19 Things I Wish I Knew Before My First Ketamine Infusion
1. Try to Schedule It Earlier in the Day
Scheduling earlier in the day will give you the best access to your favorite room. Also, you will have a chance to take a decent nap without cutting into your bedtime significantly.
Having your infusion done earlier will also allow you ample time to hydrate during the day, as you will need to due to the after-effects. Also, in the case that you had a particularly strange experience, having more hours between your infusion and bedtime will help you process your thoughts, insights and fears and lessen the chance of you feeling hugely impacted or negatively affected before bed.
2. Fast Before Your Infusion
Fast 4-6 hours before your infusion appointment. This means that you shouldn't drink or eat during that time before the infusion. You might get nauseous during the infusion, and vomit. Having content in your stomach may make this a dangerous situation.
3. Nauseous? Ask for Zofran
Ketamine may make you nauseous. I am very prone to feeling nauseous, but in my first four infusions, I never felt nauseous, thankfully.
I think this is due to the fact that the nurse practitioner gave me a Zofran tablet (that dissolves) before the infusion. The tablet is dissolved under the tongue for fast effect. It worked for me.
A Note on the Medication Versed
Some clinics offer Versed. I wasn't offered it. Another name for Versed is midazolam. It's a drug that's used for uncomfortable procedures because it causes memory loss.
Many people report that Versed kept them calm during the infusions, but it may make the Ketamine infusions less effective. There's a lot of controversy with using Versed with Ketamine. It seems to be a safe combination, but I did not use this.
I am just touching upon the subject as it seems many have been offered Versed and had mixed results with it. Versed may cause you to not remember your 'hallucinations' or experiences during the treatment.
For me, the experience (the insights I received or felt during the infusions) were definitely part of my treatment, so Versed is not for me.
3. Urinate Beforehand
The Ketamine infusion may make you want to go to the restroom during your experience. It did that to me, and it felt more intense in the third infusion (100 mg).
The nurse practitioner mentioned that this may be due to the saline that is in your system. But upon a bit of research, ketamine itself, and especially ketamine abuse, have the potential to negatively impact the bladder.
4. Protect Yourself From a Possible Urine Accident
Consider using reusable or disposable hygiene pads, or even one of those adult 'diapers' for your infusion, especially at the higher doses. This is for any emergencies they may occur.
The medical staff at my clinic mentioned that some patients actually do experience urination emergencies during the infusion. I was actually afraid of this because I felt like at 100mg I was actually a bit mentally separated from my body. I squeezed my 'Kegels' with a feeling I had to use the restroom. I couldn't tell if I 'went' or not while I was in the Ketamine infusion seat! That kind of stole from the general experience, as I was worried about whether I actually urinated during the infusion or not. The medical worker mentioned that people generally tell her they have to use the restroom during the infusion.
It would be really difficult to say anything to the staff if you are over 100 mg due to higher levels of disassociation and possible 'ego death' or 'k-hole' experiences. During my infusion of 125 mg, I felt that there was no way (absolutely none) that I would be able to talk and tell the medical staff that I needed to use the restroom. In fact, I was very worried that I did make a 'mess', and kept touching my pants to make sure.
Your sense of touch becomes strange during Ketamine, so I truly had no idea of the situation happening in my bladder or couch. I did wear one of those cloth, washable menstrual cycle pads that I got from a popular online retailer at my 125-milligram infusion, however, just in case. Nothing happened. . .yet. I was worried because I have a bad bladder, currently, from previous issues from the past.
If you have to use the restroom during the infusion, the medical staff will have to stop your infusion 15 minutes prior to transporting you in order for you to be more aware and alert. This will cut into your infusion/experience time and may leave you feeling quite disoriented. But again, Ketamine may have your lips feeling numb and it may be incredibly difficult to talk or express yourself at higher doses, so keep that in mind.
5. Start at a Lower Dose
You may start off on a lower dose, such as 60 mg (like I did). These lower doses, like 60mg or 80 mg, are considered 'relaxing' doses. I have read some reports that people started at higher doses, like 75 milligrams or more, for their first infusion.
I highly recommend 60 milligrams, but the clinical staff may have a calculation based on your weight. Ketamine is most commonly administered in the dose of 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg, and others may require up to 0.75 mg/kg. Keep this calculation in mind, as you can probably calculate a potential first dose.
My first dose was 60 milligrams. At the time, I was upset that it was so low! But honestly, it has wonderful effects that I felt for 6 days before I received my second infusion. In retrospect, I'm glad I started at 60 milligrams because it's a good way to introduce you, gently, to the world of Ketamine infusion. If you have never done recreational drugs, like me, definitely start off at a lower dose because you will be surprised, quite surprised, as to how surreal everything becomes.
6. Bring a Blanket
Bring a blanket or a soft cardigan. Those rooms in the Ketamine clinics tend to be on the cooler side. The blanket also feels like a bit of 'security' in a situation where you may feel a bit exposed. Wear comfortable clothing.
7. Hold Side of the Couch or Have Your Feet on the Ground
Having contact with either the couch and touching it with your fingers and hands, or having contact with your feet on the ground helps you feel 'grounded'. Sometimes during the infusion, the "floaty" feeling can be a bit intense, and feeling the sides of the couch or floor can be comforting and let you know that you're okay.
The feeling might remind you of taking off on an airplane. Letting your body know you're 'grounded' helps keep you calmer during the infusion.
8. You Can't Fall Asleep
You will be awake during the infusions. Try to get sleep beforehand, however, so you don't feel the need to sleep. My infusions are for depression, so they are 40 minutes long.
Infusions for chronic pain, depending on the clinic, may be longer. The doses given are not enough to have you become unconscious. Some clinics may allow naps, however, but since you're being physically monitored, most clinics don't allow sleeping.
9. Avoid Music With Words
I'm a hypocrite for saying this because I usually listen to a spiritual app called Abide. In this App, there are options to listen to 90-minute stories that are Bible-based. The words became too intense for me at 125 milligrams. I had to remove my earbuds.
But during the 60mg, 80mg, and 100mg infusions, I was able to listen to the words and ponder upon them. I felt a comforting, safe feeling of embracing a very large calf or leg of Jesus. I almost felt his robe brushing against my face, and didn't care that he was a giant.
At 100 mg, I watched a spacey aurora-esque DVD during the infusion and felt the grandiose and majesty of God while 'floating' in space in my head.
At 125 milligrams, the words were too overwhelming and confusing, and the words became completely distorted. Trying to focus on the words and then trying to figure out what was going on in my mind's eye was too, too much for me. I feel that I almost had a panic attack, which is something I'll touch upon in a separate article.
Sometimes, the words of what you're listening to match exactly what you're seeing on the TV, but sometimes it's so off that it becomes disorienting and confusing.
With doses of 100 mg and above, I would recommend not listening to music or podcasts with words.
10. Be Consistent With Experiences
I listen to the Abide app and watch ocean scenes and request the nature sounds on the DVD. The Abide app has a very relaxing trickling water sound effect that accompanies the voices, and it feels comforting and familiar to me.
There is a comfort in knowing that the experience will be similar to the last. I usually stick to the ocean and beach retreats for the DVD, but I noticed that I had a less desirable experience at 100mg when I watched a strange, spacey aurora-based DVD on the TV.
11. Expect Breathing and Pressure Changes
Your blood pressure will rise significantly during your ketamine infusion. You may not notice this, but it will be monitored. What you may notice is that your breathing becomes labored. Breathing deeply will relax you in a way, especially when things get a little tense during the Ketamine infusions. During my strange "k-hole" or "ego-death" experience at 125 milligrams, my heart rate went up to 168/101. After the infusion, you may feel exhausted, especially if you took many deep breaths during the infusion.
Drink water and hydrate AFTER the Ketamine Infusion. It appears that Ketamine may cause cell dehydration. I try to hydrate with water, but I have noticed that having a Powerade or something with electrolytes helps as well.
You can try hydrating the day before the infusion, but just don't drink anything, or eat, 4-6 hours before the infusion.
13. You Will Likely Become Constipated
You will experience constipation after your ketamine infusion, especially if you do not hydrate. Ketamine may have a strange chemical effect on gastrointestinal stimuli.
My nurse practitioner mentioned this would happen, and sure enough, it's happened all four times so far.
14. Prepare for Headaches
You may have a headache, much like a 'hangover' feeling. The nurse practitioner told me to have Ibuprofen after the infusion, and it helped immensely, along with being hydrated.
After the first infusion, I did not hydrate at all, and also, I did not take Motrin. My headaches lasted for a day and a half.
15. Uber or Get a Ride
You will feel quite disoriented after the infusion. You do get about 15-20 minutes to relax on the couch or in the room after the infusion. There is absolutely no way that you could drive home after an infusion.
I usually take an Uber both ways. Even if you are trying to act 'normal' after the infusion, you're not. You still have a lot of ketamine in your system, so please watch your step.
On my second infusion, I thought I put my phone in my purse, and instead, I dropped it on the floor, and it completely broke. Three hundred and twenty four dollars later, I had a new phone. Be careful after the infusion. You won't be completely yourself for a few hours.
16. Consider a Nap Afterward
Taking a nap after the infusion may be a good idea to sleep off the headache. But again, drink water first and hydrate. A nap, after you get home, will help refresh you in many ways.
17. Don't Be Alarmed if You Experience Insomnia
I always have trouble sleeping the night of my infusions. Some studies mention that Ketamine may have this effect, especially if you are new to Ketamine infusions, and especially if you took a nap during that day. Consider melatonin a few hours before your bedtime to help with your natural sleep cycle.
18. Don't Be Afraid if You Relapse
My first infusion was at 60 milligrams. I felt amazing for six days. On the seventh, I went down the depression vortex, and I was really worried. Luckily, the nurse practitioner mentioned this would happen, and it was expected. The infusions are wonderful, but you need to build up the Ketamine in your system, and it begins with smaller doses. Ketamine works over time, and you may need boosters over time.
19 Consider Seeing a Cognitive Behavioral Therapist
Some people want to consider, or regard, Ketamine as a cure. It's not a cure, but rather, a tool. It's a key and a map. To navigate the world with these tools, you may need a cognitive behavior therapist. Ketamine gives you time to work on yourself. It gives you more time to be happy, try new hobbies, rediscover "you"...and this is the perfect time to work with a cognitive behavior therapist who can help shape your thoughts in a way that helps you think more positively with less effort.
I'm working with one, and it's been incredibly useful. On dark, or relapse days, I notice that I don't feel 'deep' into the hole of depression as I used to in the past. I have less 'negative ideation' thoughts.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2020 Charlotte Doyle