains why (e.g., uncontrolled hypertension, active psychosis, substance abuse risk)
Alternative treatments discussed
You can reapply after addressing barriers

Phase 2: Pre-Treatment Preparation

Days Before Your First Infusion

1. Schedule & Confirm (1 week before)

Call KwikPsych at 737-367-1230; confirm appointment time
Verify insurance pre-authorization approved (or plan for self-pay)
Ask any last-minute questions; get staff reassurance

2. Arrange Transportation (Critical!)

You cannot drive for 8–12 hours after your infusion
Arrange a friend/family member to pick you up
Or pre-book a rideshare (Uber, Lyft)
Do NOT drive yourself home; it is unsafe and illegal

3. Medication Review (2–3 days before)

Continue all antidepressants and psych medications as normal
Benzodiazepines: If on daily benzos, discuss tapering with Dr. Thangada (may reduce ketamine efficacy)
Other medications: Continue as prescribed
Bring complete medication list to your appointment

4. Prepare for Fasting (Day before)

Nothing to eat after midnight
Water OK until 2 hours before appointment
Light breakfast is acceptable if appointment in afternoon
(Fasting reduces nausea during dissociation)

5. Comfort Items (Day of appointment)

Bring headphones and calming music playlist (optional; staff provides options)
Comfortable clothing (loose-fitting; no tight belts)
Cozy blanket or sweater (clinic is cool; dissociation can feel cold)
Journal for post-session reflection (optional)

6. Mental Preparation

Read about what dissociation feels like (see "Phase 5" below)
Remind yourself: "This is temporary; I'll be monitored; staff are present"
Ask Dr. Thangada for a brief video walkthrough or photograph of the infusion room
Visualize a safe, calming place (to focus on during peak dissociation, if needed)

Phase 3: Arrival & Setup

Day of First Infusion

Arrive early: 15 minutes before appointment (allow parking/check-in time)

Upon Arrival (10–15 min)

Vitals: Nurse takes blood pressure, heart rate (critical baseline)
IV line placement (for IV ketamine only)
Patient sits in comfortable reclining chair (like dentist chair, but nicer)
Staff find accessible vein (usually arm)
Small needle inserted; thin plastic catheter left in place
Painless or minimal discomfort; staff excellent at this
Room orientation: Nurse shows emergency call button, explains monitoring
Comfort check: Blanket? Pillow? Music? Bathroom trip?
Final questions: Now's the time to ask anything; no question too small

Pre-Infusion Talk (5 min)

Dr. Thangada or nurse reviews:

"You'll feel relaxed as ketamine enters your bloodstream"
"Dissociation is normal; you'll feel safe here"
"I'll be right beside you; I'll monitor you the whole time"
"If anything feels wrong, squeeze my hand and tell me"
"This will be over in 40 minutes; you're doing great"

Phase 4: During the Infusion

The 40-Minute Experience

Minutes 0–5: "The Warmth Arrives"

Saline drip starts (feels cool on arm; this is normal)
Ketamine enters IV line
First sensation: Warm, peaceful feeling spreading through body
Breathing easy; heart monitor shows normal rhythm
Some patients feel warm tingling; others feel heaviness in limbs

Minutes 5–15: "Drifting In"

Eyes may feel heavy; blinking slows
Room sounds seem distant; music (if playing) feels surreal
Body feels like it's floating or sinking into chair
Time perception shifts; 5 minutes feels like 10
Mild dissociation beginning; not frightening

Minutes 15–25: "Peak Dissociation"

The core experience:
"I feel like I'm floating above my body, but I can feel the chair"
"The room looks dreamlike, like I'm in a movie"
"Time is weird; I can't tell if it's been 5 minutes or 30"
"My hands look distant, like they're not mine" (depersonalization)
"Thoughts are slow and calm; worry feels small"
Mild visual distortions (not hallucinations; patient remains oriented)
Monitoring continues:
Nurse checks vital signs every 15 minutes
Dr. Thangada at bedside; asks "How are you doing?" periodically
Patient can respond; communication is intact
Pulse oximetry, blood pressure cuff active continuously

Minutes 25–40: "Gentle Return"

Dissociation peaks around minute 20–25, then slowly recedes
Sensations begin returning to normal
Room becomes clearer; music louder
Heaviness lifts from body
Mental clarity gradually returns
Patient still feels dreamy but aware

Minute 40: Infusion Complete

IV removed (quick, painless)
Nurse brings water, juice
Patient sits up slowly; no dizziness expected (usually)
Transition to post-infusion monitoring room

Phase 5: What Is Dissociation? Managing the Experience

Understanding Dissociation

Dissociation is a state of detachment. It's not a hallucination (seeing/hearing things not real); it's a shift in how you perceive reality while remaining fully conscious and oriented.

What Dissociation Feels Like (Patient Testimonials)

"I felt like I was floating above my body, but I could still feel the chair holding me. It was peaceful, not scary."

"The room looked like it was underwater, slow and dreamy. Time disappeared. I couldn't tell if it had been 5 minutes or an hour."

"My hands felt like they weren't part of my body, but I knew they were. It was weird but gentle."

"I felt like I was in a dream, but I was awake. Everything was quiet and soft. Kind of nice, actually."

"I couldn't worry about anything. My depression felt distant, like it was happening to someone else."

What Dissociation Is NOT

❌ Hallucination (seeing purple elephants, hearing voices)
❌ Loss of consciousness (you're completely awake)
❌ Confusion about who/where you are (you know your name, location, date)
❌ Scary or dangerous (transient, reversible, monitored)
❌ Permanent (effects resolve within 4 hours)

Managing Dissociation Anxiety

If you feel anxious about dissociation, try:

Pre-infusion preparation: Visualize a safe place (beach, forest, cozy room) and focus on it during peak dissociation
Breathing: Slow, deep breathing (4-count inhale, 4-count exhale) anchors you to present moment
Sensory grounding: Focus on the chair beneath you, the blanket on your body, the nurse's voice
Communication: Squeeze nurse's hand; tell her you're anxious; she'll reassure you (this works!)
Reminder: "This is temporary; I'm safe; staff are right here"
Music: Calming music (not lyrics-heavy) can reduce anxiety during dissociation

Important: Staff are trained in dissociation support. You are never alone. If you become distressed, the nurse will talk you through it; you're not judged.

Phase 6: Post-Infusion Recovery & Monitoring

In-Clinic Monitoring (1–2 hours)

Immediately post-infusion:

Nurse brings juice/water (hydration helps)
Vital signs checked every 15 minutes (BP, heart rate, oxygen)
Patient rests in comfortable chair with blanket
Staff remains nearby
Some patients rest; some read or journal

At 30 minutes:

Mental state improving; dissociation mostly resolved
Mood lift noticeable? Patient reflects on how they feel
Vitals back to baseline expected
Patient may feel drowsy (normal; not dangerous)

At 60 minutes:

Patient fully alert; oriented to time, place, person
Able to stand, walk to bathroom, communicate clearly
Vitals normalized
Discharge if all stable

At 120 minutes (if still present):

Full baseline recovery expected
Mild grogginess or dreaminess acceptable
Ready for discharge with driver/rideshare

Discharge Criteria

✓ Blood pressure normalized

✓ Heart rate normal

✓ Patient alert, oriented, communicating clearly

✓ Able to walk without dizziness

✓ No concerning symptoms

✓ Confirmed driver or rideshare present

Only then: Patient released; goes home with driver.

At Home (Afternoon/Evening After Infusion)

First 2 hours after discharge:

Residual drowsiness normal (sleep is fine!)
Mild grogginess expected
Some patients feel mood lift immediately; others notice by next day
Minor residual dissociation possible (dream-like feeling); resolves by evening

Evening (4–8 hours post-infusion):

Full baseline return expected
Able to eat, drink, move freely
Can shower (optional)
Can journal or reflect on experience
Many patients feel hopeful, lighter, calmer

Sleep:

Do not drive or operate machinery for 8–12 hours
Safe to sleep; sleep aids recovery
Next day: Back to normal activities (work, exercise, etc.)

Phase 7: First Week & Ongoing Sessions

Session 1 Reflection

Next morning:

How do you feel? Mood different? Suicidal thoughts less intense?
Many patients notice a shift within hours or by next day
Some feel dramatic relief; others notice subtle changes (slight mood lift, less hopelessness)
This is not a "cure" after one infusion; it's a beginning

Sessions 2–8 (Weeks 1–4)

Schedule: 2x/week (e.g., Monday & Thursday)

Weekly progression:

Sessions 2–3: Most patients notice clearer mood improvement
Sessions 4–6: Suicidal ideation often diminishes significantly
Sessions 7–8: Consolidation of gains; functional improvement (sleep, appetite, motivation return)

What Changes

By week 2–3:

Suicidal thoughts less frequent, less intense
Anhedonia (joylessness) beginning to lift
Sleep often improves
Appetite returns
Energy slightly improved
Motivation to engage in activities returns

By week 4:

Clear mood improvement (vs. baseline)
Significant functional restoration
Ability to engage in therapy, hobbies, relationships
Suicidal ideation resolved or minimal
Hope restored

Maintenance Phase (Weeks 5+)

Transition to weekly, then biweekly:

If responding well: Move to 1x/week for weeks 5–8
Then biweekly (every 2 weeks) for months 3–6+
Duration: Discuss with Dr. Thangada; typically 6–12 months

Why maintenance?

Benefits consolidate over time
Biweekly dosing sustains improvement
Antidepressants + ketamine together more effective long-term
Some patients can eventually taper; others need indefinite maintenance

What to Bring & Wear

Essential

Insurance card (if insured)
Government-issued ID (driver's license, passport)
List of current medications (or bring bottles)
Transportation confirmation (driver's name/number or rideshare confirmation)

Comfort Items (Recommended)

Headphones (clinic has calming playlist, but your own preferred music OK)
Cozy sweater or hoodie (clinic is cool; dissociation can feel chilly)
Comfortable blanket (bring from home if preferred)
Journal (post-session reflection)
Eyeglasses (if worn; some want them off during infusion)

What to Wear

Loose-fitting, comfortable clothing (no tight jeans, restrictive belts)
Arm accessible (short-sleeved shirt OK for easy IV placement)
Comfortable shoes (easy to remove)
Layers (remove sweater during infusion if warm; clinic adjusts temperature)

What NOT to Bring

❌ Valuables (leave at home; focus on healing)
❌ Phone (clinic has secure area; avoid distractions)
❌ Medications (already prescribed; clinic has documentation)

Frequently Asked Questions

1. Will I Lose Consciousness During Ketamine?

No. Ketamine dissociates (detaches perception), but does not cause unconsciousness:

You remain fully awake throughout infusion
You can talk, respond to questions, squeeze nurse's hand
You're aware of your surroundings (though they feel dreamlike)
It's different from anesthesia (where you're unconscious)
You will have memory of the experience (though dreamlike memory)

2. What If I Panic During Dissociation?

Panic is rare but manageable:

Prevention: Pre-infusion preparation (visualization, breathing practice) reduces anxiety
During panic: Tell the nurse immediately; she'll:
Reassure you verbally ("You're safe; this is temporary")
Guide breathing (slow, deep breaths)
Remind you of staff presence at bedside
Adjust music or lighting if helpful
Result: Panic typically subsides within minutes with reassurance
Rare severity: If panic severe, staff can give mild sedative to help; ketamine effect not reduced

3. Is the Dissociation Experience Unpleasant?

Not for most patients:

Many describe dissociation as "peaceful," "dreamlike," "floating"
Some find it pleasant; enjoy the mental break from depression
A few find it weird or uncomfortable (still safe; just unfamiliar)
Important: Discomfort ≠ Danger; dissociation is reversible and monitored

4. Will I Remember the Infusion?

Yes, usually:

You'll have a hazy memory (like a dream you remember upon waking)
Most patients recall: "I was floating," "Room felt dreamlike," "Time was weird"
Some remember fragments more clearly; others remember less detail
Memory loss is not a concern; mild memory fuzziness is normal during acute dissociation

5. What If I Don't Feel Better After First Infusion?

This is common and OK:

Response timeline: Benefits often manifest by session 2–3, not session 1
First infusion: May feel only mild mood shift or residual peace
By session 4–6: Clearer improvement expected
Non-responders: By session 4–6, we can tell if you're responding; if not, we reassess protocol or consider alternatives
No pressure: This is not a "failure" on your part; some patients respond differently

6. Can I Take Antidepressants During Ketamine Therapy?

Yes, absolutely:

Continue your SSRI, SNRI, bupropion, or other antidepressants
Ketamine + antidepressants work synergistically
Do not stop meds unless Dr. Thangada specifically advises
Some patients reduce or stop antidepressants after ketamine helps; Dr. Thangada guides this

7. What Happens if I Miss a Session?

Communicate with us:

One missed session: Reschedule ASAP; brief interruption acceptable
Repeated missed sessions: Efficacy decreases; acute phase benefits may be lost
Life happens: We understand; contact us to adjust schedule if needed
Makeup sessions: Can sometimes be scheduled to catch up

8. Will My Family/Partner See Me Dissociated?

No:

Family members not present during infusion (for patient privacy and concentration)
Pick-up driver meets you in clinic waiting room; you're already recovered
By discharge, you're alert, oriented, safe to have normal conversation
No "weird" behavior at home; you're back to baseline (just in better mood!)

Disclaimer

This blog post provides educational information about the ketamine therapy experience and is not medical advice. Individual experiences vary. Some patients may have different dissociation experiences, recovery timelines, or side effects not described here.

Important Safety Notes:

Ketamine is a Schedule III controlled substance with potential risks; not appropriate for all patients
IV (racemic) ketamine for depression is off-label and not FDA-approved for psychiatric use; esketamine (Spravato) is the FDA-approved form, indicated for treatment-resistant depression
Serious adverse effects (hypertensive crisis, respiratory depression, psychotic reaction) are rare with proper screening but possible
Dissociation is normal but can be distressing for some; speak with staff if anxious
This is not a substitute for psychiatric evaluation: Before beginning ketamine, you must see a board-certified MD psychiatrist for thorough assessment
Transportation is mandatory: Do not drive for 8–12 hours post-infusion; driving while dissociated is unsafe and illegal
Individual differences: Your experience may differ from those described here; ask Dr. Thangada about what to expect for your specific situation

Before Your First Infusion:

Complete psychiatric evaluation with Dr. Thangada
Ask all questions; understand risks and benefits
Arrange transportation weeks in advance
Fast appropriately; bring comfort items
Breathe; you're in good hands

KwikPsych assumes no liability for outcomes from ketamine therapy. All treatment decisions are collaborative between patient and board-certified MD psychiatrist.

Berman, R. M., et al. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351–354.

Murrough, J. W., et al. (2013). Antianhedonic effects of ketamine and relationship to BDNF and cognition. Neuropsychopharmacology, 38(12), 2485–2497.

Morgan, C. J., et al. (2010). Cognitive impairment associated with ketamine use: A comprehensive review and proposed mechanisms. Psychopharmacology, 214(2), 245–266.

FDA Approval of Esketamine (Spravato) (2019). FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression. Retrieved from https://www.fda.gov/news-events/press-announcements

American Psychiatric Association (2023). Practice Guideline for the Treatment of Patients with Major Depressive Disorder (3rd ed.). Arlington, VA: American Psychiatric Publishing.

Fond, G., et al. (2022). Ketamine and esketamine for major depressive disorder: A systematic review and meta-analysis of efficacy and tolerability. Clinical Drug Investigation, 42(3), 233–251.