Starting ketamine treatment
Patients receiving ketamine treatment for psychiatric symptoms such as depression, anxiety, OCD, PTSD, or other conditions, generally start with a series of 6 ketamine treatments. These treatments are typically spaced close-together, taking place over the course of 2-3 weeks.
The benefit that you see from ketamine is additive – with greater duration of symptom reduction and more significant results with each subsequent infusion in a series. After the first infusion, you may notice benefits (if you notice anything at all) for as little as a few days. By the time you’ve completed the sixth infusion, most people see benefits that persist for 3-5 weeks at a time, or longer, and from here most patients move to a maintenance schedule starting with one treatment a month.
At Wells Medicine, each appointment starts with a conversation with the doctor before treatment. We’ll check in on how you’re feeling and discuss what you can do outside of ketamine treatment to address your mental health.
Here are things you can expect to see after each treatment and the some of the ‘homework assignments’ we give at each appointment to help patients sustain and improve the results they see from the ketamine infusions.
1st infusion
An important part of your first appointment is learning about the procedure and what to expect.
The experience of ketamine infusion treatments is often described as a light and floaty. After the first infusion, some patients may notice that they feel a little lighter or like they’ve had a weight lifted off of them. These effects are subtle, and generally last between 72 hours and two weeks.
At this appointment, we often discuss starting to take helpful supplements – particularly magnesium, zinc, vitamin D, and L-methylfolate.
2nd infusion
We will check in on how your last treatment felt and may adjust your dose appropriately to find the right balance for you. Regardless of how your dose changes, this infusion will likely feel less intense than your first one now that you are familiar with the experience.
You may start to notice that getting up in the morning or doing things is a little bit easier. After this infusion, families may start to notice that you’re doing a little bit better, even if you don’t feel better yet.
During this appointment, we often discuss trying to get outdoors a little bit every day for about 10 to 15 minutes. We also emphasize the importance of exercise — a 20-30 minute walk can be a good place to start if you have depression, or high intensity exercise if you have anxiety.
3rd infusion
We continue to check in on how you are feeling and possible adjustments to your ketamine dose.
We may check in on how you’re doing with activities to sustain the results of your treatments, and what you may need to help you get started. Do you need a new pair of gym shoes, for instance? Or some workout clothes? We’ll ask you to think about how you can adopt these healthier habits into your daily life.
We often ask that you begin to monitor your caffeine and other stimulant intake, which many be contributing to feelings of restlessness and anxiety.
During this appointment, we may also discuss adopting habits of meditation or prayer, or some other practice of mindfulness that speaks to you.
4th infusion
By the fourth infusion, we typically have a good idea of whether ketamine treatment is something that works for you — whether you’re part of the 70% to 80% of people for whom ketamine works well. The subjective experience of how you feel, your QIDS score, and what your family observes will all help us determine how treatment is working.
There are some things that can slow down the feeling that you’re getting benefit from treatment — in particular, heavy use of benzodiazepines, alcohol, and marijuana. For these patients, it may take until later infusions — the 5th, 6th, or even a 7th infusion — to begin to see big changes. If you’re going through a big life change, that might also impact the benefit you see from treatment.
If you have not noticed any changes by this point, it is possible you fall into the percentage of patients who do not benefit from ketamine treatment. Some patients choose to take a break from treatment and see whether they experience a drop in mood in a few weeks when the results from ketamine treatment fade.
During this appointment, we often recommend that you start coaching or therapy, often cognitive behavioral therapy (CBT).
We may suggest that that you start reducing your caffeine intake and see whether that helps relieve symptoms of anxiety.
5th infusion & beyond
We will continue to check in on how you are feeling, make adjustments to your ketamine dose as needed, and ask how your homework is going — the supplements, outside time, exercise, meditation or prayer, stimulant reduction, and therapy.
By this infusion, we expect that you will have started feeling better and emphasize the practices you can bring into your daily life to bolster your mood and create a solid foundation for your mental health.
After the 6th infusion, most patients are noticing the majority of the benefit of ketamine treatments lasting for around 3-5 weeks.
We encourage you to schedule your first maintenance appointment around 3 weeks after your last infusion. You are always welcome to call and reschedule your appointment with advance notice if you find that you need to come in a little sooner if you find that you can push your appointment back a little later.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
