Preparing for IV Ketamine or Spravato Treatment: A Comprehensive Guide

For individuals with treatment-resistant depression (TRD) or severe depressive symptoms, IV ketamine and Spravato (esketamine) treatments offer promising avenues of relief. However, preparation for these treatments is crucial to ensure safety, efficacy, and comfort. This guide provides a comprehensive overview of how to prepare for IV ketamine and Spravato treatments, helping you to approach these therapies with confidence and peace of mind.

Understanding the Treatments

IV Ketamine

IV ketamine involves the administration of ketamine through an intravenous infusion. Typically delivered in a clinical setting, ketamine infusions have shown rapid and significant antidepressant effects, particularly for individuals who have not responded to conventional treatments.

Spravato (Esketamine)

Spravato is a nasal spray formulation of esketamine, administered under the supervision of a healthcare provider. It is approved for use in conjunction with an oral antidepressant for adults with TRD or those experiencing depressive symptoms with acute suicidal ideation.

Pre-Treatment Preparation

1. Medical Assessment

Before beginning either treatment, a thorough medical assessment is essential. This includes:

• Psychiatric Evaluation: Discuss your psychiatric history, current symptoms, and previous treatments with your mental health provider.
• Physical Examination: Ensure that you are in good physical health to tolerate the treatment. This may involve a general physical exam and blood tests.
• Medication Review: Provide a comprehensive list of all medications, supplements, and over-the-counter drugs you are taking to avoid potential interactions.

2. Medication Specifics

• Blood Pressure Medication: Unless otherwise instructed by your psychiatrist, continue taking your prescribed blood pressure medications as usual on the day of treatment.
• Propranolol: If prescribed for as-needed use, discuss with your provider whether you should take propranolol before treatment.
• Benzodiazepines, Lamictal, Stimulants: Consult your provider about whether to hold these medications (such as benzodiazepines, lamotrigine (Lamictal), or stimulants like Ritalin or Adderall) on the day of treatment.
• Anti-Emetic (e.g., Zofran): If you have been prescribed an antiemetic medication such as Zofran to prevent nausea, ask your healthcare provider whether you should take it before your treatment session.

Preparing for IV Ketamine Treatment

1. Scheduling and Logistics

• Appointment Scheduling: Ketamine infusions typically require multiple sessions. Plan your schedule to accommodate these appointments, which may be spaced over several weeks.
• Transportation: Arrange for transportation to and from the clinic, as you may feel disoriented or drowsy after the infusion.

2. Pre-Treatment Guidelines

• • Fasting: Follow your provider’s instructions regarding fasting. Generally, you are advised not to eat two hours before the infusion.

• Avoid Alcohol and Drugs: Refrain from consuming alcohol or recreational drugs for at least 24 hours before your treatment.
• Comfortable Clothing: Wear loose, comfortable clothing to facilitate ease during the infusion.
• Medication Adjustments: Follow any specific instructions from your provider regarding adjustments to your current medications.
• Mental Preparation: Engage in relaxation techniques, such as deep breathing or mindfulness, to help reduce anxiety before the treatment.
• Hydration: Stay well-hydrated on the day of your IV ketamine treatment to allow easier access to veins.

• Voiding: Ensure you void (uninate) right before the treatment, as ketamine is a diuretic and can increase the need to urinate during treatment.

3. Comfort Items

• Blanket: Some patients find it comforting to bring a blanket from home. The familiarity and warmth can help create a more relaxing environment during the infusion.
• Favorite Playlist: Bringing a music device with a pre-made playlist headphones/earbuds can enhance the treatment experience. Most people find instrumental music better than music with vocals, as it can be less distracting and more soothing.   If you do not have a playlist or have commercial interruptions throughout your playlist, ask for a playlist provided by the practice.

Preparing for Spravato Treatment

1. Scheduling and Logistics

• Appointment Scheduling: Spravato is administered in a clinical setting, typically twice a week for the first month, followed by maintenance doses. Plan your schedule accordingly.
• Post-Treatment Monitoring: You will need to stay at the clinic for at least two hours after each administration for monitoring. Arrange for transportation home, as you may not be able to drive.

2. Pre-Treatment Guidelines

• • Fasting: Follow your provider’s instructions regarding fasting. Generally, you are advised not to eat for two hours before the treatment.

• Avoid Alcohol and Drugs: Refrain from consuming alcohol or recreational drugs for at least 24 hours before your treatment.
• Medication Adjustments: Follow any specific instructions from your provider regarding adjustments to your current medications.
• Mental Preparation: Similar to IV ketamine, practice relaxation techniques to help alleviate any anxiety or stress before the treatment.
• Voiding: Ensure you void (uninate) right before the treatment, as Spravato is a diuretic and can increase the need to urinate during treatment.

3. Comfort Items

• Blanket: Some patients find it comforting to bring a blanket from home. The familiarity and warmth can help create a more relaxing environment during the infusion.
• Favorite Playlist: Bringing a music device with a pre-made playlist and headphones/earbuds can enhance the treatment experience. Most people find instrumental music better than music with vocals, as it can be less distracting and more soothing. If you do not have a playlist or have commercial interruptions throughout your playlist, ask for a playlist provided by the practice.

What to Expect During Treatment

IV Ketamine

• Infusion Process: The infusion typically lasts about 40 minutes. You will be seated or lying down, and a healthcare provider will monitor you throughout the session.
• Sensations: You may experience dissociation, mild hallucinations, or a dream-like state during the infusion. These sensations are temporary and should subside shortly after the treatment ends.

Spravato

• Administration: You will self-administer the nasal spray under the supervision of a healthcare provider. The process involves spraying the medication into each nostril.
• Monitoring: After administration, you will be monitored for at least two hours to observe for any adverse effects, such as dizziness, dissociation, or increased blood pressure.
• Sensations: Similar dissociation may be experienced with Spravato; however, it is generally less intense compared to IV ketamine.

Post-Treatment Care

Recovery and Rest

• Immediate Recovery: Plan for a quiet, restful period following each treatment. Avoid driving, operating heavy machinery, or making important decisions for the rest of the day.
• Follow-Up Appointments: Attend all scheduled follow-up appointments to assess your response to the treatment and make any necessary adjustments.

Emotional Support

• Support System: Lean on friends, family, or support groups to help you navigate any emotional changes during your treatment period.
• Therapeutic Support: Continue with any ongoing psychotherapy or counseling sessions to support your overall mental health.

Conclusion

Preparing for IV ketamine or Spravato treatment involves careful planning and coordination with your healthcare provider. By understanding the process, following pre-treatment guidelines, and knowing what to expect during and after the sessions, you can enhance the effectiveness and comfort of your treatment experience. These innovative therapies offer hope for individuals with treatment-resistant depression, providing a pathway to improved mental health and well-being.