How to Prepare for Ketamine Therapy

Proper preparation maximizes the safety and effectiveness of your ketamine sessions. While the medication does the neurobiological heavy lifting, the context in which you receive it -- your physical state, mental readiness, medication profile, and environment -- significantly influences your experience and outcomes.

This guide covers everything you need to do and know before your first (or any) ketamine session, from dietary restrictions and medication interactions to psychological preparation and practical logistics.

Physical Preparation

Dietary Guidelines

Fasting before IV infusions. The most important physical preparation for IV ketamine is proper fasting. Because ketamine can cause nausea in approximately 15-20% of patients, an empty stomach significantly reduces this risk.

| Time Before Session | What Is Allowed | |---------------------|-----------------| | 6+ hours before | Full meals (your last meal before fasting) | | 4-6 hours before | Light snacks only (crackers, toast) | | 2-4 hours before | Clear liquids only (water, clear juice, black coffee, clear broth) | | 0-2 hours before | Small sips of water only |

Why fasting matters. Ketamine interacts with the body's autonomic nervous system, which controls involuntary functions like digestion. At therapeutic doses, ketamine can slow gastric emptying (how quickly food leaves your stomach) and trigger the nausea center in the brainstem. An empty stomach dramatically reduces the likelihood of nausea and eliminates aspiration risk.

Exceptions and variations:

• For at-home oral/sublingual ketamine, fasting requirements are typically less strict (2-4 hours)
• Spravato (nasal spray) also recommends avoiding food for 2 hours before
• If you have diabetes or other conditions requiring regular food intake, discuss modified fasting protocols with your provider

Hydration

Being well-hydrated before your session is important for several reasons:

• It makes IV placement easier (dehydrated veins are harder to access)
• It helps stabilize blood pressure
• It supports kidney function in metabolizing ketamine
• It reduces the likelihood of post-session headache

Aim to drink 32-48 ounces of water in the 12 hours leading up to your session. Stop drinking 2 hours before (or sip only) to comply with fasting requirements.

Sleep

Arrive as well-rested as possible. Sleep deprivation can:

• Amplify anxiety and emotional volatility during the session
• Affect your cardiovascular baseline (elevated heart rate and blood pressure)
• Reduce your cognitive resilience during the dissociative experience
• Interfere with the post-session integration process

If anxiety about the upcoming session keeps you awake, gentle sleep aids like melatonin are generally acceptable. Avoid alcohol as a sleep aid. If you typically take a benzodiazepine for sleep, discuss timing with your ketamine provider -- you may need to skip it or take it early enough that it clears your system before treatment.

Medication Interactions and Adjustments

This is the most medically critical aspect of ketamine preparation. Several common medications can interact with ketamine, reducing its effectiveness or increasing risks.

Medications That May Reduce Ketamine Effectiveness

Benzodiazepines (CRITICAL). Research consistently shows that concurrent benzodiazepine use can significantly blunt ketamine's antidepressant response.^[2] Benzodiazepines and ketamine both act on the GABA system (though through different mechanisms), and their interaction can reduce the glutamate surge that is central to ketamine's therapeutic effect.

Common benzodiazepines include:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

What to do: Most ketamine providers ask patients to hold benzodiazepines for 12-24 hours before each session. If you take benzodiazepines daily, your provider will create a tapering or timing plan. Never abruptly stop benzodiazepines -- this can cause dangerous withdrawal seizures. Work with your prescribing physician.

Lamotrigine (Lamictal). At higher doses (200 mg and above), lamotrigine may partially block ketamine's antidepressant effects by stabilizing glutamate release. At lower doses (100 mg or below), the interaction appears minimal.^[4]

What to do: Discuss with your provider. Some patients temporarily hold lamotrigine on infusion days; others continue without issue. The evidence is not conclusive enough to mandate discontinuation.

Medications That May Increase Risks

MAOIs (monoamine oxidase inhibitors). These include phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Emsam patch). The combination of MAOIs with ketamine can cause dangerous blood pressure elevations and serotonin syndrome. Most clinics require a 2-week MAOI washout before starting ketamine.

Stimulants (with caution). Medications like methylphenidate (Ritalin/Concerta) and amphetamine (Adderall) can add to ketamine's cardiovascular effects. Your provider may ask you to hold stimulants on treatment days.

Tramadol. This pain medication can lower the seizure threshold and has serotonergic properties that may interact with ketamine. Most providers recommend holding tramadol for 24 hours before treatment.

Medications That Are Generally Safe to Continue

Supplements and Over-the-Counter Products

Several supplements and OTC products deserve discussion with your provider:

St. John's Wort -- Can interact with ketamine metabolism through CYP enzyme effects. Generally recommended to discontinue 1-2 weeks before starting ketamine therapy.

CBD oil -- Limited data on interactions, but CBD can affect ketamine metabolism through CYP3A4 inhibition. Inform your provider about CBD use.

Grapefruit juice -- A potent CYP3A4 inhibitor that can slow ketamine metabolism, potentially increasing blood levels. Avoid for 24-48 hours before sessions.

Antihistamines (Benadryl, Dramamine) -- Can add to sedation. Generally hold on treatment day unless prescribed for pre-treatment nausea by your ketamine provider.

NSAIDs (Ibuprofen, Naproxen) -- Generally safe and may be helpful for post-session headaches. Can be taken with food after the session.

Alcohol -- Avoid alcohol for at least 24 hours before and after ketamine sessions. Both substances depress the central nervous system, and the combination can be dangerous.

Cannabis/THC -- While some patients use cannabis regularly, it can affect the ketamine experience unpredictably. Most providers recommend abstaining for at least 24 hours before treatment.

Mental and Psychological Preparation

Setting an Intention

Intention-setting is a practice borrowed from psychedelic-assisted therapy research that many ketamine providers have adopted. It involves identifying a clear but flexible focus for your session.

Effective intentions:

• "I want to explore what is keeping me stuck in this depression"
• "I am open to experiencing peace, even briefly"
• "I want to practice self-compassion"
• "I am ready to let go of the anger I have been carrying"

Less helpful intentions:

• "I need to be cured of my depression today" (too rigid)
• "I want to have a mystical experience" (outcome-dependent)
• "I do not want to feel anything weird" (resistance-based)

The key is holding your intention lightly -- acknowledging it before the session, then releasing attachment to any specific outcome. The ketamine experience has its own intelligence; your job is to show up and be open.

Managing Pre-Session Anxiety

It is completely normal to feel anxious before ketamine therapy, especially before the first session. Here are evidence-based strategies:

Breathing exercises. The 4-7-8 technique (inhale for 4 counts, hold for 7, exhale for 8) activates your parasympathetic nervous system. Practice this for 5 minutes in the waiting room.

Grounding techniques. The 5-4-3-2-1 method: name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. This anchors you in the present moment.

Reframe the narrative. Instead of "This is scary," try "This is something I am choosing to do for my healing." Instead of "What if something goes wrong?" try "I am in a medical facility with trained staff."

Talk to your provider. If your anxiety is severe, let the clinic know when you arrive. They may offer a brief calming conversation, guided breathing, or in some cases, a very small anxiolytic dose that will not interfere with ketamine effectiveness.

Practical Logistics

What to Bring

Essential:

• Government-issued ID (required for controlled substance treatments)
• Insurance card (even if not billing insurance, for medical records)
• Payment method (if paying per session)
• Contact information for your designated driver

Recommended:

• Eye mask or sleep mask
• Earbuds or headphones with your chosen playlist loaded
• A light blanket or cozy scarf (clinics can be cool)
• Warm, thick socks
• A journal and pen for post-session reflections
• A light snack for after the session (crackers, a banana, a protein bar)
• Water bottle

Leave at home:

• Work laptop or materials (you will not be productive)
• Anything valuable that you might misplace while drowsy
• Tight clothing or restrictive accessories

What to Wear

Choose clothing for maximum comfort:

• Top: A loose-fitting shirt with sleeves that push easily above the elbow (for IV access and blood pressure cuff)
• Bottom: Comfortable pants, leggings, or sweatpants
• Feet: Warm, cozy socks (your shoes will likely come off)
• Avoid: Belts, tight waistbands, complicated jewelry, watches that beep

Arranging Transportation

This is non-negotiable. You cannot drive after ketamine treatment. Options include:

• Trusted friend or family member -- The most common and recommended option
• Ride-share services (Uber, Lyft) -- Practical, but have your phone ready to request the ride since you may be drowsy
• Taxi -- Pre-arrange with a local company if ride-share is unavailable
• Clinic shuttle -- Some premium clinics offer transportation services

Plan for your driver to be available approximately 2-3 hours after your scheduled start time. If your driver cannot wait at the clinic, give them a 30-minute heads-up via text once your infusion ends.

Scheduling Considerations

Time of day. Most patients prefer morning or early afternoon sessions. This allows the rest of the day for recovery and integration without disrupting sleep schedules. Late afternoon sessions can sometimes interfere with falling asleep that night.

Day of the week. If possible, schedule sessions on days when you do not have evening obligations. Many patients prefer Fridays or days before their days off.

Work arrangements. Plan to take the full day off work for your session. While you will likely feel relatively normal by evening, cognitive function may be subtly impaired, and you deserve time to rest and integrate.

Childcare and responsibilities. Arrange for someone else to handle childcare, pet care, and household responsibilities for the remainder of the day. You should not be the sole responsible adult for dependents on treatment days.

Preparing Your Environment

Post-Session Sanctuary

Set up a comfortable space at home before you leave for the clinic:

• Comfortable seating or lying area with pillows and blankets
• Dim, warm lighting -- avoid harsh overhead fluorescents
• Journal and pen on the side table
• Water and light snacks easily accessible
• Phone charger nearby (in case you need to contact someone)
• Minimal stimulation -- ask household members to keep noise down

Digital Preparation

Before leaving for the clinic:

• Put your phone on Do Not Disturb (or schedule it to turn on automatically)
• Set an out-of-office reply on email if applicable
• Pause social media notifications
• Download your chosen music/playlist for offline playback at the clinic

The Week Before Your First Session

A Day-by-Day Preparation Timeline

| Days Before | Action | |------------|--------| | 7 days | Begin medication adjustments as directed by your provider | | 5 days | Stop St. John's Wort and other supplements as discussed | | 3 days | Begin reducing caffeine intake if you consume large amounts | | 2 days | Prioritize sleep; begin winding down social commitments | | 1 day | Eat a balanced dinner; avoid alcohol; organize what you will bring | | Day of (morning) | Light activity; hydrate; review this checklist; practice intention-setting | | Day of (4-6 hrs before) | Stop eating solid foods | | Day of (2 hrs before) | Stop all fluids except small sips of water |

Communicate with Your Support System

Let the people closest to you know that you are starting ketamine therapy. Not because it is dangerous or controversial, but because:

• You will need practical help (rides, childcare)
• Your mood and behavior may shift noticeably during the treatment series
• Having emotional support enhances outcomes
• Your support system can help you notice positive changes you might overlook

You do not owe anyone a detailed explanation. A simple "I am starting a new treatment for my depression, and I may need some extra support over the next few weeks" is sufficient.

Preparation Differences by Treatment Type

Common Preparation Mistakes to Avoid

Mistake 1: Not fasting adequately. "I just had a small snack" can still cause nausea. Follow the fasting guidelines precisely.

Mistake 2: Taking benzodiazepines the morning of treatment. Even short-acting benzodiazepines take hours to clear your system. Plan ahead.

Mistake 3: Overscheduling the day. Ketamine is not a lunch-break treatment. Clear your calendar.

Mistake 4: Caffeine overload. Three cups of coffee before your session may elevate your blood pressure and amplify anxiety.

Mistake 5: Arriving in a rush. Plan to arrive 15-30 minutes early. Rushing triggers your stress response, which is the opposite of what you want.

Mistake 6: Forgetting your ride. Clinics will cancel your session if you cannot confirm a safe ride home. Arrange this well in advance.

Mistake 7: Stopping medications without guidance. Only adjust medications under your provider's explicit direction.

Ready for Your Session

Preparation is an act of self-care. By taking the time to properly prepare your body, mind, medications, and logistics, you are setting the stage for the best possible ketamine therapy experience. Remember:

• Physical preparation (fasting, hydration, sleep) creates the foundation
• Medication management (especially benzodiazepines) protects effectiveness
• Mental preparation (intention-setting, anxiety management) opens the door to deeper healing
• Practical logistics (transportation, schedule, environment) remove unnecessary stressors

You have done the work to get here -- the consultations, the research, the decision-making. Now it is time to trust the process, trust your medical team, and trust yourself.

Next, read our detailed guide on what happens during your first session, or explore what to expect from the full treatment journey.