Considering ketamine infusion therapy often begins with a practical question: what happens before the first infusion? For many people, the answer matters as much as the treatment itself. You may have lived with depression, anxiety, trauma symptoms, or chronic pain for years. You may have tried medications, therapy, lifestyle changes, or several combinations of care without finding enough relief.
At Cleveland Medical Institute, we believe the consultation should make room for that full history. It is not a quick eligibility check. It is a clinical conversation about what you have been carrying, what has already been tried, what may be complicating the picture, and whether ketamine infusion therapy is a medically appropriate next step.
The Consultation Begins With Your Story
When you come to us for ketamine infusion therapy, we begin by listening. Symptoms matter, but so does their shape. Depression that feels slowed and heavy may require a different conversation than depression marked by agitation, intrusive thoughts, or severe anxiety. Pain has its own character as well, including where it began, what worsens it, and how it affects sleep, mobility, work, and relationships.
We ask about the concerns that brought you here, including when they began and how they have changed over time. We also discuss your present treatment team, current medications, previous psychiatric or pain treatments, therapy history, and any hospitalizations or major changes in functioning.
For patients seeking depression treatment, this often includes a careful review of prior antidepressants and whether they were adequately tried. For someone seeking help with anxiety symptoms, we may talk about panic, avoidance, physical tension, sleep disruption, or the particular situations that trigger distress. There is no single story that defines treatment resistance. There is only the clinical reality in front of us.
If chronic pain is part of why you are considering treatment, we also want to be clear that ketamine use for chronic pain is off-label. We discuss that distinction, the available information, and the individual medical factors that may affect whether an infusion is appropriate.
A Medical Review Is Central to the Visit
Ketamine is an anesthetic medication with effects on perception, blood pressure, heart rate, and awareness. During an infusion, some patients experience dissociation, meaning a temporary sense of distance from their body, thoughts, or surroundings. Others describe altered time perception, dreamlike imagery, nausea, or fatigue afterward. These effects are usually temporary, but they deserve direct discussion before treatment begins.
Our consultation includes a medical and psychiatric safety review. We may ask about:
- Current medications, supplements, allergies, and substance use
- Blood pressure, heart conditions, respiratory concerns, and other medical diagnoses
- Past experiences with anesthesia, ketamine, or dissociative symptoms
- History of psychosis, mania, or significant mood elevation
- Pregnancy, postpartum status, and breastfeeding considerations
- Suicidal thoughts, self-harm history, and current support systems
- Transportation and the practical support available after an infusion
This review helps us determine whether ketamine treatment may be appropriate, whether further coordination or medical information is needed, or whether another form of care would better fit your needs. A consultation does not guarantee that we will recommend ketamine. That is an important part of responsible care.
Ketamine for psychiatric conditions is an off-label use. That does not mean it is experimental in the casual sense, but it does mean we discuss the evidence, the limitations, and the individual factors that shape a treatment decision. Research into ketamine and suicidality continues, including carefully designed clinical trials, though ongoing research is not the same as a conclusion for every patient (Reilly-Harrington et al., 2025).
We Discuss Safety Without Minimizing Your Concerns
Some patients arrive worried that the altered state associated with ketamine will feel frightening or uncontrollable. This is a legitimate concern. We do not dismiss it. Instead, we explain what a monitored infusion experience may involve, how we prepare you, and what our clinical team watches during treatment.
We also discuss risks with appropriate seriousness. Ketamine is not suitable for everyone, and a history of certain psychiatric, cardiovascular, or substance-related concerns may change the recommendation. Individual response can vary. Our goal is to make sure you understand the potential effects, practical requirements, and reasons we may recommend additional evaluation before moving forward.
We are also careful not to blur psychiatric infusion therapy with other clinical uses of ketamine. Ketamine has been studied in perioperative, opioid-sparing anesthesia strategies, but those protocols involve different goals, settings, and monitoring considerations (Collange et al., 2024; Clanet et al., 2024). Your consultation is focused on your own medical needs, not on a one-size-fits-all protocol.
If you’d like a deeper look at how ketamine works and what it can treat, our Ketamine FAQs page covers common questions about the therapy in detail.
Developing a Treatment Plan, If Ketamine Is Appropriate
If ketamine infusion therapy appears clinically reasonable, we discuss what a treatment plan could look like. That may include the anticipated number and timing of infusions, monitoring during appointments, transportation requirements, medication considerations, and how we will assess your response over time.
We also consider whether ketamine should be part of a broader plan. For some patients, that includes continued therapy, medication management, sleep support, or coordination with an outside clinician. For others, we may discuss care related to PTSD treatment or chronic pain management, depending on the symptoms and diagnoses involved.
Our emphasis is not on moving quickly for its own sake. It is on deciding carefully. Mental health conditions can overlap, and symptoms such as low mood, insomnia, irritability, concentration problems, pain, and anxiety do not always point to one simple answer. National mental health resources likewise recognize the broad range of mental health conditions and the value of individualized assessment (National Institute of Mental Health, n.d.; SAMHSA, n.d.).
For patients who want to understand more about what actually happens during the infusion itself, our post on First IV Ketamine Infusion: What to Expect walks through the experience step by step.
FAQ
How long does a ketamine consultation take?
The length can vary because the conversation is shaped by your medical history, current symptoms, medications, and questions. We want enough time to understand the relevant clinical details rather than rush through a checklist.
Should I stop taking my medications before the consultation?
Do not stop or change prescribed medication on your own. Bring an accurate medication list, including supplements, and we will discuss any relevant considerations with you.
What if I am not a candidate for ketamine infusions?
Not being a candidate is not a dead end. It may mean that additional evaluation, another treatment approach, or coordination with another clinician is more appropriate at this time.
Can I seek a consultation if I am in crisis?
If you are in immediate danger, call 911 or go to the nearest emergency department. If you are having suicidal thoughts or emotional crisis, call or text the 988 Suicide and Crisis Lifeline at 988 for immediate support (988 Suicide and Crisis Lifeline, n.d.). A scheduled consultation is not a substitute for urgent crisis care.
Key Takeaways
- Our consultation begins with your symptoms, treatment history, and goals.
- We review medical and psychiatric safety factors before making recommendations.
- Ketamine for psychiatric uses and chronic pain uses is off-label, and treatment eligibility is individualized.
- We discuss possible effects, risks, logistics, and the role of other care supports.
- A consultation is an opportunity for clear questions and careful clinical decision-making.
A Thoughtful First Step
The decision to explore ketamine infusion therapy can feel significant, especially when previous treatment has left you discouraged. We approach that decision with care. Our role is to listen closely, review the relevant medical and psychiatric information, and help you understand whether this path makes sense for your circumstances.
If you are ready to begin that conversation, you can contact us to schedule a consultation in the Cleveland area. You can also schedule a consultation directly through our online form to get started at a time that works for you.
About Our Team
At Cleveland Medical Institute, our team is led by Dr. David Demangone, a board-certified anesthesiologist and member of the American Society of Ketamine Physicians. We provide individualized evaluations for patients considering ketamine infusion therapy and related treatment options in Greater Cleveland.
Medical Disclaimer
This article is for general educational purposes and is not medical advice. Ketamine treatment decisions require an individualized evaluation by a qualified clinician. If you are experiencing a medical or psychiatric emergency, call 911, go to the nearest emergency department, or contact 988.
Works Cited
1. Collange V, et al. Opioid free versus opioid sparing strategies for multimodal antinociception during laparoscopic colectomy: a randomised controlled trial. https://pubmed.ncbi.nlm.nih.gov/39393528/
2. Clanet M, et al. Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery: a randomised double-blind clinical trial. https://pubmed.ncbi.nlm.nih.gov/38435809/
3. Reilly-Harrington NA, et al. Ketamine treatment in youth for fast reduction of suicidality and engagement in psychotherapy: A randomized placebo-controlled trial protocol. https://pubmed.ncbi.nlm.nih.gov/39672260/
4. 988 Suicide and Crisis Lifeline. https://988lifeline.org/
5. National Institute of Mental Health. Health Topics. https://www.nimh.nih.gov/health/topics
6. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.