Any physician who tells you a medication has no risks is not being honest with you. Ketamine therapy for depression, anxiety, PTSD, and chronic pain has shown remarkable promise, but it carries side effects that every patient should understand before beginning treatment. At Discreet Ketamine, Dr. Ben Soffer believes informed consent starts with a candid conversation about what can happen -- not just what we hope will happen.

Here is a thorough, straightforward review of the risks and side effects associated with ketamine treatment.

Common Side Effects (Most Patients Experience These)

These effects are expected, temporary, and generally resolve within 1 to 2 hours after the medication wears off:

Dizziness and Lightheadedness

Most patients feel some degree of dizziness during and immediately after a ketamine session. This is a direct pharmacological effect and subsides as the drug is metabolized. It is one of the reasons we require a peer supervisor to be present during at-home sessions -- you should not attempt to stand or walk during the active period.

Nausea

Nausea is one of the most frequently reported side effects, affecting roughly 15 to 30% of patients. It is typically mild to moderate and can be managed effectively with antiemetic medications taken before the session. We have a detailed guide on managing ketamine-related nausea with practical strategies that work for most patients.

Changes in Perception

Ketamine is a dissociative anesthetic. At the sub-anesthetic doses used for mental health treatment, it commonly produces altered perception of time, visual distortions, a sense of floating, or feelings of detachment from one's body or surroundings. For many patients, this is part of the therapeutic experience -- it creates psychological distance from entrenched patterns of thought. However, it can be unsettling if you are not prepared for it. Read our article on the dissociative state to understand what to expect.

Increased Heart Rate and Blood Pressure

Ketamine stimulates the sympathetic nervous system, typically causing modest increases in heart rate and blood pressure. In healthy patients, these changes are clinically insignificant and resolve after the session. In patients with pre-existing cardiovascular conditions, this effect requires careful evaluation. See our articles on ketamine and hypertension and ketamine and cardiovascular disease for detailed information.

Blurred Vision

Temporary visual blurring is common during the active phase. It resolves completely as the medication wears off and does not indicate any lasting effect on vision.

Less Common Side Effects

These occur in a minority of patients and are typically manageable:

Psychological Discomfort

Some patients experience anxiety, fear, or emotional distress during a session. This may involve confronting difficult memories or emotions that surface during the altered state. While uncomfortable, these experiences can be therapeutically valuable when processed during the integration phase. Having a peer supervisor present and knowing your clinical team is reachable by telehealth provides a safety net.

Confusion and Agitation

A small percentage of patients experience temporary confusion or agitation during the active phase. This is more common at higher doses and typically resolves within 30 to 60 minutes. In rare cases, ketamine can trigger brief episodes of psychomotor agitation that require reassurance and, occasionally, a short-acting sedative.

Headache

Some patients report mild headaches following a ketamine session. These generally respond to standard over-the-counter pain medication and adequate hydration.

Fatigue

Feeling tired or mentally drained after a session is normal. Many patients benefit from scheduling sessions in the evening so they can rest afterward.

Rare but Serious Side Effects

These are uncommon but warrant awareness:

Respiratory Depression

At the sub-anesthetic doses used for mental health treatment, clinically significant respiratory depression is extremely rare. It is more of a concern with IV administration at higher doses or when ketamine is combined with other sedating substances. This is one reason we counsel patients to avoid alcohol, opioids, and sedatives on treatment days. For patients with pulmonary conditions, additional screening may be required.

Psychotic Symptoms

In patients with no history of psychosis, ketamine-induced psychotic symptoms are exceedingly rare. However, in patients with a personal or strong family history of psychotic disorders, ketamine can trigger or exacerbate psychotic episodes. This is an absolute contraindication that we screen for before beginning treatment.

Urinary Tract Effects

Chronic, high-dose ketamine use -- typically seen in recreational or abuse contexts -- is associated with a condition called ketamine-induced cystitis, which involves bladder inflammation, pain, and urinary urgency. At the therapeutic doses and frequency used in clinical treatment, this is extremely uncommon. Nevertheless, we monitor patients for any urinary symptoms and adjust treatment if they arise.

The Question of Addiction

Ketamine is classified as a Schedule III controlled substance, and it does have abuse potential. This is a legitimate concern that deserves an honest answer.

In supervised clinical settings at therapeutic doses, the risk of developing a ketamine use disorder is low. The doses used for mental health treatment are substantially lower than those associated with recreational misuse, and sessions are spaced to minimize tolerance development. That said, patients with a history of substance use disorders require additional evaluation before starting treatment, and we monitor all patients for signs of escalating use or psychological dependence.

At Discreet Ketamine, every prescription is tracked, doses are pre-determined, and patients do not have access to unlimited medication. This structure exists specifically to minimize misuse risk.

How Discreet Ketamine Manages Risk

Risk management is built into every aspect of our treatment model:

Thorough medical screening by Dr. Soffer, a board-certified internist, before treatment begins
Individualized dosing based on your medical history, weight, medications, and response
Required peer supervisor present during every at-home session
Telehealth access to your clinical team during and after sessions
Regular follow-ups to monitor for side effects and adjust treatment as needed
Complete medication review to identify potential drug interactions

Our at-home ketamine therapy is available in Florida and New Jersey, starting at $250/month. If you want to discuss whether the benefits of ketamine therapy outweigh the risks for your specific situation, check your eligibility to schedule a consultation with Dr. Soffer.

Disclaimer: Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved.

Risks and Side Effects of Ketamine Treatment: What You Need to Know