What Support People Need to Know About At-Home Ketamine

Someone you care about is doing at-home ketamine therapy and they've asked you to be present during their sessions. I'm the prescribing physician, and I want to talk to you directly. Not give you a checklist, but actually explain what you've signed up for and why your role matters.

If you came into this thinking "I just sit there for a couple of hours, right?" you're partly right. The visible job is small. But what you're actually doing is being the in-room safety net that makes the whole at-home model work. So let me tell you what that really means.

Why we require you, not just suggest you

In a clinic setting, when someone takes ketamine, there are nurses and a physician in the room. They're trained, they're paid, and they can intervene in seconds if something goes sideways.

The at-home model trades that for the comfort and accessibility of treatment in your own house. But the trade only works if there's someone reliable nearby. If your loved one had a sudden problem (a fall while walking unsteadily, a wave of intense anxiety, a blood pressure spike, even just nausea they can't manage alone), they need somebody alert and sober within arm's reach who can call me, get them positioned safely, and (very rarely) call 911.

That somebody is you. It's why we won't approve treatment if there isn't a real, reliable support person available.

This isn't ceremonial. We've seen the difference it makes when somebody is properly present versus distracted in another room or "available by phone." The presence is the safety. So please take it seriously, and if you can't commit to being fully present for the full duration of a session, please tell your loved one before they dose, not after.

What "fully present" actually means

You're physically in the home, ideally in the same room or one immediately adjacent. You're sober: no alcohol, no impairing medications, nothing that affects your reaction time or judgment for the duration. You're awake and reachable. Your phone is charged and on, with the ringer up. You have my number (or the on-call line) saved and ready.

You don't have to be staring at them the whole time. Reading a book, doing quiet work, scrolling your phone: all fine. You're not their therapist or their entertainment. You're their watchful adult presence.

Plan on being committed for the full session and recovery (typically 2 to 3 hours from the moment they dose). Don't promise to stay "until effects wear off" and then leave at the 90-minute mark because you have to pick up groceries. The recovery hour is the highest-fall-risk hour. You stay for it.

How to set up before they dose

In the hour before the session, help with a few practical things.

The room should be comfortable and prepared the way they want it. Bed, recliner, or couch with pillows. Dim or soft lighting. They may have set up music, an eye mask, a particular blanket. Leave their setup alone; they've thought about this.

Make sure the path from where they'll be lying to the bathroom is clear. Move tripping hazards. Have a small bowl or bag nearby in case of nausea. A glass of water within reach, but not where they have to climb over things to get to it.

You should know two things by heart: how to reach the prescribing clinician (have the number open on your phone, not buried in an email), and the address of the home you're in (which you'd have to give to 911 in the unlikely case it comes to that). Test that you actually have the contact info accessible; fumbling for it in a stressful moment is the wrong time to find out you don't.

Eat something yourself. Use the bathroom. Get comfortable. You're going to be there a while.

What the session looks like

For the first 15 minutes after they dose, not much happens visibly. They might mention feeling something starting. They'll likely close their eyes and become quiet. Be present and calm.

From roughly 15 to 60 minutes in, they're in the peak experience. Eyes closed, very still, sometimes moving hands or limbs slowly, occasionally speaking (sometimes coherently, sometimes not, sometimes emotionally). They may laugh, cry, sigh deeply. They may seem unaware of you. All of this is normal. None of it is an emergency.

Your job during this window is mostly to observe. Watch that their breathing stays regular and unlabored. Notice if they seem to need anything: a reposition, a bathroom trip, a hand to steady them. If they need help walking somewhere, walk with them slowly. Let them lean on you. Don't let them go alone.

If they show signs of nausea (repeated swallowing, grimacing, a hand to the stomach), help them turn on their side and bring the bowl close. Most nausea is mild and passes within minutes.

From 60 to 90 minutes in, the peak fades and they gradually return to themselves. They may want water once they're alert enough to drink safely. They may want to talk; they may want quiet. Follow their lead.

What not to do, even with good intentions

Don't try to have conversations during the peak. They're in an internal experience that's part of how the medicine works. Talking to them, asking how they feel, narrating things pulls them out of it and reduces the therapeutic value. Your silence is supportive, not neglectful.

Don't touch them unnecessarily. If they need help repositioning, fine: touch with intention and gentleness. But unexpected contact during dissociation can be startling. Save the affection for after.

Don't change their environment. If they set up a specific playlist, lighting, or eye mask, leave it. Switching the music or turning up the lights mid-session is jarring in a way that's hard to predict.

Don't film, photograph, or recount what happens later. People say and do things during the experience that they wouldn't want documented or shared. Their privacy is absolute. This includes mentioning details to other family members or friends afterward, unless they tell you it's fine.

Don't offer food or drink during the peak. Choking risk during deep dissociation is a real thing. Wait until effects have clearly subsided.

Don't panic if it seems intense. Strong emotions, unusual sounds, unusual body movement: these are usually normal. Unless there's a clear safety problem (see the next section), the most useful thing you can do is stay calm. Your calm is contagious.

When to actually call

You'll probably never need to do this. But you should know what triggers it.

Call me (or the on-call clinician) right away if:

• Their breathing becomes very slow (less than 8 breaths per minute), labored, or sounds wrong
• They're vomiting and can't stop
• They've taken their blood pressure and the reading is significantly above the parameters we've discussed with them
• They're severely agitated or panicking and it's not resolving with simple reassurance over 10-15 minutes
• They're truly unresponsive (different from deep dissociation; in dissociation they'll respond to a loud voice or gentle shoulder squeeze, truly unresponsive means no reaction to either)
• The experience is lasting much longer than expected (well past 90 minutes without coming back)
• They report chest pain or pressure

Call 911 first if there's loss of consciousness with no response to stimulation, observed seizure activity, severe respiratory distress (can't catch breath, lips turning blue), or chest pain that you'd take seriously in any other context. Call me right after.

These situations are uncommon at therapeutic doses with screened patients. But knowing what would trigger a call means you don't have to guess in the moment.

After the session

In the recovery hour, your loved one may be groggy, emotionally open, sometimes reflective, sometimes tired. Offer water. Help them to the bathroom if they're still unsteady. Don't push conversation if they want quiet; don't shut it down if they want to talk. Many patients find the post-session window to be valuable for reflection; your steady, non-judgmental presence is the right kind of company for it.

Remind them of the rules they already know but might forget while groggy: no driving for at least 6 hours, no operating anything sharp or heavy, no important decisions today. If they were planning to do dishes or run errands, gently table it.

You can leave once they're clearly back to baseline: alert, walking steadily, holding normal conversation, oriented to time and place. For most patients this is 2-3 hours after the dose. Don't leave earlier. If you have a question about whether they're ready, ask them to walk you through what they had for breakfast yesterday; if they can do it cleanly, they're back.

What you're really doing

I want to close with this: being a support person isn't a small thing. The person who asked you is doing something brave: addressing a condition that's been hard, often for years, with a treatment that requires them to trust both the medicine and the people around them. They picked you for a reason. The fact that you're reading this guide carefully means you're taking the role seriously. That seriousness, more than any specific protocol, is what makes the at-home model safe.

You don't need medical training. You don't need to understand the neuroscience. You need to be reliable, present, calm, and willing to follow this guide. That's enough. That's actually a lot.

Thank you for showing up for them.

Frequently Asked Questions

What is the role of a ketamine therapy support person during a session?

Three core jobs. (1) Be sober and physically present in the room or immediately adjacent throughout the 90-minute session (no errands, no driving anywhere, no falling asleep). (2) Maintain a calm, low-stimulation environment (dim lights, minimal noise, no demands). (3) Monitor for warning signs: difficulty breathing, choking risk if nauseated, severe distress, or any unusual physical response, and call the physician or 911 if anything seems wrong. You're not providing therapy or psychological support; you're a safety presence.

Who can serve as a ketamine therapy support person?

A trusted adult who is fully sober (no alcohol, cannabis, or other intoxicants the day of the session), reliable, and willing to stay attentively present for 90+ minutes. Common choices: a spouse or partner, a close family member, a roommate, a trusted friend. Children, casual acquaintances, and anyone who isn't 100% reliable about staying sober are not appropriate. The person doesn't need medical training (Tovani Health provides specific instructions before the session) but they do need to be someone you genuinely trust to handle the responsibility seriously.

What should the support person actually do during the 90 minutes?

Sit quietly nearby. Don't initiate conversation unless the patient does. Don't try to interpret their experience, "guide" them, or play music they didn't request. Have a phone ready and the physician's contact number visible. Keep water within reach. If the patient shows signs of nausea, gently turn them on their side (the recovery position). If anything seems concerning (labored breathing, unresponsiveness beyond normal dissociation, severe distress that isn't passing), call the physician or 911. Otherwise: read, sit, watch quietly. The visible job is small; the safety net is what matters.

Is having a support person actually required, or can it be skipped if I feel ready?

Required, not optional. The at-home model's safety profile depends on a sober adult being present. Sublingual ketamine can produce mild sedation, occasional nausea, brief dissociation, and rare unexpected physical responses, all of which are easily managed with someone present and dangerous without. Tovani Health does not approve sessions without a confirmed support person. If you don't have someone available, options include rescheduling sessions to when a trusted person can be present, asking a friend to sit-swap if multiple of you are doing therapy, or considering clinic-based treatment where on-site staff are present.

If you're the patient considering treatment

If you came to this guide because you yourself are considering at-home ketamine and were trying to understand what you'd be asking of a support person, here's the entry point.

• Eligibility check: tovanihealth.com/eligibility (5 minutes, FL and NJ residents)
• Phone: 561-468-6981
• What you get back: an honest answer plus practical guidance on identifying the right support person before your first session.

Benjamin Soffer, DO — Tovani Health

Related reading: what a session actually feels like, driving and activity restrictions, how long ketamine therapy takes to work, what to eat before and after, safety and side effects.