This page is for you, the patient. Keep it for the day of each session and the days after.

Over the next few hours you may feel tired, thoughtful or a little unsteady. A queasy stomach is common too. Those feelings are normal, and they usually ease within a few hours.

The floating, detached feeling usually fades within about an hour after the session.

Take the rest of the day easy, and do nothing strenuous. Drink water, and eat something light when you feel ready.

The side effects we tell every patient about are usually brief and mild.

• Nausea, or being sick. Drinking water and keeping to the food rule before a session prevent most of it.
• A short rise in blood pressure, pulse or heart rate. A short rise is the most common physical effect.
• Drowsiness, blurred vision, dizziness or light-headedness.
• Unsteady balance and coordination, or a headache.

Side effects usually become less frequent and less severe as your sessions go on.

If nausea was a problem today, let us know by portal message or email before your next session. We keep ondansetron, also called Zofran, for nausea.

Your ride takes you home. Someone can pick you up, or you can take an Uber.

For 24 hours after treatment, do not drive and do not use heavy or dangerous machinery.

Leave important decisions, such as legal ones, until the next day. Do not sign important documents until then either.

Those rules come from the floating state itself. So the rules apply however clear you feel at the door.

No alcohol for 24 hours before a session and 24 hours after. Alcohol acts on the same receptors as ketamine, in a different way. So the treatment works less well, and recovery takes longer.

Across the whole course of treatment, alcohol slows down and holds back the full results. Cut down, or avoid it altogether if you can.

No grapefruit for the same 24 hours before and after. Grapefruit changes the chemistry of the medicine and makes recovery less pleasant.

No recreational substances for the rest of the day.

Nobody answers our phone live. If you call, you reach voicemail, and we call back.

The way to reach us is by message, not by phone.

Some problems need to reach us the same day.

• Vomiting that keeps going.
• Dizziness that does not get better.
• Chest pain.
• Trouble breathing.
• Anything that worries you.

For any of those, send us a message in the patient portal. Sign in at able-psych.tailf00d8e.ts.net, open Messages, and press New Message.

If you cannot sign in, use the contact form at able-psych.tailf00d8e.ts.net/contact. We follow up from there.

If a problem feels urgent, call 911.

If you feel unsafe, or you are in a mental health crisis, call or text 988 at any time.

For a question that can wait, such as a question about one of your medicines, email ketamine@ablepsychiatry.com before your next appointment.

To move your next session, open your confirmation email and click cancel or reschedule.

The ketamine experience is part dream and part awareness. The dream part comes on its own, without your steering, much like a night dream.

We see the floating, detached feeling as the treatment working, not as a side effect to put up with.

A mild experience still counts. Good results can come from an effect as mild as a sense of complete relaxation. Different strengths of experience bring up different thoughts, feelings and sensations, and all of them can help.

Whatever came up today was what was ready to come up. If the session did not touch your intention, do not be discouraged. Your intention may come up in a later session.

If you felt out of control for a while, that was part of the work, not a failure. In our view, change of this kind needs moments of feeling out of control.

If your memory is hazy

Your memory of the session may be hazy: vague impressions rather than a clear story. We call these shadow memories. What stays with you is the body's form of the memory.

A shadow memory can feel like being trapped or drowning, or like shallow, quiet breathing. Other forms are tension in the belly or shoulders, clenched hands or feet, and a feeling of being small.

A hazy memory is normal. But if you have trouble remembering most of your session, tell the ketamine staff, so the dose can be adjusted.

Within about a day of each session, write down what you remember. The memory is freshest within that first day.

Any format works: a few bullet points, a page of writing, or a drawing. There is no need to write during the session or right after it.

Write what your body remembers too. Note where you felt tight, and how your breathing changed.

Write down any questions for your therapist as well. Your notes are the main thing to bring to your next therapy visit.

Some people like a question to start from. These questions come from our orientation notes, and all of them are optional.

Keep your intention short, simple and open through the first cycle. One example is, "My intention is to let go and trust myself." Another is, "My intention is to be open and surrender."

An open intention leaves room for whatever is ready to come up. More pointed intentions come in later cycles.

Keep the same intention until it feels used up.

Naming a result, such as "get less sad", works less well. A line about a habit works better. One example is "I tend to berate myself". Wanting the problem fixed fast uses the same patterns that built it, like staying busy. Becoming okay with being sad is what lets the patterns change.

"Ketamine without engaging in therapy likely will not last."

The sessions here are one half of your treatment. The work with your own therapist is the other half. We call that work integration.

Integration happens with your own therapist, because Able does not employ talk therapists.

Being in therapy through your treatment is required, not a suggestion. What counts is being in the process. Monthly visits are fine, and your therapy visits do not need to line up with your sessions.

Results vary with how the integration is done. How often it happens, when, what it focuses on, and who guides it all matter.

Therapy during a session itself is optional, and it is arranged ahead of time. Your therapist can come in and guide the session. Or you can set up your own appointment with your therapist and talk by video call.

Why therapy makes it last

Ketamine loosens the defenses that keep painful memories out of reach. Loosened defenses let you think and remember at the same time. Thinking and remembering together can bring real "aha" moments about how the past shaped the present. Ketamine also boosts creative thinking, so you can step outside your usual stories about yourself.

Ketamine is not a cure-all. In our own words to patients: "It won't magically fix all of our problems. What it will do is help us gain new tools and perspectives to navigate and overcome challenges with greater choice and ease."

The goal is not to become happier or more efficient. The goal is to be able to observe your inner world without judgment or urgency. Not to stop feeling sad, but to notice sadness and sit with it. Rushing to fix a feeling tends to feed the very pattern that keeps it stuck, like staying busy.

Dr. Sallaj puts it this way. The effect of ketamine is temporary, like visiting a new city. Yet the experience can linger and be drawn upon forever.

Getting ready for your therapist

We help you prepare for your therapy visits: what to bring, what to report from your notes, and what to ask.

Bring your notes, including what your body remembered.

• Tell us about any medicine change. Let us know before your next session if you started or stopped any medicine, by portal message or by email to ketamine@ablepsychiatry.com. That includes cold medicine, pain medicine and allergy shots. Keep taking your prescribed medicines unless we tell you otherwise.
• Hydration and sleep. How much you drink and how well you sleep both change how you respond to the medicine. So does any change in your medicines.
• Food. No solid food for 2 to 3 hours before a session. Clear liquids are fine, such as water, tea without milk and clear electrolyte drinks.
• Alcohol and grapefruit. None for 24 hours before the session.
• Your ride. Arrange your ride home before you come in.
• A calm run-up. In the run-up to a session, step away from social media, TV and stressful news. Instead, do something easy that you enjoy. A walk, a friend, a favorite meal or a bath all work. What happens close to a session shapes the experience.
• What to wear and bring. Wear comfortable, loose clothing. A short-sleeve top makes an injection easier. Headphones, a blanket and calming music are welcome, and we provide them too.

How your dose is set

The first cycle is an experiment. Finding the right dose and the right method depends on your steady feedback.

Early sessions usually use smaller doses, so the dose can be raised safely.

At the end of each session you rate how strong the experience was, from 1 to 10. A 1 means you felt nothing. A 10 means the most intense experience you have ever had. Staff rate it too. Your next dose is set from how strong the last session was.

If you miss a week, you usually go back to your last dose. There is no automatic step down.

A typical cycle is 8 sessions, once a week. The 8 sessions are a commitment, not a lock. If the treatment is not landing for you, you can stop.

In a hard stretch, sessions can run twice a week for a couple of weeks, and then go back to weekly.

There are no more than 9 sessions in any four-month period.

Each session is planned for about 2 hours. Two hours is the figure we plan to, not a cap. Some people need longer and stay longer.

If you need to leave before we are done, tell us first. We check that you are steady and can walk, and then you are free to go.

You may feel worse for a while before you feel better. Quick improvement is more common, but lasting improvement in mood is the main aim.

Benefits are most visible on the days between sessions, not during them. Keep an eye on both progress and difficulty between sessions.

Results take time. Benefits may take 4 to 8 weeks after your final session to show. We call that wait the two-month observation period.

Look for small changes first.

• Stepping back and reflecting on yourself gets easier.
• You see more options in how something might turn out.
• You become more selective with your thoughts and actions.
• Old automatic reactions that were not working for you loosen.

Follow-up after the cycle is with your own provider or therapist. Our office does not book it.

We help you get ready for that visit: what to bring, what to report from your notes, and what to ask.

You tell us how you are doing on our follow-up form. Any talk about another cycle starts from that report.

Another cycle

If you want another cycle, you first meet with the provider to review how the last cycle went and what to change. If you and the team agree another round is worthwhile, you fill in the Subsequent Ketamine Treatment Form.