Your First Telehealth Ketamine Session: A Complete Guide

The first ketamine session is the most anticipated—and often most anxiety-inducing—part of beginning telehealth therapy. Knowing exactly what will happen, what to expect from the experience, and how to care for yourself afterward removes much of the uncertainty. This guide walks you through every step, from the days leading up to your first session to the morning after.

In the Days Before

Complete All Pre-Session Requirements

Most telehealth ketamine platforms require several things to be in place before your first session can proceed:

• Medical records review: If your provider requested records from your psychiatrist or primary care physician, confirm they have been received.
• Lab work: Some programs require basic bloodwork (metabolic panel, thyroid function, sometimes EKG) before the first session. Ensure results are in your chart.
• Medication review: Confirm with your provider whether any of your current medications need to be adjusted. MAO inhibitors, in particular, can have dangerous interactions with ketamine and must typically be stopped well in advance.
• Equipment ready: Blood pressure cuff, pulse oximeter, eye mask, and headphones should be confirmed and tested. See our complete equipment and setup guide for details.
• Payment processed: Ensure your payment is confirmed so there are no administrative issues on the day of your session.

Prepare Your Space

Choose the room where you will hold your session. Ideally this is:

• A bedroom or private space where you will not be disturbed
• Equipped with a comfortable surface to lie on (bed, couch, or yoga mat with padding)
• Able to be darkened effectively
• Temperature-controlled and set to your preference

Do a dry run: dim the lights, put on your eye mask, connect your headphones, queue the playlist, and lie down. Identify anything uncomfortable about the setup and fix it before session day.

Brief Your Sitter

If you are having a sitter present (strongly recommended for the first session), spend 20-30 minutes briefing them:

• What ketamine does and what the experience generally involves
• How long the session will last
• What they should and should not do (primarily: be present, keep the space quiet and safe, do not try to talk you out of the experience)
• Emergency protocols: who to call if something goes wrong (provider number, emergency number)

The sitter's job is not to participate in the experience—it is to hold space and ensure safety. A calm, informed sitter makes a meaningful difference. For more on building your support team, read our guide on support systems for at-home ketamine therapy.

The Day Before Your Session

Light Eating and Rest

Eat normally the day before. Get as much rest as you can. Anxiety before the first session is normal; do not compound it with poor sleep habits or stimulants late in the day.

Set Your Intention

Many therapists and programs recommend spending 15-30 minutes the evening before your session writing or reflecting on your intention. This is not a goal or expectation for the experience—it is a direction, a quality you want to bring into the session.

Examples of intentions:

• "I want to approach this with openness and curiosity."
• "I want to explore the grief I've been carrying around my father's death."
• "I want to understand why I keep withdrawing when I feel close to people."

An intention is not a demand on the experience. Ketamine does not follow a script. But setting a direction helps orient your attention during the session.

The Morning of Your Session

Fasting

Most programs recommend eating a light meal 4-6 hours before the session or fasting entirely. Ketamine can cause nausea, and an empty stomach reduces this risk. If your session is in the morning, a light breakfast the night before and no food after midnight works well.

Hydration

Stay well hydrated throughout the morning, but avoid drinking large amounts of liquid in the hour before your session—this reduces the likelihood of needing to use the bathroom mid-session.

Medications

Take any required pre-session medications your provider has prescribed (often an anti-nausea medication like ondansetron). Confirm with your provider which of your regular medications to take or hold.

No Alcohol or Cannabis

Avoid all psychoactive substances in the 24 hours before a ketamine session. Alcohol in particular can increase nausea and alter the experience unpredictably. Cannabis can intensify and destabilize the experience.

The Pre-Session Video Check-In

Before you dose, your provider or care guide will conduct a brief video check-in. This typically takes 10-15 minutes and includes:

• Reviewing your vitals (blood pressure, heart rate, oxygen saturation)
• Confirming you have fasted as directed
• Asking how you are feeling and if you have any questions
• Confirming your sitter is present
• Reviewing the session protocol one more time

This check-in is your last opportunity to ask questions or express any concerns. Do not rush through it.

Taking Your Dose

Sublingual troches are the most common form used in telehealth. Your provider will tell you exactly how to take them:

1. Place the troche(s) under your tongue or between your cheek and gum
2. Do not chew or swallow—allow them to dissolve slowly over approximately 15 minutes
3. Keep the dissolved liquid in your mouth as long as directed (some protocols ask you to hold for the full dissolution time before spitting)
4. Do not swallow the liquid if instructed to spit—swallowing substantially reduces the dose's effectiveness

What Happens as the Effects Begin

Onset begins roughly 10-20 minutes after dosing. Early signs include:

• Mild tingling, particularly in the extremities
• A slight sense of detachment or floating
• Visual changes—objects may seem brighter or slightly distorted
• Sounds may seem different—music may feel more immersive

As effects deepen over the next 20-40 minutes, you will likely become significantly impaired. Lie down, put on your eye mask, and let yourself relax into the experience. Do not try to fight the sensations or stay "in control"—surrendering to the experience, within a safe container, is part of how it works.

During the Session

What to Expect

Ketamine sessions are profoundly individual. Common experiences include:

• A sense of vast space or boundlessness
• Visual patterns and imagery with eyes closed
• Altered sense of time (minutes may feel like hours, or time may seem to disappear)
• Emotional material—sometimes sadness, sometimes joy, sometimes fear
• Moments of profound clarity or insight
• Occasionally, difficult or confusing experiences

If the Experience Becomes Difficult

Difficult emotions or frightening perceptions are not uncommon, especially in early sessions when you do not yet have a framework for the experience. If this happens:

• Remember that the experience is temporary—it will end
• Try to let the emotion or sensation move through you rather than resisting it
• If you feel you need to speak, you can signal your sitter or speak aloud—your provider or guide may be monitoring
• Do not take additional medication without instructions from your provider

Physical Safety

Do not attempt to stand, walk, or leave the room during peak effects. Your coordination is significantly impaired. If you need to use the bathroom, wait until you feel substantially more oriented, and have your sitter assist if needed.

Coming Back to Baseline

Effects typically begin subsiding 45-90 minutes after onset. You will feel a gradual return of normal perception and awareness—though you will likely still feel groggy, soft, or emotionally tender for several hours.

During this re-orientation period:

• Keep the lights dim and the environment calm
• Sip water slowly
• Journal or dictate notes about your experience while still in the immediate window
• Eat a small snack if you are hungry

The Rest of the Day

You should not drive, make major decisions, or engage in demanding work for the rest of the day after a session. Many patients find they feel emotionally raw or heightened in sensitivity for several hours afterward. This is normal.

Plan for a gentle evening: light food, quiet activity, early sleep. Your nervous system has done significant work. Giving it rest is part of the process.

The Morning After

Many patients find the morning after their first session is one of the most notable parts of the experience. Some describe a lifted quality to the day—lighter mood, cleaner perception, increased motivation. Others feel flat or emotionally empty. Both are within the range of normal responses.

Journal again in the morning. What do you notice? What feels different? What came up in your sleep? These observations are valuable data for your integration work and for your provider.

References

• StatPearls: Ketamine — Comprehensive clinical reference on ketamine pharmacology, mechanisms of action, and therapeutic applications
• PubChem: Ketamine Compound Summary — NCBI chemical database entry with ketamine molecular data, pharmacokinetics, and bioactivity profiles
• MedlinePlus: Ketamine — National Library of Medicine consumer drug information on ketamine including uses, proper administration, and precautions
• NIMH: Anxiety Disorders — National Institute of Mental Health information on anxiety disorder types, symptoms, and evidence-based treatments
• HHS: Telehealth — U.S. Department of Health and Human Services guide to telehealth services, regulations, and patient resources