The Infusion Experience
A ketamine infusion involves two distinct aspects. First, there’s the technical IV procedure performed by the doctor. Second, there’s the sensation you experience during the infusion. We’ll explain both.
The IV procedure
Your first appointment will include a consultation, where the doctor will examine you and assess your condition. She will have already reviewed medical records forwarded by your referring physician, and may have had a phone consultation with them. She will then determine the treatment protocol. This means deciding on the ketamine dose, and the infusion rate and duration. The initial dose will be based on your weight, but may be adjusted in subsequent treatments depending on your response. A typical duration is 40-50 minutes. We suggest you always ask your doctor to tell you the dose, rate, and duration used so you can keep your own records and track your results against different protocols.
You will be placed in a private treatment room with a comfortable reclining chair or hospital bed. You won’t need to disrobe or put on a hospital gown. Usually the doctor will allow a loved one to stay in the room with you if you choose. You’ll be connected to monitors for blood pressure, pulse, and oxygen saturation. The doctor or a nurse anesthetist will locate a vein near the skin surface, usually on your arm, wrist or hand, then use a tiny needle to painlessly insert an extremely thin flexible tube into it. Unlike an intramuscular injection such as a flu shot, the stick of the IV needle can barely be felt because it will not hit muscle, so there is virtually zero pain involved even for people who are sensitive to needles. The tube is connected to a bag of fluid raised a couple feet above you containing your carefully-measured dose of ketamine, which will be delivered directly into your bloodstream at a rate controlled by the doctor. The tube is removed afterwards, and again you will probably feel nothing. The procedure does not involve any sutures, cutting, etc.
The doctor may suggest lowering the lights during the infusion, and if you brought someone with you, she might ask them not to converse with you unless you initiate it. Many patients choose to listen to music during the treatment.
The doctor will monitor your response during the infusion. An experienced ketamine clinician can recognize signs that the drip rate is too slow, or too fast, and may adjust it accordingly to maximize your chances of relief.
Some patients experience nausea during treatment. If you become nauseous during the infusion the doctor can help control it by adding an antiemetic to the IV. If you have a history of getting nauseous easily or being prone to motion sickness, tell your doctor in advance because he/she may want to add an antiemetic at the beginning, before the infusion starts.
When the infusion ends you will begin to regain your faculties within minutes, while the IV is still connected. The time needed to fully recover speech, balance, etc., varies from patient to patient. For most, the effects are completely gone after an hour or two. Some patients feel very fatigued afterwards.
Some doctors will require a 3rd party to sign you out and take responsibility for your safety once you leave the clinic. Others will require you to stay until they are satisfied the acute effects have completely dissipated. They will explain their requirements before your appointment so you can plan accordingly.
The sensation you experience during the infusion
This aspect of the treatment gets more attention than it merits, in our opinion. This is probably because ketamine is abused recreationally, and some people assume that a medical infusion is the same as a recreational “trip”. Wrong. And some leap to the conclusion that ketamine therapy is really just a medically-cloaked excuse to get high. Wrong.
The media often zeros in on this single aspect to generate controversy, because controversy sells. A simple story about new medical procedure can produce yawns. But a juicy exposé about a controversial treatment will attract attention – and generate revenue – no matter how badly it mangles the facts. As you read this page (and most media coverage) remember that recreational abusers take HUGE doses compared to an infusion – up to 100x more – and often mix it with alcohol and other drugs such as cocaine or meth. Medical infusion and street abuse quite simply have nothing in common.
So what’s it like?
Once the infusion begins, the ketamine will reach your brain within seconds and you’ll quickly feel its effects. You won’t be able to stand (don’t try!) or converse normally. But you won’t lose consciousness or awareness of your surroundings. Remember, the ketamine dose and rate used for these infusions is only a small fraction of what is used in surgery.
An observer will see a motionless patient who appears asleep. Physically, you will feel extremely relaxed. But your mind will be fully engaged. The sensation can be weird. But most patients describe it as pleasant.
Your experience may include something called a dissociative effect, or dissociation. Dissociation is a kind of out-of-body experience, where you partially lose awareness of your body. You can often reduce the effect simply by opening your eyes. Again, it can be weird, but most find it to be a pleasant sensation. Dissociation does not happen to every patient. Some just feel extreme relaxation.
Your mind will be very active during the infusion. In a state of deep relaxation, you may find that you’re able to reflect on past traumas or current anxieties in a very calm, matter-of-fact way – with zero emotional pain. Most patients find this very satisfying, but a small percentage may find it uncomfortable. Many patients prefer to simply let their thoughts wander, without trying to steer them in any particular direction. We suggest using whatever approach maximizes your sense of calmness and relaxation, as long as your doctor agrees.
Although most patients find the experience relaxing and pleasant, some can have brief moments of fright. Patients who begin the infusion in a state of high anxiety seem most susceptible to this. Many are desperately pinning all their hopes on ketamine to relieve their suffering, which is totally understandable but can amp up their anxiety. Some patients get very tense at the thought of not being in total control of their thoughts or body. Try your best to relax before the infusion begins.
We think it’s important not to obsess over the infusion experience. The research indicates that depression relief is produced not by the strange infusion sensations, but by physical changes in the brain that remain after the infusion ends. Yes, you might feel odd for 40 minutes or so while the ketamine is in your system. But those effects are merely a consequence of delivering the drug to its destination – they are not the cause of the depression relief.