How to Prepare for Ketamine Therapy: A Checklist

Most of the preparation that matters for ketamine treatment happens before you ever sit in the chair, and almost none of it is mystical. It is paperwork, logistics and a handful of questions asked early enough to change your decision. This guide follows the sequence a patient actually goes through (choosing and booking, screening, the days before, the session itself, and the weeks afterwards) using what our clinic and country guides document about how European services run. Protocols differ by route and by clinic, so treat this as the map, and your treating service's written instructions as the route.

TL;DR Write out your full treatment history before anything else, and take it to every appointment. Verify the clinic and the prescriber on the national register, and get the full course cost in writing rather than a per-session price. Expect a proper screening appointment covering psychiatric and cardiovascular history before treatment is booked, and disclose every medicine and substance you take. Clear the whole day of the session, arrange a lift home, and do not plan to drive. Afterwards, expect measurement, follow-up and a relapse plan, and do not leave without written aftercare and escalation instructions.

Before you book

Write the treatment history. Every antidepressant you have tried in the current episode, with substance, dose, duration and outcome. Bring it to every appointment: it is a key part of assessing eligibility and planning care, whether a psychiatrist is assessing you for a reimbursed esketamine pathway or a private clinic is screening you for infusions. It is not the whole case: diagnosis and severity, the adequacy of previous treatment, psychiatric and physical comorbidity, current medicines and substances, risk assessment and the clinician's judgement all count, but it is the part only you can prepare. Compile it before your first appointment; ask your GP to print your medication history if you are unsure of the details.

Check whether a funded route exists first. A clinic selling self-pay infusions has no obligation to mention that a covered esketamine route may be open to you. Our Europe-wide reimbursement map sets out who pays for what and under which criteria, and the eligibility check gives an early sense of where you stand: it runs in your browser and stores nothing.

Verify the provider, not the branding. There is no European "ketamine clinic" licence; what is regulated is the doctor and the facility. Check the national register that applies where you are: the CQC in England, the physician's Approbation and Ärztekammer registration in Germany, the BIG register in the Netherlands, cantonal authorisation in Switzerland, and the clinic's medical director by name. Our clinic-choice guide has the full checklist and the red flags that should end a conversation.

Get the full course price in writing. Private IV courses commonly run to around four to six infusions over two to four weeks (a consensus-based clinic practice rather than a licensed standard, so your service may plan differently), and esketamine has its own licensed induction schedule. Either way, a per-session figure is not the number you need. Published European prices range from roughly £265 at an NHS self-funded service to £595 per infusion in London (the routes behind those figures are in our guide to ketamine therapy in the UK), €200–400 in Germany and CHF 300–500 in Switzerland, with full programmes reaching into the thousands; our cost guide collects what providers actually publish. Ask what happens to your fee if screening rules you out, and what maintenance costs after the induction.

The screening appointment

Nothing should be scheduled before this. A serious provider reviews your psychiatric and medication history, checks cardiovascular health and current medicines, confirms the diagnosis, and discusses goals, contraindications and cautions. This is also where treatment gets declined, and a clinic that never declines anyone is not screening.

What screening looks for falls into two groups. First, formal contraindications: for esketamine the product licence rules out treatment where a rise in blood pressure or intracranial pressure would pose a serious risk (aneurysmal vascular disease, a previous bleed in the brain, or a recent cardiovascular event) as well as hypersensitivity to the drug. Second, cautions that call for specialist judgement rather than automatic exclusion: uncontrolled hypertension, a personal history of psychosis or of mania or bipolar disorder, and current or previous substance misuse, including ketamine itself. A family history alone is not a listed contraindication. Pregnancy is a special case: esketamine is not recommended during pregnancy, and breastfeeding requires an individual risk–benefit decision with the prescriber. IV-ketamine services set their own criteria, which may differ from the esketamine licence. Say all of it plainly at screening: the questions exist to protect you, and an incomplete history is the one thing that turns a managed risk into an unmanaged one.

Questions worth asking in this appointment: who screens me and what would make you decline to treat me; what is monitored during sessions and who responds to an emergency; how will we know whether it is working, and when do we stop if it is not; will you send a treatment summary to my GP or psychiatrist.

The days before

Ask the clinic directly for its instructions on food, drink and medicines on the day. For esketamine the label sets some of them: no food for at least two hours before dosing, no liquids for at least 30 minutes before, and no nasal corticosteroid or decongestant within the hour before the spray. Fasting instructions for IV ketamine vary between services, so follow your provider's written instructions rather than anything you read online.

Disclose everything you take (every prescribed and non-prescribed medicine, plus alcohol and any recreational drug use), and change nothing on your own initiative. Sedating medicines such as benzodiazepines and opioids, and alcohol, can deepen sedation during a session; psychostimulants, monoamine oxidase inhibitors and other medicines that raise blood pressure can add cardiovascular risk. If you are on a continuing antidepressant, do not change or stop it yourself; under the European label, esketamine for treatment-resistant depression is taken alongside a continuing oral SSRI or SNRI, and any medication change is the prescriber's decision. If you are considering a clinical trial instead, note that many studies require a supervised taper of serotonergic antidepressants before enrolment (trials guide).

The practical list is short: arrange transport home, clear the rest of the day, tell one person where you are going and when you expect to be back, and bring your treatment history along with your regulator and insurance details if a claim is involved.

On the day

A racemic ketamine infusion is usually given intravenously over roughly 40–60 minutes, with blood pressure, heart rate and psychological state monitored throughout and a recovery period afterwards; the exact protocol varies by service. A supervised esketamine (Spravato) dose works differently: you self-administer the nasal spray under staff supervision, blood pressure is checked before the dose and again at about 40 minutes, and you stay under observation, typically around two hours, until staff judge you clinically stable and ready to leave. Two hours is the usual observation period, not an automatic discharge time, and patients at higher cardiovascular or respiratory risk may need closer monitoring in a suitably equipped setting.

Transient dissociation (a detached, dreamlike feeling) along with sedation or sleepiness, anxiety or panic, nausea and vomiting, dizziness and a short-lived rise in blood pressure is common, and usually settles as the drug clears. Usually is not always: these effects can occasionally be severe or need intervention, and rare respiratory depression has been reported. That is what the monitoring is for, so tell staff immediately about anything distressing or severe rather than assuming nothing is wrong.

What to think about during the session is mostly a matter of expectations. This is not a single decisive event: the antidepressant effect of one infusion commonly attenuates over days and is generally no longer clearly evident by about two weeks, which is why repeat dosing and maintenance are discussed. For treatment-resistant depression, esketamine follows a licensed schedule (twice weekly for the first four weeks, then less frequently with ongoing review), while IV courses are planned by the clinic on consensus practice. Ketamine-assisted psychotherapy wraps preparation and integration sessions around the dosing, but psychotherapy is not part of the licensed esketamine regimen, and the evidence that it adds benefit to the drug remains limited and heterogeneous: reasonable to try, unreasonable to rely on for the whole result. The ketamine evidence review sets out what is established, what is promising and what is not yet known.

You will not be able to drive afterwards. After a supervised esketamine dose the rule comes from the label: no driving, operating machinery or hazardous activities until the next day, after a restful sleep. After an IV infusion, follow the clinic's written discharge instructions: the NHS trust service in Oxford applies the same next-morning restriction and also advises against cycling, alcohol, signing legal documents and being the responsible carer for dependants until then.

Afterwards

Good aftercare is the part patients underprepare for. Arrange follow-up, symptom review and a relapse plan: a serious provider measures symptoms on a scale rather than by impression, schedules reassessment, has a plan for non-responders, and sends a summary to your GP or psychiatrist. Relapse after stopping is common, and the maintenance question (how often, for how long, at what cost) should be discussed before you are in the middle of it rather than after.

Do not leave without written contact and escalation instructions. Seek urgent help for breathing difficulty, severe or persistent adverse effects, a marked worsening of your condition, or suicidal thoughts, and expect closer monitoring early in treatment and after any dose change. A service that hands you nothing in writing at discharge has skipped a basic step.

Psychotherapy or integration sessions may be offered around the dosing. Their additional benefit on top of the drug is not yet established, so treat them as an option to weigh on cost and fit rather than a requirement for the treatment to work, and if you do book them, book them around the sessions rather than hoping to fit them in.

Frequently asked questions

Can I drive after a ketamine session?

No. Plan for someone to take you home. After a supervised esketamine dose, do not drive, operate machinery or do anything hazardous until the next day, after a restful sleep. After an infusion, follow the clinic's written discharge instructions: Oxford's NHS service gives the same next-morning rule and also advises against cycling, alcohol, legal decisions and caring for dependants until then.

How many sessions will I need?

For IV ketamine there is no licensed schedule: recent consensus describes around four to six infusions over two to four weeks as common practice, and services differ, so your plan should be individualised and reviewed against measured response. Esketamine follows its licensed schedule: twice weekly for the first four weeks, then less frequent dosing with periodic review of continued benefit. Both are courses, not one-off procedures, which is why the full-course cost is the number that matters.

Should I stop my antidepressants before treatment?

Not on your own initiative. Esketamine for treatment-resistant depression is licensed for use alongside a continuing oral SSRI or SNRI, and any change to your medication is a decision for the prescriber who knows your history. Clinical trials are the exception: many require a supervised taper as part of enrolment.

What should I bring to the first appointment?

Your written treatment history above all: every antidepressant tried in the current episode, with dose, duration and outcome. Add a list of every current medicine, prescribed and non-prescribed, with honest notes on alcohol and recreational drug use, relevant physical health conditions, your GP or psychiatrist's contact details, and any questions you want answered before you pay.

What if the treatment does not work?

That is a question to ask before you start. A well-run service measures response with symptom scales, reassesses on a schedule, and has an agreed point at which it stops and reconsiders rather than continuing indefinitely. The one European service that publishes its own numbers, the NHS trust ketamine service in Oxford, reports that about half of patients respond well, so a plan for non-response is not pessimism, it is standard practice (NHS vs private guide).

Is it normal to feel anxious before the first session?

Yes, and it is a reasonable thing to raise at screening. Knowing the shape of the day (how long the dose lasts, who will be in the room, what monitoring happens, when you can go home) is the part of preparation that does most to settle it.

Sources

This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. Always follow the instructions of the clinic treating you and discuss your options with a licensed clinician who knows your history. If you are in crisis, contact your local emergency number or a crisis line immediately.

Reviewer's note. This practical checklist turns a complex treatment pathway into clear, patient-centred steps before, during and after ketamine or esketamine treatment. Its strengths are the emphasis on screening, medication history, transport, monitoring and follow-up; however, protocols differ by route and clinic, so readers should follow their treating service's instructions rather than treat any schedule or preparation step as universal.

— Dr. Christopher Gauci, MD MRCS(Ed) EDAIC, anaesthetist and intensive care specialist, PsyAccess medical reviewers

Medically reviewed by Dr. Christopher Gauci, MD MRCS(Ed) EDAIC, on 20 August 2026.

How to Prepare for Ketamine Therapy: A Practical Checklist

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