What to Expect in Your First Ketamine Therapy Session

Walking into something unfamiliar, especially when it involves your mental health-can feel like stepping into a room where the lights haven’t yet been turned on. You don’t know what’s in front of you, and part of you is hesitant to find out. I’ve been there. I remember sitting in a waiting room before my own first therapeutic session years ago (not ketamine, but still a big step) with my heart racing, wondering if I’d made the right choice. That mix of hope and fear? It’s real, and it’s something many people feel before their first ketamine therapy session.

But here’s the truth: knowing what to expect can take away a lot of that fear. It won’t erase the butterflies in your stomach, but it will make them manageable.

So, let’s walk through what the first session usually looks like-step by step-so you can focus less on worry and more on the possibility of healing.

1. The Consultation: Building Trust First

Before a single drop of ketamine is administered, you’ll meet with a medical provider-often a psychiatrist, anesthesiologist, or trained nurse practitioner. They’ll review your history: mental health diagnoses, medications, and even physical health factors like blood pressure or heart rate.

This isn’t just paperwork-it’s about safety and trust. Many clinics want to know not just what symptoms you’re experiencing, but how long you’ve been carrying them. Depression, PTSD, or anxiety may have followed you for years, and sharing that can feel vulnerable. Yet that honesty helps your provider tailor the experience for you.

2. The Setting: Calm, Safe, and Intentional

Most ketamine therapy sessions don’t take place in sterile hospital-style rooms. Clinics usually aim for calm, comfortable spaces-soft lighting, recliners or lounge chairs, and sometimes even blankets or headphones with curated music.

Why? Because the environment plays a big role in how you process the experience. Just like trying to meditate in a noisy room feels impossible, the right setting during ketamine therapy helps your mind settle into the journey.

3. The Method: IV, Nasal Spray, or Oral

Your first session will depend on the method chosen by your provider:

• IV Infusion – The most common approach. A slow, controlled dose enters your bloodstream over about 40 minutes.
• Nasal Spray (like Spravato) – Self-administered under supervision, usually with structured breathing breaks.
• Oral Tablets/Lozenges – Less precise in dosage, but often used for at-home or hybrid programs.

Each method has its own rhythm, but all are monitored closely. Your vitals (heart rate, oxygen levels, blood pressure) are usually checked before, during, and after the session.

4. The Experience: What It Actually Feels Like

This is the part most people are curious about-and nervous about. The truth is, no two people have the exact same ketamine experience.

Some describe it as a “floating” sensation, like being gently lifted outside of themselves. Others talk about vivid imagery, emotional releases, or even revisiting memories with a new sense of perspective. For many, there’s a disconnection from their usual patterns of thought-almost like stepping back and seeing their life from a different angle.

It can feel strange at first. But remember, the goal isn’t to have a “perfect” session-it’s to create the conditions for your brain to reset and reconnect in new ways.

5. After the Session: Integration Matters

When the infusion ends, you’ll need a little time to rest. Some people feel clear-headed within minutes; others need an hour before they’re steady on their feet. You won’t be driving home afterward, so plan for someone to pick you up.

But here’s where the real work begins: integration. This means talking about what came up during the session and connecting it to your life outside the clinic. Some clinics offer integration therapy, while others encourage journaling or working with a mental health professional.

Think of the ketamine session as the spark, and integration as the firewood that keeps it burning. Without integration, the insights can fade away too quickly.

6. The Emotional Side: Hope, Relief, and Sometimes Tears

Let’s face it-going through ketamine therapy can be emotional. Some people feel immense relief after their very first session, describing a sudden lifting of the “weight” of depression. Others notice more subtle shifts-like finally being able to get out of bed without that crushing heaviness.

But it’s not always instant. Sometimes the first session is just the beginning, and the deeper benefits build over multiple treatments. Tears may come. Laughter may come. Both are normal, and both are valid.

7. The Science: Why It Works

Ketamine works differently from traditional antidepressants. Instead of targeting serotonin or dopamine, it influences glutamate, the most abundant neurotransmitter in the brain. This rapid action can help create new neural connections, which is why many patients feel effects much sooner than with standard medications.

According to a 2022 study published in the Journal of Psychiatry and Neuroscience, up to 70% of patients with treatment-resistant depression experienced significant improvement after a course of ketamine therapy. That number alone gives many people hope when other treatments have failed.

A Personal Reflection

When I spoke with a friend who went through ketamine therapy for the first time, they admitted they were terrified. “What if it doesn’t work? What if I feel nothing?” they’d asked me the night before. But afterward, they described the experience as “a door cracked open.” Not a cure-all, not magic, but a door they hadn’t been able to find before. And for them, that was enough to keep going.

Final Thoughts

Your first ketamine therapy session isn’t just about sitting in a chair and waiting for a chemical to do its job-it’s about opening yourself up to possibility. It’s about creating a safe space for healing, allowing your brain to reset, and then carrying those insights into your daily life with intention.

If you’re considering this path, find a clinic that values not only the medical side but also the emotional and integrative side of healing. And if you happen to be in the Northeast, several trusted clinics offer ketamine therapy in Philadelphia, with structured programs and compassionate support to guide you through every step.