Ketamine Therapy Safety: Screening, Monitoring, and Follow-up

01 June 2026

Ketamine has moved from operating rooms into mental health clinics with remarkable speed. When used thoughtfully, it can loosen depression that has resisted years of medication trials, interrupt suicidal rumination within hours, and open windows for deeper trauma therapy. Its power is also the reason safety must be baked into every minute of care, from the first phone call to the final follow-up. Good outcomes are rarely an accident. They come from careful screening, measured dosing, steady monitoring, and a plan to make use of the neuroplasticity ketamine can unlock.
Who benefits, and who should pause
Not every person with depression or PTSD will benefit from ketamine therapy. Most clinics focus on treatment resistant depression, bipolar depression without a recent manic episode, PTSD, and severe anxiety that has not responded to standard care. A history of trauma is common among people who respond well, particularly when ketamine is paired with structured psychotherapy.

Certain conditions increase risk enough to slow down or redirect care. Uncontrolled hypertension, unstable cardiovascular disease, a recent aneurysm repair, and severe valvular disease raise concern because ketamine can increase blood pressure and heart rate for the first hour. Current psychosis or a recent manic episode can worsen with ketamine’s glutamatergic surge. Active substance use disorder, especially stimulants or alcohol, complicates both safety and efficacy. Pregnancy and lack of reliable contraception warrant a different path, since human data are limited. Severe liver disease shifts the cost benefit calculation because ketamine is metabolized hepatically and chronic use can stress the urinary tract.

Every practice I have built or advised starts with a straightforward rubric. If a patient’s condition can be made safer first, we do that. If another treatment is likely to work with fewer risks, we steer there. Only when the expected benefit is high and the risks are understood do we proceed.
The pre-treatment work that prevents trouble later
A meticulous intake pays dividends on infusion day. It reduces surprises, trims false starts, and protects the care team. Most of the work falls into four buckets: psychiatric history, medical status, medications and substances, and social supports.

Psychiatrically, I want to know the shape of the illness over time. Unipolar versus bipolar, any past hypomania after antidepressants, hospitalizations, suicide attempts, trauma exposure, and dissociation. I ask about prior responses to SSRIs, SNRIs, bupropion, mirtazapine, atypical antipsychotics, mood stabilizers, and psychotherapy approaches. In PTSD, I use the PCL-5 to quantify symptoms. For depression and anxiety, PHQ-9 and GAD-7 give a baseline. If obsessive thoughts dominate, I will add an OCD scale. For dissociation sensitivity, especially in complex trauma, a brief dissociation inventory helps us tailor dosing and preparation.

Medically, I document cardiovascular history, pulmonary function, sleep apnea, endocrine disorders, and neurological issues like epilepsy or traumatic brain injury. Baseline blood pressure is essential. If a patient’s resting pressure in clinic is routinely above 160/100, I partner with their primary care clinician to improve control before we start. A pregnancy test is standard for those who might be pregnant. For people anticipating a series of sessions, I check liver enzymes at baseline and after a cluster of treatments. It helps to have a starting point when a patient later reports urinary urgency or frequency, which can emerge with repeated exposure. Those symptoms are not common with short series but deserve quick attention if they appear.

Medications and substances matter more than most first think. SSRIs and SNRIs are typically fine and can continue. Benzodiazepines may blunt ketamine’s antidepressant effect, especially at higher daily doses, so I discuss a cautious taper when appropriate. Lamotrigine sometimes attenuates response, though that signal is not uniform. Stimulants increase the chance of concerning blood pressure spikes during sessions. I either hold them on treatment days or reassess the whole plan if someone relies on high doses. Monoamine oxidase inhibitors are a red flag for most clinics, although ketamine is not a classic serotonergic agent. Alcohol, cannabis, and illicit substances can muddy the waters. I screen with AUDIT-C and a brief substance interview, and I consider a urine drug screen in higher risk cases. The goal is not to shame anyone, but to set up sober, measurable sessions that we can learn from.

Finally, social context influences outcomes more than any molecule. Someone leaving an infusion to return to a chaotic, unsafe home will struggle to consolidate gains. I ask who will drive them, who will be present that evening, and whether they have a routine that helps them rest. If a person is in ongoing trauma therapy, we coordinate timing. Therapists who practice EMDR therapy often like to meet within 48 to 72 hours after an infusion, when reconsolidation windows are most open and intrusive arousal is quieter. Couples therapy can help partners recognize shifts in mood and perception that follow ketamine sessions, and it builds a language for support that outlasts the treatment itself.
A brief word on routes and dosing
Route of administration changes what we monitor and how we plan the day. Esketamine nasal spray is FDA approved for treatment resistant depression and depressive symptoms in adults with acute suicidal ideation or behavior, and it is dispensed only through a REMS program that mandates onsite observation for at least two hours. Intravenous racemic ketamine is off label for mood disorders, but the evidence base is solid. The classic starting dose is 0.5 mg per kg infused over 40 minutes, with adjustments based on response and tolerability. Intramuscular dosing is common in clinics that favor a simpler setup and a single peak, though the onset and offset can feel less adjustable than IV. Sublingual lozenges appear in home-based protocols, but they require strict screening, clear monitoring plans, and a reliable sitter. When the setting is not controlled, safety drifts.

With IV, I usually schedule six sessions over two to three weeks, then space boosters to every one to four weeks depending on symptom return. With esketamine, the label suggests twice weekly for four weeks, weekly for four weeks, then weekly or every two weeks for maintenance. The right cadence depends on the person, their goals, and what happens in psychotherapy between treatments.
Informed consent that respects autonomy
Consent is not a signature on a form. It is a conversation about what ketamine can do, what it cannot, and what it may cost. I cover dissociation, time distortion, and unusual perceptual changes that many people find neutral or even meaningful, and a small subset find uncomfortable. I discuss the typical rise in blood pressure and heart rate that settles within one to two hours, along with rare events like severe anxiety, emergence reactions, or fainting. I explain that driving is prohibited until the next day, that legal decisions and important contracts should wait, and that alcohol that evening is a bad idea.

I also speak plainly about bladder symptoms with frequent or high cumulative exposure, addiction potential in vulnerable individuals, and the fact that IV and intramuscular use for mood is off label. We set expectations around response. About half to two thirds of people with treatment resistant depression will see a meaningful reduction in symptoms in the first series. Some feel markedly better after the first or second dose, others need a few sessions before anything shifts. A minority do not respond despite our best efforts. Knowing that range helps a person avoid the trap of magical thinking or premature disappointment.
Preparing the mind and the room
Good set and setting do not replace clinical safeguards, but they complement them. I encourage people to come well hydrated, lightly fed, and rested. We review an intention roughly the weight of a sentence. A useful intention is open and grounded, such as be present with whatever arises, or observe my patterns with curiosity. A rigid checklist crowds the experience and increases anxiety.

The room matters. I prefer soft, indirect lighting, a comfortable recliner, a blanket, an eye mask within reach, and music curated to be instrumental and steady. I avoid lyrics that might drag a person toward a narrative they did not choose. Noise canceling headphones help in busy clinics. A blood pressure cuff and pulse oximeter should be easy to reach and read without fuss. Emergency supplies are in the same room, not down a hallway.
A concise screening checklist Psychiatric review, including bipolar risk, psychosis, recent mania, trauma history, suicide risk, and dissociation sensitivity. Medical review, with cardiovascular history, blood pressure, sleep apnea, neurological conditions, pregnancy status, and bladder or liver history. Medication and substance inventory, including benzodiazepines, stimulants, mood stabilizers, MAOIs, alcohol, cannabis, and illicit use. Baseline measures and labs, such as PHQ-9, GAD-7, PCL-5, vitals, and targeted tests like liver enzymes and pregnancy test when indicated. Social and therapy coordination, including designated driver, evening support, and alignment with ongoing PTSD therapy, EMDR therapy, or couples therapy. Monitoring that is calm, visible, and ready
On treatment days, I recheck vitals and mood, then confirm the plan. An anxious person sitting with a cuff that auto-inflates every 3 minutes can spiral, so I choose intervals that keep us informed without stoking fear. For IV infusions, continuous heart rate and oxygen saturation monitoring is simple to set up, and I take blood pressure at baseline, mid-infuson, and near the end, with more frequent checks if pressures climb. For esketamine, the REMS program outlines observation and discharge parameters. For intramuscular dosing, I monitor closely for the first 30 minutes, then every 10 to 15 minutes until the arc turns down.

Common side effects are predictable. Nausea shows up in a minority, and a simple antiemetic plan with ondansetron prevents most issues. Transient anxiety and dysphoria usually respond to reassurance, environmental adjustments, and slow breathing. I avoid routine benzodiazepines as comfort meds because they can mute response, but I keep a low dose available for rare, severe agitation. If blood pressure exceeds an agreed threshold, I pause or slow the infusion, talk with the patient, and allow time. Most pressures fall without medication. In clinics with strong medical support, a short acting antihypertensive such as labetalol is reserved for stubborn cases.

I keep resuscitation equipment in the room and ensure at least one person present has current basic life support certification. If a clinic treats people with meaningful cardiac risk, advanced cardiac life support training is better than nice to have. These tools are rarely used, yet their presence steadies the team and, by extension, the patient.
A practical monitoring and discharge guide Pre session: confirm fasting or light meal, last medication timing, pregnancy status if relevant, baseline vitals, and consent review. During session: monitor oxygen saturation and heart rate continuously in IV settings, check blood pressure at set intervals, note mental status changes, and manage nausea or anxiety. Post session: continue observation until gait is stable, vitals are near baseline, nausea is controlled, and orientation is intact. Discharge: ensure a responsible adult is present, reinforce no driving or major decisions until the next day, provide written instructions and emergency contacts. Same day follow-up: brief check-in by phone or secure message to assess late nausea, headache, or emotional lability. Integrating ketamine with psychotherapy
Ketamine https://www.canyonpassages.com/about https://www.canyonpassages.com/about therapy is not psychotherapy, but it can widen the door. The hours and days after a session often carry a lift in mood, a drop in avoidance, and a burst of cognitive flexibility. That is fertile ground for targeted work.

In trauma therapy, I coordinate with a person’s clinician to time sessions during this window. For complex PTSD, the goal is not to flood the system with exposure, but to leverage quieted hyperarousal to approach memories with more distance. Therapies such as EMDR can capitalize on reduced startle and increased capacity to reframe core beliefs. I have seen clients who felt stuck for months process a crucial target in the first EMDR session after an infusion because shame softened and working memory felt more available.

In couples therapy, ketamine offers a chance to reset patterns. Partners can discuss how depressive numbness or irritability has shaped daily life and agree on signals and supports for the 24 to 48 hours after sessions. One couple I worked with set a simple ritual, a 20 minute walk the evening after each infusion, phones left at home. The practice gave them a predictable, low stakes space to share impressions without analysis. Small rituals like this often do more than grand plans.

For clients without an established therapist, I build brief integration appointments into the protocol. We reflect on sensations, images, and insights without forcing interpretation. Journaling that evening helps consolidate learning. This is not abstract. People frequently report a specific pattern they wish to change, like passive withdrawal during conflict or doomscrolling at midnight. We translate that into one experiment for the week, then revisit it before the next session.
Managing special populations and edge cases
Elderly patients metabolize drugs differently and carry more cardiovascular comorbidity. I start at lower doses, extend the infusion time, and set conservative blood pressure thresholds. I pay close attention to orthostasis during discharge. For people with obstructive sleep apnea, I prefer sessions earlier in the day and ask that they avoid sedatives the night before. Their observation period leans longer if snoring or airway concerns appear.

Bipolar depression responds to ketamine, but the risk of switching to mania is real. I insist on a mood stabilizer on board and review early warning signs with the patient and their support person. We keep a low threshold to pause treatments if sleep shortens, speech accelerates, or spending spikes.

Individuals with active substance use disorder deserve nuanced care. For some, especially those with alcohol use disorder in early recovery, ketamine can aid mood stabilization and reduce craving. For others, the dissociative effect can become the focus rather than the treatment. I involve addiction specialists, consider observed dosing only, and build in additional accountability. If a person cannot safely pause stimulant use, I will not proceed in a clinic setting.

Chronic pain presents a mixed picture. Low dose ketamine may reduce central sensitization, but if someone is on high dose opioids, their respiratory reserve could be thin. I coordinate with their pain clinician and lengthen observation. TBI adds another variable, as dissociation can echo head injury symptoms. I move slowly, involve family, and set clear stop rules.
Tracking outcomes and deciding what comes next
A safe clinic measures. PHQ-9, GAD-7, and PCL-5 scores before and after the initial series show direction and magnitude. Functional markers matter too. Is the person sleeping better, getting out of bed on time, answering texts, or returning to a hobby. I ask about suicidal ideation weekly early on. It is not redundant. Rapid improvements can be followed by plateaus, and occasional dips appear as the novelty wears off.

If there is no meaningful shift after four to six sessions, I reassess everything. Sometimes the dose needs to climb modestly, or the duration of IV infusion lengthened. Sometimes the problem is not pharmacology. Ongoing psychological threats, unaddressed substance use, or a misdiagnosed bipolar spectrum can block response. It is better to call a halt and redirect than to charge through another six sessions that help no one.

When response is good, we design maintenance sparingly. Many can taper to monthly boosters. Others hold gains with psychotherapy alone. A person who improves with ketamine, completes a focused course of PTSD therapy, and rebuilds routine often no longer needs medication changes, let alone further infusions.
Practical clinic operations that reinforce safety
Behind the scenes, reliable processes carry the day. Staff should rehearse rare but critical events, from vasovagal syncope to hypertensive urgency. Medication logs must track cumulative exposure, especially in high frequency series. Clients should receive the same discharge instructions each time, ideally with a short version on a wallet card for family. Communication with outside therapists and prescribers should be routine, not improvised after a crisis.

Documentation should reflect reality. If a client reported urinary discomfort two weeks after completing a series, note the symptom, check a urinalysis, and pause maintenance until you have answers. If liver enzymes drift upward, widen intervals and consult hepatology if the change persists. A culture of transparency keeps everyone safer and makes regulators friendlier when they visit.
What patients can do to help their own safety
Most patients want a checklist they can own. I give them a compact set of commitments. They agree not to drive or sign major contracts the day of treatment. They bring a trusted person or arrange a ride home. They avoid alcohol for 24 hours. They report new symptoms, especially severe headaches, chest pain, bladder changes, or unusual mood elevation. They keep their psychotherapy appointments and complete their brief measures. When patients hold up their end, the clinic can hold up its end.
Where ketamine fits in the broader care plan
Ketamine therapy is a tool, not a destination. For some, it opens the door to PTSD therapy they previously could not tolerate. For others, it stabilizes mood enough to engage fully in EMDR therapy and process high impact memories. In a strained relationship, it may create enough breathing room for couples therapy to move beyond resentment into repair. When it works, it unlocks choice. The safety work we put in at the front end makes those choices possible rather than theoretical.

What defines a mature practice is not only how quickly it can start an infusion, but how precisely it knows when not to. The quiet victories are averted complications, coordinated care, and patients who return not only because their symptoms improved, but because they felt seen and safe throughout.

<section>
<h2>Canyon Passages</h2>

<strong>Name:</strong> Canyon Passages<br><br>

<strong>Address:</strong> 1800 Old Pecos Trail, Santa Fe, NM 87505<br><br>

<strong>Phone:</strong> (505) 303-0137 tel:+15053030137<br><br>

<strong>Website:</strong> https://www.canyonpassages.com/ https://www.canyonpassages.com/<br><br>

<strong>Email:</strong> info@canyonpassages.com mailto:info@canyonpassages.com<br><br>

<strong>Hours:</strong><br>
Sunday: Closed<br>
Monday: 9:00 AM – 5:00 PM<br>
Tuesday: 9:00 AM – 5:00 PM<br>
Wednesday: 9:00 AM – 5:00 PM<br>
Thursday: 9:00 AM – 5:00 PM<br>
Friday: 9:00 AM – 5:00 PM<br>
Saturday: 9:00 AM – 5:00 PM<br><br>

<strong>Open-location code / plus code:</strong> M355+GV Santa Fe, New Mexico, USA<br><br>

<strong>Coordinates:</strong> 35.6587872, -105.9403342<br><br>

<strong>Map/listing URL:</strong> https://www.google.com/maps/place/Canyon+Passages/@35.6587872,-105.9403342,703m/data=!3m2!1e3!4b1!4m6!3m5!1s0x87185147ef7e9491:0xb8037d6c82de503e!8m2!3d35.6587872!4d-105.9403342!16s%2Fg%2F11mrlk1njv https://www.google.com/maps/place/Canyon+Passages/@35.6587872,-105.9403342,703m/data=!3m2!1e3!4b1!4m6!3m5!1s0x87185147ef7e9491:0xb8037d6c82de503e!8m2!3d35.6587872!4d-105.9403342!16s%2Fg%2F11mrlk1njv<br><br>

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<strong>Socials:</strong><br>
Facebook: https://www.facebook.com/profile.php?id=61585098096660 https://www.facebook.com/profile.php?id=61585098096660<br>
Instagram: https://www.instagram.com/canyonpassages/ https://www.instagram.com/canyonpassages/<br>
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YouTube: https://www.youtube.com/@CanyonPassages https://www.youtube.com/@CanyonPassages
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<div>
Canyon Passages provides EMDR-focused psychotherapy and depth-oriented trauma support for individuals and couples in Santa Fe, New Mexico.<br><br>

The practice is led by Kelly Chisholm and lists EMDR therapy, trauma therapy, PTSD therapy, couples therapy, ketamine therapy, psilocybin-assisted psychotherapy, shared-trauma therapy, and spiritual growth integration among its offerings.<br><br>

The public listing places the practice at 1800 Old Pecos Trail in Santa Fe, while the official site also lists 1800 Calle Medico, Suite A1-45; clients should confirm the exact office location before visiting.<br><br>

Canyon Passages serves Santa Fe clients in person and also notes service connections for Sedona, Pagosa Springs, and online clients seeking continuity of care.<br><br>

The practice may be relevant for adults and couples seeking trauma-informed care, intensive-style therapy, and structured preparation or integration support where clinically appropriate.<br><br>

Because ketamine- or psilocybin-assisted psychotherapy is specialized and regulated, prospective clients should ask directly about eligibility, clinical screening, legality, referral requirements, and fit before assuming the service is appropriate.<br><br>

Public listing hours show appointments Monday through Saturday from 9:00 AM to 5:00 PM, with Sunday closed.<br><br>

To contact Canyon Passages, call (505) 303-0137, email info@canyonpassages.com, or visit https://www.canyonpassages.com/.<br><br>

The public map listing for Canyon Passages can help clients verify the Santa Fe location and coordinates before planning an in-person appointment.<br><br>
</div>

<section>
<h2>Popular Questions About Canyon Passages</h2>

<h3>What is Canyon Passages?</h3>

Canyon Passages is a Santa Fe psychotherapy practice focused on EMDR therapy, trauma healing, couples work, and depth-oriented therapeutic support for individuals and couples.
<br><br>

<h3>Who is the clinician at Canyon Passages?</h3>

The official site lists Kelly Chisholm as the contact person and describes her credentials as MS, ACS, LPCC, NCC, CST, CCTP, and Certified EMDR Therapist & Consultant.
<br><br>

<h3>Where is Canyon Passages located?</h3>

The public listing address is 1800 Old Pecos Trail, Santa Fe, NM 87505. The official site also lists 1800 Calle Medico, Suite A1-45, Santa Fe, NM 87507, so clients should confirm the exact suite and arrival details before visiting.
<br><br>

<h3>Does Canyon Passages offer EMDR therapy?</h3>

Yes. EMDR therapy is listed as one of the core services on the official website, and the public listing also describes the practice as using EMDR.
<br><br>

<h3>What services are listed by Canyon Passages?</h3>

Listed services include EMDR therapy, ketamine therapy, psilocybin-assisted psychotherapy, couples therapy, trauma therapy, PTSD therapy, therapy for shared trauma, and spiritual growth and integration therapy.
<br><br>

<h3>Does Canyon Passages work with couples?</h3>

Yes. Couples therapy is listed on the official site, and the public listing describes retreats and intensives tailored to individuals and couples.
<br><br>

<h3>Are online sessions available?</h3>

Yes. The official site states that Canyon Passages offers in-person and online sessions, with a focus on Santa Fe, Sedona, Pagosa Springs, and online continuity of care.
<br><br>

<h3>What are Canyon Passages’ listed hours?</h3>

The public listing shows Monday through Saturday from 9:00 AM to 5:00 PM and Sunday closed. The listing also describes services as by appointment only, so clients should confirm availability directly.
<br><br>

<h3>Is Canyon Passages an emergency mental health provider?</h3>

No crisis or emergency service was verified for this dataset. Anyone in immediate danger or experiencing a mental health crisis should call 911, contact 988, or go to the nearest emergency room.
<br><br>

<h3>How can I contact Canyon Passages?</h3>

Call (505) 303-0137 tel:+15053030137, email info@canyonpassages.com mailto:info@canyonpassages.com, visit https://www.canyonpassages.com/ https://www.canyonpassages.com/, or use the listed social profiles: https://www.facebook.com/profile.php?id=61585098096660 https://www.facebook.com/profile.php?id=61585098096660, https://www.instagram.com/canyonpassages/ https://www.instagram.com/canyonpassages/, https://www.linkedin.com/company/canyon-passages-therapy/ https://www.linkedin.com/company/canyon-passages-therapy/, https://www.tiktok.com/@canyonpassages https://www.tiktok.com/@canyonpassages, https://x.com/CanyonPassagesT https://x.com/CanyonPassagesT, and https://www.youtube.com/@CanyonPassages https://www.youtube.com/@CanyonPassages.
<br><br>
</section>

<section>
<h2>Landmarks Near Santa Fe, NM</h2>

Canyon Passages is listed near the Old Pecos Trail and Calle Medico medical corridor in Santa Fe. Clients near these landmarks can call (505) 303-0137 tel:+15053030137 or visit https://www.canyonpassages.com/ https://www.canyonpassages.com/ to confirm appointment availability, exact suite details, and whether in-person or online care is appropriate.
<br><br>

<ul>
<li>1800 Old Pecos Trail https://www.google.com/maps/search/?api=1&query=1800+Old+Pecos+Trail+Santa+Fe+NM+87505 — The public listing address area for Canyon Passages; clients should confirm the exact suite before visiting.</li>

<li>Calle Medico https://www.google.com/maps/search/?api=1&query=Calle+Medico+Santa+Fe+NM — The official site references this nearby medical-office address format, making it a practical navigation point for appointments.</li>

<li>CHRISTUS St. Vincent Regional Medical Center https://www.google.com/maps/search/?api=1&query=CHRISTUS+St.+Vincent+Regional+Medical+Center+Santa+Fe+NM — A major nearby healthcare landmark in Santa Fe’s medical corridor.</li>

<li>Old Pecos Trail https://www.google.com/maps/search/?api=1&query=Old+Pecos+Trail+Santa+Fe+NM — A key local route connected with the public listing address and useful for clients navigating the area.</li>

<li>St. Michael’s Drive https://www.google.com/maps/search/?api=1&query=St.+Michael%27s+Drive+Santa+Fe+NM — A major Santa Fe corridor near medical, office, and residential areas; clients can use it to orient around the practice location.</li>

<li>Cerrillos Road https://www.google.com/maps/search/?api=1&query=Cerrillos+Road+Santa+Fe+NM — One of Santa Fe’s main commercial routes and a practical reference point for clients traveling across the city.</li>

<li>Santa Fe Railyard District https://www.google.com/maps/search/?api=1&query=Santa+Fe+Railyard+District — A well-known arts, dining, and community destination within the broader Santa Fe service area.</li>

<li>Santa Fe Plaza https://www.google.com/maps/search/?api=1&query=Downtown+Santa+Fe+Plaza — A central historic landmark for residents and visitors orienting around Santa Fe.</li>

<li>Meow Wolf Santa Fe https://www.google.com/maps/search/?api=1&query=Meow+Wolf+Santa+Fe — A widely recognized Santa Fe venue and practical landmark for clients familiar with the city’s south and midtown areas.</li>

<li>Museum Hill https://www.google.com/maps/search/?api=1&query=Museum+Hill+Santa+Fe+NM — A notable cultural district in Santa Fe and a useful reference point east of the central city area.</li>

<li>Canyon Road https://www.google.com/maps/search/?api=1&query=Canyon+Road+Santa+Fe+NM — A well-known Santa Fe arts district and landmark for clients orienting around the city.</li>

<li>Santa Fe Community College https://www.google.com/maps/search/?api=1&query=Santa+Fe+Community+College — A major educational landmark in the southern part of Santa Fe; clients can contact Canyon Passages to ask about online or in-person appointment options.</li>
</ul>
</section>