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.

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. Clear the whole day of the session, arrange a lift home, and do not plan to drive. Afterwards, expect measurement, follow-up and a plan — including a plan for what happens if it does not work.

Before you book

Write the treatment history. Every antidepressant you have tried in the current episode, with substance, dose, duration and outcome. This document does the heavy lifting on every route: it is what a psychiatrist assesses for a reimbursed esketamine pathway, and it is what a private clinic screens against. 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. A course commonly runs to about six sessions over two to four weeks, so 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 and contraindications. This is also where treatment gets declined, and a clinic that never declines anyone is not screening.

Treatment may be inappropriate, or require particular caution and specialist evaluation, if any of the following apply: uncontrolled hypertension or significant cardiovascular instability, including a history of aneurysmal vascular disease; a personal or family history of psychosis or bipolar disorder; pregnancy or breastfeeding; current uncontrolled substance use, a history of ketamine misuse, or a high risk of compulsive use. Say all of it plainly at screening. The exclusions 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 — these are set per provider and per route, so follow theirs rather than anything you read online. If you are on a continuing antidepressant, do not change or stop it on your own initiative; 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. A supervised esketamine (Spravato) dose works differently: you self-administer the nasal spray under staff supervision and stay for about two hours of observation while staff monitor blood pressure, heart rate, sedation, dissociation, breathing and recovery.

Transient dissociation — a detached, dreamlike feeling — along with mild perceptual changes, nausea, dizziness and a short-lived rise in blood pressure and heart rate are common, and settle as the drug clears. They are what the monitoring is for, not a sign something has gone 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 typically fades within one to two weeks, which is why courses are given and maintenance is discussed. Ketamine-assisted psychotherapy wraps preparation and integration sessions around the dosing, but the evidence for the combination is early — promising rather than proven — so it is reasonable to try it and unreasonable to expect it to carry 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 nasal-spray dose the standard advice is no driving, machinery or anything hazardous until the following day, after a night's sleep.

Afterwards

Good aftercare is the part patients underprepare for. 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. Continuity matters most after the course ends: 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.

If integration therapy is part of your programme, book it around the sessions rather than hoping to fit it in. If it is not part of your programme, decide consciously who is responsible for the psychological work. If the answer is nobody, reconsider the plan.

Frequently asked questions

Can I drive after a ketamine session?

No. Plan for someone to take you home. After an infusion you should not drive for the rest of the day; after a supervised esketamine dose the advice is to wait until the following day, after a night's sleep.

How many sessions will I need?

A typical course is about six sessions over two to four weeks, followed by a decision about maintenance based on measured response. Esketamine induction is more frequent at first and then tapers. 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 current medicines and 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.

This guide awaits review by a licensed medical professional.

How to Prepare for Ketamine Therapy: A Practical Checklist

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