What should a ketamine clinic track during and between treatments?
Last updated
Track each session and the weeks after it. A 2018 review of 60 studies found that side effects of ketamine for depression were well recorded right after treatment, but long-term and repeated-use safety was barely measured. Session logs, vital signs, side effects, and regular outcome scores are how a clinic closes that gap.
What does this mean for your clinic?
If the research cannot yet tell you what happens over months of treatment, your own records have to. A 2017 consensus statement from the American Psychiatric Association's research task force made the same point. Sanacora and colleagues wrote that ketamine studies had small samples, little longer-term data on whether it keeps working, and limited safety data. They offered practical suggestions for patient safety in off-label use and urged an evidence-based approach given how much is still unknown.
What happens in the chair? Monitoring during and after each session is the clearest standard. For the esketamine nasal spray, the FDA requires a certified setting under the SPRAVATO REMS program. The patient self-administers under direct supervision, a prescriber is onsite, and staff monitor the patient for at least 2 hours afterward. They watch for sedation, dissociation, and breathing problems, and check heart rate, blood pressure, and pulse oximetry. A healthcare provider then decides when the patient is stable enough to leave. That structure is a useful model for any route: a timed session log, vital signs before and after, and a clear discharge check.
What happens between sessions? This is where outcome tracking earns its place. In the 2023 ELEKT-D trial, Anand and colleagues randomized 403 adults with treatment-resistant depression to IV ketamine or electroconvulsive therapy at five sites. Response was defined as at least a 50 percent drop on a standard self-report depression scale. Response was 55.4 percent with ketamine and 41.2 percent with ECT, and ketamine was judged noninferior. Memory scores held up better with ketamine. Ketamine was linked to dissociation, and responders were followed for six months. The lesson for a clinic is the method as much as the result. A repeated, standard score is what lets you say a patient responded, and what tells you when the effect is fading.
A note on routes. The trials cited here studied IV ketamine and the esketamine nasal spray. If your clinic also uses intramuscular, oral, or under-the-tongue forms, these findings may not carry over directly, which makes your own tracking more important, not less.
So the working list has four parts. A session log with timing, route, and the observation period. Vital signs and side effects at each visit, including dissociation and blood pressure. A standard depression score on a set schedule, before the series and during follow-up. And a follow-up cadence that keeps checking after the treatment series ends, because that is the window the research has measured least.
The takeaway
- Log every session the same way: timing, route, vital signs, side effects, and the discharge check.
- Score depression on a fixed schedule with a standard measure, before, during, and after the treatment series.
- Keep following patients after the series ends. Long-term and repeated-use safety is the least studied part of ketamine care.
This is the work Asendar™ was built for: the days and weeks between treatment sessions, when long-term effects show up or quietly don't. Auto-assigned monthly assessments keep outcome scores on schedule, and the Mental Readiness Score gives your team a daily read on how each patient is holding up.
Start a 15-day free trial for your clinicTrack CoCM minutes, catch patients at risk of missing the code, export a billing packet. No card to start, $199/mo after the trial.