Managing Ketamine/Esketamine Treatment: Discontinuation, Side Effects, and Clinic Practice

For patients who relapse after tapering off ketamine or esketamine, restarting an index course—twice weekly for a few weeks then spreading out doses—is recommended. Dysphoric reactions occur in about 1 in 200 to 300 treatments; most resolve with supportive care, while some need a short-acting benzodiazepine like lorazepam. Patients should fast for two hours before esketamine sessions. Nausea can be managed with low-dose ondansetron, and post-treatment headache with over-the-counter ibuprofen or acetaminophen.

Study at a glance

Abstract

When a patient relapses after tapering off ketamine or esketamine, consider restarting an index course (twice weekly for a few weeks, then spread out). With ketamine or esketamine, dysphoric reactions occur in roughly 1 in 200-300 treatments. Many resolve with supportive care alone; others require a short-acting benzodiazepine such as lorazepam. For esketamine sessions, have patients fast for two hours beforehand. Manage nausea with low-dose ondansetron, and post-treatment headache with OTC ibuprofen or acetaminophen.