People often describe a ketamine day in simple terms: “I felt lighter,” or “I felt weird,” or “I did not feel much at all.” Clinicians listen to that, but they do not stop there. They look for patterns that repeat across sessions, especially during the first few weeks, because the real question is not whether you had a good afternoon. The real question is whether ketamine treatment moves symptoms, stability, and day-to-day function in a direction you can hold onto.
Start With a Baseline You Can Trust
Clinicians start by defining the starting line. That step prevents a lot of confusion later.
A careful baseline usually includes symptom severity, safety risk, and the context around symptoms. Providers often document where depression sits on a validated scale because numbers let the team compare week one to week three without relying on memory. Many protocols also add structured suicide-risk screening when risk factors exist, since safety planning cannot rely on vague language.
This baseline work matters even more in a ketamine clinic setting because treatment moves quickly. When you move quickly, you need a way to tell the difference between a short lift and a meaningful shift.
The baseline also sets up practical goals clinicians can track, like sleep consistency, ability to get through a workday, or how often you spiral into rumination.
The Core Signal: Symptom Reduction Over Time
After clinicians anchor the baseline, they track symptom change across sessions with the same tools. They watch the trend line more than any single score.
In a VA cohort of 215 people receiving IV ketamine in routine care, clinicians tracked PHQ-9 scores over time rather than relying on session-by-session impressions. After about six weeks, 26% met response criteria, and 15% met remission criteria (PHQ-9 ≤ 5).
That split matters clinically because it helps teams decide whether to continue, adjust spacing, or step back and revisit the broader treatment plan, especially since the VA data also shows infusion frequency typically tapers over time as care shifts from induction toward maintenance patterns.
Comparative chart-review data adds a practical point: The curve over sessions matters. In a U.S. retrospective chart review comparing repeated IV ketamine with intranasal esketamine in a specialty service, both groups improved on QIDS-SR16. Still, the IV ketamine group showed a larger overall reduction by the eighth treatment (49.22% vs. 39.55%).
The IV ketamine group also showed a significant drop after the first treatment, while the intranasal esketamine group reached significance after the second. That kind of session-by-session measurement gives clinicians something stable to interpret when a patient’s day-to-day mood feels inconsistent.
Stability Checks: Mood Consistency, Suicidality, and “Are We Holding the Gains?”
Clinicians often shift from “Are symptoms down?” to “Are gains holding?” because instability can hide inside improvement.
Many protocols pair symptom scales with structured safety checks, including suicide-risk tools, because symptom relief does not always move in a straight line. VA protocol guidance explicitly describes using the PHQ-9 before each dose and using the Columbia-Suicide Severity Rating Scale to track suicidality risk.
This focus also shapes how clinicians interpret the course of ketamine infusion therapy. Someone might feel noticeably better right after a session, then crash hard two days later. Another person might feel little change on day one but build a steadier mood over the induction series.
Clinicians use repeated measures to separate those patterns because each pattern points to a different next step. If scores bounce wildly, the team may slow changes, adjust supportive therapy, or tighten safety planning. If scores improve and hold, the team may move toward maintenance spacing with clearer confidence.
Function, Cognition, and Emotional Regulation (The “Real Life” Markers)
Once clinicians understand symptom change and stability, they look at what life looks like outside the clinic.
Function often lags symptom relief, so clinicians track it intentionally. Clinicians also keep an eye on cognition, even when patients do not bring it up directly. VA protocol guidance references periodic cognitive evaluation, naming a brief tool example (M-ACE) at the end of induction and at intervals afterward. Clinicians do not do this to “grade” people. They do it to ensure the treatment course supports recovery without introducing a new problem.
Emotional regulation and cognitive flexibility sit in a similar bucket. A patient might describe fewer spirals, less rigid thinking, or quicker recovery after stress. Clinicians can track those shifts through careful check-ins across sessions, not by asking one dramatic question once.
When it comes to ketamine treatment, you want a change that shows up in how you respond to your life, not only how you react to a single dose.
Safety and Tolerability Are Part of Progress
Clinicians treat safety trends as part of the progress story. They look for a treatment course that the patient can tolerate and continue.
FDA labeling for intranasal esketamine spells out how seriously clinics take monitoring. The label calls for blood pressure assessment and for observation for at least two hours after administration. The same labeling gives a clear picture of common effects in trials.
In the FDA prescribing information for SPRAVATO® (esketamine), pooled trial safety data show higher rates of certain effects versus placebo nasal spray: dissociation 41% vs. 9%, sedation 23% vs. 9%, dizziness 29% vs. 8%, nausea 28% vs. 9%, and increased blood pressure 10% vs. 3%. Those FDA figures give clinicians a baseline for what to monitor across sessions, especially when adjusting dose, spacing, or support.
This matters in a ketamine clinic because tolerability can change across time. Some patients report that dissociation feels intense at first and becomes more manageable as they learn what to expect. Others feel side effects ramp up, which may push clinicians to adjust dose or spacing.
Clinicians also weigh cognitive safety. FDA labeling notes that a one-year open-label safety study did not show adverse effects on cognitive functioning, but it also notes that evidence beyond one year remains limited. That caveat pushes responsible clinics to keep checking cognition and daily functioning rather than assuming “no news” equals “no problem.”
How We Use Structured Checkpoints at Zeam
Clinicians do not collect measures to fill a chart. They use those measures to decide what happens next, and they revisit those decisions as the course evolves.
FDA labeling also reinforces this checkpoint logic by framing evaluation after the four-week induction phase as a decision point for continued treatment. That matches how many real-world programs think: baseline first, then induction tracking, then a structured reassessment rather than an open-ended drift.
At Zeam, we follow that same measurement-driven mindset, and we treat the data as part of the care relationship. We look at symptom scales over time, we track stability and safety, and we connect those signals to practical life markers like function and recovery between sessions. We also offer ketamine IV for depression as one tool inside a bigger psychiatric plan, which means we care about what happens between sessions as much as what happens during them.
If you want a course that treats measurement as part of care, we can help. We use structured check-ins during ketamine infusion therapy and review patterns across visits, not just one-day impressions. When the data suggests a shift, we adjust pacing, support, or next steps. Contact Zeam to discuss your options.
Key Takeaways
- Progress is measured against a clearly documented baseline — including validated depression scales, safety risk, and functional markers — so clinicians can compare changes across sessions rather than relying on memory.
- Trend lines matter more than single-day improvements. In VA cohort data, PHQ-9 outcomes helped teams distinguish temporary post-infusion lifts from meaningful response or remission over an induction series.
- Clinicians track stability and suicidality alongside symptom change using repeated measures and structured tools to decide whether to continue, taper, or modify the care plan.
- Function, cognition, and emotional regulation are “real-life” outcomes — not just mood scores — and many programs include periodic cognitive assessment during and after induction.
- Safety and tolerability are treated as part of clinical progress. FDA labeling for intranasal esketamine guides monitoring for effects such as dissociation, sedation, dizziness, nausea, and blood-pressure changes, and supports structured observation after dosing.
- Structured checkpoints — especially after the 4-week induction phase — guide next-step decisions, including spacing, maintenance planning, or broader treatment review.
Citations
- https://www.psychiatrist.com/jcp/clinical-outcomes-intravenous-ketamine-for-depression-va-health-system/
- https://pubmed.ncbi.nlm.nih.gov/41004170/
- https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Ketamine_Infusion_for_Treatment_Resistant_Depression_Rev_Oct_2025.pdf
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/211243s012lbl.pdf
