thoughtscape NP Psychiatry · Patient education
Ketamine
Ketalar / ketamine injection
A monitored infusion option for hard-to-treat depression. This sheet is not a home-dosing guide.
Draft for review · Clinical content has not been revalidated for this website.
The sigma-1 action awaits verification; mu-receptor laboratory findings do not prove a clinical benefit.
What it is used for
Ketamine is approved for anesthesia, not psychiatric treatment. Specialists may offer IV infusions off-label for depression that has not improved enough.
Evidence for other psychiatric conditions is more limited. Spravato is a separate, approved esketamine nasal product; its doses and rules are different.
How it works
Ketamine blocks NMDA channels involved in glutamate signaling. Changes in brain communication may help depression; the full mechanism is still uncertain.
Feeling detached or 'spacey' is an effect, not proof that treatment is working. More intense experiences do not reliably mean more benefit.
What to expect over time
DURING A VISIT
Dizziness, sleepiness, or detachment can start quickly. Tell staff about discomfort or fear; ask for help standing.
AFTER TREATMENT
Some people improve within hours or days; others do not. Benefit may fade. Track mood and daily function between visits.
OVER TIME
Your team reviews an initial course before planning more sessions. The best long-term schedule is uncertain; treatment needs ongoing review.
Taking your medication
For this infusion plan, staff give the dose in a monitored clinic. Follow that clinic's food, fluid, and medication instructions before each visit.
Arrange an escort home. Do not drive, operate machinery, or do hazardous tasks for at least 24 hours after injection and until fully recovered.
Avoid alcohol. Do not add ketamine between visits or substitute a lozenge, nasal spray, or other route. Your team must review any separate prescription.
When to get help
Tell staff now: breathing trouble, chest pain, faintness, extreme sleepiness, or frightening detachment. Severe symptoms after discharge: call 911.
Urgent assessment: painful or bloody urine, inability to urinate, flank pain, jaundice, or dark urine. Do not wait for the next infusion to report these.
Call promptly: worsening mood, suicidal thoughts, persistent unusual perceptions, or high energy with little sleep. Collapse or seizure: 911.
Early side effects
Nausea, vomiting, dizziness, blurred or double vision, anxiety, sleepiness, and blood-pressure or pulse changes can occur. Tell staff about symptoms.
Other effects to discuss
Report memory changes, urinary symptoms, cravings, or needing more frequent treatment. Liver and urinary injury are not limited to recreational use.
What to keep track of
Staff monitor blood pressure, pulse, breathing, oxygen level, and alertness during treatment and recovery. Leave only when cleared and safe to walk with assistance as needed. Repeated treatment needs liver tests and review of urinary symptoms, memory, mood, and possible misuse. Monitoring reduces risk; it does not eliminate it.
Before you start
Review depression history, suicide risk, and prior treatments. Tell the team about heart or blood-vessel disease, high blood pressure, breathing problems, liver or urinary disease, bipolar symptoms, psychosis, substance use, pregnancy, and ketamine allergy. Some risks rule out treatment or need specialist clearance. Bring every medicine and supplement; agree on an emergency plan and how to reach the team between visits.
Medicines & interactions
Alcohol, opioids & sedatives
Avoid alcohol. Opioids, benzodiazepines, and sleep medicines can worsen sedation and breathing risk or prolong recovery. Get explicit treatment-day instructions.
Regular benzodiazepines
Do not stop a regular benzodiazepine abruptly. If timing or dose needs changing, your prescriber must plan it safely.
Stimulants, MAOIs & decongestants
These may add blood-pressure or other risks. Have the team check them before an infusion; do not change doses yourself.
Naltrexone & other prescriptions
Do not stop naltrexone automatically to improve response. Review benefits and risks with its prescriber. Theophylline and aminophylline can add seizure risk.
New products & other ketamine
Check all new medicines, supplements, and substances. Oral or nasal compounded products have different dosing and added home-monitoring risks; they are not substitutes for an infusion.
Everyday tips
Plan an escort and a quiet recovery day before each visit.
Ask for a calm setting; tell staff when something feels frightening.
Keep therapy and other medicines on your agreed care plan.
Record mood, function, and how long benefit lasts—not just session feelings.
Your questions, answered
What if I miss a visit?
Call the clinic to reschedule and report worsening symptoms. There is no infusion dose to make up at home. Plan follow-up when spacing or stopping sessions.
Does quick relief mean I am safe?
No. Ketamine is not proven to prevent suicide or replace needed hospitalization. Keep your safety plan and ongoing depression care. Immediate danger: 911; U.S. crisis support: 988.
Can I become dependent?
Ketamine is a Schedule III controlled medicine. Repeated or high-dose use can cause tolerance, dependence, and withdrawal. Discuss cravings, extra use, or needing more; there is no single taper for everyone.
Pregnancy or breastfeeding?
Psychiatric use is generally avoided in pregnancy. The reviewed injection label limits use during breastfeeding to anesthesia, not depression treatment. Discuss alternatives; exposed infants need monitoring.
Storage & safety
For this infusion plan, the clinic prepares and stores the medicine. Never share ketamine or use someone else's supply. Suspected overdose needs immediate help: Poison Help 1-800-222-1222; severe symptoms or trouble waking/breathing: 911.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.