Aftercare for Ketamine & Spravato: An Expert Ketamine Therapist’s How To Guide

Treatment with ketamine therapy (racemic ketamine [the standard, traditional form] and Spravato [the nasal spray]) offers several benefits, particularly for individuals with treatment-resistant depression, anxiety, or PTSD. These benefits include rapid symptom relief, improved mood, enhanced motivation for change, and reduced suicidal thoughts. Ketamine treatment can also promote neuroplasticity, which is the brain’s ability to change or adapt – like a road system that can be rerouted or expanded. This neuroplasticity allows for clients to gain new perspectives on their life and gain motivation for change in places they otherwise felt stuck, especially in therapy. Additionally, some people experience decreased pain and improved sleep.

In order for clients to get the most out of their ketamine treatment, at Fostering Greatness we educate all of our clients throughout their preparation sessions, which occur prior to beginning their medicine sessions, on the importance of aftercare – what to do following a ketamine treatment session in order to promote progress, recovery, and improve daily functioning. In this article, our founder, Rena Beyer, MSW, LCSW will share those insights with you.

Think of your ketamine treatment as a triangle, with its three points being: 

1. The ketamine medicine
2. The therapy during your medicine sessions & integration
3. The behavior changes you make outside of your sessions —aftercare

Each of these points of the triangle impact the progress you will see with your ketamine treatment. Coming in for your ketamine sessions is one piece of the puzzle, but the other two really make the difference, and I would argue that the third point – the aftercare you will participate in – is the one that makes the most difference. With this in mind, you can see how much control you have in working towards symptom improvement!

Ketamine’s effects don’t end when your ketamine infusion does, or your session ends. In fact, research* shows that ketamine’s antidepressant effects last hours, days, and weeks following treatment, with the effects lasting longer the more sessions you have completed in a row. The days following treatment are when your brain is most open to change and healing. This is thanks to that neuroplasticity I mentioned earlier – the brain’s ability to change or adapt – like a road system that can be rerouted or expanded. This neuroplasticity allows for you to gain new perspectives on your life and the problems at hand as well as gain motivation for change in places you otherwise feel stuck. During this window for change what you do can significantly impact your treatment progress and healing! 

How ketamine works in our brains is still being studied today, but we do know a lot about it already. When it comes to aftercare, there are two important things to note:

• Ketamine decreases DMN activity. DMN stands for the brain’s “default mode network.” DMN is responsible for ruminating thoughts, default behaviors, habitual thoughts, thoughts of the past, and negative thinking. This group of brain regions are active when we are awake, but not involved in any specific mental exercise. After ketamine treatment this activity is decreased!
• Ketamine enhances BDNF levels. BDNF is a protein that plays a major role in neuroplasticity, neurogenesis, and synaptogenesis, which are the processes that are responsible for forming new neurons, strengthening existing connections between neurons, and forming new connections between neurons within the brain. Increasing BDNF can have profound effects on cognitive function, memory, mood, and overall mental health. Increased BDNF levels enhance your ability to be open with others, to bond with others, enhances your learning, and therefore supports you in being open to change. Not to mention, this makes the therapy process so much smoother than your typical therapy experience! [HINT, HINT: Know what else enhances BDNF levels? Exercising, being creative, practicing a coping skill that reduces stress like deep breathing, and learning new things. This is why these things are recommended activities for aftercare below!]

Another step to great aftercare is rest and hydration! Following your session it is recommended that you hydrate, which is a great thing to do while you are being driven home. When you return home from your medicine session, it is recommended and encouraged that you rest. Ketamine can be sedating and therefore may make you feel tired. Typically this occurs after your first few sessions only. Therefore, if following a medicine session you are tired enough to sleep, that is encouraged! If you don’t find yourself tired enough to sleep, I recommend relaxing with your favorite book, movie, or TV show.

Once you’ve rested and integrated, there are three things I recommend you then focus on for great aftercare:

• Anything that involves the senses (sight, hearing, smell, taste, and touch). Sit outside and people watch, bake your favorite dessert and eat it, wear your most comfortable clothing and wrap yourself in your coziest blanket, go for a walk and name what you see, hear, smell, and touch!
• Anything that gets your body moving. Gentle stretching, yoga, exercise of any kind, dancing to your favorite song, or a simple shimmy!
• Get into nature. Go for a walk around the block, go for a hike, walk along the beach, or simply sit outside with your feet in the grass.

There is something about ketamine and it’s synergy with those three categories. You can’t go wrong incorporating them into your aftercare routines.

Some other great options for aftercare include:

• Meditation
• Mindfulness Exercises
• Deep Breathing
• Guided Relaxation
• Grounding Exercises
• Creating and following morning & evening routines 
• Engaging, or re-engaging, in a hobby
• Engaging, or re-engaging, your support system and expanding it where necessary
• Mindful eating
• Gratitude Journaling
• Affirmations
• Therapy

It is important that you set realistic goals for yourself when it comes to your aftercare. At Fostering Greatness I ask all of my clients to “do one thing different,” which means focusing on one thing they would like to work on changing – something relatively simple and easy to complete – rather than attempting to do all that is described above, which can be overwhelming. So, I encourage you to focus on one thing today and then build from there!