The non-negotiable rule: someone else drives you home

If you call any responsible ketamine clinic in the country and ask whether you can drive yourself home after an infusion, the answer will be the same: no. Not after IV ketamine. Not after Spravato. Not after oral or sublingual ketamine. The session does not happen unless a confirmed adult driver is on the schedule and physically present at discharge.

This is not a clinic preference or a liability quirk. It is the medication. Ketamine is a dissociative anesthetic, and even at the low doses used for depression, anxiety, PTSD, and chronic pain, it impairs the cognitive and motor functions that safe driving depends on. Reaction time slows. Depth perception shifts. Decision-making and risk assessment dull. You may feel fine sitting in our recliner sipping water. You are not fine behind the wheel of a 4,000-pound car.

We say this clearly at the start of every consultation because it shapes the rest of the planning. Before you book a session, you need a person. Spouse, sibling, adult child, close friend, neighbor. Someone who can pick you up at a scheduled time, drive you home, and stay with you for the rest of the day if possible. Without that person, the appointment cannot happen.

What the FDA actually says about Spravato and driving

The clearest regulatory language on this comes from the U.S. Food and Drug Administration. Spravato (esketamine) is the FDA-approved nasal spray version of ketamine, indicated for treatment-resistant depression and major depressive disorder with acute suicidal ideation. Because it carries a formal FDA label, the post-dose driving instructions are written in regulatory plain English.

The Spravato Prescribing Information instructs patients not to drive or operate machinery until the next day, following a restful night of sleep. The Spravato Risk Evaluation and Mitigation Strategy (REMS) program, finalized by the FDA in 2019, requires that every patient be monitored on-site for at least two hours after each dose and have arranged transportation home before they leave the clinic. These are not suggestions. They are conditions of the drug's approval.

The FDA arrived at this language because Spravato's clinical trial program documented sedation, dissociation, dizziness, and impaired attention as common short-term effects, with most resolving within hours but some lingering longer in individual patients. Rather than ask patients to self-assess at the curb, the agency drew a bright line at the next day after sleep. It is the simplest rule that reliably protects the public.

Ketamine itself is FDA-approved as an anesthetic; its use for depression, anxiety, PTSD, and chronic pain is off-label. But the pharmacology is essentially the same molecule, and the post-dose impairment profile is closely related. That is why IV ketamine clinics adopted the Spravato standard rather than inventing a looser one.

Why IV ketamine clinics use the same 24-hour standard

The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3) publishes best-practice guidelines for clinics offering subanesthetic ketamine outside the operating room. Their 2023 guidance recommends that every patient arrange a responsible adult driver, abstain from driving for the remainder of the day, and avoid operating heavy machinery, signing legal documents, or making major financial decisions until they are clearly back to baseline.

The reasoning is straightforward. While IV ketamine sessions feel "shorter" because the active dissociative experience usually lasts 40 to 60 minutes, the drug's effects on attention, working memory, and psychomotor performance can persist after you stop feeling the obvious dissociation. In other words, the floaty feeling fades before the impairment does. Patients who think they feel sharp can still measurably underperform on driving-relevant tasks.

This is also why we monitor every patient for a recovery period after the IV runs out. Anesthesia-level monitoring continues during emergence: pulse oximetry, blood pressure, heart rate, and direct observation. Marla Peterson, CRNA, oversees every infusion and signs off on discharge only when your vitals are stable and you are oriented and steady on your feet. Even then, the rule holds. Stable does not mean safe to drive.

How long do residual effects last?

This is the question patients ask most often, usually in some version of "but I feel totally normal an hour later." Research on residual psychomotor effects helps explain why the rule extends beyond how you feel.

Studies of subanesthetic ketamine document acute impairment in attention, processing speed, and verbal memory during and shortly after dosing, with most measurable effects on standardized cognitive batteries returning toward baseline within a few hours. However, individual variability is significant. Some patients report grogginess, mild dissociation, or a "soft" feeling that lingers into the evening. Sleep quality the night of a session is also commonly disrupted, which itself impairs next-day function.

The FDA's "next day after restful sleep" framing is a practical compromise. Rather than ask each patient to self-assess hour by hour, it sets a simple cutoff that accounts for slow metabolizers, people who do not sleep well after dosing, and the fact that subjective alertness is a poor predictor of objective driving performance. The recovery window is broader than the dissociative window, and the gap between the two is exactly where roadside accidents would happen.

For comparison, the same logic applies to general anesthesia after outpatient surgery, to certain sleep medications, and to opioid analgesics. None of those are "you feel fine, you are fine" drugs. Ketamine sits in that same category.

Ride options in Nashville and Middle Tennessee

Most patients arrange a ride within their own circle. Spouse, parent, adult child, sibling, close friend. We strongly prefer this because a known person can answer questions at discharge, recognize if something feels off later in the day, and provide a familiar presence during a vulnerable few hours.

For patients who genuinely cannot find someone in their personal network, we can talk through alternatives during the consultation. Some options that come up:

What we do not do is release patients into a solo Uber or Lyft after a first session. A rideshare driver is a stranger who has not met you, has no idea what you just had, and is not equipped to recognize a problem. For maintenance patients well into a stable course of treatment, some clinics will permit rideshare with specific safeguards (a known person waiting at home, a clear protocol if the patient seems off), but that is a conversation we have on a case-by-case basis, not a default.

What to plan for the rest of the day

Driving is the obvious restriction. It is not the only one. The same impairment that makes you a hazard on the road makes you a liability at work, in court, and in any setting where judgment matters.

For the remainder of the day after a session, we recommend:

If you are a first-time patient, take the whole day off. If you are a maintenance patient who knows your pattern well, you may be able to manage email or low-stakes tasks in the late afternoon, but err on the side of doing less.

When can you drive again?

The standard answer, drawn from the FDA Spravato label and applied across the field, is the next day after a full night of restful sleep, once you feel completely back to baseline. That last clause matters. If you wake up and still feel groggy, foggy, or unsteady, do not drive. Wait another few hours. Drink water. Eat. Reassess.

Most patients are clear within 12 to 18 hours of discharge. Some take longer. People on certain medications, with sleep disorders, or who are particularly sensitive to sedating drugs may need extra time. There is no scoring system. The honest gut-check is: if a police officer pulled you over right now and asked you to do a field sobriety test, would you confidently pass? If not, do not drive.

We talk about this at every visit because the variability matters. Spravato and IV ketamine have different pharmacokinetics, but the practical guidance converges on the same answer. The differences between patients are larger than the differences between routes.

What to expect at Music City Ketamine

When you book a session with us, the ride conversation happens early. Our intake explicitly asks who is driving you, what their phone number is, and when they will arrive. We confirm that information when you check in. Marla Peterson, CRNA, oversees every infusion and is on-site during the recovery and discharge process, with anesthesia-level monitoring throughout.

If your driver does not show up, we do not improvise. We reschedule. If you arrive without a confirmed ride, we do not start the IV. If you are partway through a session and your ride cancels, we hold you in recovery, contact backup options on your intake form, and get you home safely even if it means a longer wait. The goal is simple: nobody leaves our building behind a steering wheel on the day of a session.

You can read more about the full session experience in our guide to your first infusion or browse our how-it-works page and FAQ for the operational details.

Honest expectations

Two things are true at the same time. Ketamine therapy is, on balance, a remarkably safe outpatient procedure with a strong evidence base for several psychiatric and pain conditions. And the post-session driving restriction is non-negotiable, real, and there for a reason. Patients who treat the rule casually are the ones who eventually have a story they regret.

We do not overpromise outcomes from any session, and we do not promise that you will feel "back to normal" before the next morning. What we do promise is that we will be honest about the rules, clear about what to plan for, and careful about how you leave the building. The rest of the day belongs to you and the person who drives you home.