The Day Before

Most of the work of a good ketamine session happens before you take the medication. Patients who have the best experiences almost universally prepare the day before:

Plan your session time. Pick a 2–3 hour window when you won't be interrupted. Early afternoon is popular — late enough that you've had a morning meal, early enough that you'll be fully clear-headed by bedtime.
Talk to your support person. Have someone you trust available (not necessarily in the room, but reachable). This is a requirement for every at-home program — not a suggestion.
Prep your space. Clean, quiet, comfortable. Dim lighting. A bed or couch you can lie flat on. A blanket.
Fast starting the evening before. Most programs ask for an empty stomach. Water is fine; caffeine and alcohol are not.
Set an intention — not a goal. Patients who go in with a rigid expectation ("I will resolve my grief tonight") often feel let down. Patients who go in curious ("I want to notice what comes up") almost always learn something useful.

The Morning Of

Light breakfast only if your physician cleared it; otherwise stick to the fasting window.
Skip caffeine. It will increase your baseline heart rate and blunt the medication.
Take your routine medications as usual unless your physician told you otherwise.
No alcohol, no recreational substances, no cannabis. Period.
Gentle movement (walking, stretching) is fine. Skip hard workouts — see Ketamine and Exercise.

Setting Up the Space

About 30 minutes before your session:

Put your phone on Do Not Disturb
Put out a bucket or small trash bag within arm's reach (nausea is uncommon but possible)
Have water nearby for afterward
Eye mask and headphones if you'll use them
A curated music playlist — most programs recommend instrumental, ambient, or specifically-designed "ketamine therapy" playlists (skip anything with lyrics, news, or podcasts)
Blood pressure cuff ready if your physician asked you to take a pre-session reading

Tell your support person: "I'm starting now. I'll check in at [time]." Give them a way to reach you that doesn't require you to look at a screen.

Taking the Medication

Sublingual ketamine (troche or ODT) is held under your tongue and allowed to dissolve slowly. The specific protocol your physician gives you is the one to follow — don't improvise.

General pattern:

Place the troche under your tongue
Let it dissolve — don't swallow the saliva right away
Hold for 10–15 minutes while lying down
After the holding time, it's OK to swallow any remaining medication or residue

You may notice a numbing or bitter sensation in your mouth — normal. Some patients describe the taste as "chemical" or "strong." Many keep a small amount of honey nearby for after.

The First 10–15 Minutes

Not much happens. You'll still feel essentially normal. This is a good time to:

Put on your eye mask
Start your playlist at a comfortable volume
Lie flat on your back
Settle into slow, even breathing

If you find yourself checking the clock or wondering when "it" will start, that's normal. Don't fight it.

The Onset — 15 to 25 Minutes In

This is when most patients first notice something. It can feel like:

Visual patterns or colors behind closed eyes, especially with the eye mask
A sense of your body feeling heavy, or lightly "humming"
Time dilating — minutes stretching
A softer, more observational relationship to your own thoughts
Music sounding richer, more dimensional

It is not like being drunk. It is not like being high on something recreational. Most patients describe it as "unusual but not unpleasant" on the first session.

A minority of patients feel nauseous in the first 30 minutes. If so: breathe slowly, use your bucket if needed, and know that it passes.

The Peak — 25 to 60 Minutes In

This is where the therapeutic work happens, though most patients on their first session don't feel like they're "working" on anything. You may:

Feel emotionally open in a way that's unusual for you
See imagery or feel "narratives" coming up
Have moments of unexpected clarity about something in your life
Feel physically disconnected from your body (this is the dissociative effect and is normal and safe)
Notice old memories surfacing
Feel nothing in particular and wonder if it's working (also normal, especially first time)

Your first session is rarely the most dramatic one. Many patients' first session is relatively mild — the body getting familiar with the medication. Sessions 2–4 are often where the deeper experiences emerge.

The cardinal rule: don't resist what comes up. If an emotion appears, let it move through. If an image appears, follow it with curiosity. If nothing appears, that's fine too — rest.

Coming Down — 60 to 90 Minutes In

The intensity fades. You'll become more aware of your body, the room, the music. Most patients stay lying down until they feel fully grounded. Some notice mild residual effects for another 30 minutes after that.

When you feel ready:

Sit up slowly
Drink some water
Check in with your support person
Take a post-session BP reading if your protocol requires it
Don't drive for at least 6–8 hours

The Hours After

Mood. Some patients feel noticeably better immediately. Some feel neutral. A few feel a little emotionally raw for a few hours. All are normal.
Energy. Gentle activities only. A walk, a meal, quiet company. No strenuous exercise, no driving, no alcohol, no major decisions until tomorrow.
Integration. This is where the value gets locked in. Journal what came up. Talk with your therapist if you have one. Don't try to analyze everything in the moment — just capture it. See the integration process.

The Day After

Most patients wake up feeling clear-headed. Some report a noticeable lift in mood in the first 24 hours — the well-known rapid-onset antidepressant effect. Others report subtler shifts over the following week.

A few patients feel mildly tired or emotionally thin for 24 hours. Listen to it. Scale back your day a bit.

When to Contact Your Physician

Your physician is reachable between sessions. Contact them if:

You have any concerning cardiovascular symptoms (persistent chest pain, severe shortness of breath)
Nausea or vomiting lasts more than a few hours (uncommon)
You feel acutely suicidal or in crisis (always prioritize urgent care / 988)
Your mood drops unusually hard 24–48 hours after the session
You have any question at all — "is this normal?" is a reasonable message

What the First Session Is Really For

The first session is diagnostic more than therapeutic. Your physician is learning how you respond to the medication — how quickly it comes on, how intense the experience is, whether the dose is right, whether any adjustments are needed. Most patients settle into a consistent dosing pattern by session 2 or 3.

Go in without expectations. The real work usually begins on session 2.

Ready to Get Started?

Dr. Ben Soffer personally reviews every patient and walks them through exactly what to expect before their first session. At-home ketamine works best when patients know what they're doing — and that starts with good information, a clean setup, and a physician you can actually reach.

What to Expect During Your First At-Home Ketamine Session