5 Questions to Ask Before Ketamine Infusion Therapy
By Charles Miller, CRNA, CMO, Founder/Owner of Scenic City Neurotherapy
Choosing a ketamine provider involves more than comparing prices or reading online reviews. The questions you ask before beginning treatment can have a meaningful impact on your experience, safety, and confidence in your care. Understanding how ketamine is administered, who will be monitoring you, and why a provider follows a particular protocol can help you make a more informed decision. Before scheduling treatment, consider these five important questions to ask before ketamine infusion therapy at any ketamine clinic.
Quick Answer: 5 Questions to Ask Before Ketamine Infusion Therapy
- How will ketamine be administered?
- What medications will be added?
- Who will monitor treatment?
- Is psychotherapy performed during treatment?
- What dosing protocol is used?
How Will Ketamine Be Administered?
The route of administration is one of the most important factors affecting both the safety and effectiveness of ketamine therapy. Common routes include oral (troches or tablets), intranasal, intramuscular (IM) injection, and intravenous (IV) infusion.
Understanding the Different Routes of Administration
Each route has advantages and disadvantages. Oral and intranasal ketamine have lower and more variable absorption than IV administration. As a result, blood concentrations can be less predictable, making it more difficult to achieve a consistent therapeutic effect. These routes are also commonly prescribed for frequent at-home use, which may increase the risk of tolerance, dependence, urinary complications, and other adverse effects when used repeatedly over long periods.
Intramuscular (IM) injection provides more reliable absorption than oral or intranasal administration and can be an effective treatment option. However, once the medication is administered, the dose cannot be adjusted or discontinued. If a patient becomes uncomfortable or experiences an unexpected medical issue, the medication must simply run its course.
Intravenous (IV) administration is widely considered the gold standard because it provides 100% bioavailability, precise dosing, and continuous control throughout the treatment. The infusion can be adjusted, slowed, or stopped at any time based on the patient’s response. IV administration also allows immediate access for medications or interventions should a medical concern arise.
Why Scenic City Neurotherapy Uses IV Infusions
For the reasons listed above, IV ketamine offers the highest degree of precision, safety, and patient comfort. Although many patients are initially apprehensive about receiving an IV, the discomfort is typically brief, and ketamine itself possesses analgesic properties that often minimize physical discomfort during treatment.
At Scenic City Neurotherapy, we administer ketamine exclusively by IV infusion. Although other routes of administration are available and often more convenient or profitable, convenience and profitability are not the factors that guide our treatment decisions. We have chosen to focus solely on IV ketamine because it offers the most precise dosing, the most predictable delivery, and the highest level of clinical control. When patients place their trust in us, we believe they deserve the treatment method most likely to produce the best outcome—not simply the easiest method to provide.
What Other Medications Will Be Added?
One of the most important questions to ask is whether additional medications will be administered alongside ketamine.
Some treatment providers routinely add medications such as benzodiazepines (Valium, Xanax, Ativan, Versed) or opioids in an effort to reduce anxiety, blunt the treatment experience, or make patients more comfortable during the infusion. While these medications certainly have appropriate uses in medicine, they may not always be compatible with the goals of ketamine therapy.
Why Additional Medications Matter
A growing body of evidence suggests that benzodiazepines can diminish ketamine’s antidepressant effects and may reduce the likelihood of achieving an optimal response. Opioids present additional concerns, including sedation, respiratory depression, and the potential to alter the therapeutic experience. For these reasons, medications that may interfere with ketamine’s mechanisms of action should be used only when there is a clear medical indication.
At Scenic City Neurotherapy, our goal is not to suppress or medicate away the ketamine experience. Instead, we focus on preparing patients through education, setting expectations, creating a calm and supportive environment, and carefully titrating the infusion to the individual’s needs. When patients understand what to expect and are properly supported throughout the process, most find treatment to be comfortable and many describe it as a pleasant experience.
Questions Every Patient Should Ask
Ketamine is not simply a medication. It is a catalyst for neuroplastic change. Every additional medication should be carefully evaluated based on whether it supports or interferes with that process. Before beginning treatment, ask your provider which medications are routinely administered, why they are used, and whether they may affect treatment outcomes.
Who Will Be Monitoring Me?
Ketamine is an exceptionally safe medication when administered appropriately, but it is still an anesthetic. Anesthetic drugs are used every day in operating rooms and procedural settings, and healthcare professionals spend years developing the knowledge and skills necessary to administer them safely.
The Importance of Qualified Medical Oversight
While ketamine has one of the strongest safety profiles among anesthetic medications, it should still be treated with the respect any anesthetic deserves. Saying ketamine is the safest anesthetic is a bit like saying it is the safest firearm. Safety depends not only on the tool itself, but also on the training, judgment, and experience of the person using it.
Your provider should be physically present and immediately available throughout your treatment. They should be well versed in airway management, cardiovascular monitoring, emergency medications, and the recognition and treatment of potential complications. Although serious adverse events during ketamine therapy are rare, the ability to respond effectively if they occur is an important component of patient safety.
Questions About Provider Training
Unfortunately, the administration of anesthetic medications by clinicians with limited anesthesia training has become increasingly common in a variety of practice settings. Patients should not hesitate to ask who will be monitoring them, what training that individual has received, and whether they are qualified to manage an airway or treat a medical emergency should one arise.
When considering ketamine therapy, remember that the medication is only one part of the treatment. The training, competency, and availability of the person administering and monitoring that medication are equally important.
Do You Utilize Ketamine-Assisted Psychotherapy (KAP)?
Ketamine-Assisted Psychotherapy (KAP) has become increasingly popular, but patients should carefully examine the assumptions behind the practice before accepting it as a necessary component of treatment.
Understanding the Role of Psychotherapy During Ketamine
Psychotherapy has traditionally been performed when patients are fully capable of critical thinking, informed decision-making, memory formation, and accurate self-reflection. Ketamine, as an anesthetic, temporarily alters attention, perception, memory formation, judgment, and suggestibility. Patients should ask an important question: if these capacities are considered important during conventional psychotherapy, why would they be considered less important during psychotherapy performed under the influence of an anesthetic?
Proponents of KAP often argue that the altered state produced by ketamine enhances therapeutic work. While this idea is appealing, the scientific evidence supporting that conclusion remains limited. More importantly, ketamine’s antidepressant and neuroplastic effects appear to be driven primarily by biological mechanisms rather than by the content of conversations occurring during the infusion itself.
Research suggests that ketamine initiates a cascade of cellular and molecular events that promote neuroplasticity. However, the formation, stabilization, and integration of new neural connections occur largely after the acute effects of the medication have subsided. This raises an important question: if ketamine creates the biological conditions necessary for change, why would psychotherapy be expected to work best while the brain is experiencing the cognitive effects of an anesthetic rather than afterward, when the patient is fully capable of participating in the therapeutic process?
Evaluating the Evidence Behind KAP
Patients should ask their provider why they believe psychotherapy during the ketamine experience improves outcomes. Ask what evidence supports that position. Ask how they address concerns regarding memory reliability, suggestibility, and informed consent during an altered state of consciousness. Most importantly, ask whether they can demonstrate that therapy performed during ketamine produces better outcomes than therapy performed after ketamine.
Psychotherapy can be an invaluable part of recovery. The question is not whether therapy is beneficial. The question is whether the optimal time for therapy is during an anesthetic state, or during the period of enhanced neuroplasticity that follows. A thoughtful provider should be able to clearly explain their reasoning and the evidence supporting their approach.
What Dose, Duration, & Delivery Method Do You Use?
The answer to this question can tell you a great deal about a provider’s understanding of ketamine therapy.
Ask what dose they administer, how long the infusion lasts, and how the medication is delivered. A quality provider should be able to answer these questions clearly and explain the reasoning behind their protocol.
Why Protocol Matters
For the treatment of depression and related mental health conditions, ketamine is commonly administered at doses ranging from approximately 0.5 to 1.2 mg/kg over a period of about 40 minutes. While individual patients may require adjustments, providers should be able to explain why they selected a particular dose and how that dose is modified over the course of treatment.
Patients should also ask whether the medication is delivered using a programmable infusion pump or simply allowed to run from an IV bag. An infusion pump allows precise control over the rate of administration and ensures that the intended dose is delivered consistently throughout the treatment. Precision matters when administering an anesthetic.
Duration is equally important. Infusions delivered too rapidly may produce an unnecessarily intense experience, while excessively prolonged infusions may alter the therapeutic effect and make dosing less predictable. A 40-minute infusion has been the most extensively studied and remains the foundation upon which much of the ketamine literature is built.
Questions That Help You Compare Providers
Most importantly, ask your provider how they arrived at their protocol. Is it based on scientific literature, extensive clinical experience, or simply convenience? A thoughtful provider should be able to explain not only what they do, but why they do it.
Ketamine therapy is far more than simply administering a medication. Success depends on delivering the right dose, over the right duration, with the right equipment, for the right patient.
About Scenic City Neurotherapy
At Scenic City Neurotherapy, we help people find real answers and lasting relief through advanced, evidence-based treatments designed to address the root of mental health and chronic pain challenges, not just the symptoms.
Founded in 2019 by Charles Miller, CRNA, our clinic leads the way in Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS) – two cutting-edge therapies proven to safely and effectively restore healthy brain communication.
Our approach is evidence-backed, informed by research, and focused on helping you feel clear, resilient, and capable of moving forward.
If you’re ready for treatment that’s built on proof, not trial and error, contact us today.
📞 (423) 228-0579
