“I wish I could have tapped the wisdom of other patients before my first treatment but there just weren’t very many of us then. I could have prepared better if I knew then what I know now.”

Dennis Hartman
Founder/CEO, Ketamine Advocacy Network

Getting The Most Out Of Treatment

If you’re going to spend serious money and pin your hopes on being a ketamine responder, you should do everything in your power to get the most out of the treatment.  Here we’ll share some practical experience from a variety of patients. Between us, we’ve had many dozens of infusions, and have picked up some do’s and don’ts along the way. Some of us did not feel our treatment was successful at first, but later recognized solid improvement. There are things you can do before, during, and after treatment to maximize your chances of a good outcome. Keep in mind that some patients do not respond to ketamine, and here we are only talking about those who do.

Rest Up

Try to be well-rested before the infusion.  If you have a morning appointment and are worried about being able sleep the night before, ask your ketamine provider if it’s ok to take a sleep aid.  Some patients feel their infusions are less effective when they are sleep-deprived.

Relax

Empty your bladder
The infusion only puts a few ounces of fluid into your body. But many patients feel like their bladder is full as soon as the infusion is over. Make sure it’s completely empty before the infusion starts, to buy yourself time at the end of the infusion before you have to make your way to the bathroom.
We realize this is easier said than done for some patients, but try to be in a relaxed state before the infusion starts.  Patients who are very tense when the treatment starts are more likely to have brief moments of unpleasantness during the infusion.  If caffeine makes you jumpy, maybe skip your daily cappuccino or wait until after your appointment. Obviously, you may be pinning a lot of hopes on the treatment and that can make you anxious.  Arming yourself with knowledge about the treatment and setting realistic expectations can help you relax when you get there.  (Do not take a benzo to relax before your appointment!  See below.)

Ask If Your Current Meds Will Interfere

Make sure your ketamine provider is aware of every drug you are currently taking, whether it’s a psychotropic med, heart medication, cough syrup, an illegal substance, etc.  Some substances can interact with ketamine or interfere with its action in the brain.  For example, high doses of benzodiazepines seem to reduce ketamine’s antidepressant effect.  If you are taking a daily high dose of benzos, your doctor might recommend reducing it before your treatment (he/she probably won’t ask you to stop taking it completely).  Other meds that can impact ketamine’s efficacy include lamotrigine, memantine, and any drug that affects NMDA receptors. Don’t hold anything back from the doctor. There’s no point investing your money and hopes unless you’ve disclosed everything and your doctor is satisfied nothing will interfere with the ketamine.

Bipolar Manic State

There is a lot of research showing ketamine’s efficacy for bipolar patients.  But some researchers say  bipolar patients get good results only when their infusion happens during a depressed state, not manic.  If you are bipolar and are in a manic state on the day of your appointment, make sure the doctor is aware.  Together you may decide it’s better to postpone until you cycle back to depressed.

Tell Your Loved Ones to Hold Their Questions

Easy to ask, hard to answer

Ask your friends and family not to bombard you with questions after the treatment.  They will naturally want to ask “Did it work?” or “Do you feel better?”  But the effects can be extremely subtle at first and many patients have trouble putting the experience into words.  You may need time to process it. Even those who can sense an immediate change often find it impossible to articulate at first.  When people ask those questions it can make you feel pressured not to disappoint them.  To them, these seem like easy questions, but to you the answers may be complicated in ways you can’t explain. Let them know ahead of time that you’ll talk about it when you’re ready, which might take a few days.

Don’t Stress Out Waiting for a “Blast” of Relief – Remember Function Often Improves Before Mood

Don’t forget that successful patients often begin functioning better before they feel better.  We’re serious: do NOT forget this fact while you wait for relief to reveal itself.  You might be inclined to find an isolated place, close your eyes, block out all noise, and concentrate hard to measure your mood, searching for any tiny changes.  It’s perfectly understandable why, but doing that won’t actually help you.  Instead, try to go about your daily routine.  You may gradually realize that it’s easier than before.  Even if your daily routine was nothing but lying in bed wishing you could get up, you may start noticing small things becoming easier, like putting on clothes, brushing your teeth, etc. These improvements can snowball in ways you don’t expect.  Many patients look back later and recognize small improvements like these as the first signs of relief, even if they didn’t seem momentous at first.

Put Your Improved Function to Use – Right Now!

If you respond to ketamine, you will be able to function better than before.  Put that ability to use!  Don’t wait, even for a minute.  If you’re able to socialize, go do it right now, instead of just patting yourself on the back for feeling able.  If you’re able to clean your house or organize your finances, do it right now, instead of feeling satisfied that you could do it.  The more you exercise your improved function, the more your mood will lift.

Imagine you had a muscle-wasting disease instead of depression, but there’s a treatment that can quickly repair the damage.  If you don’t put those newly-repaired muscles to use, your treatment was wasted.  But if you lift weights and focus on building new muscle mass, you’ll be much more able to deal with the condition if it returns, literally from a position of strength.

Successful ketamine therapy gives you the ability to build new “muscle” in the form of better function, improved habits, etc. – and the improved mood that comes with those things.  This combination can give you an entirely new power:  resilience.  If your depressive symptoms return, your new strength and resilience can help you withstand those symptoms better than ever before.  Most responders do not sink all the way back to their old baseline.  In our experience, the likelihood of permanent baseline improvement is directly related to how much you exercise your improved function while the relief holds, regardless of whether it lasts one week or six months.

Build on Your Relief to Make Lasting Emotional Gains

When a patient experiences relief like we’ve described, they can often make huge sudden leaps forward in their emotional healing. Many patients say they suddenly “get” what their therapists have been saying for years. Take advantage of this state and find a competent therapist who can help solidify your benefits into lasting emotional gains. Many patients find these improvements persist even if their symptoms return, giving them a resilience they never had before.

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